The launch of the Scottish Government’s Ten Year Mental Health Strategy in 2017 was welcomed as a sign of the government’s commitment to address some of the very worrying statistics related to the nation’s mental health, and particularly for those of us with a vested interest in our children’s mental health.
Half of mental health problems are established by the age of 14 and 75 per cent by the age of 24. Research also indicates that 10 per cent of all children aged between five and 16 have a clinically diagnosable mental health problem. This equates to three children in every classroom.
These concerning figures coupled with an ongoing increase in numbers of children and young people identified as needing additional support at school led to the Scottish Children’s Services Coalition’s call on Derek Mackay to triple current NHS spending on mental health services for children and young people and deliver a budget for mental health. We asked that Scotland simply match the proportion that the NHS in England spends on Child and Adolescent Mental Health Services (CAMHS), which equates to an extra £100 million a year.
What the budget delivered was an extra £10 million for children identified as having an additional support need. The increased funding was welcomed, in the same way that the Ten Year Strategy was welcomed as a sign of the government’s commitment to improving outcomes for our children. The hopeful, optimistic feeling, modest though it was in line with the small increase in funding, was shortlived.
On the same day that the budget pledged another £10 million for pupils with additional support needs, a freedom of information request identified that several NHS Boards had reduced their CAMHS budgets for the upcoming financial year despite failing to meet targets set by the Scottish Government.
The key target relates to 90 per cent of referrals to CAMHS being seen within 18 weeks. In the case of one health board, only 35 per cent of children were being seen within this target time. Figures contained in the written response to a parliamentary question indicated that a mere 0.48 per cent of the NHS budget is spent on specialist CAMHS. More concerning and confusing is that only 6.34 per cent of the overall mental health budget is spent on CAMHS.
The costs of failing to address mental health problems are well established. Those affected are more likely to be unemployed, homeless, get caught up in the criminal justice system or in costly long-term care. In many cases this can be prevented through early intervention.
The Ten Year Strategy published in 2017 has 40 action points. Those related to prevention and early intervention indicates that we need to do more to understand the various issues related to children and young people. Determine, review and evaluate are words that feature too frequently. Why is there such a need to ask questions as the initial stages of the strategy, given that this is not the first?
In 2016, A Review of Mental Health Services in Scotland was published. This was a fulfilment of one of the commitments of the 2012-15 mental health strategy. The report was in turn a review of the impact of the 2003 Sandra Grant report to review the state of mental health services in Scotland.
If we have been reviewing and strategising about mental health since at least 2003, why do we still have so many questions, particularly related to CAMHS? Waiting targets are not being met, funding is being cut, and almost 20,000 referrals have been rejected in the last three years. Why can we not commit to a couple of apparently obvious actions?
The Ten Year Strategy calls for the provision of trained, frontline, mental health staff in custody suites, prisons, doctor’s surgeries and A&E departments. If we know that 50 per cent of mental health problems are established by the age of 14, why is this support not directed to early intervention which would help to reduce the need for custody suites and prisons? If 75 per cent of mental health problems are established by the age of 24, why is the CAMHS budget only 0.48 per cent of the overall NHS budget?
Why, critically, can we not learn from the experience of others? The British Association of Counsellors and Psychotherapists reported last year that 88 per cent of children who received support from school counsellors in Wales did not need onward referral to CAMHS. Funding is a critical issue, so why can we not spend to save in the future and follow the example of Wales and Northern Ireland and make school counselling services mandatory? Must we remain slow to learn?
Kenny Graham is head of education at Falkland House School, a member of the Scottish Children’s Services Coaliton.