The state of child and adolescent mental health on World Mental Health Day
What is the state of Child and Adolescent Mental Health in England today? An important question to ask on World Mental Health Day.
In 2010, the policy context that drives CAMHS in England shifted dramatically, as government policy discourses sought to prioritise ‘mental health at all ages’.
The CAMHS ringfence was removed, enabling money previously reserved for CAMHS to be pooled in the more general clinical commissioning group budgets for health (NHSCC 2016). Whilst nominally, children’s mental health is still ‘everybody’s business’ the reality is that these changes have produced a climate in which CAMHS has been increasingly underfunded and under strain, as its special role in supporting, promoting and restoring the mental health of children and young people becomes less and less protected.
The government has in recent months promised £1.25 billion for CAMHS, with a lot of this committed to training and extending the workforce. But this money is clawing back a shortfall that arises from years of austerity cuts — so we are regaining lost ground in CAMHS, not building on achievements that pre-date 2010 (Young Minds 2015).
Beyond the specific funding allocated to specialist CAMHS service, policy has shifted the way that we talk about mental health. As a recent analysis shows quite clearly, pre 2010 policy emphasised how socioeconomic difficulties increased the likelihood that children would experience psychological distress and mental health difficulties (Callaghan, Fellin and Warner-Gale, 2016) . It focused on supporting families — socially, economically, and psychologically — to improve children’s resilience and to support them and help them to recover from mental health difficulties. In contrast, post 2010 policy tends to individualise distress as ‘mental illness’, and focuses on parenting and individual therapy as a way to deal with such individual illness.
This change in discourse matters. It has far reaching practical implications.
By locating the causes of children’s mental health difficulties as individual vulnerabilities and bad parenting, this discourse of mental illness in CAMHS distracts us from the state’s responsibility to protect children from socioeconomic conditions that impact their wellbeing. And yet we know that child poverty and other indices of social disadvantage and exclusion accounts for a huge percentage of children’s mental health issues (Parker et al., 1995; Rogers and Pilgrim, 2014). The impact of social policies associated with austerity and the spiralling rates of child poverty in England are obscured, as we appear to begin to believe that, in children’s mental health, there is no society only individual (children) and (bad) families.
It has been suggested that changes in education policies have also had an impact on the increasing numbers of children requesting support through CAMHS (Devon 2016). The role of contextual factors like school testing pressures and long hours culture are also obscured as increasing rates of psychological difficulties are re-read as disorders of the brain (Rose and Abi-Rached, 2013).
We urgently need to ensure that children and young people have the high quality mental health services that they deserve. We have a responsibility to ensure that our children and young people enjoy the best possible start in life, supported and held by our society. On this World Mental Health Day, we need to ask ourselves what such support would look like. I would suggest that top of the list should be:
- Restore the CAMHS ringfence to ensure that money intended for CAMHS is spent in CAMH
- Take radical and urgent action to reduce child poverty, and acknowledge its impact
- Re-examine educational policies to identify sources of disproportionate stress for young people — children and young people should not be being stressed out by testing cultures and the imposition of long working hours.
- Ensure that all vulnerable children have access to mental health services and support — regardless of whether they meet diagnostic criteria for a mental health ‘diagnosis’
We cannot tolerate the growing crisis in children’s mental health. Investment in CAMHS is to be welcomed, but it must be accompanied by a shift in discourse and practice.
Dr Jane Callaghan is course leader for the MSc CAMH at the University of Northampton, where she also leads the Northampton development of CYP IAPT programmes as part of the Midlands Collaborative. Her full analysis of CAMHS policy development 2000–2016, co-authored by Lisa Fellin and Fiona Warner-Gale. A full pre-publication copy of this paper can be found here (open access), whilst the official published version can be downloaded from Clinical Child Psychology and Psychiatry.
Originally published at janeemcallaghan.wordpress.com on October 10, 2016.