On Monday 30th October I asked the Government what action they were taking to ensure that children and young people could access mental health services in a timely way. I have been campaigning to improve CAMHS and this was my latest attempt to put the Government on the spot.
The best that Lord O’Shaughnessy, the Lords Health Minister, could offer was that each year 70,000 more children will receive evidence-based mental health treatment. This is less than half of the 150,000 CAMHS appointments that children and young people miss each year for various reasons – another issue that I have raised recently.
One of the critical issues, at a time of increasing demand for help, is the shortage of qualified staff. We now have 6.6% fewer CAMHS psychiatrists than we had in 2013 and only 2.6% of doctors who complete their foundation training go into psychiatry. Although the Government talk of 21,000 more mental health staff in post by 2020, I have yet to be convinced that there are any real plans to train, and then employ, these staff. Specialist mental health nurses are also an issue given today’s figures from the UK Nursing Register about the reduction in the number of registered nurses.
A student starting at medical school will need 13 years of training to become a consultant psychiatrist, so there are no quick fixes for increasing the numbers, particularly when in 2016 over one third of places for core psychiatry training remained unfilled. At the moment, nearly half of trainee psychiatrists come from abroad, but this “trainee migration” into the UK may well be affected by the Brexit process and is not helped by the £2000 levy (introduced in April 2017) for any employer sponsoring a psychiatrist on a Tier 2 visa.
There is no shortage of evidence of the crisis in meeting the rising demand for CAMHS, but it is much easier to bandy figures around than to talk about the very real distress of children and young people who cannot get the help they need whilst they wait weeks or months.
In October the Care Quality Commission published its phase one report on a major review of children and young people’s mental health services. CQC found significant variations in the needs of children, as a result of their different circumstances and their stage of development, but more important is the variation in the availability and quality of services. Schools, GP practices and A&E staff do not have the skills or capacity even to identify mental health problems, let alone treat them, which leads inevitably to missed opportunities to direct young people to the services they need early before the problem escalates into crisis.
Once a problem is identified, there are barriers to accessing care, with long waiting lists for specialist care in the community and a lack of in-patient beds close to where the young person lives.
We must do something to discourage qualified staff from leaving the country whilst we train more. Whilst increasing the level of services available is vital we also need to tackle the complexity and fragmentation of services, with more effort to join-up the services that are provided by so many different organisations.
* Baroness Walmsley is Co-Deputy Leader of the Liberal Democrat Group in the Lords.