Are mental health services letting young people down?

Writing exclusively for Society Central, a former Minister of State introduces a new review of the evidence on children’s mental health. Too many young people are struggling without adequate help, he says.

Photo credit: Tjook

Experts tell us just one in four children and young people with mental health problems receive any support or treatment.

With approximately 7.5 million children aged 5-16 in this country and an overall prevalence of mental illness of 9.6 per cent among them, there are likely to be more than 700,000 children suffering from a mental health condition – and 500,000 not getting any treatment.

While the exact figures are elusive, research suggests half of all people with lifelong mental health problems have experienced their first signs and symptoms by the age of 14. Without access to timely and effective mental health support, it can come as little surprise that problems continue, and in many cases deteriorate in adult life.

For this reason, when I was chairing the CentreForum Commission on mental health it quickly became clear to all of the commissioners that children had to be a key focus of our work. We made a set of recommendations for improving access and coverage that would make a significant difference, but the question that was at that stage unanswerable was a simple but vital one: what do we already know?

Stocktake of evidence

Today the commission publishes a report which attempts to answer that question. Investing in Children’s Mental Health offers – for the first time – a comprehensive stocktake of the evidence on what works.

The report looks across the piece at children and adolescent mental health, and focuses particularly on the four most common mental health conditions that affect children and young people: conduct disorder (affecting 5.8 per cent), anxiety (3.3 per cent), depression (0.9 per cent) and ADHD (1.5 per cent).

Bringing together the evidence on interventions for conduct disorder it demonstrates that they have significant potential to improve lasting outcomes for children with early behavioural problems.

Research suggests children with early conduct disorder are 10 times more costly to the public sector by the age of 28 than other children, and may, over their lifetime, create costs of around £260,000 per child. So there is a crystal clear case for investment in effective interventions that address local need.

These would not just save public expenditure – just as importantly they would improve the lives of children and their families, improve their attainment and allow them to fulfil their potential.

Value for money

It is every bit as vital though, that the more expensive interventions for adolescents are also a key part of the mix. As the Centre for Mental Health’s report says, these programmes also represent excellent value for money. They have an average return of around £13 for every £1 invested, and also have the potential to reduce substance misuse, risky sex and teenage pregnancies as well as improving relationships with parents.

The mistake that must not be made is to cherry-pick initiatives which appear to deliver the most positives for the least money. That will simply not work.

It is universally acknowledged that the system is broken and we need lasting change. To this end the Minister for Mental Health, Norman Lamb, announced a CAMHS taskforce last summer which offers a once in a generation opportunity to set the direction for change. It must offer politicians a clear set of goals, a route map for reforming the “broken and dysfunctional system” he described.

And any future government must pick up the mantle and ensure that this evidence base is used as a starting point to establish a new offer for children and young people which reflects and meets local need.

Involving young people in the redesign of Children and Adolescent Mental Health Services (CAMHS), measuring and reporting on outcomes must be at the heart of the transformation that needs to take place. Just as it was with the Children and Young People (CYP) Improving Access to Psychological Therapy (IAPT) programme which I launched in 2011, it is critical that the voice of children and young people is heard in the service design and that success is measured against delivery of the outcomes that matter to them.

Evidence is key

We must have an end to the current situation where many of the interventions CAMHS offers are not-evidence based, are poorly targeted and are badly implemented by staff without the necessary training. These services do not deliver value for money, and don’t improve outcomes for children and young people.

This report establishes the evidence base to challenge this kind of poor practice and must be used as such. Get it right and we can reduce the life-long burden of mental illness in our country. Fewer adults living with life-long mental health problems. More children able to make full use of the opportunities education has to offer. More people able to work and contribute. More people living happier, healthier, more fulfilled lives.

Above all we have the opportunity to make a serious dent in the scandalous 20 years of lost life expectancy that people with severe and enduring mental health problems face.

The taskforce is due to report in March 2015. This report clearly sets out the value of the tools and evidence we already have at our disposal to make this vision a reality.