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Action needed to prevent young people’s mental health services slipping backwards

Urgent action is required to prevent mental health services slipping backwards as a result of additional demand created by the pandemic, MPs have warned.

Despite progress in the numbers of young people receiving treatment, the health and social care committee said it was unacceptable that more than half of young people with a diagnosable condition pre-pandemic do not receive the mental health support they need.

Health and Social Care Committee Chair Rt Hon Jeremy Hunt said: “Partly because of the pandemic, we are seeing demand for mental health treatment pushing NHS services to breaking point. Whilst we recognise that capacity to provide such services is increasing, we are not convinced it is happening at a fast enough rate.

“There is a growing risk that elective and emergency care pressures will mean mental health services once again become the poor relation,” he added.

The report by the committee states that the mental health of children and young people has worsened in the pandemic. It cites research from the Centre for Mental Health showing that in England 1.5 million children and young people under 18 will need new or additional mental health support. Furthermore, data from NHS Digital shows that in 2020 potentially one in six young people had a diagnosable mental health disorder, up from one in nine in 2017 which is placing a massive additional strain on already stretched children and young people’s mental health services.

However, the committee stresses that the Department of Health and Social Care and NHS England have made progress in expanding the provision of children and young people’s mental health services in recent years, with significant additional funding.

“However, we are deeply concerned that the pressure created by fighting a pandemic and dealing with the backlog it creates is leading to a neglect of long-standing mental health priorities. We are also worried that a sufficient proportion of the additional funding from the health and social care levy has yet to be allocated to mental health in a way that is consistent with repeated commitments to parity of esteem,” the report states.

The report highlighted:

  • In priority areas such as eating disorders, their independent Expert Panel rated as ‘Good’ overall the commitment that 95% of young people should access treatment within 1 week (urgent cases) and 4 weeks (routine cases), although they expressed concerns that the level of treatment was not always appropriate.
  • Progress was noted towards the implementation of proposals and ambitions laid out in the 2017 Green Paper Transforming children and young people’s mental health provision and the NHS Long Term Plan that will see 47% of school children able to access new Mental Health Support Teams by 2023–24.

Yet even after those ambitions are met, far too many children and young people will be unable to access the care that they need, the report warns.

Half of all mental health conditions become established before the age of 14, so while there has been progress that the number of young people receiving treatment has risen from just 25% to around 40% of those with a diagnosable condition pre-pandemic, it is not acceptable that more than half of young people do not receive the mental health support they need.

Furthermore, there are doubts about the commitment to ensure at least 70,000 additional children and young people receive evidence-based treatment every year, which the committee’s panel rated as requiring improvement overall and which needs to be more ambitious, not least because the proportion accessing adequate care has gone into reverse because of the pandemic.

“The combination of this unmet need prior to the pandemic and additional needs created by the pandemic means that the scale and speed of improvements planned by the NHS are simply not sufficient for the task at hand. Significantly more ambition is needed and without urgent action there is a risk of provision slipping backwards,” said the report.

The report highlights:

  • The new Mental Health Support Teams represent a valuable opportunity to identify and support children and young people who are beginning to experience mental health problems. However, no funding to roll them out nationally has been identified in the recent Spending Review settlement and planned timescales lack ambition. Funding must be found.
  • Smaller problems too often escalate to the point of crisis because of long waiting times and high access thresholds, but crisis care too is fraying at the edges and only receives a ‘Requires Improvement’ rating overall the committee’s panel. The report backs a national network of open access hubs to offer earlier intervention for young people without the need for a referral.
  • There are too many children and young people in inpatient units subject to inappropriate care: far from home, without adequate understanding of their rights, and subject to restrictive interventions.
  • Mental health services in general - and children and young people’s mental health services in particular - have been disappointingly overlooked in the recent Spending Review. Commitment to parity of esteem requires action not just words.

“Children and young people’s mental health is an all-society issue. The problems discussed in this report can only be addressed by Government departments, local government and the health system acting together to promote good mental health and prevent new crises emerging. We recommend setting up a Cabinet sub-committee to bring together different departments to make sure this happens,” the report concludes.

Children and young people’s mental health

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