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June 8, 2014

Medicine Balls, Private Eye Issue 1366
Filed under: Private Eye — Dr. Phil @ 8:47 pm

Urgent Investment Needed in Young People’s Mental Health Services

The British Medical Journal’s erroneous over-egging the risks of side effects of statins lead to former heart surgeon Sir Magdi Yacoub pronouncing that everyone over 40 should be on a statin to lower their cholesterol. Whilst statins can be life saving for those at high risk of heart disease and stroke, there is no evidence that the mass medicalisation of those at low risk and with no symptoms, would do any good. Making everyone pill-dependant, anxious and ‘at risk’ at the age of 40 is hardly a recipe for happiness, and the money would be much better spent on mental health services which are failing badly in the NHS.


A report by NHS England leaked to the Observer has found that only a quarter of children with mental health conditions receive the treatment they need, but this is hardly news. Multiple previous reviews have found the same problems, but the current budget cuts and increasing demand is tipping the service into crisis. Only 6% of spending on mental health goes on services aimed at children and young people, yet 50% of lifetime mental illness starts by the age of 14. MD’s own experience of trying to access mental health services for young patients it that they have to be very severely ill before they will be seen in many parts of the country. So young people with moderately severe anxiety and depression are left to deteriorate with no specialist care until they get bad enough to warrant it, often by self-harming or suicide attempts. NHS England  found that whilst 35% of adults with anxiety or diagnosable depression are not in contact with mental health services,  this rises to 76% for those aged five to 15.


There has also  been a sharp rise in the number of young people needing assessment for complex conditions such as attention deficit hyperactivity disorder (ADHD) and autism, and many face severe delays or are not seen at all. The report echoed MD’s experience that many services were unable to offer early intervention and we’re becoming ‘urgent only.’ In England there is only one mental health specialist per 30,000 young people under 20, compared with one per 5,300 in Switzerland, 6,000 in Finland and 7,500 in France.


A recent survey by YoungMinds, a mental health charity, found that two-thirds of local authorities had cut their budgets for young people’s mental health. Sarah Brennan, chief executive of YoungMinds, told the Observer: “It is verging on inhumane for children and young people to end up, as they do now, being shipped hundred of miles across the country for the nearest bed, held in police cells or placed on unsuitable adult wards. We should be ashamed of the paltry support and care we assign to the mental health of children and young people in this country.”


The government is investing a modest £17.4m to try to improve earlier intervention, diagnosis and treatment of mental health problems in under-18s, and the hope is that technology in the form of ‘e-Therapies and computer based-applications’ will work for the prevention and treatment of less every mental health problems and substance misuse in this group, to take the strain off frontline services. A recent systematic review of these services by the  National Collaborating Centre for  Mental Health found that the evidence of their effectiveness was limited. ‘When considering  e-Therapies collectively, the treatment delivered shows promise and may be beneficial for improving the mental health of some  children and young people.’ It also stressed that ‘e-Therapies are not a replacement for face-to-face therapy and, if used, should form part of a child or young person’s overall therapeutic plan.’


Clearly more research is needed, as is current data on the numbers of children and young people with mental health problems. The last national study was done 10 years ago and so commissioners are either ignoring the problem or ‘buying blind’ which is unlikely to result in a rational, cost-effective service. There is good information for young people with mental ill health and their carers, such as the MindEd website launched by the Royal College of Psychiatrists in March. It helps parents identify mental illnesses in their children at an early stage when early intervention could stop it progressing. GPs manage most mental health problems, often very effectively, but if referral to a specialist service is needed, it’s a long wait to get the right care. Mental health services are  much less sexy than, say, those for cancer and heart disease, but those with mental illness are at far higher risk of physical illness too and the impact on the whole family is huge. And the later the illness is picked up, the more damaging and costly it is. To deny proper care is a false economy as well as inhumane.