Baroness Joan Walmsley writes…Wasting a rare resource – and children’s lives

One of the worst scandals in the NHS is the provision, or lack of it, for children with mental health problems.

“Stick with us” is a major report by the Children’s Society about more than 150,000 missed CAMHS appointments in 2016. It is estimated that, at £290 per appointment, they cost £45m last year – much less than it would cost to collect proper data about child mental health. The last proper data was collected in 2004, so it’s not just the present government who are to blame.

These figures, obtained by FOI requests to providers of specialist CAMHS services, are obviously available to government. However, one can only assume that the government did not know, or chose not to find out, how bad the situation is.

As the report points out, there are many reasons why children and young people miss appointments: failure of parents to get them there; lack of transport; lack of appointments at an appropriate time; length of waiting time (average 58 days) between referral and initial assessment so people forget about them; length of time between assessment and first treatment (average 41 days but up to 208 days); stigma; etc etc.

What is of particular concern is that, having crossed the threshold for a referral, which is set pretty high, too few missed appointments are followed up. Instead 20% of 16-17 year olds who didn’t turn up are discharged without a risk assessment.

It’s difficult to know where to start in addressing this issue, when child mental health remains a Cinderella service, but there is enough evidence in serious case reviews to indicate the worst outcomes.

The Children’s Society recommendation include:

  • the forthcoming Mental Health Bill should introduce maximum waiting times and require providers to follow-up missed appointments
  • strengthening Working Together to Safeguard Children to require local areas to record and respond to missed appointments
  • NHS should routinely collect and monitor this data
  • CQC should monitor how providers prevent and respond to missed appointments
  • Clinical Commissioning Groups should pilot CAMHS interventions in accessible settings with flexible appointments

I will be raising these issues when the Mental Health Bill comes to the House of Lords. For some of the most vulnerable and fragile children and young people, travelling some distance to an unfamiliar building, explaining where you are going and missing at least half a day of education, are several bridges too far.

But there is some good practice. In some schools, counselling is provided discreetly on site. Sessions, which are just one lesson long, are offered at a different time each week.  I am not suggesting that will work in every case, but some secondary and primary schools find that it does.

Of course, some schools might not have space for this and some CAMHS staff might baulk at travelling to different schools, but none of these objections have anything to do with the needs of the children and young people themselves. Perhaps the idea of moving the service to the client rather than making the client travel to the service is altogether too radical? However, if we can save a few million quid and a few kid’s lives, it is certainly worth looking at.

* Joan Walmsley is a Liberal Democrat member of the House of Lords

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