Promoting Good Mental Health

At the core of the work of the ACP and its members is a wish to prevent or reduce the impact of mental ill-health on infants, children, young people and families.

Where difficulties have developed or become entrenched there should be timely and effective services to meet a range of needs, some of which can be severe and complex. The crisis in the availability of child and adolescent mental health services is well documented, with many more children and young people needing treatment than there are services to provide it. Action is being taken by all the nations of the UK to improve this situation and the ACP is working hard to support these developments and make sure children and young people get the care and treatment they deserve.

Complex needs in children and young people

  • One in eight 5-19 year olds had a diagnosable mental disorder in 2017, equating to roughly three children in every classroom. Currently only one of these three children is able to access treatment and support.
  • The significant and rapid expansion of mental health services for infants, children, young people and their families is a welcome element of the NHS Long term plan (LTP). The commitment to early-intervention services in schools and colleges is a positive development that will increase the capacity in the system and help to address the needs of some children and young people. As there is more extensive provision of services in the community the needs of the two children in each classroom who are currently not receiving help will be uncovered and understood, and some of these will require specialist input.
  • 40% of children with mental health difficulties suffer from two or more mental disorders; this equates to approximately 48 children in the average state-funded secondary school, 14 children in the average state-funded primary school and 13 children in the average independent school who are likely to require specialist support.
  • Children and young people with complex needs have often suffered from early trauma or adverse childhood experiences, or are in the care system. They can be hard to understand and engage in treatment and require a multi-disciplinary approach.

Specialist services need further investment

  • Specialist children and young people’s mental health services are already suffering from high demand, long-term underfunding and service transformations which leave them without the specialist clinicians they need to respond effectively. Unless the expansion of children and young people’s mental health services is allied to a commensurate increase in specialist services and clinicians who can lead and support the staff in schools and also assess and treat children and young people with more chronic, severe or complex needs, it will not be effective.
  • There is currently a significant misalignment between the severity of need and provision. More funding alone will not solve the problem. A drive towards short-term solutions intended to meet immediate pressures ignores the complexity of the needs of many children and young people who require specialist treatment. Specialist multi-disciplinary services in many parts of the country are currently inadequate to meet the needs of this group of patients and in many places are being eroded by service transformations designed to increase capacity whilst driving down costs. Such service transformations can have the effect of reducing the effectiveness of services and in fact driving up costs across the system.
  • Not providing the right treatment at the right time has significant implications both for the patient and the wider system. This includes worsening mental health and a further strain on NHS resources through an increase in A&E attendances and inpatient treatment, with an increasing cost of patient care. The cost of providing CAMHS community support for a year is £3,000 compared to £100,000 a year per inpatient.

A multi-disciplinary service is essential

  • Effective, timely and responsive services for infants, children and young people with mental health difficulties, and their families and carers, depend on multi-disciplinary teams able to offer a range of evidence-based treatments and interventions. These teams should include child and adolescent psychiatry, clinical psychology, child and adolescent psychotherapy, family therapy, other psychological therapies, nursing and allied professions as appropriate to the needs of the population.
  • Child and Adolescent Psychotherapists (CAPT) are amongst the most highly skilled and rigorously trained mental health professionals working with the most vulnerable and disturbed children and young people; often those whom other therapeutic interventions have not been able to help. They are a crucial element of these specialist treatment teams and are essential to the aims of the Long Term Plan.
  • As well as providing specialist treatment alongside other professions, Child and Adolescent Psychotherapists are well placed to contribute to assessments to ensure that children and young people with severe mental health needs are identified and directed to the most appropriate care. This improves patient care and helps to prevent more costly intervention being required further down the line.
  • They also play a crucial role in providing training, case consultation, supervision and specialist clinical leadership for colleagues across the wider children’s workforce so that they are better able to carry out their work.
  • If specialist services including CAPT are not properly supported this may have a negative effect on outcomes. Not only will there be an inadequate number of specialist clinicians to meet demand but other mental health staff will not have sufficient leadership and supervision to help those with complex or severe mental health needs. Patients will not receive the specialist support they need, and there will be knock-on cost impacts on the NHS and wider society.