World Mental Health Day 2018

It has been a few months since my last post on mental health and it seems right to post today, to mark World Mental Health Day (WMHD). This day has been celebrated – if that is the correct word – since 1992, and is co-ordinated by the World Federation for Mental Health (WFMH). This year’s theme is ‘Young People and Mental Health in a Changing World’ – you may have seen the logo:

On their website, the WFMH explain the reasons for this choice of theme:

“Imagine growing up in our world today. Constantly battling the effects of human rights violations, wars and violence in the home, schools and businesses. Young people are spending most of their day on the internet – experiencing cyber crimes, cyber bullying, and playing violent video games. Suicide and substance abuse numbers have been steadily rising, LGBTQ youth are feeling alone and persecuted for being true to themselves and young adults are at the age when serious mental illnesses can occur and yet they are taught little to nothing about mental illness and wellbeing…..We want to bring attention to the issues our youth and young adults are facing in our world today and begin the conversation around what they need in order to grow up healthy, happy and resilient.”

Here in the UK the Education Policy Institute (EPI) published the results of its recent survey at the weekend, and although news coverage didn’t mention its relevance to the WMHD theme I don’t think the timing was a coincidence. The EPI undertook Freedom of Information requests from 60 providers of Child and Adolescent Mental Health Services (CAMHS) and from local authorities, and received 54 provider responses, so I think it safe to describe the study as comprehensive. Their headline finding is that referrals to CAMHS have increased by 26% over the past five years. Based on data from 50 of the respondents there were more than 264,000 referrals of under-18s in 2017/18. Having worked a lot with our CAMH services during my years in the NHS I find this figure horrifying: the service was already overrun with referrals, and is now under even more pressure. And we should never lose sight of the fact that every single one of these referrals represents a child (or children) and family which is being torn apart by their problems. It’s heartbreaking.

There is a good report on the study here on the BBC’s website: it makes for interesting reading. Interesting, but very scary and worrying. Some 27 local authorities (out of 111) reported that they had ceased to provide services for the mental health and wellbeing of children and young people in the past eight years. Over and above the loss of those related services, far too many – more than 20% – of provider referrals were refused treatment as not meeting required criteria. In effect, the children and young people weren’t considered sufficiently unwell!

The BBC report quotes the official Department of Health position: “We are transforming mental health services for children and young people with an additional £1.4bn and are on track to ensure that 70,000 more children a year have specialist mental health care by 2020-21.

“We are improving access to mental health services through schools with a brand new dedicated workforce, as well as piloting a four-week waiting time standard in some areas, so we can better understand how to reduce waiting times.

“We are completely committed to achieving parity between physical and mental health as part of our long-term plan for the NHS, backed by an additional £20.5bn of funding per year by 2023-24.”

This is being followed up by a speech today by the Prime Minister, in which she is fleshing out some of these commitments. For the first time we are to have a minister with specific responsibility for suicide prevention, and £1.8m is to be provided to the Samaritans to enable them to continue their helpline for four years. For children and young people, the government is promising more support in schools, bringing in new mental health support teams and offering help in measuring students’ health, including their mental wellbeing. There will also be a new annual progress report each year on WMHD. This is all being announced at a global summit on mental health being held in London, attended by representatives from around fifty countries. I wonder what, if anything apart from the usual platitudes, will come out of this, and what the composition of that attendance is – does it, for example, include large countries who are really in a position to make a difference? We can but hope so.

Of course, any government initiatives on mental health are welcome, but please forgive me for being a little cynical about this: the government has been making noises about improving mental health services – both for children and adults – for quite a while now. But, as I covered in my piece Mental Health Matters in September 2016, there doesn’t seem to be any certainty of service commissioners making this additional funding available to the providers for whom it is intended. To date, there has been a lack of joined up thinking about mental health treatment, and drastic changes are needed. And then there is the question of whether this funding exists at all. Remember that Vote Leave promise of making an extra £350m per week available for the NHS if we left the EU? Well, the latest official figures suggest that, rather than making that saving, Brexit is actually losing us more than £500m per week, and that is before we even jump off the cliff! And we also need to consider the haemorrhage of staff the NHS is already suffering pre-Brexit, a position which doesn’t seem likely to improve if the government continues to bury its head in the sand over the disastrous effects of losing freedom of movement across the EU. Even if that funding were somehow to materialise from some magic money tree – which I very much doubt – where are all these new specialist staff going to come from? Even if the money was already being provided – which it isn’t – there is no way that all of the specialist staff required could be recruited and trained in time to meet the government’s stated aim. In short: it’s as valid as a promise to give us all a pet unicorn.

Sadly, I fear that this is all a very long way short of what the WFMH describes in its objectives for this year’s WMHD. The figures I have quoted relate to the more serious cases which require specialist treatment, but there are far greater numbers of young people who are affected by the issues set out in the WMHF statement: how are they going to get the help they need in current circumstances? So much needs to be done, but do we have the resources and the desire to make this happen? I’d love to be proved wrong, but I’m not sure that we do. Of course, I know there are no easy answers to this, but I hope today will be a starting point for us to review our priorities as a society. If we don’t give our children and young people the best possible start in life we are failing them. I hope the Government has the will, money and resources to deliver on today’s announcement. It will be interesting to see how much they will have achieved by the time their first annual report comes round next 10 October, and whether they will have done enough to confound my doubts.