THE BLOG

Mental Health Services for Young People Need Money and New Ideas, Not Outrage

01/02/2015 20:39 GMT | Updated 03/04/2015 10:59 BST

It's encouraging to hear leading politicians now talk and pledge openly about young people's mental health, but it's a scandal that near systemic collapse is what it's taken to achieve this. When even minister of state for care and support Norman Lamb is able to conclude that children's mental health services "are not fit for purpose" (after three years under his watch) it is clear we're about to hit bottom.

Multiple investigations and reviews have found the same failings; the predictable result of chronic long term under-investment in the face of growing demand and complexity (have a read of last year's Centre for Social Justice report and the recently concluded enquiry by the House of Commons Health Committee if you want to understand quite how bad things have got).

Last summer the government was moved to established a task force to look at the way in which child and adolescent mental health services are commissioned, but a quick glance at a few headlines will tell you what's going on.

Despite the fact mental health issues represent about a third of our overall burden of disease in the UK and cost us over £100billion a year, spending on these services amounts to only 13% of the total NHS budget (NHS England, 2014). Worse, given half of all adult mental health problems (excluding dementia) start before age 15 and three quarters by age 18, it's hard to understand why only 6% of these already limited monies go toward child and adolescent mental health. (Let's not forget that these are services which have also had to manage cuts of £50million since 2010). Finally, and this speaks volumes; funding for mental health research represents a meagre 5% of overall health research spending (Mental Health Foundation, 2013).

It is this basic poverty of resources and new learning from which all other challenges flow; both for young people who experience unbearably long waits for limited treatment options, and for services with diminished budgets trying to manage the increasing demand for them. Imagine for one moment we resourced physical healthcare to the same extent and with the same lack of interest in new or better treatments.

Fifty years ago a group of far sighted individuals in Bristol had an idea called Off the Record that remains relevant and urgent to this time and context. It was the idea that young people have need of support that is accessible to them independently of adult permission, judgment or referral. Support that is culturally bespoke and sensitive to the particular challenges - biological, social and existential - that this phase of life brings. Support that does not label or pass judgement on the individual in order to exclude or admit them into the service. And support that recognises 'being a young person' is a social construct that has evolved socio-economically to last a decade or so longer than it did even half a century ago when Off the Record was born.

Good ideas like Off the Record endure. They are, though, becoming harder to protect, and not for want of money or will. Like many voluntary sector organisations in the field our most pressing challenge currently comes from being overwhelmed by young people unable to access other parts of a mental health system paralysed by diminished capacity and poor design.

Why is demand and complexity rising among the young? This is probably the more interesting and important question, and it is staggering that in 2015 the data to venture an answer remains so limited. What is real is the increasing numbers of at risk young people coming to us. Much too frequently for comfort these are referrals fresh from the accident and emergency room and the assessments and intake of statutory mental health colleagues, whose highly pressurised caseloads mean only the most acutely complex and unwell young people now meet the threshold for a service.

The simple answer to this pressure would be to introduce our own exclusion criteria. To limit demand by only accepting a narrow band of presentations or 'wellness' that are a comfortable fit for our service. But that would mean mirroring other parts of a failing and often abusive system.

Which is why, if you work in this highly-pressurised context the woefully reductive narrative around mental health in the media is so frustrating. To have the systemic context of human suffering as well as the reality of under resourced, under researched and over stretched services reduced to one of personal failure and blame does nothing but recycle stigma, create stressed defensive professionals, and ultimately even poorer services; even if we can and must acknowledge that services and sometimes professionals do let people down.

There's no magic wand for someone experiencing a mental health difficulty save timely access to appropriately resourced services. And since we lack the political introspection to ask more urgent questions about the health of our increasingly unequal world and the political and economic aetiology of mental ill health more specifically, the basic issue of resources seems to me the most urgent place for our contemporary politicians to fix their gaze.

In anticipation of the predictable groans about austerity, deficits, and doing more with less - an unprecedented upward re-distribution of wealth has taken place since 2008; I humbly suggest that the arithmetic is actually quite simple.

Off the Record (Bristol) is currently celebrating its 50th anniversary year supporting young people in Bristol. You can find out more about the charity at otrbristol.org.uk and follow OTR on Twitter: @otrbristol