THE mental health of our children and young people is never out of the headlines these days.
And with good reason. One in six young people in Scotland are currently suffering from a mental health condition.
A high statistic for such a small nation, you may ask. But I see it daily.
Working on the frontline every day – I see the desperation from families and loved ones wanting the best help for their young ones.
I also see the hope on their faces that one day, their child or teenager will get better.
Sadly, we currently have a mental health crisis on our hands.
The latest round of waiting time figures from Public Health Scotland makes for dismal reading.
Statistics reveal 70 per cent of children and young people were seen within 18 weeks from September to December, last year.
This is a drop from 79% in the previous quarter and from 73% in the same period the year before. It’s also worth noting that the Scottish Government’s own target is 90%.
If they’re lucky enough to be seen, they may then have to wait longer for specialist assessments or treatments. Sometimes there just aren’t enough resources for a proper follow-up.
It’s true that the pandemic has affected both CAMHS [Child and Adolescent Mental Health Services] and adult mental health services. But truth be told - things were already very difficult before the Covid-19 crisis hit.
The impact of the last two years has been exacerbated by a mental healthcare system that can often be confusing and disjointed, increasing the possibility of young people falling through the gaps between services.
It’s also a system which can create delays to treatment and although we’ve been campaigning hard – mental health services remain a long way from an equal footing with physical health.
There is a sense of urgency, now. What most people would take for granted from specialist services in physical healthcare is something we’re still fighting for.
Working as a psychiatrist has given me a bird’s eye view of how services are currently running in Scotland.
There is a postcode lottery. Unfortunately, how much help you get, is based on where you live. There are great variations up and down the country.
Our most recent research by the Royal College of Psychiatrists in Scotland, found the level of spending per head of population for CAMHS services helping those aged 0-17, varies significantly.
The biggest contrast was found between the Western Isles - where £156 per head was spent in 2019/20 - and Orkney, where only £20 was spent despite having a similar size of population.
While £44 was spent per head in Fife, a large geographical area, more than £105 was spent in Tayside during the same period.
And the figure for Glasgow and Greater Clyde was £90 compared with £103 for Lothian.
The level of spending on CAMHS across the country really is quite striking.
After two years of the NHS being stretched beyond belief – goodness knows what those figures look like now.
We also have the problem of some young people being referred to CAMHS when sending them to another service, within the local community, would be more appropriate for their condition.
This would free up services for those who need to see a psychiatrist, as not everyone does. There may be more appropriate and immediate help in other areas of our mental health service for these people.
We recently ran our own poll with CAMHS psychiatrists from across Scotland.
Our research showed almost nine in ten (88%) said their services were either insufficiently or very insufficiently resourced.
About 84% said they had seen a significant increase in the need for mental health services during the pandemic and more than six in 10 (62%) said the Covid crisis had a very negative impact on the wellbeing of children and young people to whom they provide care.
More than nine in 10 (92%) of the 51 respondents said that the staffing situation had got worse due to the pandemic.
This research highlights big problems. But as clinicians, what are our solutions?
The powers that be need an urgent action plan. We know huge areas are underfunded while others with a lower population are receiving more money.
It doesn't make sense that a child under the age of 17 gets a different level of service when it comes to their mental health, depending on where they live.
More needs to be done on investigating how these vital services are funded across each health board – so every child and young person is given the best chance of treatment and support.
We also desperately need more trained staff to allow us to deliver specialist care – in fact - we need around 500 more workers in CAMHS of all professional types.
It goes without saying, there also needs to be much greater co-ordination between services so every young person gets the right support, at the right time.
If a young person isn’t clinically in need of CAMHS, then they should be given access to the right care and support.
Early intervention also needs to be closely looked at. It’s necessary to prevent a generation of people suffering with mental health difficulties in the future.
Although we very much welcomed the efforts that have already gone in to investing into CAMHS through the Mental Health and Renewal Fund – people cannot assume that this means the job is done. To put it bluntly, this investment cannot end if we want meaningful change.
Funding in CAMHS as well as in adult mental health services needs to be sustained.
We need planning in place to enable these vital services to meet the ever-increasing demand.
As psychiatrists working hard on the frontline during the worst health crisis in modern history, we know our caseload will dramatically increase in the future.
Our young people need help with their mental health more than ever and we need a proper explanation as to how targets will be met. There is no point in covering the wounds with sticking plasters – we need a plan.
There is no health without mental health and that’s why those in power should be pulling out all the stops now and outlining how they will meet their own targets by 2026.
For the sake of all our children and young people. For the sake of future generations. These are problems which need solutions. We need swift action. We need it now.
Dr Helen Smith is chair of the CAMHS Faculty at the Royal College of Psychiatrists in Scotland
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