The long wait for help: The children being failed by Scotland's mental health crisis
In the depths of winter, as ambulances queued up outside A&E departments and patients crowded into hospital corridors, it was hard to avoid the challenges facing the NHS. As nurses and paramedics threatened to strike and newspaper headlines told of a succession of human tragedies, each one more shocking than the last, politicians talked of reform and the need to do things differently.
As the worst of the winter crisis now recedes from view, the health service finds itself back in default mode – just about managing in the face of increasing pressures as it one again slips down the list of immediate political priorities. But while 999 calls are being responded to more quickly and the impending meltdown appears to have been staved off at least for another few months, the country remains in the grip of a medical emergency.
The emergency takes many forms, the symptoms of an ailing system badly in need of care. One of these is the crisis in child and adolescent mental health services (CAMHS). Despite not having the same profile as the difficulties facing A&E or cancer care, the situation is no less shocking.
According to figures from Public Health Scotland (PHS), there were more than 7,500 children and young people waiting to begin treatment in the last three months of 2022. The figures, the most recent available, show that while the number is falling (down from over 10,000 in the same period the previous year) just 70 per cent of patients were seen within 18 weeks of referral – well short of the Scottish Government’s target of 90 per cent.
You don’t have far to look to find the human consequences of this failure. One such case was raised at Nicola Sturgeon’s final First Minister’s Questions – that of 10-year-old Alan Galbraith, who has been waiting years for his treatment to begin, indeed as long as Sturgeon’s successor, Humza Yousaf, was health secretary.
“He will have days where you won’t get a word out of him,” Alan’s dad Robert said at the time.
“I feel like he is just being left. It doesn’t matter what happens with him. There has been an array of cancelled appointments. We expected them to give Alan a diagnosis, maybe start medication, something to help but there has been nothing.”
Another example is that of Charlie Gardner, a Primary 7 pupil who had only seen one doctor since 2020 when his case was raised in the Scottish Parliament in December. That was despite his mum finding a video he had posted to TikTok asking if anyone else felt like they wanted to die because they were so different. She said CAMHS was been dealing with referrals as far back as 2018 when she got in touch about her son’s case.
“That means, having had his difficulties identified early on in primary school, he could be in high school before anything is done.”
Suicide accounted for around a quarter of deaths among five to 24-year-olds between 2011 and 2020, compared with just 1.2 per cent of those aged 25 and over
Dr Elaine Lockhart, chair of the child and adolescent faculty at the Royal College of Psychiatrists, says the current waiting times are the result of a “perfect storm” of increased demand, gaps in the workforce and a system already straining at the seams before the pandemic arrived.
“Children’s mental health had been getting worse before the pandemic, but the Covid lockdowns were really bad news for children’s mental health and wellbeing and the most vulnerable were affected the most,” she says.
“The increase in social inequality over the past few decades has also been really bad news for children’s mental health, and services themselves have been affected by the pandemic – not just in terms of increased demand but in terms of the workforce. We just don’t have enough trained clinicians to meet the need. The whole system has been really overrun.”
While the pandemic had a profound impact on people of all ages, there is conflicting evidence about the long-term effect on mental health. An analysis of 137 studies published by the BMJ last month found a “high level of resilience” with “minimal to small” changes in general mental health, anxiety, and depression.
But NHS statistics show that the number of under-18s in contact with mental health services in England rose by nearly 30 per cent last year – from 768,083 in 2020/21 to 992,647 in 2021/22. A study of teenagers in Iceland, published last month in The Lancet Child & Adolescent Health, found that elevated depressive symptoms and worsened mental wellbeing in those aged 13 to 18 had persisted up to two years into the pandemic.
It’s clear many children coped with the challenges of the pandemic well, but for those already struggling with mental ill health, the impact of lockdowns, lost schooling and the general heightened sense of anxiety are likely to have made their condition worse.
Indeed, a study published by PHS last summer found the mental health impacts of the pandemic in Scotland had been “uneven” with the potential to “worsen and widen mental health inequalities across society”.
“Where people started from, and their social and economic position may well influence the impacts of the pandemic on their mental health and wellbeing,” the report said. “It may also influence the emotional and financial resources people are able to draw on to recover from the pandemic.”
Worryingly, where a person lives may also have an impact on the treatment they receive. A study by Dr Lynne Gilmour, of Stirling University, found that a quarter of children referred to CAMHS were suicidal. But while 82 per cent of those children were offered an appointment in one health board area, the figure fell to 31 per cent in another part of the country. The report found a lack of consistency across the country for how suicidal children and young people are dealt with – an approach described as “arbitrary” by Gilmour.
This postcode lottery is far from being unique to Scotland, however. Research by The House, Holyrood’s sister title, found that across the UK, spending per child is four times higher in some parts of the country than others, while average waits for a first appointment can vary from 10 days to three years.
Children’s mental health had been getting worse before the pandemic, but the Covid lockdowns were really bad news for children’s mental health and wellbeing and the most vulnerable were affected the most - Dr Elaine Lockhart
The research found that the average wait for a first appointment rose from 16 weeks to 21 weeks in England between 2021 and 2022. In Scotland, it went up from 10 weeks to 15 weeks between 2017 and 2023, while in Wales, where NHS trusts have smaller caseloads, the average wait was just 2.6 weeks.
The Scottish Government says it’s getting to grips with the CAMHS crisis, even if most of the evidence suggests otherwise. The new mental health minister, Maree Todd, who previously worked as a pharmacist in a psychiatric hospital, has said the government is now on the right “trajectory” to tackle the situation, although she admits there is much work still to do.
This year the government will spend just over £290m not only attempting to address the CAMHS backlog, but on improving community-based mental health support for both children and adults.
Recent interventions include the opening of a new outpatient facility in Hamilton where children and young people up to the age of 18 can be assessed and treated for emotional, behavioural and mental health problems.
A new prevention strategy has also been published to tackle suicide – the leading cause of death for children and young people in Scotland. Suicide accounted for around a quarter of deaths among five to 24-year-olds between 2011 and 2020, compared with just 1.2 per cent of those aged 25 and over. Considering the needs of children and young people when taking action to address suicide is one of the strategy’s guiding principles.
But the real issue preventing progress in reducing waiting times is staffing. Figures obtained recently by the Scottish Conservatives using freedom of information legislation show that as of December, there were 190 CAMHS vacancies in NHS Scotland, with 89 of those left unfilled for at least three months.
While all this matters for children and their families now, it is also likely to store up problems for the NHS in the long term due to the insidious nature of mental health problems which, if left untreated, can worsen and begin impacting on physical wellbeing.
“The frustration I feel is that a lot of focus and funding goes on acute secondary care services, the general hospitals and A&Es,” Lockhart says. “You can understand why that is, but what we know is that quite a lot of that has its roots in childhood.
“If, for example, you haven’t had your ADHD recognised and diagnosed what we know is that some young people go on and self-medicate with alcohol and drugs and then they can end up developing other health issues and can end up in A&E. We’re always firefighting within the NHS and that funding is always where the acute physical healthcare crises are – we’re just not getting in there with the preventative approach.”
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