The latest waiting time figures have reinforced calls by the Scottish Children's Services Coalition (SCSC) for providers to increase investment in mental health services for children/teenagers, with a focus on prevention and early intervention. With an increasing number of children/teenagers being identified with mental health problems, the SCSC highlight a postcode lottery for access to treatment across the country.
Covering March to June 2019, the figures* show that 4,010 children/teenagers started treatment at child and adolescent mental health services (CAMHS) in this period. The Scottish Government has an 18-week waiting time target in which people should receive treatment from CAMHS.
The 18-week target should be delivered for at least 90% of patients. However, the NHS in Scotland, including 12 of the 14 regional health boards, failed to meet this target. Of the individual health boards missing this target, NHS Grampain reported the lowest percentage of patients being seen with 18 weeks (51.2%). While 69.7% in the NHS in Scotland are being seen within this 18-week waiting time, still in itself far too long, more than 3 in 10 are failing to be seen within this period.
Figures also indicate that 151 children/teenagers in this period had been waiting for over a year prior to being seen for treatment, an increase from 118 in the previous quarter (January to March) and three times that from the same quarter of last year (52).
In addition, more than 1 in 5 are having their referrals for treatment rejected, with children/teenagers having no real understanding of what is happening to them after the rejection.
The importance of early intervention and prevention in an overburdened system
It should be noted that a mere 0.53% of the NHS budget is spent on CAMHS, amounting to £61.074 million, and only 6.34% of the overall mental health budget is spent on it.
These very low figures come at a time when mental health services are creaking at the seams due to a greatly increasing demand, as evidenced by these waiting time figures. Research indicates that 10% of children/teenagers (aged five to 16) has a clinically diagnosable mental health problem, with half of mental health problems established by the age of 14 and 75% by the age of 24.
While acknowledging the great efforts the Scottish Government is making, such as an additional £250 million of funding announced in the Programme for Government of 2018, the SCSC has called for the Scottish Government to greatly increased investment in CAMHS and for a more consistent approach to delivering these services across Scotland. It has also called for a renewed focus on prevention and early intervention for those with mental health problem, reducing the need for referral to the increasingly under-pressure CAMHS.
This includes embedding mental health within education from an early age in order to strengthen knowledge and awareness of mental health, as well as reducing the stigma associated with mental health. Classes should be provided to all students in the context of a whole-school approach, with training for all staff involved in education and providing counselling support.
Babylon Health surveyed 2,000 UK adults to better understand their experiences with mental health** and how they think the condition is perceived in the UK. The majority of respondents (74%) think that mental health "is not openly discussed enough" in schools and colleges.
Dr Claudia Pastides, a London-based GP with Babylon Health, highlights the need for schoolchildren to receive mental health support:
“It’s important to remember that it isn’t always easy to tell when people are struggling with their mental health. Sometimes people will walk around appearing as though all is well, when in fact the truth is far from it.”
“Some of the signs and symptoms to look out for include: Being increasingly sad, losing an interest in life/things they were once interested in, behaving in a very anxious or aggressive way. Also use of drugs and alcohol can be a symptom.”
“Creating a culture where it is ok not to be ok and to talk openly about mental health is key. A good way to do this is by improving mental health awareness. Educating staff, parents and students about mental health problems is key. It is also very important to help to create a positive and safe school/university environment.”
“Encouraging students to help each other and be considerate of one another’s mental health should be a priority, as should promoting physical activity and good physical health, as this all contributes to wellbeing. Ensuring there is accessible school/university-based mental health support is important. This can be via counsellors, school nurses or a nominated person that students can go to with regard to mental health concerns.”
- See more: An anti-glossary for school mental health lessons
- See more: Increasing numbers of pupils with mental health issues are being identified in Scotland's schools
A spokesperson for the SCSC said:
“These latest waiting time figures highlight that fact in this mental health crisis we are continuing to fail thousands of children and young people with mental health problems. The great efforts the Scottish Government is making is to be welcomed, but more clearly needs to be done to address this epidemic.
“These newly released figures highlight that the NHS in Scotland, including twelve of our health boards, is failing to meet what is already a lengthy waiting time. Yet we know that three children in every classroom has a clinically diagnosable mental health problem.
“There must be a radical transformation of our mental health services, with a focus on preventing such problems arising in the first place and intervening early, especially when we know that half of all mental health problems begin before the age of 14. This includes embedding mental health within education from an early age as well as providing training for all staff involved in education.
“With mental health and the issues associated with it representing one of the greatest public health challenges of our time, we must ensure that children and young people are able to get the care and support they need, when they need it. This includes investing in greater community support and support at school, reducing the need for referral to specialist CAMHS.”
Click here for the full report.
* figures from the Information Services Division, part of NHS National Services Scotland.
** Read Babylon Health's full report here.