‘Crisis’ for young mentally ill in Wales – Children’s Commissioner’s report

Mental health services for young people in Wales are still in a state of ‘crisis’ six years after the Assembly Government launched its strategy to drive up standards, suggests a new report by the Children’s Commissioner for Wales.

A lack of investment in Child and Adolescent Mental Health Services (CAMHS) has prevented real improvement in services for some of the most vulnerable young people in Wales, the report concludes.

Authored by Maria Battle, the acting Children’s Commissioner, the report says: “The CAMHS strategy in Wales was published under the title ‘Everybody’s Business’ in 2001, and it was welcomed as a comprehensive strategy that would, if properly resourced, make Wales a leader in this area.

“The CAMHS implementation group, set up by the Welsh Assembly Government, estimated that an additional £10m per year would be needed for the first three years of delivering on the ‘Everybody’s Business’ strategy.

“A financial commitment was made by the then Health Minister Jane Hutt, but despite this CAMHS provision is in crisis in Wales, largely due to lack of investment.”

The report – entitled ‘Somebody Else’s Business?’ – is based on a scoping exercise carried out among Local Health Boards and NHS Trusts across Wales in January and February this year.

Other findings highlighted by the exercise include:

• Unacceptable delays in decision-making about treatment and placements for mentally ill children, who consequently suffer deterioration in their health while waiting for decisions to be made
• Non-recurrent funding which leads to a loss of confidence in CAMHS from children
• The exclusion of 16- to 18-year olds who are not in full-time education from CAMHS
• Children and young people in some areas not assessed by CAMHS prior to hospital discharge following an incident of self-harm, despite all children having a right to this assessment.

The report says that the Assembly Government should end the practice of funding important CAMH services with short term non-recurrent funding.

“There must be stability in the funding of CAMHS in Wales as in adult mental health services,” the report continues.

“It would appear that resources and their scarcity are driving the provision of CAMHS rather than the needs of individual children and young people. The number of gatekeeping procedures and arbitrary decisions appears to place the mental health of young people at risk.

“Children often spend several weeks in the paediatric ward when their physical medical needs have been resolved before an appropriate CAMHS bed can be found for them.

“Adolescents are often being treated on adult mental health wards, which are not attuned to providing services for this age group and where the experience can be a frightening and damaging one for young people.”

The Children’s Commissioner also recommended that the Assembly Government review its commissioning policy to end confusion between partner organisations about their responsibilities and empower children by taking their views into account.

Reacting to ‘Somebody Else’s Business?’, a spokesman for the Welsh Assembly Government said: “We recognise that there is much still to do, but WAG is playing its full part in improving services for the children of Wales.

“A review of CAMHS provision is being undertaken by the Wales Audit Office and Health Inspectorate Wales.”

Alun Thomas, Deputy Chief Executive of Hafal – the principal Welsh charity for people with severe mental illness and their carers – said: “We recognise these concerns and urge the Health Minister and the Assembly Government to deliver on a whole range of mental health strategies currently in place in Wales.

“Mental health generally continues to be the Cinderella services, with CAMHS appearing to fare little if at all better than adult services.

“The Minister has identified mental health as one of her priorities but we believe that patients will continue to get a raw deal until the commissioning decisions for mental health services and specialist services – such as adolescent inpatient services and services for children with eating disorders -are made centrally by the Assembly.

“One of the greatest difficulties for this age group is lack of clarity in where services should sit – whether in young persons or adult services.

“Unfortunately it is the young people who suffer when adult services won’t accept 16- and 17-year old referrals but children’s services are unable to provide support to 16-17-year olds who have left education.

“Services for children and young people must reflect their needs and be appropriate, safe and therapeutic.

“Hafal has recently developed a service in Powys funded by Comic Relief for people aged 16 and 17 with our partner organisation Rekindle, and our experience shows us that while there are a number of good quality local examples of services for young people, much more needs to be done across Wales.”

• To read the Children’s Commissioners ‘Somebody Else’s Business?’ report, click here

• To read the Welsh Assembly Government’s 2001 strategy ‘CAMHS in Wales – Everybody’s Business’,
click here