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CAMHS cash at risk of being diverted from frontline, commission finds

Funding meant to address the problems with child and adolescent mental health services (CAMHS) is at risk of being diverted from the frontline, the Education Policy Institute (EPI)’s Independent Commission on Children and Young People’s Mental Health has warned.

In March 2015, the government promised £1.25bn for CAMHS over the next five years, equating to £250m per year. However, the commission’s report found that only £143m of this was released in the first year, of which £75m was distributed to CCGs.

“It is not yet clear how much of this has been spent on frontline services, but reports from mental health providers indicate that they have not yet seen this increased investment,” the report noted.

In 2016-17, £119m has been allocated to CCGs, but this has been included in their total baseline allocation. The report said the fact that the money was not ring-fenced also created a risk that funding would be diverted to other priorities covered by national targets, such as reducing A&E waiting times.

“It is also important to consider this additional investment in the wider context of funding for the whole system,” the report added. “Children’s mental health services have been historically underfunded. In 2012-13 £704m was spent on CAMHS, the equivalent of about 6% of the total mental health budget, or around 0.7% of the total NHS budget.

“This is in spite of prevalence data showing that one in 10 children and young people experience mental health problems and that 75% of young people experiencing a mental health problem are thought not to access any treatment.”

Commenting on the commission’s findings, Norman Lamb MP, a former care minister and chair of the commission, said: “The prime minister, in her very first speech, rightly highlighted the inadequacies of the country's mental health provision as a ‘burning injustice’.

“Today we call on the government to meet this commitment – and take urgent action to ensure children and young people with mental health problems receive the care they need.”

The report also quoted figures from the Children’s Society showing that, between 2010-11 and 2015-16, spending by local authorities on early intervention services fell by 31%, and it is due to fall by 71% by the end of the decade.

Furthermore, the commission identified a “postcode lottery” for CAMHS, with almost a quarter of children and young people turned away from services. A report from the Children’s Commissioner, published earlier this year, suggested the number being turned away could be as high as 28%.

The EPI commission also quoted this year’s Adult Psychiatric Morbidity Survey, which shows that two-thirds of 16-34-year-olds who attempted suicide had not subsequently received medical or psychological help.

The commission analysed 121 local plans for improving CAMHS. It rated just 15% of them as ‘good’, 48% as ‘requires improvement’ and 37% as ‘requires substantial improvement’.

And according to FOIs it issued to CAMHS providers, over four-fifths had experienced recruitment difficulties, and spending on agency staff had increased from £27m in 2013-14 to £50m in 2015-16.

The commission argued that local areas should not receive additional CAMHS funding unless they could demonstrate that all funding would go to children’s mental health services and that they had robust plans to improve care. They should also carry out audits of their progress in delivering the plan in 2015-16 and 2016-17.

The Commons Public Accounts Committee had previously warned that the lack of ring-fencing could also affect the government’s promised funding increase for adult mental health services.

Dr Phil Moore, chair of the NHSCC mental health commissioners network, saidCAMHS was a "rare case" where funding should be ringfenced because of its historic status as a "Cinderella service".

Government recommendations

The EPI commission added that the prime minister should announce a National Challenge on Children’s Mental Health as a “key priority” of her administration.

This should include easy-to-access services in every area, a national government programme to ensure a stronger focus on mental health and wellbeing within schools, and the establishment of a Mental Health Research Institute.

Joy Chamberlain, chair of the Independent Mental Health Services Alliance (IMHSA), welcomed the recommendations, and added that the government should address “entrenched commissioning barriers” such as the difficulties in stepping down patients between inpatient and community services and the use of unaccountable block contracts.

“IMHSA hopes that the government and NHS England will take forward these recommendations,” Chamberlain added. “The independent sector is a willing partner for this work to ensure that children and young people are able to access the support they need, when they need it.”

Jeremy Hunt, the health secretary, said the government would “say more about further plans to improve children's mental health services soon”.

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