Last week the Children's Society published a new report that found that although we've made progress in getting young people's mental health at the top of the national policy agenda, thousands of young people are struggling to benefit from CAMHS (Child and Adolescent Mental Health Services) care once they have been referred for treatment.
The report is based on freedom of Information (FOI)data obtained from NHS mental health trusts, and lays bare the number of missed appointments and young people dropping out of care. In 2016, there were 160,000 missed appointments by children aged 10 to 17, costing health services about £45million a year. One in five children missed three or more appointments.
We need to ask some difficult questions about why this is, and what we can do to keep children more engaged with services. In an ideal world, young people would be able to access services when, where, and how they want to. But the current system offers little in the way of choice.
As an adult, you have a choice about going to services, you may be encouraged by friends and family but it is up to you. That sense of sovereignty and self-direction is an important first step in meaningful engagement. Children on the other hand can often feel disengaged from the whole process. Parents may take them to their GP, who then refers them to CAMHS.
From the start, we need to be cultivating the sense in young people that they are getting help on their own volition, acknowledging the bravery it takes to open up about mental health and how many adults struggle with this. Children under 16 can make decisions about their care if they are considered Gillick Competent.
Some young people may not want their parents or carers involved, and there could be many good reasons why. These are all things that should be considered, from the seemingly small things that set the tone for engagement with services to the bigger questions around parental involvement which could be actively discouraging young people from opening up.
We need to understand why children too often don't attend services once they have been referred. Given the complexity of mental health problems there's no one right answer, but some of the young people that the Children's Society spoke to simply didn't trust the system to help. Assuming a young person makes it to their first appointment, mental health services have the first added challenge of having to prove them wrong.
We know that good, trust-based relationships between mental health practitioners and young people are essential. Yalom refers to the practitioner being 'present and faithful' - being lovingly present with the person; by being trustworthy, interested and by believing that their joint activity will be ultimately be redemptive and healing.' But as the new report points out, too often poor relationships between professionals and young people, the clinical nature of the service and difficulties getting to appointments mean that children miss appointments.
When appointments are missed, it's not uncommon for resource poor CAMHS services to discharge young people, creating a missed opportunity to follow up to find out what went wrong and to apply learning to ensure that we're doing everything possible to keep children engaged with support that could help them. We know that only 25% of children and young people with a mental disorder access mental health services, and with the additional funds this is only likely to go up to about 35%.
With more children set to access these services it's increasingly urgent that we understand the complex reasons why children and young people may miss their appointments, learn from any mistakes and approaches that can help such as the Choice and Partnership Approach (CAPA).
The new report 'Stick with us' proposes a new approach to missed appointments, recommending ways to incentivise the reduction of missed appointments and ways to trial new methods, such as advocacy to deliver CAMHS interventions. They suggest a single point of access, which is available in some areas, and which we called for in the Values Based Children and Young People's Mental Health System. It was also a recommendation in Future in Mind.
As the government prepares to release a Green Paper on children's mental health and the Thematic Review of CAMHS, we hope to see new and existing approaches taken forward to bring about the changes needed to improve the whole children and young people's mental health system.