Government plans to broaden the reach of talking therapies are intended to help young people to access mental health support at the earliest possible stage, thus stemming problems before they get out of hand.
But according to a survey by the British Psychoanalytic Council (BPC) published this month, the shift towards the brief interventions used in the Improving Access to Psychological Therapies (IAPT) scheme is putting pressure on NHS psychotherapists to offer short-term care, meaning that children and young people with complex, long-term mental health needs are missing out.
More than three quarters of survey respondents also warned cuts are leading to longer waiting lists, treatments being brought to an end prematurely and a reduction in the choice between different types of therapy.
Gary Fereday, chief executive of the BPC, says an increasing focus on short cognitive behavioural therapies means some children that require different types of treatment are not getting the help they require.
“While the IAPT service, with its focus on short-term cognitive approaches, is effective for some, it’s not an effective intervention for everyone,” he says.
“It is often administered by someone who has not had the same degree of training as a psychotherapist. It can be the case that they ‘open up’ the problem, but are not able to address it. The young person can go back to their GP in no better a position than when they started. Potentially they are more upset and emotionally disturbed because it has stirred up feelings. It has also cost money.”
The BPC is lobbying government for better qualified clinicians to assess all children before any decisions on treatments are taken.
Barbara McIntosh, head of young people’s programmes at the Mental Health Foundation, is also concerned that children with deep-seated mental health problems could be overlooked.
Lack of treatment
A report last year by the London School of Economics’ mental health policy group found that of 700,000 children with problem behaviours, anxiety or depression, three quarters get no treatment.
“Young people are finding it hard to get referred to services,” she says. “They go to their GP, but they don’t quite know where to refer them. There needs to be greater knowledge of children’s mental health needs among GPs.”
Early intervention projects being developed with IAPT funding include scenario-based work with young people on situations around bullying or being robbed – situations that can trigger anxiety or depression – to build up psychological resilience and problem-solving skills. The government has allocated £54m to children and young people’s talking therapies until 2015.
But McIntosh says the government and professionals are yet to find the right balance between boosting acute treatment services and developing early help projects.
“In the long-term, it is more sensible to invest in the under-fives, to help parents with their children to build psychological resilience and problem solving, so we don’t have problems when children are at school age,” she says. “We need to provide an alternative to traditional psychological therapies – a whole range of innovative and interesting practices that help children gradually to self-manage and get them through the crisis that is often the reason for the referral in the first place.
“We should also be looking to provide outreach services, taking a more personalised approach rather than having them just sitting in a clinic. But that individualised approach is quite rare with children.”
Barbara Rayment, chair of the Children and Young People’s Mental Health Coalition and director of Youth Access, says improving data recording systems is vital if professionals are to prevent children and young people from being deprived of support.
“Figures available often relate to what is going on in statutory services, and do not acknowledge the contribution of voluntary sector organisations,” she says. “Being able to assess that level of need is difficult. Most local authorities do not track the issue in any systematic way, so we don’t have any reliable data about the numbers of young people who are looking for help.”
