The Times

Rosemary Bennett and Kaya Burgess

As always Gerry Gajadharsingh writes a comment at the end of each newsletter/blog article to give his clinical perspective.

The scale of the crisis that is engulfing children’s mental health is revealed today with official data showing that a record number of youngsters are being admitted to hospital for self-harm, eating disorders, depression and other psychological disorders.

Emergency admissions for psychiatric conditions soared to 17,278 last year, double the number four years ago. There were 15,668 admissions of young women aged 15 to 19 for cutting, burning or harming themselves, compared with 9,255 admissions in 2004.

A total of 2,965 children were treated on wards for anorexia and other eating disorders, a 12 per cent jump in one year and double the number treated a decade ago.

Experts say that exam stress, social media, bullying and the pressure to look slim and attractive are combining to make children’s lives unmanageable. However, they also criticised savage cuts to early intervention services, which meant that families struggled on alone until they reached crisis point and turned up at A&E.

Only 6 per cent of the NHS mental health budget goes on services for children and teenagers.

In response to the crisis, The Times today launches a manifesto written by Tanya Byron, the leading clinical psychologist and government adviser, and three other experts in the specialty, representing the Royal College of Psychiatrists, Great Ormond Street Hospital and the YoungMinds charity.

It calls for:

• A “state-of-the-nation” study to be carried out immediately to update statistics that professionals have to use, which are now 11 years old.

• An urgent revival of early intervention services in schools and communities to prevent children from being forced to wait until their conditions are life-threatening before getting help.

• Investment in emergency beds to end the scandal of children being held in police cells, on adult psychiatric wards or being sent across the country in the midst of a crisis.

• The 18-week waiting time for non-urgent physical health treatment to be extended to cover non-urgent children’s mental health.

Professor Byron called the manifesto “a blueprint for urgent change”. She said: “When are we going to wake up to the fact that mental health problems in children can be as serious and life changing as physical illnesses? How as a society can we justify the fact that the mental health of children is so low on our list of priorities?”

Assessing children who could be treated effectively and early but often have to wait months for treatment can be a daily reality for those who work in the sector, she said.

“In this election year this manifesto sets out clearly and definitively a blueprint for urgent change. We are fundamentally letting young people down.”

The latest evidence that children are being failed came during an inquest yesterday into a 16-year-old girl with a history of self-harming, who committed suicide hours after attending A&E for her injuries. Numerous attempts to get proper psychiatric help for Aleysha McLoughlin had failed and she grew disengaged and eventually refused all offers of help.

The manifesto authors say that it is frustrating that ministers claim children’s mental health is a priority while figures show spending on services has fallen every year since 2010.

With only three weeks to go before parliament is dissolved, the government is yet to publish its plans to restructure Children’s and Adolescent Mental Health Services. A leaked copy seen by The Times suggests that the report shies away from making any estimate of the resources needed to meet rising demand.

Norman Lamb, the health minister responsible, said: “Children’s mental health care is a priority. We’ve invested £7 million in new beds, £150 million in support for young people with eating disorders and who self-harm and we will shortly publish proposals on how we can make sure every child gets the care they need at the right time.”

Andy Burnham, the shadow health secretary, said: “If mental health is the poor relation of the NHS, then children’s mental health has become the poor relation of the poor relation.”

Peter Hindley, chairman of the Royal College of Psychiatrist’s Child and Adolescent Faculty and one of the authors of the manifesto, said: “Ensuring the safety of children and young people should be the No 1 priority. Failure to improve inpatient and community care will mean they will continue to be at risk to themselves and others.”

Case study: Three years in a fearful wilderness

Within the course of a few months, Sorcha Monaghan’s life fell apart (writes Rosemary Bennett). The 13 year-old went from being a bright, beautiful, student to a girl who was unable to face school, maintain friendships and began self-harming.

“I knew this was serious and she needed help,” Liz Monaghan, her mother said. Thankfully her GP agreed and referred Sorcha to CAMHS. However, in the time it took to get an initial assessment she had virtually stopped going to school, so extreme had her anxiety become.

Family therapy was offered and things seemed to improve. An opportunity came for Sorcha to move from the family home in Leeds to London to live with her father and the family saw this as a chance for a fresh start.

However, the symptoms emerged once more and within weeks she had again stopped going to school, unable to face the day.

Educational support was well-meaning but inflexible — impossible with a condition that changed day to day. Sorcha’s parents eventually felt there was no choice but to try to teach her at home.

There was no prospect of psychological treatment. Mother and daughter were told that waiting lists were often longer than six months and a CAMHS therapist suggested Mrs Monaghan buy a book on CBT and try to do it herself.

Knowing her daughter needed professional help, the pair moved back to Leeds, where Sorcha’s history was known. “We arrived back in June 2013 and by December Sorcha still had not had an assessment, even though she was a continuing patient. Her mental health deteriorated as she waited for an assessment and treatment and her symptoms became life-threatening” Mrs Monaghan said.

Eventually, three years into her illness, Sorcha was offered six months of CBT. That has now ended. Group therapy was offered but Sorcha’s agoraphobia and anxiety mean she is unable to attend.

Gerry Gajadharsingh writes:

Unfortunately this is the tip of the iceberg. 17,000 emergency admissions in the UK for diagnosable psychiatric conditions in children is extremely high, a 100% increase in 4 years. It seems utter madness that we have to wait until children are so ill that they need hospitalization before they get the help that they need. 

Given that number, imaging the number of cases that we are seeing in primary care (both the NHS and private sector), although they may not be bad enough to need hospitalization, they are presenting with a range of symptoms where underlying stress/anxiety/depression is a large contributory factor. Appropriate healthcare support for mental illness has always been the poor relation in healthcare; it seems to be getting worse. Categorising health problems as either “physical” or “mental” is so outdated and obviously not helping and driving competition for resources.

With the NHS struggling for resources many patients are now turning to the private sector, with many clinicians and their respective professions having to develop their skills and strategies to take account of the stress/anxiety/depression impact on symptom presentation.

Whilst talking therapies can be helpful and in many cases necessary, the response depends on the experience of the therapist and their type of therapy. So often there are also great practical self-help therapies such as mindfulness breathing re-education and learning meditative techniques. Whilst addressing eating habits can be challenging in children (especially in those with eating disorders) realising that “Everything can be about something else” means that parents and clinicians who are helping children with physical symptoms, need to be aware that the symptom may not be the problem. Helping children (and parents) understand this, thus tackling problems before they turn into a mental health crisis, may go some way to reducing the serious mental health issues that children are now facing.