In this article, Jenny Welling-Palmer, our Mental Health lead, who has held strategic and operational roles in a number of large teaching hospitals, shares her thoughts.
It is hard to get through a week in the press without seeing child and adolescent mental health services (CAMHS) hitting the headlines. In this article we outline the key issues that have been facing CAMHS and what the NHS is doing to improve services.
The profile of CAMHS was raised in 2016 when the then Secretary of State for Health Jeremy Hunt said that CAMHS were the “biggest single area of weakness in NHS provision”. Since then, the CQC, HSIB, the Royal College of Psychiatry, YoungMinds, along with a host of other organisations have all spoken out about the need to improve services.
Recognizing there was a national problem, at the beginning of 2017 Theresa May commissioned the Care Quality Commission (CQC) to undertake a national review of CAMHS. The CQC published their full report in March, which said too many people are reaching crisis point before accessing support; services across healthcare, education and social care are too fragmented; and the current pace of change needs to be urgently accelerated in order to achieve the scale of change needed. NHS England’s national mental health director Claire Murdoch (also Chief Executive of Central and North West London NHS Foundation Trust) who has never shied away speaking directly about CAMHS, said the CQC was right to highlight the need for better cross-sector working.
The transition between CAMHS and adult services
Only one month ago, the Healthcare Safety Investigation Branch (HSIB) published its national investigation report into the transition between CAMHS and adult services. This followed the death of a teenager who committed suicide months after their transfer from CAMHS to adult services. In one study, of the 25,000 young people who transfer from CAMH to adult services only 4% said they received an ideal transition. The HSIB report set out a number of recommendations for improvement, all of which were focused on being more flexible on providing a needs-based service so that young people who don’t meet adult criteria still receive adequate support. The report also recommended that the CQC inspect the end to end CAMH to adult services pathway.
The Royal College of Psychiatrists also spoke up, saying there is a postcode lottery for children accessing eating disorder services, especially outside of London. Mental health trusts have been set a target to treat 95% of urgent cases within a week and 95% of routine cases within four weeks by 2020/21.
A number of trusts have made the news, with lengthily waiting list issues, young people being sent miles from home to access an inpatient bed, demand far exceeding capacity, GPs frustrated in primary care and parents and carers increasingly exasperated.
So, what is being done to improve CAMHS?
A huge issue comes down to funding. The statistics are familiar – mental health accounts for 23% of the burden of disease but only 11% of the NHS budget is spent on mental health. For five years in a row physical health services have received a larger cash increase than mental health. All CCGs in England are now required to meet a mental health investment standard. Last year in 16/17, 32 CCGs missed the target, and 32 are forecasting missing it for 17/18. Claire Murdoch wrote to CCGs stating that 85% was not good enough in hitting the standard given it is now a national requirement.
There have been some injections of new funds. Eating disorders has been ringfenced £30m in new funds. The hope is that waiting lists will reduce, more young people will be seen and treated in services, and the national targets will be achieved across England.
In January NHS England also announced it would commission 131 new CAMHS beds to increase the total capacity across England by nearly 10%. This is a much-needed increase, aiming to eliminate out of area placements, specifically focusing on the South, London and the Humber.
Going forward the Sustainability & Transformation Partnership (STPs) have a key role to play in helping to improve services and better join them up across organisations and geographies. However, the mental health charity, YoungMinds, recently undertook an analysis of the 44 STPs and found that 23% did not have any commitment or plans to improve performance against national priorities for children and young people with mental health problems. Only 30% gave children and young people mental health plans “strong visibility”. It is hoped that STPs will not miss this opportunity to improve CAMHS and will understand the important role they have to play in improving services and fast.
CAMHS is nationally in safe hands; Tim Kendall, Claire Murdoch and Paul Farmer to name a few are all invested in ensuring children and young people receive the best care possible from mental health services.
If you are interested in understanding better how our service can help address CAMHS in your area. Please contact us on 01865 261467 or email Jenny.firstname.lastname@example.org
Jenny Welling-Palmer is the Mental Health lead at Consultant Connect. She previously worked as Managing Director for Beacon UK, an innovative mental health system integrator that works in collaboration with the NHS. Prior to this Jenny held a number of strategic and operational roles in a number of large teaching hospitals.