Today’s children are much more aware of their own mental health, and much more prepared to discuss it, than in past generations. But they are also aware of how hard it can be to get help. The stories I have heard from children over the last few years are remarkably similar: struggling to access support, often being turned away, or given one appointment where they are told they are not “ill enough” to qualify for healthcare services.
The children I meet who have received treatment are generally positive about how they have been helped; it is getting through the front door that remains an ordeal. Too often, I hear about how mental health issues developed, and very often became worse, before a child was given any help at all. These failures in mental health provision can be tragic for children, but they also cascade into costs for wider society.
In January, I published my annual children’s mental health briefing. It is important to recognise that children’s mental health services are in a better place than they were three years ago when I published my first briefing on this issue. However, the current system is still far away from adequately meeting the needs of all the estimated 12.8 per cent of children in England with mental health problems, or the many more who fall just below the threshold for clinical diagnosis.
Overall, services are improving, with an extra £60m invested in specialist children’s mental health services and an additional 53,000 entering treatment according to the last year’s figures. There have been big improvements in eating disorder services: the number of children accessing them has increased by almost 50 per cent since 2016-17.
But these services are still far from where they need to be. Last year, just over 3 per cent of children were referred to mental health services – representing only about one in four of those believed to have a diagnosable mental health condition. On average, children are waiting just under eight weeks (53 days, down from 57 days a year ago) to enter treatment. Where a waiting time target has been introduced – currently just for eating disorders – waiting times are much shorter: 80 per cent of children accessed such services within four weeks.
Treatment also varies hugely across the country. We have found there are Clinical Commissioning Groups (CCGs) where more than half of children referred to Children and Young Person’s Mental Health Services (CYPMHS) do not go on to treatment. This includes Knowsley, where 64 per cent of children referred have their case closed before treatment.
The amount we spend on children’s mental health services also falls short. Although children account for 20 per cent of the population, they get only 10 per cent of total mental health spending – on average, the NHS spends £225 for every adult and £92 for every child. Out of 195 CCGs in England, 161 increased spending on CYPMHS (per child) in 2018-19, and on average spending went up from £54 to £59 per child in real terms. As a result, an additional £50m (in real terms) was spent on children’s mental health across England.
Maintaining the current rate of expansion of services will require significant commitment and resources in the years to come. It is still not clear whether national and local government and the NHS are facing up to the scale of problems in children’s mental health services and the devastating impact this has on young people.
Of course, we also do not yet know the impact of the coronavirus lockdown. Last month, we asked another 2,000 children aged 8-17 years old about stress: whether they feel it, and what they feel about it. Some 88 per cent said they themselves had felt stressed, and – unsuprisingly – many children told us the virus was the biggest reason for this.
In March, a survey of children with a history of mental health needs by the charity YoungMinds found 83 per cent of respondents felt the pandemic had made their mental health worse by some degree. While three quarters said they were able to access support, usually online, a quarter were not receiving any help at all. The figures are especially worrying when taking into account reports from Childline of an increased demand in counselling sessions.
Even before the pandemic, there was no government plan for a comprehensive service in every area – and still no commitment to placing a counsellor in every school. I have long argued that this would make a huge difference by tackling problems before they reach crisis point.
My over-arching recommendation is simple: the government should commit to delivering the services its own modelling has shown are needed. NHS England should be clear what they mean by “all children who require specialist services” and what they will be providing within specialist services. This will make what other agencies need to be providing much clearer. They should also look to speed up the expansion of services by investing in more voluntary and community sector provision.
I would also like to see a basic benchmark for the type of services children should be able to access in their school, their local community and online, alongside a set of clear expectations on each body that collectively meets the needs of children. Greater transparency as to what is currently provided – and by whom – is key. Clear accountability, so that individual decision-makers are held to account for what they or do not provide to children, is also a must.
None of this can be done without increasing funding.
It is important to recognise and welcome the real progress in recent years: more children are receiving the help they need and this positive trajectory is expected to continue into the future. But I would like to see the government commit to providing help for 100 per cent of the children who need it, not 20 per cent. If not, thousands of children will continue to suffer. They will become adults without getting the help they need.
Anne Longfield is Children’s Commissioner for England.