Thursday, 5 February 2015
CHILDREN'S MENTAL HEALTH
UK politicians have just announced plans to improve mental health services for children and young people. But it's a case of too little too late as well as a pre-election gimmick to garner good headlines. The problem of child and adolescent mental health has been known about for the past 20 years, yet it has been ignored or treated in a tokenistic way by all major political parties in or out of government. Suicide is now the second-most common cause of death in young men and women in Britain, yet stigma and shame continue to blight those trying to cope. Three young people commit suicide every day while tens of thousands self-harm or suffer serious depression and anxiety preventing them studying or in some cases even attending school. Working class children feature disproportionately in the numbers affected. School teachers and Parents are crying out for the resources to tackle the problem.
Official statistics show the volume and complexity of child and adolescent mental health problems has increased rapidly during the past five years of austerity. Public health enquiries and other research has highlighted the need for a response to meet the overwhelming demand which has stretched existing provision beyond its capacity to cope adequately. Government policy directives encourage multi-disciplinary and more interprofessional working methods as part of the strategic response yet they do not provide any more finance to increase service provision. Demand has outstripped supply meaning that in nearly every part of the country waiting times for assessment are in excess of 8 weeks, while it can take 6 months for treatment to begin. That is a long time to leave a child and family suffering.
The traditional model of service delivery in community child and adolescent mental health care (CAMHS) in Britain began formally over fifty years ago, when the first child guidance clinic opened in East London in 1948 after earlier limited developments to help children with emotional and behavioural difficulties. This was the result after pressure from Education and Health officials since the beginning of the twentieth century, who were concerned about the abilities and behavioural problems of children brought into the new state compulsory education system. It comprised of an interprofessional team composed of various professionals with Health, Education and Social Work backgrounds who all brought their separate training, theoretical understandings, and working practices under one clinical umbrella.
Their aims were to intervene with children and families referred for help in a variety of ways where there were concerns about a child’s mental health, behaviour, or emotional development Each team member had distinctive skills and worked with the child, parents, or whole family. In the next twenty five years child guidance clinics grew in number and became accessible to more and more children and families. However, their success in offering support to parents resulted in increasing demand, creation of long waiting lists, delays in treatment, and pressure to prioritise the most urgent and worrying cases. These would invariably include children with severe and longstanding mental health problems, aggressive disturbed behaviour, physical, sexual or emotional abuse, depression, acute anxiety, and suicidal behaviour.
One of the difficulties highlighted in a seminal piece of research 20 years ago was the gap which had been steadily growing for decades between the primary care sector and the specialist child guidance service. A four-tier structure was designed to streamline the referral process for children who could be helped with minor emotional and behavioural problems at Tier 1 by GP’s, teachers, social workers and health visitors. This progressed through to Tier 4 where very disturbed young people who were at risk of harming themselves or others could be supported by highly specialist staff in forensic work or eating disorders for example. The idea was based around the simple idea that early intervention could prevent problems getting worse and thus harder to resolve. But constant changes to Primary Care, NHS re-organisation and the introduction of Private providers has destabilised the system, demoralised staff, and undermined good practice.
Child Guidance clinics were incorporated in changes brought in towards the end of the last Century and now known as CAMHS (Child and Adolescent Mental Health Services). They were health-led bodies often designed as out- patient clinics in office buildings. When children and young people were consulted they said they found these services lacked accessibility and were not designed around their needs. They were perceived as unhelpful, stigmatising and unfriendly. The milieu of young people's mental health does not stick to 9-5 office hours and it is often wrapped up with substance mis-use, drugs, alcohol and family breakdown. Poverty, Unemployment and Poor Housing are also implicated in developing mental health problems. What young people required were accessible services open at week-ends and evenings where they could drop-in, with staff who were qualified to work in a variety of therapeutic ways and who were trained in ways that enabled them to empathise and understand young people.
The last national report from the NHS, in 2008, demanded increased training for all staff working with young people, more specialist resources and extra investment in early intervention services to prevent problems arising in the first place. Seven years later the situation is worse. Staff vacancies are high, moral is rock bottom, budgets are slashed and demand for help and support is increasing. Early intervention services have been cut back in a classic example of a false economy. The United Kingdom has the unhappiest children in the European Union according to the World Health Organisation and the Children's Society charity research. If Economic austerity is set to continue after the General Election in May then the current announcements by major politicians will be seen to be just more empty rhetoric with young people set to pay a heavy price.
CAMHS Expert and UNICEF Children's Champion