Latest waiting time figures have reinforced the call by a coalition of leading independent and third sector children and young people’s service providers for dramatically increased investment in mental health services, delivering services for children and young people that are ‘fit for purpose’.
The call from campaign organisation, the Scottish Children’s Services Coalition (SCSC) comes as the latest waiting time figures from the Information Services Division, part of NHS National Services Scotland, highlighting a ‘postcode lottery’ in mental health treatment. 1 They also demonstrate that the NHS in Scotland is ‘creaking at the seams’ when it comes to dealing with an increasing number of those children and young people being identified with mental health problems.
Covering the quarter October to December 2017, the figures highlight that 4,015 children and young people started treatment at specialist child and adolescent mental health services (CAMHS) in this period. The NHS in Scotland, including ten of the 14 regional health boards, failed to meet the Scottish Government 18-week waiting time target for children and young people to receive treatment from CAMHS. This target should be delivered for at least 90% of patients.
While 71.1 per cent in the NHS in Scotland are being seen within this 18-week waiting time, still in itself far too long, more than a quarter (28.9 per cent) are failing to be seen within this period.
These include NHS Fife (63.8 per cent), NHS Forth Valley (54.7 per cent), NHS Grampian (39.1 per cent), NHS Highland (77.7 per cent), NHS Lanarkshire (66.7 per cent), NHS Lothian (59.8 per cent), NHS Borders (59.3 per cent), NHS Tayside (41.5 per cent), NHS Dumfries and Galloway (80.5 per cent) and NHS Orkney (61.1 per cent).
The figures also indicate that 40 children and young people had been waiting for more than a year prior to being seen, nothing short of a national disgrace 1, and of the 8,980 referred to CAMHS only 6,994 were accepted for treatment, meaning that 22 per cent were rejected, with no real understanding of what has happened to them following this rejection.
It should be noted that a that a mere 0.48 per cent of the NHS budget is spent on specialist CAMHS, amounting to just over £54 million. In addition to this, only 6.34 per cent of the overall mental health budget is spent on CAMHS.
These very low figures are despite the fact that mental health services are literally ‘creaking at the seams’ due to greatly increasing demand, as evidenced by these waiting time figures. 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), with 50 per cent of mental health problems established by the age of 14 and 75 per cent by the age of 24.
The SCSC has called for the Scottish Government to greatly increased investment in CAMHS and for a more consistent approach to delivering these services across Scotland. It has also called for a renewed focus on prevention and early intervention for those with mental health problems. This includes greater school-based counselling services, on-demand counselling services in GP surgeries and greater community support generally, reducing the need for referral to under-pressure specialist CAMHS.
The costs of failing to address mental health problems 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:
“These latest waiting time figures demonstrate that we are continuing to fail many of our children and young people with mental health problems. No longer can mental health be viewed as a ‘Cinderella’ service and we must put money behind the rhetoric if we are to just keep pace with investment south of the border.
“It is clearly disappointing to note these newly released figures highlighting that the NHS in Scotland, including 10 of our health boards, are failing to meet what is already a lengthy waiting time. This is no coincidence given that a very small proportion of the overall NHS and mental health budget is being spent on addressing the needs of children and young people, and yet we know that three children in every classroom has a clinically diagnosable mental health problem.
“There must be a radical transformation of our mental health services, with a focus on preventing such problems arising in the first place and intervening early, especially when we know that half of all mental health problems begin before the age of 14.
“With mental health and the issues associated with it representing one of the greatest public health challenges of our time, we must ensure that children and young people are able to get the care and support they need, when they need it. This includes investing in greater community support and support at school, reducing the need for referral to specialist CAMHS.”
1 Table 1a. Available at: http://www.isdscotland.org/Health-Topics/Waiting-Times/Publications/2018-03-06/CAMHS_Waiting_Times_Tables_March_2018.xlsx (accessed 6th March 2018).