England's child mental health services 'failing three-quarters of kids'

'Cinderella service' hit by budget cuts and increasing demand

Only a quarter of children with mental health conditions are receiving the treatment they need, according to a study produced by the body charged with improving the health service in England.

An internal presentation, produced by NHS England and shared with the Observer, paints a picture of a service in crisis, according to one charity, because of budget cuts and increasing demand. It notes that "multiple reviews have identified the same problems".

The report also provides evidence that, as a result of a rise in young people needing treatment for complex mental health conditions, assessments for conditions such as attention deficit hyperactivity disorder (ADHD) and autism are being delayed, while others are not being identified or treated. The presentation says that 35% of adults with anxiety or diagnosable depression are not in contact with mental health services, but this rises to 76% of those aged five to 15. It notes that only 6% of spending on mental health goes on services aimed at children and young people, even though 50% of lifetime mental illness starts by the age of 14.

The analysis – carried out over in the past three months – will raise concerns that a service that is already failing to meet the demands of many users is being cut further, and will support claims that young people are being hit by a double whammy: mental health is a "Cinderella service" compared with physical conditions; and within that service young people do not receive the same level of attention as adults.

The presentation reveals that cuts are increasingly being reported in places such as south-west London. It says the Maudsley Child and Adolescent Mental Health Services reports cuts across its London boroughs ranging from 17% to 38%, and quotes the concerns of mental health teams across the country.

One team said that its £1m budget was to be slashed by £300,000 from next year. As a result, it was having to draw up plans to become an urgent assessment and urgent treatment service only.

Specialists would be unable to deliver the therapy for which they had been trained. Another acknowledged that its specialist and early intervention services were being dismantled.

A third said that an increase in both routine and emergency presentations had left it with no choice but to give priority to clinical risk cases over routine follow-up activity, such as assessments for ADHD and autism.

The document quotes statistics, which reveal that in England there is only one mental health specialist per 30,000 young people under 20, compared with one per 5,300 in Switzerland, 6,000 in Finland and 7,500 in France.

A recent survey by YoungMinds, a mental health charity, found that two-thirds of local authorities had cut their budgets for young people's mental health.

"For all the welcome policy announcements from government about children and young people's mental health, the picture on the ground for many children, young people and their families is of services in crisis," said Sarah Brennan, chief executive of YoungMinds.

"The cuts to early intervention services are now causing severe pressures on inpatient beds. It is verging on inhumane for children and young people to end up, as they do now, being shipped hundred of miles across the country for the nearest bed, held in police cells or placed on unsuitable adult wards. We should be ashamed of the paltry support and care we assign to the mental health of children and young people in this country."

The presentation explains that a database mapping mental health provision for young people was "discontinued post April 2010".

"The last national study was done 10 years ago and so we have no up-to-date national information on the numbers of children and young people with mental health problems," Brennan said. "Planning service provision without current data is extremely difficult, fraught with risks and not cost-effective."

The acute strain on the system will have repercussions later on, the presentation warns. It claims that social emotional programmes – used to treat "conduct disorder" (more commonly known as antisocial disorder) in young children – save the NHS £84 for every pound spent.

Dr Jacqueline Cornish, NHS England's national clinical director for children, young people and transition to adulthood, said: "We must make sure children and young people get the right care from the right person as soon as possible.

"We are specifically investing £17.4m to improve earlier intervention, diagnosis and treatment of mental health problems in under-18s, as we know that this is the most efficient and effective way to tackle mental health problems."

But Enver Solomon, director of evidence and impact at the National Children's Bureau, said that children and young people's mental health had not received the "financial and political priority" it deserved for far too long.

"It is very clear that there is a damaging lack of clarity on responsibility and accountability for the effective commissioning of children's mental health services as well as an alarming reduction in the provision of specialist and early intervention services,"


Jamie Doward

The GuardianTramp

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