Mental health problems include depression, anxiety, eating disorders, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD) and self-harm.
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 a mental health problem in any given year. These problems disproportionately affect those children and young people from lower income households and areas of deprivation.
Child and adolescent mental health services (CAMHS) embrace the range of services across agencies – NHS, local authorities, third and independent sectors – that contribute to the mental healthcare of children and young people (and their families and carers).
Supporting an increasing number of people identified with mental health problems is one of the greatest public health challenges of our time.
In order to achieve this we are campaigning for increased investment to deliver a wide-range of high-quality, well-resourced and quickly accessible CAMHS. This will assist in the provision of adequate staffing and includes primary care, community-based support and specialist inpatient services.
Focus on prevention and early intervention
We are seeking a radical shift towards preventing poor mental health and promoting wellbeing, as well as early intervention. This includes greater investment in primary care and community support, as well as greater support within schools. The provision of easily accessible community-based support can reduce the need for referral to more costly specialist CAMHS, which are under considerable pressure and can result in long waiting times for treatment.
We are also seeking greater collaboration between the public sector and independent and third sector service providers, so that those children and young people with mental health problems receive the best possible care and support, tailored to their individual needs.
The number of those seeking treatment for mental health problems has increased significantly, including those presenting with more complex needs. However, the impact of austerity and a lack of resourcing, including staffing, means that services are overstretched and unable to adequately address this demand.
Many children and young people with mental health problems, for which an early diagnosis and treatment are essential, are therefore not receiving appropriate care and support.
It is vital that there is increased investment and adequate staffing to deliver more efficient and effective CAMHS, with a 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, resulting in a potentially high cost to society and the economy.
The social and economic impacts of these problems if they are not treated and persist into adult life are well-recognised. Those affected, for example, are more likely to die younger, be unemployed, become homeless, or end up in extremely costly long-term care.
Ensuring that children and young people with mental health problems can quickly access the appropriate treatment is vital in assisting them reach their full potential.
Our campaigning is currently focused on two key areas of concern:
1. Waiting times to access CAMHS
2. A lack of appropriate CAMHS inpatient facilities
The Scottish Government has set a target for the NHS in Scotland to deliver a maximum waiting time of 18 weeks from a child or young person’s referral to treatment for specialist CAMHS. This is in itself still far too long and would not be tolerated for those with physical health issues.
Faced with a greatly increased demand on services and a lack of resourcing, including inadequate staff numbers in certain areas, the NHS in Scotland is failing to achieve this waiting time target. With a considerable variation in waiting times between regional health boards, this has led to a ‘postcode lottery’ when it comes to the treatment of those with mental health problems.
Any delay in diagnosis and appropriate support for the child or young person concerned, as well as for their family, can have a devastating impact. Investment in these services will also serve to prevent longer-term social and economic costs.
We are seeking to ensure that all health boards meet the waiting time target, with action plans that include clear, funded and measurable timetables put in place for those currently failing to meet this.
Despite increasing demand there are only 48 specialist hospital beds provided within the NHS in Scotland for adolescents under the age of 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 five to 12 year olds 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 which are inappropriate for their circumstances. Figures from the Mental Welfare Commission, for example, indicate that there were 71 admissions, involving 66 children and young people (under the age of 18), to such non-specialist wards in 2016/17.
In addition, there are no secure inpatient facilities in Scotland for children and young people with a severity of mental health needs that require this specialist care, including those with a forensic history (i.e. a criminal record) and 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.