THAT four health boards are failing to meet waiting time targets for young people needing mental health treatment is bad news, but no surprise. New figures also show these boards have contributed to NHS Scotland missing an overall target of starting treatment for 90 per cent of young people within 18 weeks. The figure is 83.6 per cent.
We know there is a crisis in Child and Adolescent Mental Health (CAMHS). But it’s worth doing the arithmetic. In the first three months of this year, 16.4 per cent of 4,333 young people did not get the mental health treatment they needed within 18 weeks. That is 711 distressed or traumatised children and young people told “sorry, we don’t have the resources to help you right now”.
What are they referred for? It can be anger management, anxiety, school phobia or autism. They may be excluded from school for aggressive, violent behaviour or self harming. Mental health professionals are reluctant to generalise, but there is a general rule that boys tend to act out when they are distressed, injuring others, or damaging property, while girls tend to turn inwards, with ill-health taking the form of self-harm, depression or eating disorders.
These are not the kind of concerns that readily tolerate an 18-week wait for help. The Scottish Children’s Services Coalition says it is deeply concerned about this postcode lottery. Delays can lead a problem to become a crisis for the young person concerned, it says, as well as for their parents or wider family.
The other really significant figure in the latest data is that in more than one in five cases (21 per cent) referred, CAMHS refuses to accept a child for treatment.
I sit as a panel member in the Children’s Hearings System and I see this regularly – a child is giving cause for concern and a panel is waiting to hear whether a CAMHS referral can help, only to be told the child was refused treatment, deemed not to meet the threshold.
In some cases, arguably, the need does lie elsewhere. Some parents who have difficulty disciplining their child, for instance, will seek a mental health diagnosis, to help explain the problems they are having. But it is hard not to escape the feeling sometimes that this is more about rationing care.
Sophie Pilgrim, of Kindred Scotland, a member of the SCSC agrees. “The bar for children to access in-patient psychiatric care is far higher than for adults. Children are left at home with extreme risk to themselves or their family, because there just isn’t the appropriate level of provision,” she says.
One solution, plainly, is to invest more in CAMHS services. The Scottish Government claims to be doing this, pledging an extra £150 million. It is questionable if this is enough. Roughly three-quarters of mental health problems develop by the time someone is 20, but only 5.8 per cent of the Scottish mental health budget is invested in CAMHS.
Arguably, what is needed is not an extra £150m, welcome as it would be, but a wholesale rethinking of mental health services and early intervention to save money and prevent problems escalating. SCSC is calling for this and an inquiry into the 21 per cent who are turned away. Other children’s charities agree this is urgently needed.
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