05.11.14
Children’s mental health services have ‘serious and deeply ingrained problems’
There are “serious and deeply ingrained problems” with children’s and adolescents’ mental health services (CAMHS), according to a report from the Health Select Committee.
Experts in the sector say it comes as no surprise that the committee found the problems run throughout the whole system, from prevention and early intervention right through to inpatient services.
The government says the Children’s and Young People’s Mental Health and Wellbeing Taskforce, launched in August, will look to address many of the issues raised.
The committee highlights the importance of early intervention in CAMHS, as this can provide support to young people before mental health problems become entrenched and reduce the need for hospital admissions. However in many areas early intervention services are being cut or are suffering from insecure or short term funding. The report recommends that the government taskforce should audit commissioning of early intervention services in local authorities and come up with recommendations on how to incentivise early intervention.
Access to inpatient mental health services also has major problems; the report says children and young people’s safety is being compromised while they wait for a bed to become available. Often when beds are found they may be in distant parts of the country, making contact with family and friends difficult, and leading to longer stays.
The committee is especially concerned with the practice of taking young people detained under the Mental Health Act to police cells, usually when there is no ‘safe place’ in hospitals. It says in no uncertain terms that this practice needs to be “eradicated” and directs the Department of Health to be “explicit” in setting out how this will be done.
The committee also heard how young people with mental health problems and their parents had to battle to access appropriate services. In some areas, it has been reported that services will not kick in unless the young person has attempted suicide.
Those planning and running services have been operating in a "fog" without a clear national vision or adequate funding, says the committee.
Particular problems persist in the commissioning of CAMHS, it adds. Despite the move to national commissioning of inpatient services over a year ago, many of the perceived benefits of national planning have not been realised. The Health Select Committee plans to review this area further in 2015.
The report makes specific mention of the positive impact out-of-hours crisis services and paediatric liaison teams can have, however it says the availability of these services, which bridge the gap between inpatient and outpatient care, is extremely variable. It is especially critical of the commissioning arrangements around them, saying they act as a perverse incentive driving admissions as these are then funded by NHS England rather than CCGs.
The Royal College of Nurses say that it’s a “disgrace” that vulnerable children are being let down. Referring to the current commissioning arrangements as “perverse”, they say that pressure on services and a lack of resources is compromising patient safety.
Anna Feuchtwang, chief executive of the National Children’s Bureau said: "Sadly it will come as no surprise to many in the sector that the Committee has found serious problems in the commissioning and provision of CAMHS across the country.
“The areas highlighted for action echo those changes we have been calling for. Schools need to be better supported to make a positive contribution to children's emotional wellbeing; there needs to be better data on children’s needs to inform planning of services; and there needs to be clear national direction-setting backed by resource.
“All agencies need to fulfil their responsibilities to children in this area and we must not shy away from holding them to account. As the Committee rightly points out, local authorities' role in public health should provide an opportunity to strengthen, not weaken their contribution. The NHS must be able to identify and meet need, with better training for GPs and high quality specialist services close to home.”
Care and support minister, Norman Lamb MP, said: “I am determined to make sure young people get the mental health care they need. We’ve invested £7m in new beds, I’ve launched a Taskforce to improve services and we are introducing a new waiting time standard to make sure young people with psychosis get prompt treatment. I strongly welcome this report which will support our work and the work of the Taskforce to make sure children and young people’s services get the priority they deserve.”
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