In the run-up to the general election both the Lib Dems and Labour are promising to boost funding for mental health services for children and adolescents – but will it be a case of too little too late?

One in 10 children – the equivalent of three children in every classroom – is thought to have a diagnosable mental disorder. So what is being done to help deal with mental ill health in the young?

Not nearly enough, says the mental health charity YoungMinds, which has warned that cuts to children and young people’s mental health services have led to a national crisis in service provision. More than half of England’s councils have either cut or frozen budgets for child and adolescent mental health, according to Freedom of Information requests made by the charity.

High cost of cuts

Health cuts have impacted “severely” on specialist child and adolescent mental health services (CAMHS), believes David Goodban, interim head of the children’s and young people’s programme at the Mental Health Foundation (MHF).

“Cuts have also impacted on other services critical for support of vulnerable children, which means they present with mental health problems that are more serious or with more frequency,” he says. YoungMinds wants to see joined up services which are easily accessible as soon as children and young people require them.

“We cannot continue with this chronic underfunding, which results in so many young people being turned away and never getting the help they need,” chief executive of YoungMinds, Sarah Brennan, has commented.

As things stand, children and young people’s mental health services account for between 6 and 18 per cent of local mental health budgets, according to David Goodban – but half of lifetime mental disorders starts by age 14. “They should really have about a third of the budget. Addressing problems early saves money later,” he says.

He believes that accountability – not just more funding – is critical. “Government has pushed responsibility for health delivery to local level,” he says, “but no one is accountable for failure to deliver adequate services. Without accountability, localities will not invest in services.”

 

 

Early intervention

Many things need to happen to improve matters, effective early intervention being a high priority, the mental health charities argue. Acting promptly to address mental health issues in childhood is essential.

“There is strong evidence to suggest that many mental health problems start in childhood and that if these aren’t managed and supported appropriately they can have a lifelong impact, not least on life expectancy,” says Jenifer Phillips of YoungMinds.

Investing in early intervention is not only crucial for the individual but also for the system. “Effective early intervention should alleviate pressure on the higher tiers of CAMHS by ensuring that the number of cases that escalate in severity are minimised,” reasons Jenifer Phillips.

One in 10 children is thought to have a diagnosable mental disorder

Indeed, the need for timely intervention was brought into sharp focus in July last year, when NHS England released a report into Tier 4 CAMHS (the service which treats patients with more complex needs). It found an undersupply of beds in some areas. “A postcode lottery situation regarding local provision had led to 16 per cent of young patients having to travel more than 100 miles to get a hospital bed,” says Jenifer Phillips.

Under-resourcing of early intervention services and Tiers 1-3 (community or outpatientbased services) is having a knock-on impact on Tier 4, she believes, “with increased demand for in-patient treatment as problems are left to escalate and increase in severity”. The Royal College of Psychiatrists believes there has been a large increase in young people’s mental health problems in the past 25 years. But it is hard to be precise about how many children and young people are experiencing mental health issues, as there hasn’t been a national prevalence survey since 2004.

“Obviously this is not good enough,” says Jenifer Phillips, “as you can’t effectively commission services based on out-of-date information.” “We need an up-to-date idea of the prevalence of mental disorder in children and young people,” agrees David Goodban. “Unless the Department of Health can be persuaded to put more funding into it, it will be difficult to get a clear answer as to whether things are getting better or worse.

“We need to know what we are dealing with. And we need to know what it would cost to provide the services that are needed.” Because of this lack of current data it is also hard to tell what the commonest forms of mental health issues are for children and young people. Calls to the YoungMinds parent helpline suggest that the issues parents seek advice about most regularly are anxiety, disruptive behaviour, depression and selfharm.

Nearly 80,000 children and young people are believed to suffer from severe depression, while statistics show the number of young people being admitted to hospital because of self-harm increased by 68 per cent in the past 10 years.

Greater complexity

Dr Andrew Hill-Smith, a consultant child psychiatrist at the Surrey and Borders Partnership Foundation NHS Trust and a member of the Royal College of Psychiatry’s Faculty of Child and Adolescent psychiatry, believes that we are “seeing a greater complexity of problems nowadays, including developmental disorders and social difficulties”.

On the positive side, he says, “there is much more recognition of mental health issues, while stigma surrounding mental health has been reduced, so more people are coming forward for treatment.”

However, he says, “from a CAMHS point of view, we only see the tip of the iceberg – there are many other young people with mental health problems who don’t come through to see us.” There is so much at stake in terms of getting mental health care right.

Sarah Brennan sums the situation up as follows: “Overwhelming evidence suggests that if we get it right for children and young people, we will greatly reduce the burden of mental health for future generations.”