Children’s mental health: In the limelight but challenges remain

Ibrahim Zafar

Last week was Children’s Mental Health Week, which came at a time where mental health in general has found itself in the political lime light.

Noises from Government, and recent policy announcements have been encouraging, but the positive impact on patients is likely to take some time to be felt.

This year, Children’s Mental Health Week fell shortly after the release of NHS’s long-awaited Long Term Plan. MHP’s own analysis suggest that mental health was by far the most mentioned individual subject matter in the plan – more so than cancer, dementia and stroke combined.

The past decade has seen mental health issues take increasing prominence in the national healthcare debate, and whilst it’s encouraging to see more awareness and funding for mental health, especially in children and young people (CYP), Children’s Mental Health Week offers an opportunity to highlight how much there is still to do.

What’s the current situation?

In England today, one in eight five to 19-year olds are estimated to have a clinically diagnosable mental health condition. Whilst the overall number of CYP with a diagnosed mental health condition has fallen in the past decade, research by the Education Policy Institute found a 26 per cent increase in the number of children being referred to mental health services.

An increased demand for CYP mental health services relies on there being adequate facilities both to assess and treat these conditions. Unfortunately, however, current recruitment problems and services suffering over-capacity tell the tale of an NHS that is not yet equipped to cope with this increased demand.

Take for example Liverpool CCG, who recently announced that for attention deficit hyperactivity disorder (ADHD) services alone, it would take five years for ADHD disorder assessments to return to “acceptable levels”.

Mental health service capacity problems are not just a localised issue. One in five children with a diagnosed mental health condition are being denied access to child and adolescent mental health services (CAMHS) in England simply due to their condition “not being serious enough”. Perhaps most telling of the current state of services is the Public Accounts Committee report on CAMHS, which simply stated that, “services for children and young people with a mental health condition will not reach most of those who need help.”

So, what’s being done?

If the current state of children mental health services, and access to those services, is enough to bring worry to even the most ardent optimist, there should least be some positives to take from current NHS initiatives to tackle the problems, as well as from the changing perception of mental health in Westminster.

Since the publication of the NHS Five Year Forward View (FYFV) in late 2014, support for CYP with mental health problems has come a long way. NHS England estimate that they are on track to meet their target to increase the proportion of CYP with a diagnosable mental health condition who receive NHS-funded treatment from 25 per cent, to 35 per cent by 2020-21.

The commitment made in the NHS Long Term Plan that funding for CAMHS will grow faster than overall NHS funding and total mental health spend has been welcomed widely, as is the news that young people will be able to access mental health support teams in schools and colleges as outlined in the Government’s Children and Young People’s Mental Health Green Paper. However, given recent cuts to services across the country, how the NHS deals with the additional demands is yet to be detailed.

The NHS’s focus both on improving access to mental health services and redesigning the current service delivery programme is not lost on policy makers either. Polling undertaken by MHP shows half of MPs believed mental health should be the Government’s primary focus in the delivery of health policy.

Grand ambitions, but will they work?

Children’s Mental Health Week offered an opportunity for an introspective review into the current state of mental health initiatives in England. Although several small initiatives championed by notable individuals such as the Duchess of Cambridge are helping to raise the profile of CYP mental health, current statistics should show that work still needs to be done.

Charities and stakeholders have responded to proposals outlined in the Government Green Paper and the Long Term Plan and have, for the most part, welcomed the efforts to raise investment for CAMHS. However, organisations such as the Royal College of Psychiatrists have noted that to fulfil promises made in the Long Term Plan, the NHS requires a “skilled mental health workforce to deliver the help patients need.”

Changing attitudes to mental health in Westminster, and the shifting face of NHS policy, indicate a positive future for CAMHS, but current service capacity and workforce issues which affect accessibility remain problems without an easy answer.