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Thursday 1st
posted by Morning Star in Features

Young people in Britain are being failed by a disjointed, tokenistic and cash-starved approach to their wellbeing


BOTH Labour and Lib Dem politicians have recently announced a raft of plans to improve mental health services for children and young people — but these represent nothing more than pre-election gimmickry to garner good headlines.

Child and adolescent mental health challenges have been in the public eye for the past 20 years, yet they have been at worst ignored, and at best treated tokenistically by all major political parties in or out of government.

Suicide is now the second most common cause of death in young men and women in Britain, yet stigma and shame continue to blight those trying to cope. Three young people commit suicide every day, while tens of thousands self-harm or suffer serious depression and anxiety preventing them studying or in some cases even attending school.

Working-class children feature disproportionately in the numbers affected. School teachers and parents are crying out for the resources to tackle the problem.

Official statistics show the volume and complexity of child and adolescent mental health problems has increased rapidly during the past five years of austerity.

Public health enquiries and other research have highlighted the need for a response to meet the overwhelming demand which has stretched existing provision beyond its capacity to cope adequately.

Government policy encourages multidisciplinary and interprofessional responses, yet it does not provide any more finance to increase service provision. In nearly every part of the country waiting times for assessment are in excess of eight weeks, and it can take six months for treatment to begin. That is a long time to leave a child and family suffering.

The traditional model of community child and adolescent mental healthcare (CAMHS) in Britain began formally over 50 years ago, when the first child guidance clinic opened in east London in 1948 after earlier limited developments to help children with emotional and behavioural difficulties.  

This was the result of pressure from education and health officials since the beginning of the 20th century, who were concerned about the abilities and behavioural problems of children brought into the new state compulsory education system.

It comprised a team composed of various professionals with health, education and social work backgrounds who all brought their separate training, theoretical understandings and working practices under one clinical umbrella.

Their aims were to intervene with children and families referred for help in a variety of ways where there were concerns about a child’s mental health, behaviour or emotional development. Each team member had distinctive skills and worked with the child, parents or whole family. In the next 25 years child guidance clinics grew in number and became accessible to more and more children and families.

However, their success in offering support to parents resulted in increasing demand, long waiting lists, delays in treatment and pressure to prioritise the most urgent and worrying cases.

These would invariably include children with severe and longstanding mental health problems, aggressive and disturbed behaviour, experience of physical, sexual or emotional abuse, depression, acute anxiety and suicidal behaviour.

One of the difficulties highlighted in a seminal piece of research 20 years ago was the gap which had been steadily growing for decades between the primary care sector and the specialist child guidance service.

A four-tier structure was designed to streamline the referral process for children who could be helped with minor emotional and behavioural problems at tier one by GPs, teachers, social workers and health visitors.

This progressed through to tier four, where very disturbed young people who were at risk of harming themselves or others could be supported by highly specialised staff.
 
It was all based around the simple idea that early intervention could prevent problems getting worse and thus harder to resolve. But constant changes to primary care, NHS reorganisation and the introduction of private providers have all destabilised the system, demoralised staff and undermined good practice.

Child guidance clinics were incorporated in changes brought in towards the end of the last century and now known as CAMHS. They were health-led bodies often designed as outpatient clinics in office buildings.

When children and young people were consulted they said they found that these services lacked accessibility and were not designed around their needs. They were perceived as unhelpful, stigmatising and unfriendly. The milieu of young people’s mental health does not stick to 9-5 office hours and it is often wrapped up with substance misuse, alcohol and family breakdown.

Poverty, unemployment and poor housing are also implicated in developing mental health problems. What young people required were accessible services open at weekends and evenings where they could drop in, with staff who were qualified to work in a variety of therapeutic ways and who were trained to empathise with and understand young people.

The last national report from the NHS in 2008 demanded increased training for all staff working with young people, more specialist resources and extra investment in early intervention services to prevent problems arising in the first place.

Seven years later, the situation is worse. Staff vacancies are high, moral is at rock bottom, budgets are slashed and demand for help and support is increasing. Early intervention services have been cut back in a classic example of a false economy.

Britain has the unhappiest children in the European Union according to research by the World Health Organisation and charity the Children’s Society.

If economic austerity is set to continue after the general election in May then the current announcements by major politicians will be seen to be just more empty rhetoric, with young people set to pay a heavy price.

Steven Walker is a Unicef children’s champion




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