Children's mental health - a Cinderella story?
Having been overlooked for decades, child mental health could finally be going from rags to riches
If mental health is the Cinderella of NHS services, then child and adolescent mental health is Cinderella’s even poorer relation. One in 10 children aged between five and 16 have a diagnosable mental health disorder – equating to three children in every class – and nearly 80,000 experience severe depression. Yet this sizeable problem receives a tiny amount of funding. Children with mental health problems account for just 6 per cent of the NHS mental health budget and a tiny 0.6 per cent of overall health spend.
Things looked set to change last year, with something of a wake-up call for children’s mental health. The poor facilities – forcing some children to spend a night in police cells – sparked widespread criticism in the media. And, under the coalition, the Liberal Democrats took the lead in cementing plans to improve care.
Since then, the Liberal Democrats have been ousted from government. So what lies ahead for children’s mental health and could the change in political leadership undermine the drive for progress?
"We’ve been living with the idea that mental health problems don’t start until you become an adult"
David Branford, chair of the RPS English Pharmacy Board and former chief pharmacist at a mental health trust
Overlooked and underfunded
It is easy to see why children’s mental health services have traditionally struggled to command attention. Firstly, they have had to contend with the long-held stigma surrounding mental health as a whole. It’s a problem that Lucie Russell, director of campaigns and media for child and adolescent mental health charity YoungMinds, has seen for herself. “People don’t understand it and are frightened by it,” she says.
Faced with this unease, many have chosen to avoid delving too deeply into the issue. Even healthcare professionals have succumbed to this tendency, believes David Branford, chair of the RPS English Pharmacy Board and a former (now retired) chief pharmacist for a mental health trust. Doctors and pharmacists will see children with mental health problems every day – it may be the girl who is becoming painfully thin or the boy who struggles to meet your eye – but Dr Branford believes there is an element of denial at play. “We’ve been living with the idea that mental health problems don’t start until you become an adult,” he explains.
And so treatment has fallen by the wayside: children’s mental health services have proven an easy target for funding cuts.
There have been some exceptions. Initiatives such as Increasing Access to Psychological Therapies – a scheme to increase support for sufferers of depression and anxiety disorders – have received “significant investment” to help children and young people with mental health problems, says Peter Hindley, chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists.
But overall there has been “significant disinvestment” in services through cuts to CCG funding and social care funding, says Dr Hindley. His point is illustrated by NHS England’s admission in January that funding of child and adolescent mental health services had fallen by £50 million over the past five years. Dr Hindley believes the figure is closer to the £100m mark if you take into account health and social care. Fighting the erosion of funds has been tough; Dr Hindley says it is “difficult” for people to advocate for children because they don’t have a vote and are often “neglected” by the political process.
1 in 10children aged between five and 16 have a diagnosable mental health disorder1 |
6%of the NHS mental health budget goes towards children with mental health problems |
£50mhas been lost from the funding of child and adolescent mental health services over the past five years2 |
References: 1. ONS, Mental health in children and young people, 2005 2. NHS England
The impact on care
The cuts to funding have inevitably impacted on care. Those working on the frontline of child and adolescent mental health have voiced concerns over the treatment of this vulnerable group of patients. A survey by the Royal College of Psychiatrists revealed widespread fears in the profession that a lack of acute mental health beds and stretched community services were putting children and young people with mental health problems at risk.
Almost 80 per cent of the 370 child and adolescent psychiatrists who responded in 2013 had felt worried about their patients while they were waiting for a bed. And more than three quarters said they had seen young people diagnosed as being a high risk to their own safety and others - therefore needing a bed – being managed in the community.
There were more harrowing results to come. Six in 10 respondents reported young people being held in inappropriate settings such as paediatric wards, police cells and A&E departments. And 14 per cent of respondents cited cases of children and young people attempting suicide while waiting for a bed.
YoungMinds’ Ms Russell believes the results reflect the harsh reality for children and young people with mental health problems. They face being “stuck on waiting lists for months on end” – and, once they do receive treatment, may have to travel “hundreds of miles” for an inpatient bed. Worse still, they could be one of those who end up in a police cell. “They are not getting the support they need, while also dealing with the pressures of growing up,” Ms Russell stresses.
All change
But that all looks set to change, thanks to last year’s surge in interest in child and adolescent mental health. Heartbreaking stories of distressed children being sent to hospitals 100 miles away from their families prompted the government and media to call for an improvement in services.
Their calls were answered by the children and young people’s mental health and wellbeing taskforce – a group of experts brought together by former Liberal Democrat shadow health minister Norman Lamb.
In March, the team published a series of recommendations to transform care over the next five years (see The five-year plan, right). These set out to address weaknesses in the system – for example, prison cells should not be used as a place of safety, and care should be near the patient's home – as well as driving improvements by encouraging joined-up commissioning. Of course, these changes need money and the taskforce also called for the “right investments” to be made. But Mr Lamb stressed that achieving change wasn’t just about funding, but a “fundamental shift in culture”.
Responses to the report have been largely positive. Dr Hindley believes the recommendations are “very sensible”. They will need to be backed by funding, though, or the situation could simply get worse. “If you don’t have additional resources, you will just increase demand without the opportunity to actually meet demand, so it might increase frustration and disappointment,” he points out.
Ms Russell echoes the warning. Although she feels encouraged that the government has recognised the “chronic” underfunding of children’s mental health services, she stresses that the recommendations of the taskforce must be more than empty words. “[They] need action on the ground, otherwise we will still have the same crisis,” she says.
"If you don’t have additional resources, you will just increase demand without the opportunity to actually meet demand, so it might increase frustration and disappointment"
Peter Hindley, chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists
Political influence
This action may depend on the will of the newly formed, Tory-led government. Under the coalition, the Liberal Democrats appeared particularly passionate about improving mental health services. All parties mentioned mental health in their pre-election manifestos leading up to the election, but the Liberal Democrats arguably took the lead in this area. It set out plans to cut waiting times to no more than six weeks and to act on the recommendations made by the children’s and young people’s mental health taskforce.
Some pledges made under the coalition will remain. For example, the government remains committed to spending £1.25 billion on children and young people's mental health services over the next five years. It is also determined to ensure that 75 per cent of people referred for talking therapies receive treatment within six weeks – and that 95 per cent start within 18 weeks.
In its pre-election manifesto, the Conservatives also pledged to put mental health on a par with physical health But, unlike the Liberal Democrats, they did not specify that they would act on the recommendations made by the children’s and young people’s mental health taskforce. At this early stage of the government, it is too early to say whether this will be the case.
Jeremy Hunt’s first speech as reinstated health secretary at the King’s Fund on May 20 offered hope. He described the Liberal Democrats’ emphasis on mental health during the lead-up to the election as “absolutely commendable” and said he was “determined to carry on the fantastic work” led by Mr Lamb.
And, having analysed the Conservative stance on the topic, Dr Hindley is hopeful the happy ending for children’s mental health will come to fruition. Prior to the election, the Tories were supportive of increasing care and he believes they will stand by this ethos – as he says, it would be “very disappointing” if they didn’t.
His view echoes the general optimism surrounding children’s mental healthcare. Yes, it has been neglected and mistreated in the past, and there is no certainty over how care will develop. But the fact that this Cinderella specialty has gained so much attention from politicians and healthcare professionals alike is encouraging in itself. The general sense is that care for vulnerable children can and must improve – the idea of well-funded, well-designed services is no longer a fairytale.
