Finding a Cure for Mental Health Services

I love Child and Adolescent Psychiatry.There’s not a day I regret choosing this fascinating sub-specialty. But unlike my peers in other medical specialties, my colleagues and I face a daily struggle to provide our patients with the most basic of care that they require. As in all other parts of the Mental Health system, services are desperately stretched, with assessment waiting lists in some areas of up to a year, and grossly understaffed multidisciplinary teams. Patients in need of help are frequently turned away, told that they don’t “meet threshold” for assessment; invariably they will sadly meet these absurdly high thresholds some way down the line, when the presenting problem which should have been tackled far sooner, has worsened.

Sadly, this situation comes down to money. In an unspoken national scandal, the political will to provide adequate funding for mental health services is absent. Politicians superficially accept the concept of a ‘Parity of Esteem’ (that we should treat physical and mental health equally), but their empty words rarely translate into action.

There is a now well documented rising demand for Child and Adolescent Mental Health Services (CAMHS), with increased rates of self-harm and eating disorders in those under 18. It’s never been harder I believe, to be a teenager, with pressures of school and social media (selfies, sexting, cyberbullying etc), drugs and alcohol.

Despite this exponentially increasing need, during my time in training, there have been £35million of financial cuts across CAMHS. Since 2010, 20% of Local Authorities have frozen or reduced their budgets every year in this area. Spending on private mental health inpatient beds has consequently doubled in two years, due to a lack of resources.

Because any new funding in mental health is rarely “ringfenced” (aka protected), it has a habit of never reaching the frontline, Clinical Commissioning Groups (CCGs) diverting it elsewhere. Last summer, ministers declared that they would invest an extra £1.25billion in CAMHS (£250million every year until 2020).  Recently, I was interviewed on the BBC News to say, loud and clear, that this money has not yet materialised. Many of us doubt it ever will.

I have had children in mental health crises taken to police cells as places of safety because there was no suitable provision in a medical setting. Others have been admitted to beds on adult psychiatric wards, because no CAMHS bed has been available across the whole country.

The truth is that Mental Health remains deeply stigmatised, partly by a lack of understanding. Additionally, patients with mental health needs struggle more than most to advocate for their own care, especially when their insight to their illness is limited, or if they have little social support.

Cutting spending in CAMHS is not only a scandal, it’s a false economy. Half of all adult mental illness is detectable at age 14. One in ten children has a diagnosable mental health disorder (that’s 3 in every primary school class!). Investing in caring for children is in the long term interests of the healthcare system.

To end on a positive note: It’s not all doom and gloom. The clinical work in psychiatry is richly rewarding. No other specialty gives the clinician the opportunity to develop such personal and meaningful connections with its patients. The impact that appropriate and well-delivered care can have is life-changing, be that through medication, talking therapies, or often a combination of both.

I urge you to consider a career in psychiatry. We need resilient, resourceful and (more than ever), politically-savvy graduates who are willing to stand up for the most vulnerable in society, especially our children.

Dr Rory Conn 

ST5 Child and Adolescent Psychiatrist

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