This article was first published by The Guardian on 7th December 2016
Norman Lamb, Liberal Democrat MP for North Norfolk and former Minister of State for Care & Support
If mental health is the Cinderella service of the NHS, then child and adolescent mental health services (CAMHS) is the Cinderella service of the Cinderella service. It’s a cliche that bears repeating, because the reality of children’s mental health services in this country still falls woefully short of the vision set by the Liberal Democrats and Conservatives during the coalition government.
One in 10 children suffers from depression, anxiety or another diagnosable mental health problem, and 75% of mental illness starts before the age of 18. Intervening early with effective, evidence-based support can not only stop a child’s condition deteriorating to crisis point, but also have a transformative effect on long-term recovery and life prospects in adulthood.
When mental ill health costs the economy an estimated £105bn every year, the economic as well as the moral case for prioritising children’s mental health is unanswerable. But when I became minister, I was horrified by what I witnessed.
For too many people, help is not available when they need it. Nearly a quarter of young people referred to specialist CAMHS services are turned away, often because they fail to meet outrageous eligibility thresholds. The anorexic teenager is denied treatment until she becomes dangerously thin. The boy with OCD is told there is no specialist support until he has experienced repeated suicidal thoughts. And those who do get treatment are often faced with excruciating waiting times, which can vary dramatically across the country.
As well as being morally indefensible, it is the antithesis of the important principle of early intervention. We have ended up with a grossly inefficient system designed to treat rather than prevent mental ill health in children. Fragmented, tiered services are complex and dysfunctional, while the perverse financial incentives in the system fail to encourage a focus on prevention and instead push children into specialist acute settings where NHS England picks up the bill, rather than local clinical commissioning groups.
Determined to address this appalling situation, I set up a task force. The result was Future in mind: a blueprint for the modernisation of child and adolescent mental health services, backed by extra funding of £250m each year until 2020.
At its heart is a significant shift towards the prevention of ill health, working with schools to strengthen resilience and improve support before health deteriorates. Attracting support from across the political spectrum, it was subsequently endorsed by NHS England’s own five-year plan for mental health.
The Conservative government, however, has shown little drive to deliver on this golden opportunity. In the first year of the promised investment, only £143m was released instead of the £250m expected. Mental health providers have reported that the money failed to reach frontline services, with many still seeing cuts to their budgets.
Worse still, the government chose not to make up this £107m shortfall in the second year of the programme. Nor was the money that was allocated to clinical commissioning groups ringfenced, so there is a real risk that it will leak out to other local priorities such as A&E waiting times.
It’s hardly surprising that we’ve not seen the progress many had hoped for. The Education Policy Institute’s commission on children’s mental health, which I chair, recently published its final report, highlighting that excessive waiting times and treatment thresholds are still commonplace. There also remains a dreadful cliff edge at the age of 18 when young people make the transition from CAMHS to adult services.
The health secretary, Jeremy Hunt, recently pledged his commitment to CAMHS, which he rightly identified as the “biggest single area of weakness” in the NHS. But rhetoric is not enough. It’s now time for a bold statement of intent, otherwise all momentum will be lost.
We need to see a bold programme of reform – implementing the principles of Future in mind – with an ambitious focus on schools and prevention, early intervention, and improving access to high-quality services. The EPI commission called for the government to use the additional £250m a year as a lever to drive continued change, making receipt of the money conditional on areas demonstrating that all the money is being spent on children and that there is an ambitious programme to shift resources to prevention. Each area should also be expected to demonstrate that they have delivered on their plans.
The chronic underfunding of children’s mental health services must be consigned to history. Despite receiving a paltry 0.7% of the total NHS budget, CAMHS is too often at the front of the queue when there are cuts or “efficiencies” to be made. The health secretary should make it his priority to reverse this scandalous disinvestment, pushing and cajoling the NHS to ensure that every last penny of the extra money secured by the Liberal Democrats is spent as intended.
Children and young people have been let down for too long. We know what an effective and modern children’s mental health service looks like, and we have a roadmap for how to get there. Responsibility now lies with the government to deliver on it so that all young people receive the support they need to flourish and achieve their full potential.