Kristy Adams: Without Child and Adolescent Mental Health Services getting more funding, we are storing up trouble

23 Jul

Kristy Adams is a company director. She is leading the Health & Happiness lessons for six to 16 year olds for the online catchup school @InvictaAcademy.

The Government invested an extra £1.4 billion in children’s mental health services from 2015-2020 after the recommendations of the Future in Mind report of 2015. CAMHS currently accounts for 0.7 per cent of NHS spending and around 6.4 per cent of mental health spending.

CAMHS is the child and adolescent mental health services. If your child is having serious mental health problems and is self-harming or suicidal, their school or GP will contact the CAMHS team for an assessment and help for your child.

In the UK we have 14 million children of a total population of just over 68 million, so children make up around 20 per cent of the population – yet CAMHS only receives 6.4 per cent of mental health spending. The numbers don’t add up. The UK is not alone in this fact.

Katie Gibbons wrote in The Times this week about research published in the Evidence-Based Mental Health journal. “The researchers accused high-income nations of failing vulnerable children and said that they could ‘afford to do better’.

“The authors analysed data from 14 studies in 11 countries – the US, Australia, Canada, Chile, Denmark, Britain, Israel, Lithuania, Norway, South Korea and Taiwan – published between 2003 and 2020.”

The studies involved 61,545 children. The authors from Simon Fraser University in Vancouver said, “Only 44.2 per cent of children with mental disorders received any services.” The findings showed “robust services are in place for child physical health problems such as cancer, diabetes and infectious diseases in most of these countries.” The research showed “an invisible crisis in children’s mental health.”

Two families I know well have teenagers who have sought help from the UK CAMHS teams in their area. The service in both cases was superb; highly-skilled experts treated both students, who have gone on not only to survive but thrive. For those that qualify for help the service is first class, but what of the children who don’t meet the threshold for treatment?

Christmas tree twinkling, December 2020, mulled wine on the hob and after such a long time in face masks, lockdowns and fear of losing jobs – the peace seemed a chink of light in my friend Josie’s house. Only for it to be shattered hours later when her 15-year-old daughter found her sister trying to kill herself.

No warning, no run up, ambulance called. The elder daughter is 18. Maisy (not her real name) was admitted to hospital. Neither of her parents was allowed to accompany her and she was released next morning at 7am. One phone call to follow up and that was the end of the mental health support. Gareth Southgate did a better job of supporting his footballers than the mental health team did with a suicidal teenager. The suicidal teenager had undiagnosed autism.

Another friend, Katie, has a 14-year-old daughter Bella, who went into a meltdown over the Government’s communication of how she would gain her GCSEs. Was she taking them? If her teachers were assessing, would she gain the grades needed to gain a college place?

Poor communication from the Government meant teachers and schools hadn’t got a clue what was happening. Bella’s anxiety and fear became more serious as she considered the move from school to a new sixth form. Bella was self harming, wasn’t sleeping and she refused to leave her room. Katie listened to her daughter and contacted school to ask for help. Bella was refused help by CAMHS; she didn’t qualify as she wasn’t trying to take her own life.

Katie took her daughter’s concerns seriously and found a private counsellor and clinician. Bella was diagnosed with autism and, through the help of professionals and her family, she is now doing well. Katie says she was able to get Bella help because they used the money that would have been spent on a holiday, but what about the families in identical circumstances who can’t afford to pay?

Prior to the pandemic I visited a primary school where I led an assembly on democracy. I met the super-efficient head teacher before my talk. Having completed hundreds of school visits over the years – as a director of a learning board trust – I can spot a well-run school at 20 paces.

This one was all singing, all dancing with a buzz of learning and a joy to be in. I asked the Head my killer question. ‘What would you like the Government to do differently to most improve the lives of your students?’ Her reply was instant: fund CAMHS properly.

The previous week one of her students had been self harming with a compass. Because the girl hadn’t broken the skin, she didn’t qualify for CAMHS help. The issue stemmed from the girl’s struggle with undiagnosed dyslexia. Her parents had to pay privately for a professional counsellor.

This began a research project for me. I found three charities that could help schools with trained children’s counsellors and funding. The charities have partnered with churches and faith groups to provide money and resources. I communicated this information to schools and political leaders at a local council.

I believe in personal responsibility, I’m a Conservative and I believe in resourcing all organisations/charities to solve problems. But here’s the crux of the matter – currently CAMHS doesn’t have enough resources to help children in crisis who are not suicidal (and it doesn’t have the money for preventative work) and that’s just not good enough.

It makes sense to invest in mental health for young people because they are valuable, our country’s future and the problems won’t go away. Indeed, the things they are struggling with will be carried into their adult life. One in three adult mental health conditions relate directly to adverse childhood experiences and the NHS will continue to need to give individuals care in adulthood, which involves cost.

