Lara* was taken to the ER by her parents after she took paracetamol with suicidal intent. When the mental health staff tried to understand her state of mind, they heard that Lara had been having trouble concentrating in school and was overwhelmed by exams and friendship problems.
She often felt sad and depressed. She had developed habits and rituals, packing her school bag and coming to school at a particular time to help her cope, but sometimes she too would overeat or harm herself.
Every day, more and more young people like Lara are taken to A&E, but a recent report They highlighted the problems they have in accessing services. He described support services as “broken under pressure”, leaving children “bouncing off services” that are “overly medicalised, bureaucratic, unresponsive, outdated and isolated”.
As a psychologist working with youth and child and adolescent mental health services (Camhs) for 25 years, the report resonates. Services are organized by diagnosis, but psychiatric medical diagnoses are not a perfect science even for adults, let alone developing children and adolescents, whose responses to stress are subject to change. A child who struggles to concentrate and feels pressured by schoolwork, for example, may feel sad and depressed on some days and anxious and worried on others, and may use both self-harm and not eating as coping strategies.
Labeling these feelings “ADHD” or “anxiety” or “depression” or “eating disorders” or “OCD” can be a quick shorthand to summarize your experience and guide treatment. But, as this report highlights, they are instead used as an entrance ticket to different parts of Camhs. Since services are already full, children with multiple tickets are told to go elsewhere; that his “disorder” does not reach clinical severity. The managers raise the drawbridge to protect their services.
Why do managers do this? Because Camhs workers, like almost every sector of the NHS, are completely overworked. Physicians are being forced to do more with less, managing more cases with fewer resources, and higher levels of distress are affecting morale and retention. I see staff requesting career breaks, working fewer hours or moving to the private sector where a better work-life balance is possible.
NHS staff do not go lightly. People go into healthcare because they want to help, and leaving is a tortured decision. As Adam Kay’s memoir illustrates, This Is Gonna Hurt; NHS staff become disillusioned when the demands placed on them exceed their capacity. We have seen it happen with odontology Y midwiferyand I fear that Camhs will be next.
Government investment in mental health, such as it is, has focused on mental health support teams employing mental health professionals in education, who are generally recent graduates receiving minimal training, at low salaries. They are using these positions to start their careers before continuing after a year or so. This is a major design flaw: it takes time for distressed children and adolescents to trust adults, and it is that trusting relationship that allows them to heal and receive therapeutic advice. An adult may come to therapy prepared and ready to take advice, but adolescents are more skeptical about adult opinions, and successful therapy with this population requires earning their respect before they will listen. Making these relationships is the challenge (and joy) of Camhs’ work. It is less likely to happen if mental health education professionals leave after a year.
Good mental health for children and adolescents requires positive, long-term relationships with caring and valued adults. Ideally this happens in the home, but additionally or alternatively it can happen in communities, schools, youth clubs, sports fields and dance groups. Mental health services are the last resort. But what I do know is that children are disenfranchised from society without ties to positive adult role models and interests that engage them.
Covid exacerbated the mental health issue, but even before that, diagnoses skyrocketed. Given the evidence that one in six children suffer from a probable mental health condition, it is time for the government to consider the impact of each policy on the well-being of young people. My heart sank when Liz Truss promised new selective elementary schools and Oxbridge entrance interviews for all triple A* students, because I see the victims of these exclusionary “race to the top” educational policies every day. These policies harm not only young people who fail the crucial exam(s), and often suffer from a feeling of “not being good enough” in their adult years, but also anxious perfectionists who are on a relentless hamster wheel. of academic excellence. until they break emotionally.
As a therapist and Camhs worker, it will not surprise you that I believe we need more investment in fully trained staff and a focus on staff retention. But the answer lies not simply in more Cams, but in better Cams. We need joint thinking about entering mental health services at the regional health level, so that young people and their families are no longer “bouncing” between services, with managers forced to pass the patient to protect their teams with work overload.
We need distress-driven service, rather than diagnosis-driven service. We need services, both for mental health and in the community, that prioritize long-term care, not short-term repair, and government policy that takes into account the mental health of the next generation. We must address the root of youth problems, not just their symptoms. They will thank us.
*Patient name and details have been changed
