is the government finally ready to give youth mental health the attention it needs?
Last week the NHS Long Term plan was announced, promising to give more money and resources to childhood and youth mental health. But is it a step in the right direction or just too little too late?
Last week saw the release of the NHS Long Term Plan, a comprehensive look at the future of the NHS. The bulk of the plan focuses on intervention – preventing people from getting ill to ease the burden on services and to save money.
One particular area of focus was child and adolescent mental health, with the plan promising, among other things, an extra £2.3 billion for services per year by 2023, with a commitment to a proportional growth in funding for children’s mental health. Support for an additional 345,000 children and young people was also promised through the traditional CAMHS (Children and Mental Health Services) route, with specialists to be embedded in schools and colleges with an eye to early intervention. The plan also focused on overhauling crisis care -- which is currently chronically overburdened -- with 24 hour phone lines to be set up and specialist services for children with severe mental illnesses to be expanded. And moves will also be made to ensure that 18-25 year olds experience a smoother transition from CAMHS to adult mental health services, something that currently causes many young people to drop out of mental health care altogether. It sounds like a pretty comprehensive plan, and undoubtedly it’s something the NHS’ mental health service is in dire need of.
Mental health support for young people is currently “very variable across the country”, Andy Bell, CEO of Centre for Mental Health, tells me. With growing awareness, more young people are seeking help than ever before. But budget cuts have simultaneously put services under strain -- a troubling combination. Many services for young people now have to apply high thresholds for help -- leading to long waiting times or, in some cases, young people being turned away entirely because they’re ‘not unwell enough’.
But despite overburdened services and overstretched staff, the current state of mental health care in the NHS is not all negative. There are some positives -- Andy points specifically to significant improvements in specialist support for young people with eating disorders, as well as provision of treatment for people having their first experiences of psychosis. But it goes without saying that much more still needs to be done before our public health services are able to treat and offer mental health care to everyone who needs it.
So, how will the Long Term Plan build on the NHS’s successes -- and, perhaps more importantly, improve services that are currently seriously lacking? Well, right now it’s hard to say. “What was published is a lot of what might happen but not as much on how,” Lee Hudson, mental health lead at the Royal College of Paediatrics and Child Health (RCPCH), says.
Some of the proposed aims of the plan could also be hard to execute. Much of the plan involves prevention -- early intervention through teams placed in schools. The idea, of course, is that detecting mental illness early can prevent young people from ending up in what Lee calls “dire situations”, and perhaps before they develop full-blown disorders. This, in turn, would theoretically reduce waiting lists and waiting times for those with severe problems that require the next level of treatment.
But the plan doesn't outline a full rollout, instead, preventative measures will be tried out through various schemes. “It’s sensible in some ways, because we won’t spend a load of money and use a lot of resources in one go, and we can also see what works,” Lee says. “But the problem is that a large number of children are just not going to be able to access that service, because it’s being rolled out so slowly.”
And what of the next five years, while services catch up? “There doesn’t look like there’s extra resource going into CAMHS teams, and if schools identify a whole load of children with mental illnesses it’s likely that there’ll be an increased referral to CAMHS,” he explains. But because under current Tory austerity measures resources and funding won’t have increased for these services, they could potentially be under more strain than ever, with more and more young people turned away.
And then there’s another issue. With so much emphasis diverted away from the NHS itself and placed instead on schools, the Long Term Plan fails to account for children who aren’t in school, leaving another gap for vulnerable young people to fall through. “What about children with severe mental health problems who, for various reasons, are not in school?” Lee points out. “If you’re not there, you’re just not going to be able to access these services.”
The workforce within the NHS itself is, perhaps obviously, a major issue. “We really need to increase the number of people working in children and young people’s mental health, particularly those who can provide psychological therapies,” Andy says. “And we also need to educate the wider children and young people’s workforce to be more mental health literate, so that young people with emerging difficulties can get quicker access to help.”
This is already happening in some areas, for example with specialist mental health teams being embedded in diabetes departments across children’s hospitals. But these services are still few and far between.
As with many aspects of healthcare, at the heart of the issue is one thing: money. “It’s crucial that the money earmarked for children’s mental health is spent as intended, and that local NHS bodies are able to account for how they have spent it and with what impact,” Andy says. Lee agrees. “The obvious obstacles are economic -- the money that goes into the NHS is entirely dependent on the economy. That’s an obvious issue.” As he points out, the plan is long term -– and with no idea how Brexit is likely to play out, many elements of it are subject to change.
With mental health increasingly on the political agenda, we can hope that, as with eating disorder services, things will only improve from here. But for now, we don’t know exactly how the plan will play out, with so much dependent on economic and political factors. And for many children and young people already enrolled in mental health services or unable to access care, the changes are too little, too late.
The gap between early prevention and treatment is perhaps the most important aspect of the plan, and the aspect with the most uncertainties. What will happen to the many young people already attempting to access services now, already aware of their mental health problems and attempting to seek treatment? Early prevention is all well and good, but how many young people need to die before they’re able to get treatment?
Some of these young people have severe mental illnesses, far beyond mild anxiety or depression -- and it’s these patients, already excluded from schools and communities, who we need to help the most. Whilst the Long Term Plan might be bringing awareness to mental health care in the public eye, whether or not it can truly help those who need it most is uncertain.