Each year, thousands of children who are referred to mental health services in Scotland wait for unacceptable periods of time for treatment to begin. Figures released by ISD Scotland this week revealed that between July and October more than 1,300 children had to wait longer than 18 weeks – the Scottish Government set standard. And, more than 20% of the children referred were never seen at all because they were rejected for not meeting the criteria.
Here we get a snapshot of how so many children in our country are being let down, with potentially devastating consequences.
A particularly vulnerable group of children who can suffer because of these long waiting times are those who have been sexually abused.
Each year, hundreds of children in Scotland call the NSPCC-run Childline service because of sexual abuse. A significant number of them also talk about mental health issues, with symptoms often being triggered by the trauma of the abuse they have experienced.
It is vital these children receive the correct and timely support they need to help them recover. Research shows that therapeutic intervention within four to six weeks of a trauma or disclosure decreases long term post-traumatic disorders.
However, it is not just lengthy waiting times that prevents these children from getting timely help – some, do not even get the option of mental health services or other therapeutic support.
NSPCC Scotland research has shown that Child and Adolescent Mental Health Services appear to be inaccessible to those who have experienced sexual abuse, because of strict referral criteria. Not all children who have been abused have a diagnosable mental health problem but the need for therapeutic support to help them deal with the trauma and prevent mental health problems, which are so strongly associated with sexual abuse, is indisputable.
Compounding this is the fact there is currently no standard expert assessment of a child’s emotional and mental health following disclosure of sexual abuse, and no routine follow up. Also, the availability of specialist therapeutic sexual abuse services is patchy and inconsistent across Scotland with the third sector, already under immense strain, being the main provider. An NSPCC Scotland study found that provision is best for older children but decreases with declining age of the child, with extremely poor provision for primary aged children. There is an almost complete dearth of services for children aged five and under or those with disabilities, who are at significantly higher risk of experiencing sexual abuse.
At the NSPCC, we believe it is paramount that when a child discloses sexual abuse, an assessment of their emotional and mental health support needs is carried out by an expert. This should also consider the support needs of parents and carers who are not the abusers.
The CAMHS crisis is not one that has gone unnoticed by the Scottish Government. Indeed, two years ago it commissioned Audit Scotland to write a report on rejected referrals to CAMHS and it set up a taskforce in response. The report noted that the Scottish Government’s Mental Health Strategy focused on early intervention and prevention but in practice this was limited, with mental health services focusing on specialist care and responding to crisis.
Audit Scotland called for an integrated approach, with councils and health boards working together to identify and address gaps, and in partnership with children and young people, their parents and carers, to develop a clear and coordinated approach to delivering these services.
No-where is the need for such an integrated approach more apparent than for children who have suffered sexual abuse. Meeting the complex social, emotional and therapeutic needs of these children and their families, demands close working between health – including CAMHS – social care and the voluntary sector. Only then can we ensure that these children get the right help and support at the right time.
The Scottish Government has committed to a Barnahus (“children’s house”) model – a one stop shop providing an integrated health, therapeutic and justice response to victims of abuse – and is currently developing standards. We wholeheartedly support this. But in the almost five years since this model was first mooted, support for children affected by sexual abuse hasn’t improved at all.
In the meantime, many of these children and young people can be left struggling with mental health issues with no-where to turn.
The Scottish Government needs to truly honour its commitment to early intervention and prevention – with investment. It is only then that we will start to make headway - breaking free of this firefighting cycle, where we only have the resources to respond to children once they have reached crisis point.
Joanna Barrett is Policy and Public Affairs Manager at NSPCC Scotland