BY: Denis Campbell Health policy editor
NHS services for the soaring numbers of children who have self-harmed, tried to end their life or are having a breakdown are woefully substandard and risk prolonging their suffering, according to their psychiatrists.
More than seven out of 10 (72%) consultant psychiatrists who specialise in treating children and adolescents say that NHS care for under-18s experiencing a crisis in their mental health is either inadequate (58%) or very inadequate (14%), according to a survey undertaken for the Guardian. Only 19% said NHS services were adequate and just 9% said they were good.
Experts said that the results of the survey, in which 253 of about 2,000 specialist psychiatrists working in Child and Adolescent Mental Health Services (CAMHS) care took part, are further proof of how poor NHS services are for the growing number of children and young people struggling with serious psychological and psychiatric illnesses. Earlier this month, the Guardian disclosed that the NHS in England is sending under-18s with life-threatening eating disorders for residential care in Scotland because it regularly runs out of beds.
“These young people feel very upset, very distressed, they may have self-harmed, they have very negative self-thoughts, possibly including suicidal intent, and they feel hopeless and that they can’t go on. Some may recently have tried to take their own lives,” he added.
The survey results come as pressure on mental health services for children is increasing, with figures from NHS Digital showing that the number of under-18s attending A&E in England due to a mental health crisis has risen by more than half in the past five years. Those turning up as a result of psychiatric conditions such as psychosis more than doubled from 6,950 in 2010-11 to 14,917 in 2014-15, while those seeking treatment after harming themselves rose from 13,504 to 17,019 over the same period.
One major problem was A&E staff being unsympathetic to under-18s who end up there seeking care in the midst of their mental health crisis.
“They sometimes encounter a very negative attitude from A&E staff, such as being told that they are wasting staff time, why have they come, and that they are wasting valuable resources that other people need, and staff not realising the severe distress that these children and young people are experiencing. This can be very bad for their health,” said Hindley.
Three out of four psychiatrists said that the inadequacy of child and adolescent mental health crisis services meant that the young person’s mental state could deteriorate further, while 71% said it resulted in an increased chance of risky behaviour, including impulsive behaviour or aggression to others. Two thirds (66%) said that a failure to give young people in crisis immediate expert help meant that psychiatric problems were in danger of becoming more chronic as a result.
Services for children in crisis were also hampered by a lack of inpatient beds for under-18s, delays in their condition being assessed and a postcode lottery in out-of-hours crisis care, in which a psychiatrist or mental health nurses comes and assesses the young person, Hindley added.
“This feedback from clinicians working at the frontline exposes the depths of the crisis facing child and adolescent mental health services in England. Where else in the NHS do 72% of our doctors tell us that the services being provided are inadequate or very inadequate?”, said Luciana Berger MP, a member of the Commons health select committee and ex-shadow minister for mental health.
“This worsening situation is totally unacceptable and compromises the recovery and future life chances of some of the most vulnerable young people in our country,” she added.
Sarah Brennan, the chief executive of the charity Young Minds, said that for such distressed and vulnerable young patients, getting timely help was vital. “When a child goes through a mental health crisis, getting the right support quickly can be life-saving. But at the moment, too many children are being placed on adult wards or in police cells, or are forced to travel long distances to find the nearest available bed. Our helpline often receives calls from parents who are desperate because of the lack of appropriate services,” she said.
Cuts in recent years to early intervention services provided by the NHS and local councils meant children’s mental health problems worsened because they were not detected or treated quickly enough, often leaving schools to pick up the pieces, Hindley added. Councils’ spending on early intervention schemes fell from £3.2bn a year in 2010-11 to just £1.4bn in 2014-15.
Jeremy Hunt, the health secretary, recently said that CAMHS services were the NHS’s greatest area of weakness across the range of care it provides. Responding to these new findings, he said: “Every child in crisis should get the support they need, which is why we are investing £1.4bn in children and young people’s mental health care, and why every local area is transforming their services.
“There are a record number of CAMHS beds and there will be liaison mental health services in every A&E by 2020. But we know that must be done and we will say more on our plans to improve children’s mental health services soon,” Hunt added.
• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.
• This article was amended on 27 December 2016 to clarify the number of people involved in the survey.
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