Survey highlights crisis in services for children and young people

It comes as no surprise that four out of five social care
professionals working with children believe that mental health
services for children and young people have reached crisis
point.

Anecdotal accounts from professionals working with children and
young people have reiterated the severe shortage of services for
the growing numbers who need them.

Community Care‘s survey of professionals on the front
line, including those working in new programmes such as Sure Start
and projects funded by the Children’s Fund, outlines how severe the
crisis in mental health services has become. It was commissioned
from NSM Research.

More than half of the 1,560 respondents work in child
protection, the rest in family support. Almost half – 46 per cent –
of these spent more than 20 per cent of their time dealing with the
mental health needs of children and young people.

Children come to their attention from a large variety of sources
but the majority – 22 per cent – said they were referred by parents
and families. Nineteen per cent of referrals came from work with
education services and 17 per cent were referred because of
behaviour problems defined as self-harming, violence, misuse of
drugs, and family breakdown.

The number of children and young people with mental health
problems has increased over the past five years, according to
respondents. More than a third said that the number of children and
young people with severe mental health problems had gone up and
two-thirds said the number with moderate mental health problems had
risen. Four out of five care professionals believed that during the
same period there was a higher prevalence of those suffering
emotional or behavioural problems or hyperactivity.

But almost one-third of our survey respondents said they had to
wait for a month before a place became available.

More worrying was the fact that one-fifth of the children
referred by respondents had been turned down for a service, and
two-thirds of those children did not access alternative
services.

Seventy-one per cent of respondents reported difficulty in
getting children and young people with mental health problems to
attend appointments with GPs, psychiatrists and psychologists.
This, coupled with the fact that almost four out of five
respondents believe young people feel stigmatised by the tag of
“mental illness”, shows that specific, child-friendly services are
needed urgently.

Social care professionals were also critical of the health
service. More than two-thirds (67 per cent) believe health
professionals are under-diagnosing mental health problems in young
people. The lack of services available was cited by nearly 80 per
cent of social care professionals as the reason for the
under-diagnosis.

This points to a worrying trend whereby health professionals,
knowing there is a severe shortage of treatment facilities
available (an initial assessment appointment can take up to a
year), simply do not make the diagnosis. It leaves families in
limbo as they know something is wrong with their children but
nobody will diagnose the nature of the problem.

We can only assume that the under-diagnosing revealed by our
survey does not include severe mental health problems that require
urgent treatment. But that does not lessen the load on families
(see case study).

While more than half said they did not really feel qualified or
experienced enough to work with children and young people with
severe mental health problems, 45 per cent felt they were qualified
or experienced enough to carry out this demanding work.

Respondents suggested a range of solutions to improve services.
Early diagnosis and intervention programmes were high on the list
of solutions as were increased resources, more accessible services,
reduced waiting lists and improved working between agencies. When
asked where resources should go, most chose early diagnosis and
intervention, training staff and support for families.

When it came to preventing mental health problems in children
and young people, the majority of respondents – 85 per cent – said
more therapeutic services for abused children could help.

More than four out of five said that parenting programmes and
support work with substance misusing parents could prevent mental
health problems in children.

A total of 77 per cent said specific training for residential
child care staff, foster carers and adoptive parents could
work.

More than half – 54 per cent – said that more emphasis on the
mental health needs of mothers pre-birth to improve the detection
and support for women with post-natal depression could prevent
mental health problems in their children.

Our survey has thrown up a challenge to the government and all
policy makers – mental health services for children and young
people need urgent treatment.

They have not just reached crisis point but some problems are
critical already. They need expansion and investment. The majority
of our sample agreed that existing services were unstructured,
medically-driven and alienating.

Community Care‘s Changing Minds campaign is aiming to
change that.

– As part of Community Care‘s Changing Minds campaign, we
are publishing findings from four major reports from the Mental
Health Foundation on the mental health of young offenders (8
August), looked-after children (15 August), homeless young people
(22 August) and young people with emotional and behavioural
difficulties (29 August).

Using our website, which will carry summaries of the reports,
readers can become involved in the consultation process by using
our web link to add your views. See www.community-care.co.uk

What you can do

1 Sign up to Community Care’s Changing Minds campaign
petition
2 Write to your MP using our draft letter in this issue.
3 E-mail the government’s children’s task force, which is drawing
up the national service framework for children, including mental
health, with your views on childrenstaskforce@doh/ss/gov.uk

4 Contact your MP directly, invite him or her to your organisation
to see the work you do, and explain the need for protected
resources as well as similar services.
5 Work constructively with other agencies to ensure a partnership
approach so children and young people with mental health problems
do not slip through the existing net of services.
6 Ensure children’s mental health needs are high on the agenda of
your agency.

No beds here

All names have been changed.

– One mother wants a secure psychiatric placement for her
14-year-old foster son. Jodie has Asperger’s syndrome and an IQ of
48. He was at a Steiner school until the age of 10 when staff could
no longer cope with him, so he went to a special school where he
developed a sexual interest in babies and young children. He
abducted a six-year-old boy and had to leave. At his next school,
he attacked a member of staff with an axe. He says he wants to kill
babies, smears faeces on photos of babies, and masturbates in front
of his foster mum and her two other foster children. He urinates in
nappies and put one on his toy cat. He strangled the family rabbit.
He has seen a child psychiatrist who said he does not have a mental
illness. Social and education services say there are no in-patient
facilities for his age group.

– Mary is 15-years-old. She took an overdose, then threatened
her mother with a knife, and began staying out until 3am. When she
overdosed for the second time, her mother took her to hospital
where Mary told the doctor she was hearing voices that told her to
hurt herself and her mother. She was admitted to the paediatric
ward and saw a family therapist and psychiatrist. According to her
mother, the child psychiatrist spent only 15 minutes with her
before discharging her. Her mother believes she was discharged
because there was no in-patient bed available locally.