Mind That Child

16th September 2016

The youth mental health crisis has been in the news like never before, accompanied by some alarming statistics: one in ten children will experience a mental health problem of some kind; three quarters of these will go untreated. Jennifer Lipman investigates and ascertains what help is available locally.

This time last year, Sam Lethbridge thought things were on the up. Five years after her now 11-year-old daughter began battling a range of serious mental health issues, the little girl had recently been discharged from a residential mental health centre for children, where she received specialised psychological and medical support.  

For the Borehamwood-based family, it was a great summer. “After seven months she had the coping mechanisms. She was in such a better place.” But after discharge, Lethbridge says that the promised follow-up support from Hertfordshire NHS Trust and Hertfordshire’s Child and Adolescent Mental Health Services Unit (CAMHS) failed to materialise, leaving the girl without help at a vital time.

A year on, and she is unable to attend secondary school as planned, while Lethbridge tells of regular setbacks that have seen her daughter suicidal and ending up in A&E to secure her safety. With experience of running a support group for parents whose children also suffer from mental health problems, she says that the story she hears time and again is of overstretched services, poor care and long waiting times for appointments. “If it was just me I would say we slipped through the net, but that’s not the case,” she says. “There is such underinvestment in children’s mental health.”

Although her case is particularly severe, Lethbridge’s daughter is far from unique in suffering from mental illness. The charity Young Minds says that as many as ten per cent of UK children are living with some form of mental health problem, with up to one in 15 deliberately self-harming and almost 80,000 enduring severe depression. The numbers are even higher when it comes to children in care. Nor is it this limited to teenagers: a survey by the National Association of Head Teachers found that a fifth of children are having mental health problems before age 11.

“There are indications of a significant rise in the last five years,” explains Emily Frith, Director of Mental Health at the Education Policy Institute, citing data showing that the number of young people attending A&E because of a psychiatric condition has more than doubled since 2010. “Referrals to specialist mental health services have also increased. We don’t know if this is because more people have mental health problems than in the past or if people are more likely to seek help.”

There is no easy way to tell the scale of the problem. As Lethbridge points out, you can’t ‘see’ if someone has a mental health problem just by looking, meaning it’s not always diagnosed in the way a broken leg would be. “When you say ‘mental health’, people think One Flew Over the Cuckoo’s Nest,” she says. “Most of the time you wouldn’t know with my daughter. It’s bubbling away underneath.”

Having sold their house amidst the challenge of supporting their daughter, the Lethbridges are now digging deep for private therapy. The CAMHS treatment her daughter received prior to hospitalisation, says Lethbridge, was “nothing but a tick-box exercise… You’d go for an appointment and they would get an update, but never actually do any therapy.”
Hertfordshire County Council have disputed some of these claims and emphasised that mental health and education organisations have since met with the family to agree a plan of care. They also stress that other families have had more positive experiences.

Overall, though, the consensus is that child mental health services are struggling. The Children’s Commissioner found that 28% of referrals are turned away, while in one NHS Trust, young people were on waiting lists for an average of up to 200 days. “Provision is patchy and highly variable in terms of access, availability and quality,” says Frith. “Many children and young people simply get no treatment at all.”

There are myriad stories of young children being detained in adult mental health wards – something that NHS England has called unacceptable – or of children being admitted hundreds of miles from home because no beds are accessible locally.

“The biggest challenge is getting the right service at the right time,” adds Alison Roy of the Association of Child Psychotherapists. While she says that there tends to be more emphasis on therapy for children, compared with a focus on medication in adult mental health services, she suggests “there is definitely a much stronger emphasis on shorter term interventions”. 

As with anything, it comes down – at least partially – to money. In the broader picture of the NHS, mental health is sidelined; Young Minds calculates that just 7% of the overall mental health budget (0.7% of the NHS budget) is dedicated to children. And despite pledges by George Osborne in 2015 of an extra £1.25 billion over five years, critics argue more investment is needed.

“Child and adolescent mental health in the UK has always been an under-resourced field,” sighs Dr Ramya Mohan, a Consultant Developmental Psychiatrist in London. “We have a long way to go to provide support and timely access to the majority who require it.”

