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Young minds do matter

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As prescriptions for antidepressants rise, the wai As prescriptions for antidepressants rise, the wait for ‘talking cures’ continues to be up to a year

‘What I was promised would be a six-week pit stop has become a six-month jail sentence.’ These are the words of Isabelle Garnett, mother of Matthew, a 15-year-old boy with learning difficulties who has been kept in a mental health ward for the past six months. A severe case that offers a microcosm of the challenges facing children’s mental health services.

An investigation by the charity YoungMinds, found that 34 out of 51 local authorities in England have reduced their Children and Adolescent Mental Health Services (CAMHS) budget since 2010. One council reported a drop of 41% in their CAMHS budget from 2010.1

In addition, a survey conducted by YoungMinds of over 300 CAMHS staff revealed that 68% said that local services will only see severe cases in response to budget cuts.2 Young people with emerging mental health conditions are being sidelined until their conditions become considerably worse.

Norman Lamb, the former minister for care and long-time champion of mental health, described CAMHS as being ‘stuck in the dark ages’ – underresourced and unable to provide the comprehensive treatment available for physical health services.

The government has announced an extra £1.25 billion for CAMHS by 2020 .But it is disputed whether this money is reaching those who need it. A report by thinktank Centre Forum, states that this funding has not been ring-fenced and from 2016/17 it will be part of the CCG’s baseline allocation.3 ‘There is, therefore, a substantial risk that it could be siphoned into other priorities for investment, or used to back-fill cuts from local authority investment in children’s mental health,’ the report’s authors state.

The chair of the NHS Clinical Commissioners Mental Health Network, Dr Phil Moore recently called for children’s mental health to be ringfenced at a commissioning level, to stop the funds being redirected to other areas.

‘Despite our commitment to better mental healthcare for young people, it has to be acknowledged that CCGs are dealing with increasing financial challenges times and a myriad of competing demands on budgets,’ he said.

‘This, combined with the fact that children and young people’s mental healthcare is in desperate need of heavy investment having historically been treated as a “Cinderella service”, is why we believe this to be a rare case where funding should be ring-fenced.’

The challenge
One in 10 children and young people aged five and 16 suffer from a diagnosable mental health disorder. Between one in every 12 and one in 15 children and young people deliberately self-harm. As shocking as these statistics are, children’s mental healthcare still receives just 0.7% of the entire NHS budget.

‘Draining money from early intervention services is short-sighted, and just stores up problems for the future as young people are left without access to early help, meaning mental health problems become more serious and entrenched,’ said Sarah Brennan, chief executive of YoungMinds. ‘It is therefore vital that councils and NHS commissioners prioritise funding comprehensive CAMHS services to avoid deepening the potential damage that further cuts could cause to children and young people’s mental health.’

Service disparity
Problems with funding have led to a demand that far outweighs supply for specialist mental health services. The Centre Forum report found that 23% of children and young people referred to CAMHS are turned away due to their condition not being considered ‘serious’ enough for specialist treatment. A 2010 survey,2 mentioned in the report, found that more than three quarters of GPs said they were unable to secure access to psychological therapies for young patients.

‘We have seen a huge increase in demand in recent years,’ says Mini Pillay, a child and adolescent psychiatrist at South West Yorkshire Partnership Foundation NHS.

‘It’s important to remember that only about 25% of young people with a diagnosable mental health condition make their way to the service,’ says David Goodban, interim head of the Children and Young People’s programme at The Mental Health Foundation and a former regional lead for CAMHS. ‘No one is looking for the 75%. We are potentially looking at the tripling of the numbers of clinicians and funding, but this is not a national priority.’

Barbara Rayment, director of Youth Access, a youth support charity says more focus needs to be given to preventative services for young people. ‘We will not improve access or reduce the need for expensive crisis interventions unless we can really start to expand our investment in genuinely young people-focused services.’

According to Mind, waiting times can have a devastating impact on a person’s life. They can exacerbate mental distress, cause relationships to break down and, in extreme cases, lead to suicide attempts. Additionally, people who manage to access psychological therapies within three months of diagnosis are five times more likely to say that their treatment was successful, compared with those who had to wait over a year.

‘This is where the gaps between physical and mental health show,’ says Ian Hulatt, the mental health nursing lead at the RCN. ‘If you were diagnosed with diabetes, there is no way you would wait a year to see a diabetes specialist.’

The alternative
A recent study in the European Journal of Neuropharmacology found a 54% increase in the number of young people prescribed antidepressants in the UK between 2005-12.

Mr Hulatt thinks that the increased waiting times are directly linked to the rise in antidepressant prescriptions.

‘The factors are related. If a clinician is presented with a young person with a mental health condition, they will want them to have therapy,’ he says. ‘But they will be aware of the waiting lists, and so will prescribe antidepressants. This is appropriate, but it is only doing half the job.’

While antidepressants are a recognised treatment for managing depression in children, NICE clinical guidelines state they should not be offered initially for symptoms of mild depression. In more serious cases, antidepressants are only supposed to be used in conjunction with psychological therapies. Many of these drugs are also not licensed for use in under 18s.

‘Inevitably a rise in people accessing CAMHS and a rise in incidence of mental health difficulties can lead to a rise in antidepressant prescribing ,’ says Ms Pillay. ‘Any medication that is prescribed, whether for mental health difficulties or physical health difficulties, needs to be appropriate, evidence-based, and justifiable for that individual. If medication is prescribed without adequate clinical indication, there’s a risk of exposing individuals to its side effects with no benefits to balance this out.’

So not only are young people being let down when it comes to a lack of funding, but it is, in some cases, at risk of exacerbating their situation. ‘The recognition of CAMHS services, and the boost in funding are certainly encouraging,’ said Mr Hulatt. ‘But that is little conciliation for a young person who has been waiting to see a therapist for more than a year.’

The situation remains dire. Thousands of children are unable to see a mental health professional, running the risk of exacerbating existing mental health problems. The boost in funding is welcome, but while uncertainty remains about its destination, children in need of treatment remain in danger.

References

1. YoungMinds. Stop cutting CAMHS services. 2013

http://www.youngminds.org.uk/about/our_campaigns/c...

2. Mind. We still need to talk. 2013. http://www.mind.org.uk/media/494424/we-still-need-...

3. CentreForum. Children and Young People’s Mental Health: State of the Nation. 2016

centreforum.org/publications/children-young-peoples-mental-health-state-nation/

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