The longest wait

Experts agree that extra funding for services must be combined with a greater emphasis on prevention to tackle the crisis in young people's mental health

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With waiting lists lengthening, experts are urging not only extra funding for services but also a greater priority for education to tackle what some have called an epidemic in young people’s mental health.

A recent investigation by The House magazine using Freedom of Information requests shows that the average waiting time for a young person seeking an initial appointment with mental health services has risen to 21 weeks this winter, up from 16 weeks in 2021.

Its survey of 70 NHS trusts revealed that three of the 11 with the longest waiting times for young people are in the North. But the charity Young Minds says one in six children aged five to 16 were identified as having a probable mental health problem in July 2021, a huge increase from one in nine in 2017. And the number of A&E attendances by young people aged 18 or under with a diagnosis of a psychiatric condition more than tripled between 2010 and 2018-19.

“What’s really clear is that we have an absolute crisis on our hands with young people who need to be seen, who have an urgent mental health difficulty and need to be seen promptly,” said Rachel Calam, professor of child and family psychology at Manchester University.

“The longer it’s left the worse the problem can become and it doesn’t just affect the individual child or young person – it affects the whole family and it can have really long-lasting effects as well. So it’s extremely important that people that are seen promptly.”

The House’s survey showed a postcode lottery in mental health services, with spending per young person four times higher in some parts of the country than others

She said the lack of prompt interventions means more young people having to cope with distressing difficulties and that a backlog of cases combined with new referrals means from the point of view of mental health services, “it’s going to feel like an epidemic”.

The House’s survey showed a postcode lottery in mental health services, with spending per young person four times higher in some parts of the country than others. Sheffield Children’s Hospitals, Cumberland, Northumberland, Tyne and Wear NHS Foundation Trust and Lancashire and South Cumbria NHS Foundation Trust had some of the longest average waiting times for young people in the country. 

One patient at South West Yorkshire Partnership NHS Foundation Trust waited 147 weeks for treatment – although individual waits can often be unrepresentative outliers. 

A South West Yorkshire spokesperson said: “We are sorry that some children and young people are waiting for child and adolescent mental health services (CAMHS) treatment to start. Sometimes the longest wait is impacted by the specific type of treatment a child needs, and the availability of a practitioner with specialist skills to provide it. Where demand for CAMHS support is outstripping capacity we are working with our commissioners on possible solutions.”

The spokesperson said all children and young people who are waiting for treatment will have received an assessment and that the trust prioritises children and young people believed to be at increased risk. “We also make sure that we keep in touch with children and their families while they are waiting for treatment to start, and provide signposting to support whilst they wait.”

“What we are perceiving now is an issue that has been bubbling on for a long time and it comes to a the resourcing of mental health services for children and young people,” said Nihara Krause, consultant clinical psychologist and founder of Stem4, a teenage mental health charity.

“There’s been a lack of parity firstly between physical and mental health provision, a lack of parity in terms of services for children and young people versus services for adults, and a lack of parity in terms of funding between North and South.”

Krause said services are affected because GPs are leaving primary care and specialist services have a problem both in training employees and retaining experienced staff. That has limited the opportunities for early intervention for young people experiencing mental health problems and forced services to determine whose needs are the most urgent.

The Children’s Society has seen a rise in the number of 9-11 year olds who have expressed suicidal thoughts

But for patients waiting a long time, their needs may have become more complex and severe, she added. “They’ve developed more than one mental health condition because that’s the nature of mental ill health – you might start off as being anxious. It then becomes an anxiety disorder. It then exists with depression. Depression, then, will exist with suicidal ideation to some people, so it gets more and more complicated.”

The Children’s Society has seen a rise in the number of 9-11 year olds who have expressed suicidal thoughts, with more self-harm happening at primary school age and eating disorders also being diagnosed. It also notes a “significant decline” in children’s wellbeing as they get older.

The NHS released a long-term plan that states over the coming decade the goal is to ensure 100 per cent of children and young people who need specialist care will be able to access it and by the end of 2023 new mental health support teams will be working in schools. But the document on the website hasn’t been updated since 2019.

Experts agree that services are underfunded. 

Amy Dicks, policy and impact manager at the Children’s Society, calls for greater investment in children’s mental health services, including early support hubs in communities for people to seek help with a referral or waiting list. 

“What we find is that parents are so grateful for open access hubs like the ones we provide that include advice and guidance for how they can support their child,” said Dicks.

“Teachers need much more support to be able to spot the signs that pupils might be struggling with their mental health.”

But she said prevention should be part of the mix to tackle the crisis. “Mental health and wellbeing should be embedded in school curriculums, as well as a broader rebalancing of the curriculum to value personal, social, and health education alongside maths and English. 

“Teachers need much more support to be able to spot the signs that pupils might be struggling with their mental health – often warning signs can be misjudged as bad behaviour. Where there are concerns, children should be supported by a trained wellbeing professional rather than with a teacher with little training.

“We also need to recognise the impact of different cultural views about mental health as these can be embedded at a very early age – we need to work with communities, religious and faith-based organisations to remove stigma and open up conversations about the importance of good mental health for children and families.”

Calam also supports a mix of investment in treatment and prevention.

“If I was the parent of a young person who was self-harming, I would say that they need to increase funding that enables very rapid response to people who are sitting on waiting lists who really shouldn’t be sitting on waiting lists. They should be seen now. 

“But this is a really long-term problem and so all levels of that public health pyramid need to be addressed. Prevention should be the ultimate goal, and we’ve seen examples of it in other countries or with other governments where they’ve really focused on preventive services and the sorts of things that schools can do, that primary care level health can do.”

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