If we want to save money, let’s treat the patients while they are children. It makes so much sense to invest in CAMHS so it can offer a broader service including preventative care. Part of the children’s mental health service should include identifying autism in under 18s (and as girls are often failed to be helped, targeting identifying girls.). 50 per cent of the clinical commissioning groups couldn’t give an account of the additional money the Government gave them from 2015-2020 and how it was spent. Greater accountability is required.

The Simon Fraser University in Vancouver researchers concluded governments would “need to substantially increase the spending on children’s mental health budgets.” This is particularly urgent given documented increases in children’s mental health needs since Covid-19.”

Here’s my call to action: identify dyslexia and autism more accurately and earlier to produce better outcomes, and increase the budget for CAHMS – so that services are proportional to the percentage of children in the total population. Both of these will provide a better service to our children and cost the country less money in the long term.

(Names have been changed to protect identities).

Edward Davies: Work and relationships are the core components of mental health. The lockdown has damaged both.

4 Nov

Edward Davies is Director of Policy at the Centre for Social Justice

The Coronavirus crisis will have many knock-on effects, but one of the biggest – the decline in the nation’s mental health – is already daily headline fodder.

Research published in the British Journal of Psychiatry found that recent suicidal thoughts had increased from one in 13 to one in 10 respondents since March: that’s the equivalent of an extra 830,000 adults thinking of ending their life.

A mega-survey conducted by Mind, the mental health charity, found that more than half the adult population reported a deterioration in their mental state during lockdown. Even six months on from telling us all to ‘stay at home’ ONS analysis finds almost four in 10 adults reporting high levels of anxiety in October.

The Department of Health in England has said, predictably, that it is increasing investment in mental health services in response. But maybe it shouldn’t. We need to learn from the last few months that addressing the mental health needs of the country is not about an ever-increasing spiral of public service spending.

Child and Adolescent Mental Health Services (CAMHS) are overwhelmed, and the knee-jerk response to expand them is understandable. But by the time a child gets there they are already likely to be suicidal. We must go much further upstream.

The last six months have reminded us that good public services, important though they are, are not at the root of mental wellbeing. In fact, the two core components have little to do with public services or government at all, and were profoundly undermined by the lockdown: our work and our relationships.

First, on work, there are few more important things to a person’s mental health than having a reason to get up in the morning. The Royal College of Psychiatrists is unequivocal about the importance of employment for people with mental health problems, they say it is “central to personal identity; provides structure and purpose to the day; gives opportunities for socialisation and friendship; and increases social networks – a core component of social capital”.

And secondly, on relationships, the evidence is even stronger. The Grant Study, a landmark 75-year longitudinal study of Harvard students, is utterly unequivocal about the importance of our relationships to mental and physical health:

“So what have we learned? What are the lessons that come from the tens of thousands of pages of information that we’ve generated on these lives? Well, the lessons aren’t about wealth or fame or working harder and harder. The clearest message that we get from this 75-year study is this: good relationships keep us happier and healthier. Period.”

The quality of our close relationships is fundamental to child mental health, too. Family instability is the single biggest reason that children report attending CAMHS. But, deeper than that, NHS data shows the very structure of our family relationships has a fundamental impact on the mental health of our children.

A primary school child with married parents has a six per cent chance of a mental disorder. It rises to 12 per cent for cohabiting parents and 18 per cent for lone parents.

This overwhelming evidence on work and relationships is reflected in the “happiness data” initiated by David Cameron and still quietly being collated by the ONS. After our health itself, the two most significant factors in an individual reporting that they are satisfied with their life is their marital status and employment status – way more important than other items we might assume, such as housing or income.

So what does that mean coming out of this crisis? It means that whenever policy talk turns to mental health, we need to remember the lessons of both this recent pandemic and thousands of years of history and evidence.

Public services are hugely important, but we will not prevent this problem by constantly pouring water on the fire.

If we want to truly tackle mental health problems in this country, we need to go deeper. We need to ask why, if close relationships are so important, we have allowed the most stable relationship form – marriage – to collapse to a quarter of the rate of a generation ago.

Why do our homes get smaller, our commutes get longer, and more people than ever live completely alone? As a start we should invest in greater relationship support in the early years of children’s lives and revive the Government’s Family Test to ensure housing and economic policy supports rather than hinders families’ wellbeing.

The Government has committed (but not spent) £2.5 million to conduct research into family hubs; this shouldn’t be a dry exercise, but should be done quickly enough to provide a road map to the delivery of family hubs in every part of the country.

Rev-up family support at pivotal moments like the birth of a first child. Birth registration should be a gateway into family support at the very moment parents need it most. Simply fire-fighting this problem with well-intentioned hoses of ever more school counsellors and spiralling public services will never prevent it in the first place.