A few years back I found myself on a first aid course. Tom, the elderly chap teaching us CPR, took a break from resuscitating his unusually antiquated dummy to solemnly address his audience. One of our group had asked what damage you might do if you don’t do it properly. He said, “If you find a person who isn’t breathing or whose heart isn’t beating, it doesn’t matter if you hurt them. Doing nothing will hurt them more”.
I was reminded of Tom recently when I read the recent report from Barnardo’s Chief Executive Javed Khan. He said that three quarters of children with mental health difficulties now get no support. This is an extraordinary claim. It probably doesn’t feel extraordinary in a country that has experienced eight brutal and incoherent years of austerity fetishism, but it is. He suggested that Britain is now confronting a mental health crisis because resources for children are so stretched that some only receive help if they seriously self-harm or attempt suicide. According to Khan, young people’s mental health has never been worse in the organisation’s 152-year history. Yet, it was his final statement that struck a chord and reminded me of old Tom (more of which later)-
“Radical action is needed because funding cuts have forced charities to abandon vital services”.
Mr Khan’s call for radical action is supported by the latest available research. Recent figures from NHS trusts in England revealed that 60% of children referred for specialist care by their GP were not receiving treatment. Moreover a lack of mental health support is now leaving some children stuck in hospitalbecause their home area cannot provide the specialist support they need to ensure they remain safe.
The demand side of the argument doesn’t look any better. According to the charity YoungMinds, 3 children in every classroom have a diagnosed mental illness and 1 in 10 will develop an eating disorder before their 25th birthday. In some parts of the country rates of childhood depression, anxiety, self-harm and eating disorders are up by 600% on previous years. The NSPCC recently noted that the number of schools seeking help from NHS mental health services has risen by more than a third in the last three years. A perfect storm of shrinking budgets and service reorganisation alongside the increasing need for treatment has created this crisis in youth mental health services.
If all of this seems familiar, it’s probably because it was also reported a few years ago. In 2016 there were reports that two-thirds of GP referrals for child mental health led to no treatment. Similarly, in 2016 Pulse magazine announced that 60% of GP referrals to child and adolescent mental health services (CAMHS) led to no treatment and a third were not even assessed. Indeed, and in a claim resonant with Mr Khan’s, the report noted that GPs told Pulse that CAMHS were refusing to treat patients unless they had attempted suicide or self-harmed.
What was particularly interesting, since it was Pulse magazine, was that the comments page was full of reactions by GPs. I’ve picked a few choice responses that stood out to me-
“We’ve now got a letter we send to parents, the CCG and back to CAMHS explaining our impotence in the face of “computer says no” rejections before the child is even seen.”
‘Anonymous 2’, a sessional/locum said
“The only reason this isn’t terrible news is that sadly it isn’t news. Every GP I know has this experience with CAMHS on a regular basis. I’ve had calls from CAMHS following referrals for very serious issues asking me or my colleagues to downgrade the referral because they cannot see the patient in time to meet the timeframe required, or they have decided that they don’t think it’s that serious…without seeing the patient.”
“The running down of the ChildAvoidanceMHS is a national disgrace. I’ve long since given up referring these poor children, the false hope in the desperate parents’ eyes dashed when their referral is rejected is just cruel.”
The political response has, at best, been abject, even in an era famed for abject political responses. Policymaking mandarins in Education and Health have become enthralled by the kind of cost-free solutions which play really well in ideologically stunted groupthink cocoons. The sacked children’s mental health Tsar Natasha Devon, after being systematically ignored, noted that the only scheme the Department of Education appeared to be interested in was peer-to-peer mentoring. As Ms Devon herself noted this solution was little more than taking away medical support for children’s mental illnesses and then asking children to look after themselves. Moreover, the core proposals in the recent green paper on children’s mental health have been described by two cross-party scrutiny committees of MPs (yes, that’s two cross-party committees of MPs) as failing a generation.
The prime minister has talked about this issue as a burning injustice and she may well believe this to be the case. But the combination of a Brexit-dreadlockedcabinetin thrall to ideologically hamstrung political opportunists, the monumentally complex political influences on NHS funding and the unerring cruelty of austerity-era zombie politics have combined to open up a yawning gulf between what is needed and what is now available for the most vulnerable children. This is not ‘strained services’. It is not even under-funding. It is a vacuum and it needs to be recognised as such. The British state has absolved itself of its responsibility to young people’s mental health.
For those of us moved by this crisis, our options are similarly circumscribed. We can wait for the next general election. We can spread articles on social media. We can donate money. We can do some research on the unfolding crisis. Recent researchsuggested that we urgently needed to investigate the experiences of children and young people who are rejected by CAMHS. These are all reasonable things to do but unlikely to make a great deal of difference if recent evidence is anything to go by.
So what to do? Recent work from the New Economics Foundation and NESTA has argued the case for a ‘health as social movement’ approach. They suggest that social movements for health are part of a long history of community development, citizen participation and person-centred health and care. The report describes communities engaging in local action to help themselves and others to stay well. The most important distinguishing feature is that local action involves connecting with local assets and resources that are not part of the formal economy. If all of this sounds a bit Big Society then that’s because it is. But this NEF approach may be a useful starting point for developing localised social movement approaches to children’s mental health that hold a space to recognise and seek to address the vacuum in support.
We need to consider this approach now not because we are wedded to some mythical big society nirvana that keeps hedge funds happy with our current tax settlement. It is not because this is necessarily the most effective way of supporting vulnerable young people (sorry NEF). Nor is it because it can replace well-funded statutory provision (sorry Department of Health policymaking mandarins). It is because the state and the government have completely, mercilessly abandoned young people with mental health problems.
It’s at this point that old Tom from the CPR course hoves back into view. A recent account from an assistant head in Leicestershire discussed the fear of delving into mental health because of lack of knowledge. But as Tom said, doing nothing is likely worse. And we may be in that territory now.