Children with mental health problems face long waits for treatment, says report

NHS mental health services for children and young people are at breaking point, with waiting times on the rise and a lack of inpatient beds, a new poll has suggested.

A snapshot survey of 35 NHS trust leaders in England found that most units were struggling with demand, while young people are also turning up at A&E having self-harmed or experiencing suicidal thoughts.

Some 85% of trust leaders, who together oversee about 60% of children and young people’s mental health services, said they could not meet demand for children and young people’s eating disorder services – the highest result for any service.

Meanwhile, two-thirds could not meet demand for community Child and Adolescent Mental Health Services (CAMHS, 66%) and inpatient CAMHS services (65%).

The survey, carried out by NHS Providers, found rising numbers of children and young people at A&E with mental health problems, with one trust leader saying they had seen an increase of up to 50%.

All mental health trust leaders said the demand their trust or local system is experiencing for services is significantly (80%) or moderately (20%) increasing compared to six months ago.

Looking at reasons for the high workload, NHS trust leaders cited increased complexity of cases due to the Covid-19 pandemic (88%), additional demand due to the Covid-19 pandemic (42%) and a lack of care (42%) in the community.

The next significant reasons included not enough patient beds (36%) and not enough staff.

Some 84% of trust leaders said the amount of time children and young people are currently having to wait to access treatment for services is significantly (29%) or moderately (59%) increasing compared to waiting times six months ago.

Meanwhile, 61% of trust leaders disagreed (29%) or strongly disagreed (32%) with the statement: ‘There are enough inpatient mental health beds for children and young people in my trust/local area.’

One chief executive of a combined mental health, learning disability and community trust, said: “[The] latest data shows a 72% increase over [the] usual level of CAMHS referrals.

“[It is the] biggest increase since schools resumed. Most alarming is the increase in first presentation with very acute symptoms: anxiety, suicidality and self-harm.”

Deputy chief executive of NHS Providers, Saffron Cordery, said: “Covid-19 has clearly had a big impact on children’s lives and their mental health.

“As the NHS focuses on recovery from the pandemic, we must recognise the extent of its impact on mental health services and ensure they also get the focus and attention they need.

“Despite welcome support and improved funding for some mental health services over recent years, the pandemic has brought into sharp focus the impact of rising demand and chronic underinvestment in beds, workforce and capital. We are now into a time of reckoning.

“Trusts are doing all they can to reduce waiting times, intervene as early as possible and to prevent mental, ill health in the first place.

“These findings provide further powerful evidence that in addressing the NHS’ backlog of care and the impact of Covid-19, mental health services – including those for children and young people – must be an absolute priority.”

She said measures that were needed included investment in staff, a commitment to expand services in the community to avoid inpatient admissions where possible, and a “quick expansion in the bed base where it’s needed to bring care closer to home”.

Claire Murdoch, NHS England’s national mental health director, said: “The pandemic has turned lives upside down, hitting young people particularly hard and in some areas, staff are now treating more children and young people than ever before – the NHS has responded rapidly to the increased demand with a wide range of services available for those who need help, including through 183 mental health support teams working with schools across the country.

“The NHS is playing its part to manage increased demand for mental health and anyone who needs support should continue to come forward, but everyone, including social media and advertisers who have so much influence on the minds of our young people, should step up and play their part too.”

It comes as MPs were told that Covid-19 has been a “crisis upon a pre-existing crisis” in mental health care for children and young people.

Dr Bernadka Dubicka, chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists said that even pre-pandemic the “wrong sorts of people” were admitted for treatment in hospital because of “failures in community care”.

She told the Health and Social Care Committee: “What we’re seeing now in terms of the impact of Covid as a crisis upon a pre-existing crisis”.

She added: “So we’re seeing more and more looked-after children coming in because of the failures of social care; young people who are incredibly emotionally disregulated and trying to kill themselves and harm themselves, but that was due to the lack of the right support in the community; the number of young people with autism and learning disabilities has increased significantly, again because families weren’t getting the right level of support – I remember one family trying to go abroad to Europe, try to get the right kind of support for their child in the community.

Meanwhile, Kamena Dorling, head of policy at the charity Article 39, raised concern about children with mental illness who were physically restrained.

She said that in 2019/20, 616 children were subject to “restrictive interventions” and a third of those children were subject to face-down physical restraint.

She told MPs: “Guidance emphasises it should be avoided, and states of this position can and has caused death after as little as 10 minutes by causing a cardiac event.

“It is completely unclear to me, why we are still seeing this used on children, and I think we’ve got, we just got to a stage where the use of restraint is almost seen as the kind of normal in terms of reacting to challenging behaviours.”