As an organisation which supports some of Scotland’s most vulnerable children and young people, we recently welcomed the new Scottish Government Cabinet Secretary for Health and Sport, Jeane Freeman MSP, to her role.
Given our commitment to improve services for those with mental health problems, it was heartening to see one of her first actions was to recognise as “completely unacceptable” that one in five children and young people seeking mental health treatment have this rejected.
We have previously expressed concerns over the increased demand on child and adolescent mental health services (CAMHS) and that a high number of children and young people referred for treatment have this rejected, often with no explanation or with no alternative support. This leaves many thousands of vulnerable children and young people in limbo.
An audit commissioned by the Scottish Association for Mental Health (SAMH) and NHS Information Services Division was undertaken on behalf of the Scottish Government to review this situation. What is clear from their recently published report is that the needs of many of these young people are not viewed as severe enough to warrant CAMHS – however, appropriate alternative support is lacking.
Many children, young people and their families said that they had received a rejection letter within a very short timescale, and feel angry, aggrieved, cheated and let down that no proper assessment process has been undertaken.
More disturbingly, it appears that some clearly require treatment but this is being rejected, often without any face-to-face meeting with a specialist. Only 31 per cent of those who undertook an online survey got a face-to-face assessment, and the majority were rejected on the basis of a written referral.
It was disturbing to read the harrowing first-hand accounts of the experiences of young people and their families. This includes some believing that they would not be seen unless they were suicidal or at risk of harm, and the impact that failure to get good enough treatment has on mental health, often with the situation worsening and entering a crisis situation. There was evidence also of those who were self-harming, but whose condition was not deemed severe enough to warrant treatment. This is wholly unacceptable.
It is pleasing to see the Cabinet Secretary fully accepting the 29 recommendations outlined in the report on these rejected referrals and creating a new CAMHS taskforce, headed by mental health expert Dr Dame Denise Coia, backed with £5 million of investment to reshape and improve CAMHS.
This aims to ensure that all children and young people are appropriately triaged, given proper explanations if their referral is refused and directed to alternative support services. One of the key recommendations was the requirement for increased investment in CAMHS and the provision of alternative support services, for those who may not require CAMHS, with mandatory signposting to these. Yet we have seen cuts to these support services over the years. If we are to deliver support, we need greater investment not only in CAMHS, but in alternatives.
It was heartening to also note the desire for a nationwide provision of schools-based services is recognised.
Investing a fraction of the mental health budget on school-based counselling services, for example, helps keep children in school and avoid unnecessary and often stigmatising mental health diagnoses, as well as reducing the burden on stretched and costly CAMHS provision. Counselling services are guaranteed in all secondary schools in Northern Ireland and Wales. In Wales the vast majority of children and young people who received counselling (88 per cent) did not require any onward referral once it had been completed. To put this in context, the cost of five sessions of counselling is equivalent to just one contact with CAMHS.
Achieving good outcomes for children and young people’s mental health demands a contribution from the whole of society, including the health service, local government, the third sector and beyond.
Significant improvements require to be made and these can only be achieved through a collaborative approach between partner agencies. Issues around mental health represent one of the greatest public health challenges of our time and we would urge the new Cabinet Secretary to put mental health at the heart of the Scottish Government health agenda, providing the high quality support that children and young people deserve.
Lynn Bell is CEO of Love Learning Scotland, a member of the Scottish Children’s Services Coalition.