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‘We’ve got this kid who hears voices. God knows when he’ll get help.’
‘We’ve got this kid who hears voices. God knows when he’ll get help.’ A report for the Centre for Social Justice found staggering delays in mental health services for children and young people. Photograph: TMO Pictures/Alamy
‘We’ve got this kid who hears voices. God knows when he’ll get help.’ A report for the Centre for Social Justice found staggering delays in mental health services for children and young people. Photograph: TMO Pictures/Alamy

Children are suffering as mental health services fail to cope, say parents and teachers

This article is more than 9 years old
Headteachers say better mental health services are needed, not more guidelines telling schools how to make referrals

It started with anxiety: worries about a spelling test, a school trip or a play he was taking part in. When his mother dropped him off at school, 10-year-old Leo would beg her not to leave. Then he started running out of the building and trying to climb over the surrounding walls."I tried everything I could to get him into class," recalls his mother, Heather Deevey (not her real name). "Some days I'd have to carry him from the car park into the school, with him kicking and hitting me. One time, I found myself lying on top of him, trying to restrain him, while the teachers looked on in horror. I remember thinking: 'If he's going to hurt someone, it's better if it's me'."

Born 11 weeks prematurely, and placed straight into local authority care, Leo has foetal alcohol syndrome (mental and physical impairments caused by alcohol consumption during pregnancy). He was adopted at 18 months old, and has attachment disorder, which can cause difficulties in managing close relationships. His behaviour can be violent and aggressive. Sometimes he says he wishes he were dead.

Leo's parents believe he has a mental health problem and needs urgent treatment – and possibly medication to help manage his symptoms. But he's been on the waiting list for specialist NHS child and adolescent mental health services (Camhs) for more than 18 months now. And while he was predicted above average achievement for his age by the end of primary school, having not attended school full time since last September, he is falling behind academically.

Debbie Gore's 11-year-old son, Joe, who has autistic spectrum disorder, loves going to his special school, but she fears his poor behaviour could become too much for his teachers. "He screams all the time, hits himself and headbangs the wall to try and get rid of his anxiety. And he pushes people over – the teachers and other children. He's quite bright, but he doesn't learn anything because it's all they can do to get him to sit still." Joe has been on the Camhs waiting list for three years.

The children's experiences echo the findings of a recent report from the Centre for Social Justice, which found "staggering" delays and shortfalls in mental health services for children and young people. In June, the mental health charity Young Minds released the findings of a series of Freedom of Information requests, which showed that 77% of NHS clinical commissioning groups (now responsible for designing local health services in England) had frozen or cut their Camhs budgets between 2013-14 and 2014-15. About 55% of local authorities that supplied data have cut, frozen or made below-inflation increases to their budgets for Camhs in the same time period.

The Department for Education recently issued a 47-page guidance document on mental health and behaviour in schools, which covers, among other things, how to recognise the signs of mental health problems such as anxiety, depression, self-harm and eating disorders and refer children to the local Camhs service. But some headteachers say this is missing the point.

"We're not stupid; we've been working with children for years so we don't need someone to tell us what sort of child should be referred and how you do it," says Christine Phillips, headteacher of a large London primary school.

Craig Hammond, a headteacher at a secondary school in the south-east agrees: "It feels as if the government is trying to push the responsibility of dealing with mental health issues on to schools, but we are just not adequately trained or resourced to do so."

He is currently trying to support a "tier-4" child (the highest level of need according to Cahms guidelines - tier 1 being the lowest) who is showing signs of schizophrenia. "So we've got this kid in school who is hearing voices. He's in the system, but God knows how long it will take for him to be seen. It's really quite frightening."

The money for Camhs provision comes from clinical commissioning groups, local authorities and the Department of Health. But as funding arrangements vary across the country (and sometimes according to the level of need) it's difficult to get a national picture of the extent of the problem. And long waiting times are only part of the jigsaw. Even where resources are available, they are often being used inefficiently, say critics.

Gore got a Camhs appointment for Joe 18 months ago, but found out, on arrival, that he had been referred to the wrong part of the service (he had been referred as a tier-2 patient, but, she was told, needed to be seen by a specialist in tier 3). Even though it wasn't her mistake, he was placed at the bottom of the list for tier-3 cases. Gore is a single parent and her son is sometimes violent towards her. "Sometimes I wake up and his hands are around my neck. I don't think he means to hurt me, but you do have to sleep with one eye open."

