We need an action plan for children’s mental health services

Despite all the focus and talk on early intervention for children and young people there is one critical area that continues to go in the wrong direction. Early identification and help for children with mental health problems remains as poor as ever. This was graphically illustrated in a report this week that found internationally recognised early intervention psychosis services for teenagers were struggling due to budget cuts, staff losses and high caseloads. The mental health charity Rethink that carried out the survey of services said it would lead to more young people requiring hospital admission or detention under the Mental Health Act.
 
Mental health services for children and young people have long been seen as a Cinderella service that is poorly funded and never given the political priority that other health provision, such as cancer, have had. Only six per cent of spending on mental health goes to services aimed at children and young people. Yet we know that half of lifetime mental illness (excluding dementia) starts by 14 years old.

The what works evidence is not in question. Recommended therapies for depression, conduct disorder, ADHD and other conditions have been validated by the National Institute for Clinical Excellence. And the invest to save prevention evidence is also strong. For example, social and emotional programmes to prevent conduct disorder can deliver substantial savings by avoiding costs to other services, such as the the police and youth offending teams, in the future.
 
So why is the system failing to intervene early? The answer is that specialist and early help services are being slowly dismantled. Funding cuts are resulting in CAMHS services having to only focus on urgent assessment and treatment cases. High-risk cases are having to be prioritised over routine activity, such as assessments for ADHD.
 
The government emphasises that it has invested millions in an improving access to psychological therapies programme which it says will “transform services”, covering six out of 10 children and young people under 19 by 2015.

But the picture on the ground that is beginning to emerge anecdotally, is that the programme is being undermined by staffing and wider resource reductions. There is a serious shortage of skilled, trained and supervised staff to meet demand.
 
Amidst much publicity the Deputy Prime Minister unveiled the government's mental health strategy last month. What is now needed is a clear delivery action plan on children’s mental health that is backed up by resource commitments and takes a whole-system approach across all services, especially schools. In the same way that shortly after coming into office the government set out an action plan to tackle the sexual exploitation of children that addressed activity across agencies, the equivalent is urgently needed for mental health. Without a central government drive for change effective early intervention to tackle mental health problems will continue to be a vision rather than a reality.
 
Enver Solomon is Director of Evidence and Impact at the National Children’s Bureau