The house of commons health committee report on Child & Adolescent Mental Health services (CAMHS) is out today, and it’s pretty strong stuff.
They call for a major re investment in services, particularly Early Intervention, backed up by clear service specifications with nationally agreed minimum standards. There’s also a welcome emphasis on psychiatric liaison in hospitals (thanks to Peter Hindley and Sebastian Kraemer)
They are rightly critical of NHS England and their slow response to the inpatient bed crisis, but are also aware of the perverse commissioning incentives driving this. In fact they agree with Norman Lamb that commissioning of CAMHS is wholly dysfunctional.
There’s a radical and welcome emphasis on mental health in schools, including mandatory training for teachers and OFSTED inspection, and (hurray!) mental health on the schools curriculum!
Finally, there’s an acknowledgement that throughout the system CAMHS is not prioritised, either by NHS England, the CQC, schools, Local Authorities, acute trusts and CCGs.
But if you thought that last sentence was confusing, you’re some way towards grasping the limitations of this report. Children and young people’s mental health has always been about more that specialist services, and has always required a ‘whole-system approach’ (see the 2008 CAMHS review, for instance), but the system has become so hopelessly complex with the latest reforms that no-one really has the levers of power any more, and it’s impossible for even as influential a body as this committee to do more than urge agencies to prioritise CAMHS.
There’s also a lot of detail that needs to be sorted out- it’s not clear that they have a clear view on how to sort out commissioning (who does?), or remove perverse incentives, or how to make schools have effective, evidence-based provision rather than the current random assortment of therapies and counsellors. But the government have appointed a CAMHS task force, which is working on these issues already (I was there this morning, and it’s a very energetic group!), so this will be sorted out in time….
Time….. there’s the rub. By the time the Task Force reports in March we’ll be deep in a General Election campaign, so nothing will happen till May at least. Meanwhile, children and young people will continue to be excluded from schools that can’t cope with them, self-harm while on waiting lists for overstretched services, and be carted around the country from police station to adult ward in search of an elusive CAMHS bed.
So what can we do? Well, I think the one thing we can do is make vulnerable children a political issue, not just today, but for the next 6 months, so that the political parties have to address this in their manifestos, have to talk about it during the campaign, and when in May we have a new government, they will have a mandate and a plan to sort this mess out.
And when does something become a political issue? When the electorate want it to be. Over to you.