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Nearly one in four children denied access to mental health services in England

Crisis required before referral is accepted, says independent Commission report

Caroline White

Monday, 11 April 2016

Young people’s mental health services in England are, on average, turning away nearly a quarter (23%) of children and teens referred to them for treatment, finds a report* published today by a dedicated Commission, set up by independent think tank CentreForum.

The Commission on Children and Young People’s Mental Health found that this was often because the threshold for access to services was too high, with the condition not considered serious enough, or suitable for specialist mental health treatment.

Something has to go drastically wrong before some services will accept a referral, preventing what is often the most effective treatment for mental health conditions—early intervention, says the report.

The report cites various examples of service eligibility criteria, including one that suggests that those hearing voices should seek specialist help only if they “heard voices that command particular behaviours,” and another that would not accept those who expressed suicidal thoughts unless this had happened more than once.

But access is not the only cause for concern, says the report. The median waiting time for all providers was one month for a first appointment and two months until start of treatment. But the average waiting times vary widely among providers, from two weeks in Cheshire to 19 weeks in North Staffordshire.

The average waiting time in Gateshead, for example, is five times as long as it is in neighbouring Tyneside. Similarly, waits in London vary widely from two months in Kensington and Chelsea, to nearly six months in Brent.

But this average waiting time conceals longer “hidden waits”, says the report. The average of the maximum waiting times for all providers was 26 weeks (6 months) for a first appointment and nearly ten months (42 weeks) for the start of treatment. Some providers did not measure waiting times at all, meaning that some patients could even be waiting longer than this.

Analysis of NHS benchmarking data for the report found that the average of the maximum waiting times for all providers has more than doubled since 2011-12.

The amount spent on children’s mental health in different areas and regions also varies enormously, says the report. There is a much higher level of expenditure in the North compared to the South and East of the country. But demand for mental health services is much higher in the South and the East, resulting in capacity problems, such as in the South West, where since April 2015 there have been more than 50 days on which no beds were available in the whole region.

There has also been a significant rise in children’s mental health problems over the past five years, says the report, with three pupils in every classroom having a mental health problem, which adds up to around 720,000 children and young people aged between 5 and 16 in England alone.

In the context or rising prevalence, access and treatment issues have become all the more pressing, it says, particularly as mental health problems are linked to early death, while young people with an emotional disorder are more likely to smoke, drink and use drugs than their peers.

They are also more likely to have time off school and fall behind in their education; and are more likely to earn less money as adults or to experience unemployment. As well as the personal cost, the estimated long-term cost to the economy of mental health problems is £105bn a year, the report points out.

Despite this significant impact, only 0.7% of NHS funding is spent on young people’s mental health, and only 16% of this is spent on early intervention, says the report.

“This report demonstrates a stark inequality within the NHS where, unlike those who are physically ill, children and young people with mental health problems are still not always getting the right treatment, at the right time, in the right place. While this issue has become a policy priority in recent years, there is still a long way to go before there is equality for mental health in the NHS in England,” concludes the report.

Norman Lamb, Chair of the Commission, writes in the report’s foreword: “This is not about blaming services, or those who commission them. It is a highly complex problem which has existed for decades. Those who work in services are all too aware of the lack of equality for mental health care. Transforming services will take time and sustained commitment.”

* Emily Frith. CentreForum commission on children and young people’s mental Health: Sate of the Nation. CentreForum, April 2016.

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