The threshold to access mental health support for children who have been abused is too high, social workers and other professionals have said.
A survey by the NSPCC of 1,256 professionals working with children found 96% felt there were not enough child and adolescent mental health services (CAMHS), and 98% said provision of other therapeutic services was insufficient in their area.
More than half said thresholds had caused problems getting help for children, and the same proportion said waiting times had been a barrier to getting support from local CAMHS teams. Cuts in available services were identified by 37% of professionals as another barrier to accessing mental health support for young people.
Peter Wanless, chief executive of the NSPCC, said the views of professionals spoke “loud and clear”.
‘Corrosive effects’
“The government and those that commission services urgently need to increase what is currently available to support this most vulnerable group of children. Getting help to these children earlier is vital and can prevent longer term damage to the lives of those who have survived the horror of abuse,” Wanless said.
The survey collected responses from social workers, nurses and doctors. Of professionals who had experience of referring children with mental health problems to services over the past five years, almost 80% said accessing these services had got harder.
Wanless added: “We know that children are often left alone to deal with the corrosive emotional and psychological consequences of appalling abuse and that all too often they face long waits for help with their trauma, or the services offered aren’t appropriate for children whose lives have been turn upside down by their experiences: this must change.”
A government spokesperson said: “We are investing £1.4 billion into young people’s mental health and are working with local areas to improve services in hospitals, schools and communities so young people get better quality mental health care as quickly as possible, a key part of which involves helping the victims of abuse.”
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Interesting post… but, I cannot help thinking that it covers only a fraction of the issue. The survey found that mental health support for abused children may be too difficult to access, and that this leaves vulnerable young people in a very exposed and unprotected position. As you rightly say, much of this problem is down to budgetary cuts and subsequent lack of resources. I will also agree that waiting times and thresholds create a significant barrier to providing timely and appropriate assistance.
However, in my eyes, this is only a part of the picture. What I firmly believe is that we do not, as a culture, understand enough about mental health, full stop. Child and adolescent mental health is also misunderstood, and service provision is not really a priority. This makes perfect sense, if we stop to consider the fact that mental health services have always been “Cinderella services” in comparison to services that deal with physical health problems. It is this very separation between the mental and the physical that I see as so very ignorant and ill-thought-out. Human beings are HOLISTIC creatures, when they work right, they are a harmonious melding of body and mind. Our minds and bodies are necessarily intertwined – body affects mind and mind affects body. You CANNOT have the one without the other. So, why TREAT the one and not the other? Something that affects the mind also affects the body.
Still, we have divided services – and consequently divided funding. Mental health services and physical health services are separately funded, and separately housed. Mental health gets a fraction of the budget that physical health receives, leading to huge waiting lists for referrals and a shameful lack of facilities. Added to this, there is a stigma and prejudice that surrounds mental health services, which does not surround physical health services. Mental illness is seen as “dirty”, “shameful” and “something to look down on”. This negative attitude, in turn, leads to further excuses for lack of funding and development. It is societal prejudice against the mentally ill that has lead to mental health services being seen as a second-rate “Cinderella service”.
How can we, as a society, place physical health before mental health and wellbeing; how can we rate the former as more important than the latter? We need to take a long, hard look at societal values – and at the way we have come to understand the world. If we do not appreciate the importance of mental wellbeing, and the need for parity between mental and physical health services, then we will continue to experience significant problems (and that is putting it mildly). Worse still, we place ourselves in a situation where health and social care treatment is inadequate – both for mental, and for physical, health problems. We need to appreciate the interrelation between the two, and develop services that can address this.
For example… Imagine a man (call him Joe Bloggs) is a self-employed roofer, and sole family earner, but has a nasty fall at work. As a consequence, he fractures his pelvis, and right wrist. He remains in hospital for some time, battered, bruised and suffering concussion. During this time, he is clearly unable to work; he does not know when he is able to return to working. Joe is finally discharged from hospital, but needs a lot of care from his wife, who also has two little toddlers to look after. Joe needs physical support to help with tasks like washing and dressing. His wife does all the cooking and housework, but finds the extra pressure exhausting. Four months after the accident, Joe is still unable to work; but now he is behind on paying his bills, too. Without his regular income, the family are short of money. This increases tension between Joe and his stressed wife, who have stopped talking, other than when they argue. As a result, Joe feels very depressed; and the whole family, including the toddlers, are unhappy because they have limited money for things they used to enjoy, such as hobbies.
I’m using this scenario to show you that MENTAL HEALTH and PHYSICAL HEALTH are intrinsically linked; as well as to show you that what affects only one family member at first, may go on to affect the WHOLE family. Although Joe Bloggs initially experienced a physical injury, the facts surrounding his protracted and stressful recovery period lead him to become depressed. Joe does not require merely physical assistance. It might be said that his wife, too, could benefit from some emotional support. The whole family may require interventions that assist with such things as… allocation of household chores; help with addressing financial problems; time to relax; depression or stress; communication strategies…
It seems likely, to me, that in a situation such as above, Joe and his family might require support from a variety of services, including both physical, and mental health services. It also makes sense to me to suggest that the services involved in assisting the family should co-work very closely together.
