Plans up in smoke

Most professionals support the government’s proposals for child and adolescent mental health services. But a lack of money may prevent them ever coming to fruition, says Steven Walker

Child and family social workers are set to find their job becoming more difficult as it becomes clear that the government is failing to adequately fund and support child and adolescent mental health services (Camhs). The financial crisis affecting primary care and mental health trusts will scupper the government’s pledge in 2003 to establish a comprehensive child and adolescent mental health service in England and Wales by this year.

This has taken place in a period in which the latest survey of the mental health of children and young people revealed that one in 10 have a diagnosable mental health disorder, while one in five suffer a psychological disturbance that warrants intervention. The prevalence rates for socially excluded young people, such as refugee and asylum seekers and ethnic minorities, are much higher. Also, 90 per cent of young offenders and nearly 50 per cent of looked-after children have mental health problems.(1)

The 2004 National Service Framework for Children, Young People and Maternity Services (NSF) set national standards for the first time for children’s health and social care, aimed at promoting high-quality, women- and child-centred services and personalised care that met the needs of parents, children and their families. It was published in September 2004 by the Department of Health with the Department for Education and Skills, under the Change for Children – Every Child Matters reforms.

This was a significant collaboration between two government departments about their shared responsibilities for supporting the NSF, which was originally seen as health-driven. During the development of the NSF, children’s social care moved from the DH to the DfES, so it was crucial that the DfES ratified the document.

This unique joint responsibility and the equal attention to health and social care needs are now threatened. The NSF is a 10-year strategic plan to achieve child-centred services and reduce inequalities of care. It covers 11 standards and standard nine requires Camhs to deliver a comprehensive service in all areas by 2006, under the priorities and planning framework. The implication is that in any place there should be shared planning about how needs are to be met across the range of children’s mental health services.

Later government priorities, which emphasised the need to maintain the levels of services achieved through the previous planning round, gave further support to the expectation of a comprehensive Camhs.(2)

Unlike other NSF standards, specific funding was allocated to councils through the Camhs grant and to primary care trusts to improve child mental health services.

But the health money is no longer ring-fenced and, under the local government performance formula, three-star councils are not constrained by explicit targets. In the context of NHS overspending, PCTs and mental health trusts are reducing Camhs provision, leaving education and social services departments to cope as more troubled children and young people fail to obtain help from health service providers.

One achievement of the NSF is that the psychological well-being of children and young people is recognised throughout the document as an integral part of their healthy emotional, social, physical, cognitive and educational development. The belief that child mental health is everyone’s business is embedded in the policy. This implies that all those who come into contact with young people can influence the child’s emotional well-being, to promote mental health and intervene early to prevent problems starting or recognise when they begin to emerge.

In child mental health services, partnership working is of paramount importance with joint commissioning, joint management and joint provision of services. This too is at risk. The NSF describes a range of provision where collaborative provision between child mental health services and professionals and other agencies and services is essential to meet the needs of young people comprehensively.(3) But all this good practice is at risk of being undermined and dismantled as budget deficits take effect. Services for which collaborative partnerships are essential include those for children and young people who are: