“I’ve contemplated killing myself a few times.” Sensing the pause in my throat the 19-year-old young man quickly followed: “But obviously I didn’t, I self-harmed instead. It was the only way they’d take me seriously.”
This young man went on to explain to me how, from an early age, his parents had suspected he was autistic but hadn’t taken him to be tested. At school, his emotional and mental health began to rapidly deteriorate. Bullying led to severe panic attacks, which meant rarely leaving the house. Throughout all this he had bounced from one counsellor or support service to another. Finally the panic attacks became so bad he was admitted to hospital. At first he felt “relieved” at the attention, but when he found out the waiting time for a specialist appointment would be three months his condition regressed. He felt he had no option left but to self-harm to get the right help.
This story was shared with me as part of a focus group conducted for the recently released report A Healthy State of Mind from Localis, the thinktank for which I am director. The four participants sketched out a wretchedly consistent picture of a young people’s mental health service letting down too many, too often. We are at risk as a nation of failing an entire generation of vulnerable young people who need specialist support.
The system, bedevilled by months-long waiting lists because it fails to differentiate between those in crisis and those close to it, makes vulnerable young people feel like nobody cares and nothing can be done. The solution is urgent reform, but where to start?
The most obvious place to provide support is in schools. Localis analysis shows 75% of local mental health plans mention school-based approaches – 40% of those plans refer specifically to school-based counselling. And yet, when you get into the detail, a meagre 3% actually plan to commission school-based services. Of course, an effective mental health system for young people is about more than school-based services, but it’s hard to imagine one without them.
Norman Lamb, former minister for mental health, criticised the “inertia of implementation” at our report’s launch, arguing the coalition government set the right direction with the report Future in Mind but local failures to deliver and commission services are responsible. According to Lamb: “The £1.4bn (we) leveraged has been funneled into other parts of the NHS to prop up budgets. The money hasn’t been spent on young people’s mental health services.”
Performance locally varies considerably. Take the strength and difficulties questionnaire which every child in the looked after system must be assessed against. The questionnaire is a screening tool that helps professionals understand the level risk of a young person faces with regards to their mental health.
Despite completion of the questionnaire being a statutory duty for councils, the national average completion rate is only 75%. There are 62 councils that fall below the national average and there are even a handful which record 0% completion rates. This means for the most vulnerable young people, those in care, it’s too often a case of pot luck whether your council assesses you or not.
More troubling is the low likelihood of services being able to hit the government and NHS England’s target of 35% of young people with a clinically diagnosable mental health condition receiving specialist community based support by 2020-21. Localis analysis suggests 58% of local areas are on course to miss their target. In some areas this will mean thousands of young people missing out on the specialist support they need. Even if government hits its modest target of 35%, Localis estimates that by 2020-21 approximately 555,000 young people in need of specialist mental health support will still not be receiving it.
The government should commit to a programme of mental health services reform, not just the repeal of outdated legislation. It should accelerate the investment in the promised 3,000 GP-based mental health therapists and implement the Carter review’s recommendation that teacher training include a mandatory module on mental health. It should also be bold and take a percentage of the pupil premium and mandate that it is used for the provision of mental health support in schools.
What political capital the prime minister has left should be spent addressing our mental health crisis, particularly for young people. Mental health was one of the “burning injustices” Theresa May called out on the steps of Downing Street last July. She should not forget this commitment. Significant reform would be a worthwhile legacy.
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