Child and adolescent mental health: special report

One in 10 children are known to suffer from a mental health problem, so news this week that the NHS will fail to meet a key child mental health target was greeted with some concern.

The NHS in England will not deliver a comprehensive child and adolescent mental health service by the end of the year, a leaked government letter has revealed.

The letter from Department of Health official Richard Gleave to strategic health authority chief executives made clear they were “not on track” to meet the three performance indicators that make up the target.

Just 162 of the 302 primary care trusts in England are able to provide a Camhs for children with learning difficulties, the letter says. Only 224 are providing a service for 16 and 17-year-olds and 249 provide a round-the-clock emergency Camhs.

Performance against the indicators varies markedly around the country. While the PCTs in South East London Strategic Health Authority meet all the targets, only 36 per cent of the indicators have been met in Cumbria and Lancashire.

The charity YoungMinds said the failure to meet the target would leave many children and their families without essential support services. Training and consultancy manager Lee Miller says Camhs provision is “really struggling at the moment” but admits progress has been made over the past three years, during which time the government has pumped an extra £300 million into services.

Good progress
One example of good progress is in the south London borough of Southwark, which aims to meet the three elements of the target and a fourth local-authority measured element this year.

The borough’s joint commissioner for Camhs Ragnhild Banton says it is a challenging time as the additional government money  is now being levelled off and providers have to worker smarter with the money they have .

Camhs funding is paid in two parts, one to local authorities and one to primary care trusts. Banton says her post as a joint commissioner, managing the funds for Southwark Council and Southwark PCT is invaluable in getting health and social care to work productively together.

She says Southwark is fortunate in the level of its grant –  about £1.8 million – but argues that increased commissioning with the voluntary sector is crucial to its success. 
 
A tenth of the budget has been spent on five voluntary sector contracts, offering early and less stigmatising responses to young people.

Emotional problems
A contract with Fairbridge is helping the trust meet its 16 and 17-year-olds target, the charity offering a six-month programme involving intensive outreach, outdoor pursuits such as sailing and substance misuse treatment as well as helping young people tackle emotional problems.

The learning difficulty target is being addressed through funding additional psychology and nursing posts at the Wilfrid Sheldon Child Development Centre, which accommodates a range of practitioners including paediatricians, social workers and physiotherapists, so families do not have to visit several different sites.

The round-the-clock service target is being achieved through the use of a rota of psychiatrists. Children under 16 are referred through children’s accident and emergency and 16 and 17-year-olds are triaged out to be seen by a Camhs consultant.

In addition, charity Place 2 B is working with children, parents and school staff in 11 primary schools and the charity Young Carers will support 20 children with mental health needs or parents with a mental illness.

Banton says all voluntary sector partners have an NHS staff member acting as a link worker to them, so there is an easy point of contact for any issues that might arise.