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Children's mental healthcare forgotten: News focus

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Only six per cent of the NHS mental health budget is applied to children and young people's services and yet the majority of mental health problems start in the teenage years. In a recent analysis into children's mental health services, Norman Lamb, minister of state for care and support, questioned the rationality of this funding allocation.

Mental health services have historically received less of the NHS budget than physical health services and mental health has long been seen as the poor relation of physical health.

In October 2014 Nick Clegg announced that NHS England would invest £120m into improving mental health services from next year. This will include introducing the first ever waiting times for mental health services. From April 2015, 75 per cent of patients needing talking therapies will be guaranteed treatment within six weeks and 95 per cent will start within 18 weeks, which will bring mental health services on a par with some physical health conditions.

Despite the positive attention around improving mental health services as a whole, children and young people's mental health services have been identified as lacking the funding and resources needed to properly support all children and young people with mental health problems.

An analysis of Child and Adolescent Mental Health Services (CAMHS) (see box, p20) by the House of Commons Health Committee, published in November, found that there were 'serious and deeply ingrained problems with the commissioning and provision of mental health services for children and adolescents. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people.'1

In the first step to eradicating these problems Mr Clegg has established a mental health taskforce. One of the main priorities will be to discuss the sustainability of children's mental health services, how they are commissioned and provided and how young people can easily access them through schools, voluntary organisations and online. The taskforce includes secretary of state for health Jeremy Hunt, Mr Lamb, home secretary Theresa May and education secretary Nicky Morgan. It is due to publish its findings next spring.

Currently the taskforce is running a consultation seeking views from professionals who work with children and young people on how mental health services could be improved. The consultation will run until
5 December.

Other government initiatives, specific to nurses' contribution to mental health, include a week of action hosted by the DH nursing team including Viv Bennett, director of nursing, Pauline Watts, professional officer for health visiting and Wendy Nicholson, professional officer for school and community nursing, among others. The week focused on improving health in children and young people. The first day hosted webinars and blog posts on the importance of emotional resilience in children and young people and looked at partnership working between midwives and health visitors, as well as recognising the effects of bullying.

@WeSchoolNurses hosted a Twitter chat in which participants identified an increase in children needing mental health support and a reduction in CAMHS. This has left school nurses managing emotional and behavioural issues in school-age children.2

The school nursing service is spread thinly meaning that children may not receive the support they need at the right time.

Out-of-date

The most recent set of data from the Office for National Statistics (ONS) on children and young people's mental health dates back to 2004.1 Up until then, this study had been conducted on a five-yearly basis. The chief medical officer has asked for a repeated ONS survey, in the near future and more regularly so that there is more up-to-date information about children's mental health.

Dr Trudie Rossouw, a consultant child psychiatrist and associate medical director for children's services, at the North East London NHS Foundation Trust (NELFT), says there could be any number of reasons why there has been a rise in children's mental health. 'Society is different to how it used to be. With the adolescent group things like cyberbullying is definitely more prevalent. Due to the economy and parents losing jobs and becoming more stressed, this has a negative impact on the child.'

Rates of children's mental health problems have been on the rise in the last 20 years according to a ChildLine report, published by the NSPCC. It found that there had been a 116 per cent increase in counselling sessions about suicide in the last three years.3 The most vulnerable age group is 12 to 15 years, but greater numbers of younger children are seeking help.3

Data from YoungMinds show that 12 per cent of five to 16-year-old children have a diagnosed mental health condition and between 10 to 20 per cent of all children and young people experience mental health problems.2

While it is commendable that there is an increased drive to improve mental health services, data stating early intervention is important to combating mental health problems should not be ignored. Dr Raphael Kelvin, the clinical lead for MindEd, a new government scheme to tackle mental health problems in children and young people, stated in an interview with the Journal of Health Visiting, that 75 per cent of mental health problems in adult life can be first detected in people under the age of 21 and 50 per cent by 14 years old.4 Figures like this prove that early intervention is crucial and can stop mental health problems from becoming so severe that they become lifelong conditions that can be more difficult to treat or maintain.

Yet, data from YoungMinds into CAMHS also suggests that 60 per cent of the local authorities that responded have either frozen or cut CAMHS budgets since 2010-2011 and 55 per cent have either cut, frozen or increased budgets below inflation since 2013-2014.1

Unclear pathways

One of the biggest concerns raised in the report was the way that CAMHS interacts with other services both in early intervention and in transferring children over to adult mental health services. A DH spokesperson says that the end of children's mental health services are often referred to as 'the cliff edge of lost support' as children are often lost in the system between leaving CAMHS and moving on to adult services.

The taskforce will look at the way that children's mental health services are commissioned, as there is currently a lack of clarity on this. 'Some are commissioned by local authorities and some are commissioned by CCGs. Due to this it's difficult to understand exactly how much money is being spent on children's mental health services,' she says.

The Howard League for Penal Reform, a charity dedicated to reducing crime and fewer people in prison, issued an FOI request in 2014 to find out how many mental health trusts have spaces for children to be admitted as inpatients. They found that nearly 74 per cent of mental health trusts do not have enough spaces for children. It found that there were only 161 places of safety in England for children some of which can only accommodate one person at a time and a third of them do not admit under 16s. The data identifies that children are often detained in a police cell while they are assessed.1

Natalie Moore, a staff nurse at CAMHS eating disorders, says that once a child turns 18 they are immediately transferred over to adult services. 'Maybe it would be better if there was a leeway of six months or so to allow for transition [between child and adult services] whilst receiving support,' she suggests.

NELFT is currently working towards joint working between CAMHS and health visitors and school nurses to be able to identify mental health problems earlier in children. The integration also means that children will benefit from clear referral routes into CAMHS.

Dr Rossouw says: 'Health visiting and school nursing and the CAMHS work will come together under one integrated management structure. We will be rolling out a single point of access where these services can be reached and depending on the need of the child, the child will then go into a treatment pathway.

'School nurses and health visitors will have links to specialist primary mental health workers and to specialist services such as our parent-infant mental health services and those workers would get trained and skilled by the mental health workers to be more able to identify mental health needs in young people and children, and then to intervene in some cases where its possible but in other cases to put them on to the right pathway for intervention at a much earlier stage.'

Understanding the commissioning pathways and prioritising early intervention are steps in the right direction to improving children's mental health services. The creation of the taskforce with the relevant political figures from the DH and Department of Education will ensure children receive the support they need as quickly as possible.

When research proves that early intervention can prevent mental health problems from continuing into adulthood, it would be 'irrational', among other things, for the NHS not to invest in the future generation.

What do you think? Leave a comment below or tweet your views to @IndyNurseMag

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