Government hopes cash boost will transform children's mental health
Monday, March 30, 2015
The government is to pump over £1bn into overhauling children's mental health services by 2020, but experts say this alone will not be enough to tackle deep-rooted problems with access to therapy and the commissioning system.
News of a £1.25bn investment in mental health services for children and new mothers is a welcome boon for the sector.
Announced during the pre-election budget, the majority of the cash (£1bn) will go towards treating 110,000 more children during the five-year term of the next parliament - the equivalent of 22,000 additional children each year at an annual cost of £200m.
A further £118m will be spent by 2018/19 to complete the roll-out of the Children and Young People's Increasing Access to Psychological Therapies (IAPT) programme, ensuring that there are talking therapists in every part of the country. In addition, £75m over the next five years (£15m a year) will be spent providing the right care for more women experiencing mental ill health during the perinatal or antenatal period.
The Department for Education will also provide an extra £1.5m towards piloting joint training for designated leads in child and adolescent mental health services (CAMHS) and schools to improve access to services. Announcing the funding, Deputy Prime Minister Nick Clegg said he wants to start a "seismic shift" to "revolutionise" children's mental health services.
"By introducing access and waiting time standards, and committing to talking therapies for children in every region, we are helping to build a fairer society where young people can get the right treatment and support they deserve to live a better life," he said.
But following years of under-investment, can the funding transform the help provided to young people experiencing mental health problems?
Five-year action plan
The government funding pledge forms part of its wider response to the findings of the Children and Young People's Mental Health Taskforce. In its report Future in Mind, it outlines 10 aspirations that it wants to see by 2020 (see box). Several of these are linked to the announced £1.25bn investment over the next five years, not least the £1bn set aside to ensure that in every part of the country, children and young people have "timely access" to clinically effective mental health support.
The government says this will be achieved through the development of a "comprehensive set of access and waiting times standards that bring the same rigour to mental health as is seen in physical health". But exactly what form the standards will take is yet to be confirmed.
The Association of Child Psychotherapists (ACP) says it wants the funding to be used to lower thresholds for access to CAMHS services to include less severe difficulties and disorders.
"This would also meet early intervention goals and would mean that children and young people could access treatment and support before reaching crisis point such as having to attend hospital after an overdose," an ACP spokeswoman says. "It would be less costly overall, but would require more staff and access in community settings with a link to, and input from, specialists."
However, there are a number of ambitions that appear to have no additional funding attached. One of these is the ambition to deliver a "step change" in how care is delivered. This would involve moving away from a system characterised by services being delivered independently by different organisations, towards a system built around the needs of children, young people and their families.
The government says this could be done through "collaborative commissioning approaches" between clinical commissioning groups, local authorities and other partners, as well as having lead commissioners who would be responsible for developing a single integrated plan.
Closely linked to this is the government desire to make mental health support more visible and easily accessible for children and young people through every area having "one-stop shop" services that provide mental health support and advice services in an "accessible and welcoming" environment.
It suggests that access to support could also be improved by having named points of contact in specialist mental health services and schools.
The government says much of the transformation of the design and delivery of local offers are "cost neutral", as they require a different way of doing business rather than further significant investment. But it does concede that a number of proposals in the report require decisions on investment and local service redesign that will "need explicit support from the next government" during what it concedes will be a "very tight" Spending Review period.
"We are realistic in this respect," the report states. "At national and local level, decisions will need to be taken on whether to deliver early intervention through an 'invest to save' approach and/or targeted reprioritisation, recognising that it will take time to secure an economic return for the nation."
Sue Bailey, chair of the Children and Young People's Mental Health Coalition, says the £1.25bn set aside by the current government is unlikely to help with the more complex proposals involved with implementing the national ambition between 2015 and 2020.
Although she welcomes the national roll-out of IAPT services, and the new access standard and waiting times targets, she says existing services must be prepared to adapt. "Money can act as a catalyst and bring people together, but it also requires leadership and a will to work differently," she says.
"We need the next government to prioritise children and young people's mental health and wellbeing, and take up the challenge of funding and implementing some of the bigger proposals in the report."
Barbara Rayment, director of Youth Access, the national membership organisation for young people's information, advice, counselling and support services (YIACS), says implementing the taskforce's proposals is "not without challenge".
"The new funding announced in the budget is excellent news, but will only bring the proportion of NHS funding on mental health that goes towards children and young people up to eight per cent - which is still scandalously low when one considers that 75 per cent of all life-time mental health problems emerge by age 18," she says.
Latest available statistics (see graphic) show that spending on children's mental health disorders came to £0.7bn, compared with £10.5bn on adult mental health disorders.
Rayment says that to successfully bring about the changes outlined by the taskforce requires dedicated joint-working. "This agenda goes far broader than NHS CAMHS commissioning," she says.
"It requires contributions from a range of public health, housing and youth commissioners, as well as adult mental health commissioners.
"Real change will only come about if all commissioners recognise their responsibilities to deliver on the vision for change set out in Future in Mind.
"Health and wellbeing boards and clinical commissioning groups, for their part, have a critical responsibility to invest in services."
Rayment adds that there is a danger that the kind of services praised by the taskforce could be subject to funding cuts.
"We recognise that NHS England will be keen to ensure that the new funding goes to where it is needed on the frontline - including, critically, integrated young person-friendly services - and trust that many voluntary sector YIACS will benefit from some of the resources.
"In the short term, however, there remains a serious danger that we will lose some of the very services the taskforce has identified as central to the future landscape of provision. It is critical that local authority, CAMHS and adult commissioners protect and increase funding for existing YIACS services."
Andy Bell, deputy chief executive at the Centre for Mental Health, says the government funding does not absolve schools, CCGs or local authorities from investing in better support.
"It is vital now that every health and wellbeing board assesses the mental health needs of children in its community and brings together all the services that can help to promote wellbeing and resilience to work with young people to develop more effective solutions," he says.
Government aspirations for services by 2020
1. Improved public awareness and understanding of mental health, so people think and feel differently about mental health issues; stigma and discrimination are tackled; and young people do not fear being judged.
2. In every part of the country, children and young people have timely access to clinically effective mental health support when they need it. This will be achieved through a five-year programme to develop access and waiting time standards.
3. A step change in how care is delivered, moving away from a system defined in terms of the services organisations provide (the four-tiered model of child and adolescent mental health services) towards one built around the needs of young people and their families.
4. Increased use of evidence-based treatments with services that are rigorously focused on outcomes.
5. Making mental health support more visible and easily accessible.
6. Improved care for children and young people in crisis so they are treated in the right place at the right time and as close to home as possible. This includes ensuring no child under 18 is detained in a police cell as a place of safety.
7. Improving access for parents to evidence-based programmes of intervention and support to strengthen attachments between parents and children, building resilience and avoiding early trauma.
8. A better offer for the most vulnerable children and young people, such as those who have been sexually abused or exploited, making it easier for them to access the support they need when and where they need it.
9. Improved transparency and accountability across the whole system, to drive further improvements in outcomes through benchmarking local services at a national level.
Training professionals who work with children and young people in child development and mental health, so they can understand what can be done to provide help and support for those who need it.