THIS is how I see it. It is how things OUGHT to work in all situations – including child abuse. We ought to be aware that children who are on the receiving end of abuse may suffer both emotional, and physical, problems. Think about it! Abuse is multidimensional in nature. ALL types of abuse, be it physical, sexual, neglect… involve an element of emotional abuse as well. A child who is physically hit, for example, will not only experience the physical outcome of being hit (bruises, fractures, cuts); he or she will also experience the psychological outcome of being hit. It is the activating of negative emotions such as fear, worry, horror… that makes abuse mentally damaging. It is also the fact that these negative feelings and emotions persist, often for considerable time – certainly for as long as the child or young person is unable to escape from the abusive situation. They often persist long after, because by this time the child has learned to fear and mistrust the abuser and the abusive situation; the child also learns to fear and mistrust similar people and situations (even if they might turn out actually not to be abusive). Children react to abuse much as they do any other situation – they learn from it. Sadly, the learning is seldom positive. Abused children learn to see themselves as whatever the abuser says they are – weak, stupid, ugly, fat…
We need services for abused children that will address BOTH the physical and the mental legacy of abuse. I would argue that, perhaps, our current way of going about things is not the best, or even the right, way. I have already said that to separate services into mental and physical creates problems; for funding, for resources and for co-working and information-sharing. It also means that mental health services remain stigmatized.
Stigma is a MAJOR problem that I, personally, do NOT feel mental health services (and the people using them) should have to face in this day and age. Have we moved on so little from the prejudiced views of our forefathers, who threw the mentally ill into Asylums, locked them in straitjackets, and laughed at them for being “fools”? Do we have no more empathy and compassion? No offence, but the fact that use of mental health services remains stigmatized is an enormous barrier to treatment. Am I talking about an “elephant in the room”, here?
Well, let’s get down to the facts. Even now, in the 21st century, some people STILL discriminate against people who use, or are associated with, mental health services. This means that both patients, and staff, may be tainted by stigma and negative labels. despite the fact that mental illness is surprisingly common (statistics suggest that one in every three or four of us will experience some kind of mental illness during our lifetime) there are still some cruel and heartless people who discriminate against mental illness. Children are bullied at school because they have a parent or family member who is mentally ill (I know this from PERSONAL experience – I am one of those kids). Employees are harassed at work, or viewed as less capable, for admitting to mental illness. People still use derogatory terms like “nutter”, “loony” as insults, implying that mental illness is something insulting, something nasty. As a consequence, some people fear admitting to mental illness, and do not seek treatment, because they are frightened of attracting negative consequences.
Sadly, I believe that reliance upon CAMHS as the first line in supporting children who have been abused is seriously problematic, because it risks attracting NEGATIVE STIGMA to those children. This is not the fault of CAMHS, it is the fault of society and societal beliefs; but without changing those beliefs, the fact is that receiving treatment at a mental health facility remains stigmatizing. Children who have been abused are already very vulnerable; the last thing they need is to be on the receiving end of additional stigma. We should note, here, that once a negative “label” (i.e. stigmatizing name or opinion) has been attached to a person, it can persist for a very long time. Our culture is VERY unforgiving! Once a negative association has been made between a person, and mental illness, this negativity can persist for a lifetime. A child labelled as “depressed” due to abuse, may find it harder to get work as an adult, may be treated less favourably in educational settings, or may find this label affects their adult relationships. Why? Because many people see only negative connotations to labels such as “mentally ill”, “depressed”, “bi polar”… Just like our prejudiced forefathers, they too are prejudiced, and see mental illness as a sign of being “unworthy”, “less than” or “incapable”.
Should we burden already abused kids further with such labels? Personally, I think not. Instead, we should re-think how services are structured and provided. Right down to the language and terminology we use. We need to educate the general public, and we need to think about the connotations associated with our use of specific language – “mental”, “schizophrenic”, “emotionally disturbed”… Perhaps we have all become guilty to some extent of couching certain illnesses and conditions in terms that border on permanently derogatory? Maybe we need to think again about what mental health services are, and what they ought to be? Maybe they need finally to be accepted by, and effectively integrated into, physical health services? Maybe we need to learn that because humans are holistic – body and mind together – our service provision should be holistic? Maybe we need to eradicate prejudice and stigma via re-education and re-integration? Maybe we need to finally get what it means to work in “integrated teams” – NHS and Social Care staff truly working TOGETHER, with an understanding of, and respect for each-other’s roles – as opposed to merely paying lip-service to this phrase?
It’s NOT just about access to services, waiting times… it’s about FAR more. When will we all wake up and realize this? When will we address the TOTALITY of the problem, as opposed to just the “tip of the iceberg”?