Some children and young people struggling with their mental health have been told by GPs to “pretend things are worse than they are” to increase their chances of receiving treatment, a report from the Care Quality Commission (CQC) has found.
Too many young people find themselves at “crisis point” before accessing mental health services due to the high eligibility thresholds, the CQC argued adding that these people therefore don’t get the care they deserve, because the system is “complicated, with no easy or clear way to get help or support”.
“Children and young people deserve to have their mental health needs and wellbeing put at the heart of every decision, be that planning, commissioning or resourcing,” said Dr Paul Lelliott, deputy chief inspector of hospitals at CQC. “Currently, this is not the reality everywhere and we heard from too many young people who felt they could only access care at a crisis point because local services are not working together, or are not able to work together effectively to support their mental health and wellbeing.”
The CQC, an independent regulator of health and social care services in England, put together a report examing mental health care, how needs were identified and how services worked together, in 10 local areas across England.
They spoke with more than 1,300 young people and looked at how they moved through mental health services to understand their journey. A significant finding was the slow and “confusing” referral routes for children, making it harder for children to access the right support at the right time.
The report stated: “During our fieldwork we found that staff working in emergency departments did not always know how to access mental health support for the children and young people in their care. Some school nurses said they were the ‘first port of call’ for mental health problems identified in schools, but they did not know how or where to refer pupils onward to appropriate care.”
In one area, school staff told CQC that specialist CAMHS would not always accept referrals directly from GPs without schools being involved. In these instances, the referral had to be redirected back through the school, causing delays in children and young people accessing care. In contrast, in other areas, referrals to specialist CAMHS would only be accepted via GP practices and not from schools. For children and young people, this meant being bounced between different parts of the system and delays in getting the support they needed.
“This confusion, combined with a lack of information about what the referral process entailed, created increased anxiety for them and their families and carers,” CQC wrote in their report.
Other issues they reported on included staff shortages and distance travelled to mental health services. Based on their findings, CQC is calling for changes to how local bodies work together to support and care for children and young people with mental health needs and for national bodies to champion and enable this change. CQC has committed to working with other regulators on joint inspections (such as Ofsted, Her Majesty’s Inspectorate of Constabulary and Fire and Rescue Services and Her Majesty’s Inspectorate of Probation) so they can consider the quality of care across whole systems.
CQC has recommended:
The Secretary of State for Health and Social Care to drive joint action across government through the inter-ministerial group on mental health, to ensure children and young people’s mental health becomes a higher priority across government departments.
National bodies including the Department of Health and Social Care, Health Education England, NHS England and NHS Improvement must recognise and build on the examples of good, person-centred care that exist, and to support people working locally so they can develop innovative approaches to high-quality care based on local need.
Those leading regional sustainability and transformation partnerships (STPs) and Integrated Care Systems (ICSs) to reach out and collaborate with organisations beyond traditional health and social care services including schools, police and probation services, and charities.
Commissioners and providers across education, local authorities and the NHS to work with NHS Digital to drive cross-sector improvement in the quality and availability of data, information and intelligence.
Ofsted and inspectorates of independent schools to recognise and assess how schools support children and young people’s mental health.
Dr Lelliott added that despite the pressure the system is facing, they saw “dedicated staff across the country” whose work presents an opportunity to transform and improve the experience of children and young people with mental health needs.
“With children’s mental health a high priority for Government, we must grasp this opportunity,” he said. “Our report provides clear recommendations based on listening to children and young people, as well as looking at all the organisations with a role to play in this area. We all need to act now and to act together. If we do not, we risk letting down children and young people across the country and undermining their potential in adult life.”
Commenting on the report, Sarah Brennan, chief executive of YoungMinds, said the charity strongly supports the call for better joined up services and for young people to be at the heart of decisions made about care. “The quality of treatment that CAMHS provides can be excellent, but it varies across the country, and too often young people find it desperately hard to get any help at all,” she said. “Every day we get calls to our Parents Helpline from parents whose children have been waiting up to 18 months for treatment, or who have been told that they don’t meet the threshold for services in their area.
“We regularly hear from young people who have started to self-harm or become suicidal while waiting for appropriate help, and who have ended up going to A&E because they haven’t been able to find support elsewhere. This simply shouldn’t be happening in 21st Century Britain.”
In 2019/2020, the CQC will report on the progress the different organisations have made to act on the recommendations in the report.
For more information and support:
PAPYRUS: Children and parents can contact HOPELineUK for advice and support. It is confidential and you will not be judged. Call 0800 0684141, text 07786209697 or email firstname.lastname@example.org.
Childline: Remind your child that Childline is there to give them free, confidential support and advice, 24 hours a day on 0800 1111 or at www.childline.org.uk.
YoungMinds: The parents helpline offers free, confidential online and telephone support, including information and advice, to any adult worried about the emotional problems, behaviour or mental health of a child or young person up to the age of 25. Call 0808 8025544.