Nor is this just an issue at crisis point. Too often, preventative care and early intervention simply isn’t happening. “The problem is not going to go away if we only look at the clinical end,” says Emma Smale from Action for Children. She points to a reduction in services “which are not necessarily labelled mental health services but are vital for the development of strong relationships for children” such as youth centres. Likewise, she emphasises that parents need more support in managing challenges like money worries. “Strong parenting is a key preventative measure,” she says. “Lots of parents struggle and need to be helped. Those services need to be available and not stigmatised.”

All this begs another question: why are we seeing a rise in child mental ill-health? Are today’s children thinner skinned, or is it simply that they are becoming better at seeking help, or is it down to growing awareness of relatively common conditions like ADHD?

While those things may be relevant, there are clearly other factors. “For so many young people we see in mental health services, their early start has been traumatic,” says Roy.

Equally, there are a number of pressures these days that simply didn’t previously exist. As a clinician, Dr Mohan has seen how societal changes – from sexting and cyber-bullying to the increased focus on exams and results – have created a more complex world for young people. “All of which can potentially disrupt child and adolescent psychosocial development and increase the risk of mental health issues.”

Recent years have seen increased focus on support and counselling within schools, and a joining-up of the approach between schools and health and social care. Yet, says Frith, it’s still ‘a postcode lottery’, because it is up to the school leadership to decide what support to offer. She wants schools to adopt a ‘Whole School Approach’ to mental health. “This can include learning about it in PHSE lessons to increase everyone’s knowledge, training for teachers and the provision of school-based counselling.”

Meanwhile, for parents, navigating the UK’s mental health services landscape and knowing what to fight for is difficult. Hertfordshire is not unusual in offering several avenues for support, including the NHS, the local authority and charities, CAMHS, and the Positive Behaviour, Autism, Learning Disability and Mental Health Service (PALMS).  

It’s easy to get lost in the array of acronyms. “It’s overwhelming, it’s draining, it consumes your every moment; your life is chasing people, trying to find out what’s going on, trying to make sure one department speaks to another,” says Lethbridge. “It’s your job as the parent to not only be there for the child, but to be the professional as well.” She explains that her support group has been a lifeline. “You can ask advice about medications, from people that have gone through it.”

For parents worried about their child’s wellbeing, Roy advises starting with the GP, but adds that services are meant to take seriously self or family referrals, so it may be worth composing a letter explaining your concerns. “It’s also helpful to have support from schools and other professionals who know your child.” 

With rising talk of a crisis, NHS England tasked Clinical Commissioning Groups to develop Local Transformation Plans. In Hertfordshire, a five-year plan is now in place, which a county council spokesperson says will include “a new approach that places an emphasis on prevention and early intervention and the delivery of services and interventions that offer swift, evidence-based and flexible support”.

In light of the money pledged by the Government, Frith says there must be “a rigorous process of assurance of how local areas are planning to spend the additional investment”. Smale echoes this, pointing out that there needs to be clear accountability about where the money is going. “We have to understand what works,” she says.

Beyond words like ‘transformation’, Roy says that the crux of the issue is reducing bureaucracy and providing more resources in the community and in clinics. “There should be more groups available and more accessible therapy appointments with specialists,” she says, adding that it’s also about service providers engaging with hard-to-reach groups, so that intervention happens before a crisis.

For those with experience of child mental healthcare, the key issue is parity with physical healthcare. “You wouldn’t discharge someone having a severe broken limb and not follow up with physiotherapy,” says Lethbridge. “It’s the same principle.”

A year on, her wish now is for her daughter to be readmitted to residential care. “That’s a hard thing to say, but the work they did was so good. Our hope is she can go in again, and on discharge we can make sure support is in place.”

And if not for herself, she hopes others will receive better support. “I can’t tell you how much time I’ve spent in tears watching my little girl go from being this beautiful, bubbly child to having this mental health illness that is crippling her,” she says. “What we have gone through should not happen to anyone else.”

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