Child and Adolescent Mental Health: A thought with the ‘future in mind’

If I told you that only 25% of children with cancer received treatment, would you think that acceptable?  You wouldn’t, because it isn’t. Yet this is the percentage of children and young people with a diagnosable mental health disorder who get help. What’s more, this has been the case for as long as I have been working in Children’s Services, which (without putting too finer point on this) is a very long time.

First, let’s contextualise this, what is the scale of need? It is important to note that although we have some percentages and statistics, the real picture could well be worse – our latest prevalence survey over a decade out of date and we have no national outcomes data. However, as we have local figures, we can make a good estimate. With that in mind, approximately 950,000 children and young people aged 5 to 17 are thought to have a mental health disorder and only 233,000 receive treatment. But what conditions are our children and young people experiencing? Just take a look at the condition specific prevalence below:

• Conduct disorders: 8% or just over 510,000 children and young people
• Anxiety: 3% or about 290,000 children and young people
• Depression :9% or nearly 80,000 children and young people are seriously depressed
• Hyperkinetic disorder (severe ADHD): 5% or about 132,000 children and young people
• Eating disorders: Over 1.6 million people in the UK are estimated to be directly affected by eating disorders

Looking at those, now let’s think about the dangers of untreated mental health problems in our future generation. Fundamentally, it is at the very least life-changing, and at the extreme life-threatening. Mental illness is strongly associated with behaviours that pose a risk to young people’s physical health, such as smoking, drug and alcohol abuse and risky sexual behaviour. Self-harm rates have increased sharply over the past decade, evidenced by rates of hospital admission and calls to helplines, along with a survey of young adults found 6.2% of 16–24 year olds had attempted suicide and 8.9% had self-harmed. It’s frightening to know that suicide is the leading cause of death in young people, and anorexia nervosa is the third commonest chronic illness of adolescence and has the highest morbidity and mortality of all psychiatric disorders. Aside from these figures I do believe we all know, or know of, a young person who has struggled with their emotional and mental health, and I don’t just mean within our professional lives.

The short and long term consequences are also felt to the public purse. Mental illness during childhood and adolescence in UK costs £11,030 to £59,130 annually per child and 50% of lifetime mental illness starts by age 14, and 75% by age 18. Subsequently, mental health in adulthood is the largest single cause of disability, representing a quarter of the national burden of ill-health, and the leading cause of sickness absence in the UK.

So why are services not working? This is not to say that there are not very good hardworking people striving for proper provision in Child and Adolescent Mental Health Services (CAMHS). The momentum to improve the outcomes for children and young people has existed within services for all the years I’ve been in social care, we have known for many years that only a small proportion of children and young people with problems receive help.  We know that children and young people in difficulty need coordinated support from all those around them, family, peers, schools and other professionals. A whole Health Select Committee enquiry reported what professionals and patients have known for years. We know all this, yet have constructed a system that encourages fragmentation and fails to invest to ensure children and young people have the best chance of success. Services providing mental health interventions and support can come from all manner of commissioning structures and budgets – be it NHS, local authority or the voluntary sector. Throw into the mix huge stigma, poor accessibility (from high entry criteria thresholds to manage waiting lists, to impossible geographical locations for children young people) and poor transitions (where young people are made to leave CAMHS at 18 years old without forward care in place) and you have a recipe for disaster.

So what is different now? In reading ‘Future in Mind’, the report to come out of the Children and Young People’s Ministerial Taskforce earlier this year, I finally believe that all the knowledge and determination that has been in sitting in service silos for years has been pulled together into a real, achievable, national ambition. It sets out in, 49 proposals, what we can do now, and, with extra resources, where we could go next, as long as we work together.  There is a clear consensus that we must all take responsibility to do better to equip the next generation to cope with the challenges they will face, and that we  must do this together.   These are arranged into 5 key themes:

• Promoting resilience, prevention and early intervention
• Improving access to effective support – a system without tiers
• Care for the most vulnerable
• Accountability and transparency
• Developing the workforce

To make change happen, each area is being asked to produce a ‘Transformation Plan’ that should cover the whole spectrum of services for children and young people’s mental health and wellbeing. There’s no denying that the recent injection of cash will help, but what we really need to think about in such an unstable economy, particularly for public services, is how do we ensure the changes services make with this money are sustainable?

From experience my thought is, which I was pleased to see reflected in the report, is the need to incorporate the national ambition into local offers, so services can do what’s right for the population that are providing for, and be instrumental in shaping that provision. This means real collaboration with children, young people and families, and all the partner agencies that provide care to them. Looking at need, and at which pieces of the puzzle each and every partner gives, then putting that jigsaw together. This will be a challenge and I believe Transformation Plans will not be easy for some areas. They must commit to transparency, service transformation and monitoring improvement, and work in ways that are different and uncomfortable at first. However, laying effective foundations through carefully thought out planning, perhaps with help and support at first – will pave the way for effective joint work and real change for the future.

Let’s get it right this time, together, with the future in mind.