27 Apr Is CAMHS failing to help the UK’s young people?
338,000 children were referred to CAMHS in 2017.
An ex-CAMHS psychiatrist has revealed the unresolved issues and failing new approaches in the NHS’s child and adolescent mental ill health services by stating that the government are “failing children and young people”.
Over the last 20 years the number of young people experiencing difficulties with their mental health has risen. Children as young as five are struggling with emotional, depressive and behavioural disorders, but are facing year-long waiting lists and inconsistent counselling. This raises the question as to what the fundamental issues with the services are, and why CAMHS (Child and Adolescent Mental Health Services) is often a commonly shared anecdotally bad-experience amongst teens.
125 young people participated in a survey to gather their thoughts on the topic. Of the 35% of young people who had been referred to, and treated by CAMHS, almost all felt they were unhappy with the length of time they had waited for their first session. Lauren, who was admitted to CAMHS at age 14 for various emotional and anxiety disorders said that “the time in between my referral and my first session was four months. By that time my condition was so bad that I’d started self-harming and had made attempts to end my life.”
Charity ‘Young Minds’ describes psychologists as “a group of professionals who help you understand the way you behave, feel and think about things. They aim to help you understand why you feel the way you do, what’s behind the way you act towards other people and why some things happen to you.” Hannah, who was admitted to become a CAMHS inpatient five times throughout her battle with anorexia explained to me why her experiences were both good and bad.
“I’ve experienced five CAMHS which were all very different. In some of the care homes we were treated like violent criminals. A lot of harmless things I said were pathologised and treated suspiciously. I remember one time being told that I was inciting harmful thoughts upon the other patients for saying “chemistry is crap” in one of my lessons. […] Some of my counsellors were incredible, however. They made the transition from CAMHS to adult services a lot easier.”
Hannah was first referred to CAMHS at age 14. She waited over two months for her first meeting as her doctor did not deem her condition to be life threatening. She explained how she was able to “tip-toe around” being admitted as an inpatient for six months; speaking in hindsight, Hannah feels unhappy with how easily she was able to do this despite her condition needing urgent intervention. When asked whether she thought the Young Minds definition of a psychologist was accurate to her experiences, she explained that “it’s hard to say. A handful of psychologists I have been given have gone above and beyond the definition. There is a real lack of consistency in the system.”
Major investigations into the mental health of children and young people in England were carried out in 1999, 2004 and 2017 by the NHS. Studies showed that the number of mental health illnesses in young people aged five to fifteen had increased by 19% from 1999 to 2017. Despite 338,000 children being referred to CAMHS in 2017, only 6.4% of government mental health funding currently goes to CAMHS. Young people are suffering the repercussions from this lack of funding through waiting lists of over six months and insufficient therapy. This often longs out their recovery process and worsens circumstances for them. Robert, a child psychiatrist who worked for various CAMHS across Greater London spoke to me about his thoughts on the current state of the services (his name has been changed). “CAMHS is in chaos. They lack even the minimum funding required for basic resources, the right staff and decent spaces.
“One issue with the current system is the transfer of admin to electronic mediums – this is putting aside the fact that there often isn’t enough funding for enough computers anyway. Having to create detailed electronic packs and files for every patient means the number of patients I could see in a day was much less. I used to see one patient every hour, write notes on a pad and taking no breaks. It was deeply satisfying and rewarding to not be bogged down by menial tasks such as waiting for files to save and export. […] The lack of sufficient time is a systemic issue throughout the organisation. It leaves psychotherapists with having to make life and death decisions on the spot as well as leaving suffering young people to prolong their battles and feel unworthy of receiving the help they deserve.”
In 2015, the government pledged an extra £1.4 billion over the course of five years to “transform” CAMHS. Research conducted by Young Minds into the responses of 199 Clinical Commissioning Groups (CCGs) from Freedom of Information requests revealed that less than 50% of the CCGs were able to provide full accountability on where their money was being spent. In addition to this, a high proportion of the additional government funds were used by the CCGs to backfill cuts. When asked why only 6.4% of government mental health spending went on CAMHS in 2018, Theresa May responded that money was being injected into mental health care “across the board”. I asked Robert about his thoughts on why the government were still limiting the funding for CAMHS, and why CAMHS were using their additional funding to backfill cuts and spend on other priorities.
“The NHS’s CAMHS has undergone years of underinvestment and underfunding, so despite the money they are pumping in currently (which still is not enough) it will take a long time to mend the provisions. We are definitely at the beginning of the transformation of CAMHS, but there is a lack of consistency due to some practices needing more help. Some practices are still dealing with being severely under-resourced, and so need this money to put into backfilling cuts. Others, especially in London where the denied-referral rate is much lower, will use the money to further reduce the rate of denied referrals or to decrease the waiting period.”
Before Hannah’s eating disorder grew to be life threatening, there were many times she felt failed by CAMHS. She told me “I was young, impressionable, deteriorating and desperately needed some intervention. Earlier intervention may have ended made my experience with anorexia a lot quicker. […] It’s been six years and I have only just been able to say I am no longer affected by my mental illness.” Perhaps the government’s plans to reform CAMHS are about to be in full effect, or perhaps CAMHS’ years of ill-nourishment will leave children and young people still on a waiting list for change.
