The reality is that nothing I have encountered previously in my career has compared to working in a child and adolescent mental health service (CAMHS) over the past year.
In the first lockdown, it seemed our patients and their families were coping fairly well. We had staff absence to manage as they caught Covid or had to isolate but the main challenge was adapting the way we work.
We rely hugely on communication, both verbal and non-verbal but had to get used to video appointments or using PPE to see patients face-to-face.
Working in mental health is very much a multidisciplinary effort but we haven’t been able to work as closely as a team. Remote working and social distancing have become our new normal.
We have had to be creative so we continue to support each other and look after our own mental health – crucial for the work we do. Small things like a socially distanced cuppa or ten minutes fresh air at lunch time have never been more important.
In this winter lockdown, it has become clear that more people are struggling. By the autumn of 2020, we started to see more emergency presentations of some very unwell patients, often presenting quite late and needing intensive treatment or even hospital admission.
Self-harm and suicide attempts amongst our young people have been increasing in recent years. We don’t fully understand why and the reasons are likely to be complex but it does seem to me that the positives of social media, so crucial in maintaining connection over the past year, can also be a toxic environment for some.
I had predicted we would see an increase in anxiety and depressive disorders. However what has been more surprising is the number of patients presenting with eating disorders. This seems to be happening throughout the UK and actually makes perfect sense given that these disorders thrive in isolation.
Of course, the negative impacts of social isolation on mental health are well known and children need the social interaction and stimulation of school and activities.
I really worry about our more vulnerable families living in poverty, poor housing and lacking accessible, safe outdoor space.
We know that the mental health of adults has suffered throughout the pandemic and this inevitably has a huge impact on their children. Our colleagues in social work tell us they are equally busy dealing with concerns relating to parental depression, anxiety and alcohol misuse.
I fear in CAMHS we may not be passed our peak and could be seeing the impact of this pandemic for years to come. Services which have struggled with chronically long waiting lists will find it ever harder to cope.
We urgently need to focus on better recruitment and retention of psychiatrists, investment in early intervention services and an increase in overall funding for CAMHS (currently around 0.56 per cent of the total health spend).
We know how to treat poor mental health in childhood in order to avoid issues persisting into adulthood. We just need to be resourced so we can do this for every child and young person who needs it.
Dr Julie Arthur is a consultant child & adolescent psychiatrist