There are serious and deeply ingrained problems with the commissioning and provision of children’s and adolescents’ mental health services (CAMHS), a report by the Health Select Committee has concluded.
These problems run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people, the report added.
The Committee’s critical report highlighted a number of key concerns. For instance, it said there are major problems with access to inpatient mental health services, with children and young people’s safety being compromised while they wait for a bed to become available. Often when beds are found they may be in distant parts of the country, making contact with family and friends difficult, and leading to longer stays.
Funding – or the lack of it – was also highlighted as a major problem. The report noted that while demand for mental health services for children and adolescents appears to be rising, many clinical commissioning groups have frozen or cut their budgets. Also, in many areas early intervention services are being cut or are suffering from insecure or short-term funding.
The Committee also noted its particular concern about the “wholly unacceptable” practice of taking children and young people detained under s136 of the Mental Health Act to police cells, which still persists. The Committee added that it expects the Department of Health to explicitly set out how this practice will be eradicated in its response to the report.
In addition, the Committee noted “unacceptable variation” in community CAMHS services, with some providers reporting increased waiting times for services and higher referral thresholds. The Committee noted young people and their parents have described “battles” to get access to CAMHS services, with only the most severely affected young people getting appointments; they also described the devastating impact that long waits for treatment can have.
Recommendations made by the Committee include that NHS England and the Department of Health should monitor and increase spending levels on CAMHS until the Committee can be assured that CAMHS services in all areas are meeting an acceptable standard.
The Committee also recommended that there is unacceptable variation in perinatal mental health services and that they must be available in every area.
Positive response from sector
Dr Peter Hindley, chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists said the report reiterated concerns the College has consistently highlighted. “Clearly there are significant problems with access to inpatient mental health services, and as the report rightly highlights, it is unacceptable that children and young people’s safety is being compromised while they wait for a bed to become available,” he said.
“Of particular concern is the wholly unacceptable practice of taking children and young people detained under s136 of the Mental Health Act to police cells. Our manifesto: Making Parity a Reality also highlights this issue and one of our key asks for the next government is that it should ensure the use of police cells as ‘places of safety’ for children be eliminated by 2016, and by the end of the next Parliament occur only in exceptional circumstances for adults.
“However, we are also delighted that the Health Select Committee has highlighted the importance of early intervention and effective services to minimise the need for inpatient care. This needs to be underpinned by joined-up, effective commissioning.
“We urge the government to take on board the recommendations of this report to help ensure vulnerable children and young people with mental health problems are given the support and help they need and deserve.”
Jenny Edwards, chief executive of the Mental Health Foundation added: “Whilst the Committee explicitly recognises examples of good practice in many parts of the country the overall picture makes grim reading. Fragmented services under enormous strain are struggling to deliver adequately within an overall system which has failed adequately to prioritise their funding, commissioning, and inspection. The Committee has identified shortcomings in governance at every level, from the Departments of Health and Education via NHS England, Ofsted and the CQC [Care Quality Commission], right down to local areas.
“We feel that the continued scrutiny that this Committee can bring to bear, especially on the work of the CAMHS Taskforce and its recommendations, will help to ensure that the issues it has raised will be prioritised by ministers and by all political parties.
“Without understanding the true scale of need, and what it will cost to meet it, government will continue to be unable to implement the changes so urgently needed. These changes will need to be implemented quickly, within the lifetime of the next Parliament, if we are not to lose a generation of young people to mental health problems which were avoidable, had the evidence based treatments we know work, been made available.”