The Scottish Children’s Services Coalition is campaigning to improve mental health support for children and young people. To achieve this we are seeking the increased provision of a wide range of high-quality, well-resourced and easily accessible services, tailored to their individual needs.
Mental health problems impacting children and young people include depression, anxiety, eating disorders, ADHD and self-harm.
Providing support and treatment, child and adolescent mental health services (CAMHS) are delivered by a range of agencies, contributing to the mental healthcare of children and young people (and their families or carers). These include the NHS, local authorities, and the third and private sectors.
Research indicates that 10% of children and young people (aged five to 16) have a clinically diagnosable mental health problem, around three in every class, and 20% of adolescents may experience such a problem in any given year. These disproportionately impact those from lower-income households and areas of deprivation.
It is however widely recognised that these figures are well out of date and the number of children and young people experiencing mental health problems has increased significantly over recent years, exacerbated by the devastating impact of the Covid-19 pandemic and increasing financial hardship.
Our children and young people are facing a growing mental health crisis, and it is vital that they are able to access the right care so they can realise their full potential.
The escalation in the number of those with mental health problems has led to a greatly increased demand for services. This also includes a rising number of those with more complex needs presenting for treatment. A lack of resources and inadequate staffing however means that mental health services are overstretched, leading to a significant and growing number of children and young people waiting to access the support they need.
Addressing this, we are calling for a national crusade to ensure the right support is available, improving mental health and wellbeing through radically transforming services. This aims to ensure that children and young people are able to get the help they need when they need it, delivered in the most appropriate setting, and includes a renewed focus on improving prevention and early intervention services.
To deliver such a transformation, we are campaigning for substantially increased investment to deliver a wide range of high-quality, well-resourced and easily accessible services. This is especially vital given the damaging impact of the Covid-19 pandemic and associated lockdowns, exacerbated by the cost of living crisis, on the mental health and wellbeing of children and young people. It includes the provision of suitably resourced and staffed primary care services, community-based support and specialist CAMHS.
We are also seeking greater collaboration and co-ordination between agencies, including specialist CAMHS, primary care, social work, schools, and the voluntary and private sectors. This seeks to ensure that children and young people receive the right support at the right time, tailored to their individual needs.
With an increasing demand for services, compounded by cuts in support, many children and young people with mental health problems for which an early diagnosis and treatment are essential are not receiving this in a timely manner.
To address this we are seeking a renewed focus on early intervention, preventing poor mental health, and promoting wellbeing. This includes greater resourcing of primary care and community-based services, as well as expanded mental health wellbeing education and support within schools. Effective provision of such lower-level support can prevent problems from deteriorating to the extent that access to costly and overstretched specialist CAMHS is required. It also serves to assist those requiring these specialist services, which often have lengthy waiting times for treatment, to access them more quickly.
Increased investment is vital to the delivery of more efficient and effective mental health services, with a renewed focus on prevention and early intervention.
If a child or young person with mental health problems is left without support and access to treatment the worst their outcomes are, commonly persisting into adult life. They are, for example, more likely to die younger, be unemployed, become homeless or end up in costly long-term care.
The Scottish Association for Mental Health has highlighted the social and economic costs of these problems as amounting to £10.7 billion in 2009/10 (it should be noted that these figures are some years out of date and will have increased dramatically).
Ensuring that children and young people with mental health problems can quickly access the appropriate treatment is vital in supporting them to reach their full potential.
Our campaigning is currently focused on two key areas of concern:
We are campaigning to ensure that children and young people have prompt access to specialist CAMHS through greater investment in these services, increasing their capacity. This will support the delivery of an adequate CAMHS workforce and form part of an overall strategy to ensure that appropriate care and treatment are provided when needed.
The Scottish Government has set a target for the NHS to deliver a maximum waiting time of 18 weeks from a patient's referral to treatment at specialist CAMHS (met by at least 90% of patients). This is in itself still far too long and would not be tolerated if these were physical health conditions.
However, faced with a greatly increased demand for services against a backdrop of inadequate resourcing and staffing, the NHS in Scotland is failing to achieve this 18-week target. This has led to a backlog of children and young people waiting far too long to access vital treatment. A wide variation between health boards in the average time that children and young people wait from referral to treatment has also led to a postcode lottery of support for those with mental health problems.
Any delay in the diagnosis and treatment of the child or young person concerned, as well as for their family or carer, can have a devastating impact with conditions frequently worsening while they wait.
We are seeking to ensure that waiting lists for CAMHS in all health boards are cleared and that the 18-week waiting time target is met. Action plans that include clear, funded and measurable timelines must be put in place for those health boards failing to meet this target. These plans should have a particular focus on delivering a suitably resourced CAMHS workforce, and appropriate support services should be provided to those waiting for treatment.
We are campaigning to increase the provision of CAMHS inpatient facilities – including the delivery of these north of Dundee – as well as secure care for those children and young people with the highest level of mental illness.
Despite increasing demand, there are only 48 specialist hospital beds provided within the NHS in Scotland for children and young people (aged 12 to 18) with mental health problems. These are located in three CAMHS inpatient units – Edinburgh, Glasgow and Dundee – with no provision north of Dundee. There is a further six-place unit for those aged five to 12 in the Royal Hospital for Sick Children in Glasgow.
Under the Mental Health (Care and Treatment) (Scotland) Act 2003, a responsibility is placed on health boards to provide accommodation and services to meet the needs of persons under the age of 18.
However, a lack of specialist beds for children and young people who require inpatient mental health care means that they are sometimes forced to remain at home, often with the individual’s condition deteriorating and the family reaching crisis point.
Some are admitted to CAMHS inpatient units which are often far from home, leaving them isolated from family and friends, which is detrimental to their recovery.
Others are admitted to non-specialist adult mental health or paediatric hospital wards, settings often inappropriate for their circumstances. Figures released by the Mental Welfare Commission for Scotland indicate that in the 2022/23 financial year there were 79 admissions, involving 66 children and young people (under the age of 18), to such non-specialist wards.
In addition, there are no secure intensive psychiatric care units in Scotland for children and young people with severe mental health needs that require this care. There are also no specialist inpatient facilities for those with a learning disability and/or autism spectrum disorder.
We are seeking to ensure that a child or young person requiring inpatient mental health care receives it in a timely manner, delivered in an appropriate setting.