Mark Hunter reports on fears that children’s mental health
services have become a victim of demarcation disputes.
It is estimated that a fifth of children and young people under
the age of 20 will experience psychological problems. For some the
experience will be distressing but transitory. For others it will
be the first experience of a long-lasting and potentially serious
mental illness – schizophrenia, for instance, typically makes its
first appearance during late adolescence or early adulthood.
Unfortunately, research consistently paints a picture of child
and adolescent mental health services (CAMHS) as fragmented,
under-resourced, poorly staffed and ill-equipped to deal with the
needs of young people.
Earlier this year, for instance, the Mental Health Foundation’s
Turned Upside Down survey catalogued the experiences of 45
young people using community-based crisis services.1 The
report made sombre reading, listing inadequate resources, poor
communication between services and a lack of specialist knowledge.
It also highlighted inadequate services for young people with a
dual diagnosis; perceived power imbalances between statutory and
voluntary agencies; and a difficulty in engaging young people who
did not want help.
Ruth Lesirge, director of the Mental Health Foundation, says:
“Our research shows that many young people are being let down badly
by the current mental health services. If young people’s needs are
to be met, the government should be listening to what young people
have to say and establishing a framework for community-based mental
health services for 16 to 25-year-olds, that young people find
approachable and accessible.”
What many observers find puzzling about these shortfalls is that
they are still evident more than two years into an £84 million
funding programme which appeared finally to be taking CAMHS
seriously. Where, they are asking, has all the money gone?
In the case of at least £10 million, the answer appears to
be not on what it was intended for. In a written answer to a
parliamentary question last month health minister John Hutton
admitted that the last of the three tranches of the money had been
handed over to the health authorities with no specific direction as
to how it should be used.
Hutton did announce that this year’s CAMHS grant to local
authorities would be increased from £5 million to £15
million. He also revealed that the service would be brought into
the National Service Framework for Children’s Services, expected to
be launched in 2003.
This final move does address one of the most obvious anomalies.
Ever since the NSF for Mental Health Services was set up, CAMHS
specialists have bemoaned the fact that children and adolescents
are excluded from its remit. But does its inclusion in the far
broader children’s framework really make sense?
“I suppose that the government is, at least, finally addressing
the issue,” says Lesley Warner, spokesperson for the Mental Health
Foundation. “But we have been arguing for a long time that CAMHS
should have its own national service framework. It is already a
very neglected area and the danger is that bringing it together
with all the other children’s services means it is more likely to
be diluted or overlooked.”
Children’s mental health charity YoungMinds is suspicious that
the inclusion of CAMHS within the new children’s framework has been
influenced by the mounting criticism ministers are facing over
their decision not to ring-fence the final £10 million
installment of the CAMHS funding.
And YoungMinds deputy director Dinah Morley is scathing about
the suggestion that incorporation into the children’s NSF could
mean more funding for CAMHS.
“National audits have clearly shown that health authorities have
consistently failed to ensure the development of this important
service. Unless funds are specifically ring-fenced for CAMHS, then
this service will not grow,” she says.
The result of this neglect, according to Warner, is that mental
health services are not only failing vulnerable children and young
people’s immediate needs, but also missing the opportunity for
potentially serious mental illnesses to be nipped in the bud.
“There is evidence that early intervention for children with
emotional and behavioural problems can prevent problems later on in
life,” she says.
But this can only happen if CAMHS become more in tune with the
way young people live and interact with society.
“We need to go back to basics and try to develop more accessible
ways in which young people can seek help,” says Warner. “It may be
that the elegant psychiatrist in his suit and appointment for three
months’ time is not what young people need.”
Rather, the Mental Health Foundation would like to see a
national strategy that ensures emergency responses are available
during weekends and holidays, that ends the practice of placing
under-18-year-olds on adult psychiatric wards and provides
community-based services which actively involve young people at
every stage. The charity also believes that all young people
treated under statutory mental health services should have access
to an independentadvocate.
It is unlikely whether a frightened and vulnerable 15-year-old
who has just suffered his or her first psychotic episode really
cares which particular NSF their care is pigeon-holed into. Just so
long as it comes quickly, with a friendly face and is appropriate
to their needs.
1 Mental Health Foundation, Turned Upside
Down, MHF, Jan 2001