Last week the UK Government’s Child Mental Health Taskforce published a report: Future In Mind – Promoting, protecting and improving our children and young people’s mental health and wellbeing.
As a clinician working for part of my week in an NHS acute psychiatric ward for 12-18 year olds, I welcome this focus on children and young people’s mental health, but I can’t help but feel a sense of unease about some of the recommendations.
The key themes the report outlines are:
- Promoting resilience, prevention and early intervention
- Improving access to effective support – a system without tiers
- Care for the most vulnerable
- Accountability and transparency
- Developing the workforce
Nothing to argue with there – some might say, but reading the report I had three main worries:
1. The vagueness, in parts (not all) of the report, in specifying how these goals are going to be achieved when designing services which need to be clear in their purpose and coherent in the way they fit with other services. There are some helpful ideas e.g. suggestions for commissioner training, and building on existing good practice in terms of coordinating young people’s care. There are also areas where there is a lack of attempt to crystallise ideas into more practical suggestions for coherent service structure, with nebulous “transformation plans” and other jargon referred to.
2. The lack of consideration of why a ‘tiered’ system exists – namely that different young people present to services with different severity of problems, and need different environments and treatment to manage this care. We need to respond differently to different levels of clinical risk and a tiered system allows us to do this more effectively and more safely.
3. The total lack of acknowledgement of cuts to outpatient child and adolescent mental health services (CAMHS), and to social care services responsible for children and young people’s well-being. These funding restrictions have contributed to the difficulties which the remaining CAMHS and social care teams face in meeting targets relating to waiting times. The report refers to government money spent on inpatient beds, Children and Young People’s Improving Access to Psychological Therapies programmes (CYP-IAPT), and MindEd resources. It is great that these are receiving funding, but simultaneous devastating staff cuts in other CAMHS services are also happening. The language around this report talks about CAMHS needing a “culture shift” and an “overhaul”, but to remove funding and then criticise CAMHS for not meeting targets or not embodying patient-centred care as much as it should feels nonsensical.
I’ll be watching developments with interest, and hoping that my concerns prove unwarranted.