A coalition of leading independent and third sector children and young people’s service providers has called for urgent action from the Scottish Government to increase investment in and radically improve mental health services for children and young people. It has also urged it to make mental health a key priority in the coming year at Holyrood and ensure that it is a major budget consideration.
The call from the Scottish Children’s Services Coalition (SCSC) (see Notes to Editors for members) comes as new waiting time figures are published today (5th September) from the Information Services Division, part of NHS National Services Scotland, highlighting a ‘postcode lottery’ in mental health treatment.
Covering the quarter from April to June 2017, these figures indicate that the NHS in Scotland, including five of the 14 regional Health Boards, failed to meet a Scottish Government 18-week waiting time target for children and young people to receive treatment from specialist Child and Adolescent Mental Health Services (CAMHS).
The NHS in Scotland provides mental health services for children and young people with a wide range of mental health problems including anxiety, behaviour problems, depression and early onset psychosis.
Research indicates that 10 per cent of children and young people (aged five to 16) has a clinically diagnosable mental health problem (around three in every classroom), and 20 per cent of adolescents may experience a mental health problem in any given year. However, it should however be noted that these figures are some years out of date and all signs are that since then the problem has got worse. Despite the enormity of this challenge, the coalition notes that less than 0.5 per cent of the NHS budget is spent on specialist CAMHS.*
The SCSC has called for a radical transformation of mental health services, with greater investment in CAMHS, as well as a renewed focus on prevention and early intervention. This includes in-school counselling, on-demand counselling services in GP surgeries and greater community support generally, reducing the need for referral to pressed specialist CAMHS.
It has also called for Action Plans to be put in place for those Health Boards failing to achieve the waiting time target, with its ultimate aim that those children and young people requiring it should get the help they need, when they need it.
The Scottish Government set a target, which dates from December 2014, for the NHS in Scotland to deliver a maximum waiting time of 18 weeks from a patient’s referral to treatment for specialist CAMHS. The target should be delivered for at least 90 per cent of patients.
The new figures indicate that of the 4,092 children and young people who started their treatment at CAMHS in Scotland between April and June 2017, 80.7 per cent were being treated within this 18 week waiting time. This is short of the 90 per cent target set by the Scottish Government.
The five Health Boards failing to achieve the 18-week waiting time target were NHS Fife (74.8 per cent), NHS Grampian (34.5 per cent), NHS Lanarkshire (78.0 per cent), NHS Highland (84.7 per cent) and NHS Lothian (58.7 per cent).
The figures published also indicate that while 8,330 children and young people were referred to CAMHS between April and June 2017, only 6,440 were accepted for treatment. The coalition has raised concerns over what action is taken to address 1,890, more than a fifth (23 per cent) referred but not accepted for treatment, and called for an inquiry into the referral process.
In addition, 37 children and young people have been waiting for over a year to be seen and 29 who started their treatment between April and June had been waiting over a year between referral and treatment.
The SCSC has highlighted that if there is increased investment in mental health services, this will not only cut waiting times, ensuring the early diagnosis and treatment of those children and young people with mental health problems, but also address the social and economic costs of failing to address these.
These costs are well-established. Those affected are more likely, for example, to be unemployed, homeless, get caught up in the criminal justice system, or are in extremely costly long-term care. In many cases this can be prevented through early intervention.
A spokesperson for the SCSC said:
“While it should be welcomed that nine Health Boards are meeting waiting time targets, the figures highlight that five of our Health Boards were failing to meet maximum waiting times, a clear ‘postcode lottery’ when it comes to treatment.
“In addition, 37 of those with mental health problems are still waiting, after waiting more than a year, to be seen and we are deeply concerned about what is happening to the more than a fifth of children and young people whose referrals for treatment are rejected. There is a need for an urgent inquiry to ascertain why these young people are being rejected for treatment and what is happening to them post-rejection.
“Research indicates that 10 per cent of children and young people (aged five to 16) has a clinically diagnosable mental health problem (around three in every classroom), and 20 per cent of adolescents may experience a mental health problem in any given year. Yet, despite the enormity of this challenge, less than 0.5 per cent of the NHS budget is spent on specialist CAMHS.
“We need to radically transform mental health services, with a focus on preventing such problems arising in the first place and intervening early to ensure that children and young people are able to realise their full potential. This includes investing in greater community support and reduces the need for referral to specialist CAMHS.
"As a coalition we are delighted that the Scottish Government has committed an additional £150 million in mental health services over the five years from 2016/17, and that this is to be partly used to bring down child and adolescent mental health waiting times, but we clearly need to do more and we would urge it to use the coming year at Holyrood to commit to even greater effort in this area.
"Families usually experience months of waiting even before a referral to CAMHS. The consequent delay in diagnosis and appropriate support can lead to a crisis situation for the child or young person concerned, as well as for their family, and the need for costly extra resources to address this.”
*ISD Scotland, Child and Adolescent mental health expenditure 2014-15, Scottish Health Service Costs, Report R340, R04LSX. Available at: http://www.isdscotland.org/Health-Topics/Finance/Costs/File-Listings-2015.asp (accessed 26th September 2016).