Health Service Focus

CAMHS: The state of play for children and adolescent mental health

National Health Executive’s Matt Roberts spoke with Whitney Crenna-Jennings, a senior researcher in mental health, wellbeing and inclusion at the Education Policy Institute (EPI) about their recently released CAMHS report.

Forming a key cornerstone of mental health provision in this country, access to children and adolescent mental health services (CAMHS) is a vital area of care which has found itself underfunded and with patchy coverage in recent times.

Steps are being taken to improve funding and close regional inequalities in the provision of services, but as the Education Policy Institute (EPI) uncovered in their annual report for 2019, using information gained through Freedom of Information (FOI) requests, there is still some distance to go to in order to attain ambitious government targets.

Speaking with Whitney Crenna-Jennings, one of the authors of the report at the EPI, we get a better understanding of what the report uncovered.

Q: You recently co-authored the EPI’s Annual Report into access to child and adolescent mental health services and it produced some rather damning statistics on the state of mental health provision available to children and young people around the country.

Could you talk us a through your findings a little bit more?

“We’ve been collecting this data through Freedom of Information (FOI) requests for the past three years, and year on year this is what we’ve found. We’ve found a quarter of referrals to specialist services are not accepted into treatment.

“In a way it’s not surprising, but in another, as time goes on and we know there has been a significant amount of money committed to improving access to and quality of services, it was surprising to us [that] we’re not seeing that filter down and have any kind of impact on the data we’re collecting.”

Q: We’ve seen an extra £1.4bn committed by Government for CAMHS services, yet seen no improvement in the last four years in the rate of rejections. Do you think this represents funds being misspent or larger underlying factors?

“It’s hard to say, [but] I think it’s a combination of factors.

“Firstly, we’re just coming out of years, decades really, of underinvestment in child and adolescent mental health services so we’re starting from a really low baseline.

“The £1.4bn that was committed was in 2014, so not that long ago, but I think there are a lot of systemic issues. It could be that funding is not reaching the frontline of all areas because its not ring-fenced, so clinical commissioning groups and other agencies could be hypothetically using it to plug other holes in health services.

“Another indicator we looked at was wait time and we do see a decrease in waiting times over the [period of our research] so it could be that money is being funnelled into reducing waiting times rather than expanding access to more referrals.

“We’re really still at the beginning of this transformation of CAMHS but it is concerning that it has been four years and we don’t see a huge amount of change or a mass rise in the level of need that is being met.”

Q: As said, we are seeing an improvement in waiting times but the average still remains some way off the government targets of four weeks. How realistic of a target do you feel these are?

“The Government is currently piloting the four weeks waiting time in a handful of areas and there are questions to when or how they would roll this out across the country. Based on the data we’ve been collecting over the past few years and what we know, it is likely to be a long way off for the country as a whole.

“There is massive local variation in terms of ease of access to services and how long you wait to start treatment and that’s likely to continue.

“We might see these four week waiting times happen in the next few years, in a few areas such as the pilot areas or some areas who are just doing a better job of delivering services, but it is unlikely we will see [these targets met] across the country in the near or medium term.”

READ THE FULL ANNUAL REPORT BY THE EDUCATION POLICY INSTITUTE HERE

Q: Good provision of mental health services doesn’t just rely on healthcare bodies, but local authorities too. Do you feel

there is enough collaboration between these at present?

“I think it’s a problem area and not something only we have found. The Care Quality Commission has repeatedly, in their reports and assessments of CAMHS, talked about this fragmentation of the service offer as a whole.

“The concern is when you have a quarter of referrals not being accepted by specialist services, some of those may not need specialist intervention or not meet the threshold, but for whatever reason they probably require some sort of support.

“As a result, the concern is that those alternative services are not in place, and not in an even way around the country. [In previous research] we carried out FOI asking what services were being offered to support the mental health and wellbeing in young people. We know local authority budgets have been reduced significantly and a lot of [these services] have been decommissioned over the past decade.

“It’s really a black hole as the government doesn’t collect data on these alternative services so we don’t know if children who can’t access specialist CAMHS or who have lower level need but require some sort of intervention are able to access those services.”

Q: Mental health services can provide a key backbone to the care of those under their services, but those who enter the system as children and young people often find there isn’t support when transitioning from these services into adult mental health services.

Is this something your data correlates with, and what can local authorities and health bodies do to improve this transition period?

“We know not just from our own research but from others, and from young people themselves, that this is a huge area of provision. We see a number of young people

dropping out of care at that point despite ongoing need.

“I think the fact we found there was not a specific service or role or specific support for children transitioning into adult mental health services in a lot of areas is a concern.

“There is expert consensus around the fact that CAMHS should be offered up to age 25, but again that is only happening in a minority of areas, with only a small number further who have plans to extend the offer. For a lot of places this still isn’t happening.”

Q: What are the EPI’s aims with carrying out this research?

“We haven’t been successful yet in engaging with NHS England on this but that is the goal and we are working towards this on that goal.

“They came out quite strongly against some of our findings this year, but we want to work constructively with them. We have plans to meet with them and present our suggestions based on the research we’ve done.

“We’re not trying to be combative, we’re just reporting the data as it comes to us. Yes, there are issues around FOI data quality, but until NHS England collects and publishes this data this is the only way we have of finding out this information.

“In an ideal world, they would be collecting, validating and publishing this data and we wouldn’t have to collect this data. That’s our position and we do have hopes and plans to engage with them in the future.”

This article first featured in the Jan/Feb 2020 edition of NHE