It was heartening to see one of her first actions of the new Scottish health secretary, Jeane Freeman, being to recognise as ’completely unacceptable’ the fact that one in five children and young people seeking mental health treatment are having this rejected.
As an organisation that campaigns to improve mental health services, we have previously expressed our concerns over the increased demand on child and adolescent mental health services (CAMHS) and that fact that such a high number of these children and young people who are referred for treatment have this rejected, often with no explanation or with no alternative support provided. This leaves many thousands of vulnerable children and young people in a state of limbo.
An audit commissioned by the Scottish Association for Mental Health (SAMH) and NHS Information Services Division was undertaken on behalf of the Scottish Government to review this situation. What is clear from the recently published report arising from this is that for many of these young people their needs are not viewed as being severe enough to warrant CAMHS, however appropriate alternative support is lacking.
Many children, young people and their families highlighted that they have received a rejection letter within a very short timescale, and feel angry, aggrieved, cheated and let down due to a feeling that no proper assessment process has been undertaken.
More disturbingly, it is appears that some clearly require treatment but this is being rejected, often without any face-to-face meeting with a specialist. In fact, only 31 per cent of those who undertook an online survey got a face-to-face assessment, and the majority were rejected on the basis of a written referral.
It was disturbing to read the harrowing first-hand accounts of the experiences of young people and their families. This includes some believing that they would not be seen unless they were suicidal or at risk of harm, and the impact that failure to get good enough treatment has on mental health, often with the situation for them worsening and then entering a crisis situation. There was evidence also of those who were self-harming, but whose condition was not deemed severe enough to warrant treatment. Situations such as this are wholly unacceptable.
It is pleasing to see the Cabinet Secretary fully accepting the 29 recommendations outlined in the report on these rejected referrals and create a new CAMHS Taskforce, headed by mental health expert, Dr Dame Denise Coia, backed with £5 million of investment to reshape and improve CAMHS.
One of the key recommendations in the report was the requirement for increased investment in CAMHS and the provision of alternative support services, for those who may not require CAMHS, with mandatory signposting to these. And yet we have seen cuts to these support services over the years. If we are to deliver the support these children and young people need we need greater investment not only in CAMHS, but in such alternative services.
It was heartening to also note the desire for a nationwide provision of schools-based services recognised. Investing a fraction of the mental health budget on school-based counselling services, for example, helps to keep children in school and avoid an unnecessary and often stigmatising mental health diagnoses, as well as reducing the burden on already stretched and costly CAMHS provision.
Issues around mental health represent one of the greatest public health challenges of our time and we urge the new Cabinet Secretary to put mental health at the very heart of the Scottish Government health agenda, providing the high quality mental health support that our children and young people deserve.
Lynn Bell is CEO of Love Learning Scotland, a member of the Scottish Children's Services Coalition. This article first appeared in The Herald on Thursday 12th July 2018.