In recent weeks, Tes has published a number of pieces exploring the current state of child and adolescent mental health services (Camhs). It’s interesting to note that, despite the Office for National Statistics reporting a doubling in the number of teenage suicides in the past eight years and a 68 per cent increase in the number of hospitalisations for self-harm since 2015, commentary on Camhs was conspicuously absent in the rest of the media during Children’s Mental Health Week, earlier this month.
This is perhaps because Camhs is no longer fit for purpose for an emotionally literate generation who often understand mental health better than their parents. Fixing that requires a complex strategy – it’s much simpler to blame the entire situation on "social media" and move on. I, conversely, am determined to explore the issue.
First, a brief history. Between 2010 and 2015, funding for Camhs was cut by £50 million under austerity measures. In 2015, a widely publicised government "investment" into children’s mental health pledged £1.5 billion over the next five years. This focused specifically on training teachers in spotting early signs and funding a pilot scheme (the results of which are yet to be published) whereby schools would have a designated Camhs worker on site.
However, in 2016 the then shadow mental health minister, Luciana Berger, published findings that revealed that the first investment of the promised funding had resulted in only half of local authorities increasing their spending on mental health in real terms. This was because the funding was not ringfenced. Then, of course, came Brexit, which, in turn, led to widespread uncertainty concerning the future status of 139,000 EU nationals who work in the NHS.
More money for child mental health?
In January of this year, the government announced a new wave of NHS funding, with mental health being apportioned £2.3 billion in its "10-year plan" (no word on whether this is in addition to the promised £1.5 billion in 2015, but I suspect not, since it was pledged under a different cabinet). It is being used to "pilot" four-week waiting lists for Camhs (why the idea that shorter waiting lists are better needs to be tested remains a mystery) as well as to increase the involvement of third-sector organisations in young people’s mental health care. However, concerns still remain over where the required new staff are going to come from to implement this and whether they will have sufficient training and expertise to do so safely.
Here’s what all of that looks like on the ground: Teachers are being given training in mental health first-aid skills. Mental health first aid is an excellent way to equip staff to spot symptoms of mental ill-health and to explain how to have conversations about it and where to send these young people for help. However, the efficacy of such training does depend on there being local services to highlight.
Owing to increased demand coupled with dwindling budgets and staff, thresholds for Camhs have grown ever higher and waiting lists longer (two years for an appointment is not unusual, according to my Twitter correspondents). It is no longer enough, for example, for a pupil to be self-harming to "qualify" for an appointment. In fact – as an investigation in the Telegraph revealed recently – sometimes a suicide attempt is not considered sufficiently "urgent".
Gill Roghoobeer, who works as a pastoral lead across a number of schools in Northamptonshire, was quoted as saying, “We are now at a stage where a child needs to have lost their life before the seriousness of their mental health needs are recognised." She added: “People are being lied to. There is no transparency from government about the real state of mental health services for the young.”
Lack of joined-up support
A number of young people have told me anonymously about their experiences of Camhs. Although they each live in different areas of the UK, there are common themes running through their testimonies.
The first was of difficulties at the "crossover" period between Camhs and adult mental health services. As a suicidal 17-year-old, one of the young women I spoke to was told by Camhs that they “weren’t sure” if they could see her because she was “soon to become an adult”, which made her “tricky”. Another young person told me that being put on an adult ward at 17 made them feel “even more isolated”. “You already feel like you’re the only person in the world going through mental illness,” they said, “then they put you on a ward where there is no one else your age you can relate to."
The second theme was of a lack of joined-up thinking between various services. Where a young person has two diagnoses (for example, autism as well as anxiety) they found themselves ping-ponging between different services, with neither prepared to take responsibility for them because they were deemed too “complex”. Additionally, other NHS staff (such as those working in A&E) often have little training in mental health. A young woman with an eating disorder who was admitted to A&E after having a heart attack caused by malnutrition was told by a nurse that she “wished she had her willpower” because she had a “great, slim figure”.
The third troubling area of consensus was the lack of monitoring or follow-up care. All the young people I spoke to told me they sometimes had difficulty attending their appointments, often because they clashed with an exam or because they were miles away from where they lived. In these instances, it is deemed that they “do not want help”. Similarly, a young person who was having regular panic attacks and “days where [they] couldn’t get out of bed” was given antidepressants by their GP and a leaflet for a local branch of MIND, with no follow-up.
Quite apart from the morality of delegating state responsibility to charities, what concerns me most about the use of the third sector is that, excellent as their services often are, they depend on the person seeking help. Mental illness mostly doesn’t work like that – there are days when getting dressed seems like an impossible feat.
Whilst all this is happening, it is teachers and parents who are expected to "mop up" children in crisis. Parents and teachers generally aren’t qualified therapists, but even if they were to practise on their child or pupil, it would constitute a "conflict of interest" (it’s important for efficacy of treatment that you don’t know your therapist in another capacity and vice versa).
In summary, it’s a mess: an almighty, massive, juddering clusterf***. If the promises of extra investment prove true, they are welcome, but fundamental restructuring is also needed if Camhs is to be fit for the modern world.
Natasha Devon MBE is the former government mental health champion. She is a writer and campaigner and visits an average of three schools per week all over the UK. She tweets @_natashadevon. Find out more about her work here