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.
Steven Walker
CAMHS Expert and UNICEF Children's Champion
