The following article was written by WPB member Liam Stowell for Nursing Times, and is reproduced here with thanks.
The current narrative around children’s mental health is one of crisis. There is news story after news story about services being at breaking point.
During the past 18 months we have been told there is a mental health pandemic coming, alongside the current Covid-19 one. This led me to wonder, is the current state of play worse than when I started in mental health services 10 years ago?
The majority of my colleagues, over the past two years, have used hyperbolic language such as: “This is the worst it has ever been” or “I don’t know how much longer I can cope with doing this”.
Yet children’s mental health services, at least on the surface, are in a better condition than they have ever been. There are ever expanding crisis services, mental health teams within schools, practitioners in youth offending services and this is all in addition to the local child and adolescent mental health services (CAMHS) offered. The data also seems to back with suicide rates in young people falling between 1999 and 2017. There has been a slight increase since then but the rate is still relatively low in comparison to other developed countries such as the US and Russia.
However, look beyond the surface and you will start to see why the pressure is building. Although there is more service provision for young people than ever before, many of the services are chronically understaffed and are not able to meet the demands placed on them. This creates the illusion of success within mental health services with an apparent broad range of services on offer, while the reality is ever-increasing waiting lists and staff shortages.
We have also seen a significant increase in young people being prescribed antidepressant and antipsychotic medication. Young people are also being cared for by mental health services for longer than ever before with a a steady increase in hospital admissions due to self-injury and overdose. Dramatic increases have been seen in the diagnosis of neurodevelopmental conditions, such as autism spectrum disorder or attention deficit hyperactivity disorder.
We now have a generation of young people that are more likely to be diagnosed and medicated than ever before, but this does not seem to be leading to better outcomes. Few people are talking about the contextual reasons behind the mental health epidemic we are seeing.
The current focus is on early intervention and prevention, but there is an argument to suggest that mental health services are not in the best position to do this. If a person is referred and accepted into a mental health service, there is a presumption that there is something mentally unwell about them, which makes the prevention aspect challenging.
Also, many of these services focus on individual difficulties, suggesting that there is “something wrong” with the patient and only they can change this. This is reflected in the majority of treatments offered, which include cognitive behavioural therapy, acceptance and commitment therapy, and cognitive analytic therapy, amongst others.
It is rare that a child is understood within their family or societal context in these services. This takes me back to me original point – why does it feel as though mental health services are at breaking point?
There is a saying that it takes a village to raise a child. Well this is also true within mental health – it takes a community help someone with mental health difficulties recover.
Over the past decade we have seen cuts across the board to public services that have not been seen for generations; unemployment has risen, individual debt has risen and there has been an increase in domestic violence, violent crime and sexual assault. Alongside this we have had a global pandemic in which children have been left in a perpetual state of uncertainty about their education.
These are the reasons mental health services feel at breaking point because large parts of society also feel this way. Unless this is addressed on a multi-system level, opening up more mental health services will only create more people for mental health services to provide care for. It is the equivalent of putting a plaster on a gunshot wound.
Liam Stowell is clinical team manager, Mid Mersey children and young people crisis response, Mersey Care