Deevey arrived at a Camhs appointment six months ago expecting to see a psychiatrist who could diagnose and treat her son. But the family was seen by a nurse, who could offer general advice, but no diagnosis. "We got six support sessions, which were a complete waste of time. Our son wouldn't participate, the nurse left partway through and was replaced with a family support worker, who didn't know anything about our case. We don't need parenting advice on stickers and star charts … we need a diagnosis from a psychiatrist and treatment for our son. So now we're back on the list and things are getting worse."

Camila Batmanghelidjh, founder of the children's charity Kids Company, which offers therapeutic and social work services in more than 40 schools across London, says it is not unusual to hear of young people being "bounced" around the system like this. "What we're hearing from headteachers is that, in some areas, Camhs has become like an "assessment" service. Families wait months – years even – for appointments, and when they finally get to see someone they're told they've been referred to the wrong department or that the person they were supposed to see has left. Then they are referred to someone else who does another assessment and on and on it goes…"

The impact on young people and their families can be devastating. Hammond recalls that a pupil who was self-harming waited two years to get the treatment she needed through Camhs. Another who was displaying aggressive behaviour waited four years (during which time he was permanently excluded from school and placed in a secure unit) before getting a diagnosis of autistic spectrum disorder. "Both were referred to the wrong services to begin with, one was initially misdiagnosed … all of which delayed their diagnosis and recovery. Six months might not sound a lot, but it's a huge period in a child's life."

Hammond is also concerned about the disconnect between Camhs and adult mental health services. "In some cases the adults in the family are experiencing mental health problems too, so it's difficult to tell whether a child is in genuine need or just apeing the behaviour of the parents," he says.

In theory this shouldn't happen. The Common Assessment Framework, introduced under the last Labour government, requires professionals (from, for example, health, education, social work or police) to meet regularly to discuss the support needed for vulnerable families. But, in practice, getting all the relevant people around the table at one time can be a challenge. "A child might get a short course of support from Camhs, but the fact that they are living in a completely dysfunctional family environment is ignored," says Deborah Tovey, a primary headteacher in south- west England. "It's a bit like putting a sticking plaster on a wound. If you get a child into therapy but you don't clear out the infection – by that I mean treat the whole family, so to speak – it's just going to fester."

Batmanghelidjh claims she has been told privately by people working for or with Camhs that staff are being asked to find reasons not to diagnose children with specific conditions as there aren't resources available to support them. "People are afraid to speak out because they don't want to lose their jobs."

Fear of speaking openly hinders discussion of the crisis, say campaigners. None of the headteachers we spoke to were willing to be identified by their real names. The parents wanted to remain anonymous to protect their children.

Headteachers are keen to point out that Camhs is not to blame for the crisis in mental health services for children and young people. As Phillips says: "We have absolutely no doubt they [Camhs] want to help, but they are absolutely snowed under. There are just so many referrals."

Both Gore and Deevey have been promised urgent Camhs appointments this month, but neither is convinced it will actually happen. "I've been there before: you're promised an appointment, they [Camhs] say they'll write to you. You ring to chase, they keep telling you it's in the post," says Deevey.

"I think people sometimes think Leo is just a naughty little boy, that he doesn't really have a problem. But at night time, when your child's in bed crying, telling you they want to cut off their own head or they wish they'd never been born, nothing seems more real."

A government spokesman for both health and education said: "We realise that good mental health services for young people are absolutely vital and something families care a great deal about. Our guidance to schools helps teachers separate poor behaviour from unmet mental health issues so that all pupils receive help appropriate to their needs. It also encourages schools to promote positive mental health through the curriculum and peer mentoring."

The spokesman said the advice had been warmly welcomed by schools, the mental health charity Young Minds and mental health professors from University College London and the University of Roehampton.

He said that the government had invested £54m in improving access to psychological therapies for children and young people from 2011-2015.

But Phillips is less than impressed. "What we need is the government to stop employing people to write guidance about things we know how to do already and actually put some money into the service and provide enough people to run it properly," she says.

Some names have been changed

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