Young people and mental health - on the edge of the abyss
We're failing our children - that's the stark message from the NSPCC. A new study shows that last year, more than one in five children referred to mental health services in England were turned away because of lack of resources. That means nearly 40,000 young people who were told their symptoms weren't severe enough.
But are they really not suffering, or is the bar being set too high because there just aren't enough staff to go round? And just how big is the problem really?
The best figures we have in the UK come from a 10-year-long study by the Office of National Statistics, which finished in 2004. At the time, one in 10 children aged five to 16 had a mental health disorder, with over one in 20 having a conduct disorder. This is so much more than teenage angst or just being stroppy or badly behaved - it has an effect on their development and their ability to live normally. Young people with conduct disorders put themselves at risk with behaviour that puts them in dangerous situations, and often find themselves socially isolated and deeply unhappy.
Other conditions like ADHD, or attention deficit hyperactivity disorder can be mistaken for conduct disorder or just bad behaviour. In its severe form it affects between one in 50 and one in 100 young people. Yet young people with ADHD are not just badly behaved, and it's certainly not just a question of bad parenting. I have seen many excellent parents in despair about one child whose behaviour is completely different from that of other children in the family. In my experience, a child without ADHD, no matter how badly behaved, can behave if the stakes are high enough. Kids with ADHD often want desperately to behave well, and find it very distressing when they're constantly told off, but they just can't help themselves.
A survey last year showed that four in five parents of a child with ADHD worry about their child starting at a new school, with more than half of them finding it more stressful than parent with a child who doesn't have ADHD. Tablets aren't always even part of the solution - and they're never the whole answer. But helping parents to set up, and stick to, the very strict regime children with ADHD need, means support and input from the health services. And the evidence is that there just isn't enough out there.
More than one in 30 young people suffers from anxiety or depression - both conditions which can blight lives. That's nearly 80,000 young people in the UK with severe depression alone - for them, their schooldays will very definitely not be the time of their lives. Depression in young people in particular is linked with high levels of self-harm, which have been rising rapidly in the last decade. It's difficult to gauge the true size of the problem, because so many young people are ashamed of self-harming and hide it even from nearest and dearest, but best estimates suggest it may be as high as one in 12. Although suicide rates are higher among men in their 40s than in any other age group, young people do kill themselves, and many more are desperate enough to try.
Against a backdrop of ever-rising need, mental health services for young people appear to be an easy target for healthcare cuts. Two thirds of local authorities in England have reduced their CAMHS (Child and Adolescent Mental Health Services) budget since 2010, with one council reporting that theirs has been slashed by over 40%. The consequences are inevitable - a rise of nearly 50% in the number of young people admitted to adult psychiatric units in the last year; one in 25 young people admitted to a psychiatric hospital more than 150 miles from their families; rare but horrifying cases of 16-year-olds held for two days in police cells until a psychiatric hospital bed could be found for them.
One in 10 young people is suffering - twice as many as a generation ago. Yet just 0.6% of the NHS budget is spent on looking after them. Money is scarce in the NHS - it's getting tighter for healthcare services across the world. But staff at the St Aubyn Facility in Colchester (a built-for-purpose youth mental health ward, with 25 beds) summed up quite how serious the situation has become when they admitted that, "in children's mental health, we usually have to make not the best but the least worse decision."
Sooner or later we have to decide - should we put our priorities into building the next generation? If, as I believe, the answer is a resounding 'Yes', we should all be making some noise.