1 Information
Children's
and young people's mental health in 2014
8. One of the most frequent observations made to
this inquiry from its outset has been the lack of reliable data
about the state of children's and young people's mental health
in 2014. The most recent figures for prevalence of common mental
health problems in children and young people date from the 2004
ONS prevalence study, a study which up until 2004 had been conducted
on a five-yearly basis. The recent NHS England review is still
based on this out of date information:
The best available estimates of the prevalence
of mental disorders amongst children and young people are those
from the Office for National Statistics surveys in 1999 and 2004.
These found one in ten children aged between 5 and 16 years has
a mental disorder. About half of these (5.8%) have a conduct disorder,
3.7% an emotional disorder (anxiety, depression), 1-2% have severe
Attention Deficit Hyperactivity Disorder (ADHD) and 1% have neurodevelopmental
disorders. The rates of disorder rise steeply in middle to late
adolescence and the profile of disorder changes with increasing
presentation of the types of mental illness seen in adults.[5]
9. The Chief Medical Officer's annual report for
2012, published last autumn, highlighted the need for a repeat
of the ONS survey; it also cited other evidence suggesting a rise
in levels of psychological distress in young people, and in particular
increasing rates of self-harm:
Self-harm rates have increased sharply over the
past decade, as evidenced by rates of hospital admission and calls
to helplines, providing further indications of a possible rise
in mental health problems among young people. However, in the
absence of up to date epidemiological data, it is uncertain whether
there has been a rise in the rates of mental health problems and
whether the profile of problems has changed[6]
10. The CMO also highlights the strong links between
mental health problems and social disadvantage, with children
and young people in the poorest households three times more likely
to have mental health problems than those growing up in better-off
homes.[7] Public Health
England provide the following observations on young people's mental
health and wellbeing drawn from other research:
Analysis of the British Household Panel and Understanding
Society survey [2011-12] shows that the rise in children and young
people's wellbeing from 1994 to 2008 has curtailed and may be
in reverse. Peak onset of mental ill health is 8 to 15 years.
10% of children have a mental health issue and half of lifetime
mental ill health starts by age 14.
The Health Behaviour of School-Aged Children
Survey [2009-10] (HBCS) found that around 30% of English adolescents
reported a level of emotional wellbeing considered as (sub-clinical)
"low grade" poor mental health, that is they regularly
(at least once a week) feel low, sad or down. This is higher among
girls than boys…
… Lesbian, gay, bisexual and transgender
young people (aged 16-25 years) report higher levels of mental
health problems, self-harm and suicidal thoughts. They experience
more verbal, physical and sexual abuse and feel less accepted
by their community.
The Understanding Society survey results for
2011-12 suggest 85.5% of children belong to a social networking
site. In England, the proportion of young people playing computer
games for two hours or more a night during the week increased
from 42% to 55% among boys and 14% to 20% among girls between
2006 and 2010. The same survey suggests 12.1% of children have
been bullied four or more times in the last six months. In some
areas more than 10% of children reported being bullied. Data from
the Tellus survey stated one-third of pupils do not think their
school is managing the problem well. Childline has reported an
87% rise in contacts related to online, cyber- bullying.[8]
PROBLEMS CAUSED BY LACK OF PREVALENCE
DATA
11. The British Psychological Society is amongst
many organisations to highlight the problems caused by the lack
of comprehensive national data on the prevalence of mental health
problems:
We do not know the scale of the problem …
we simply do not have accurate information from which to gauge
the state of children and young people's mental health nationally.
Information from ChiMat Intelligence Network March 2014 notes,
"In summary the ability to provide robust national data to
support local service planning is at best limited and planned
improvements to this position have suffered from significant delays"[9]
12. Observations from CAMHS service providers strongly
suggest that they are now operating in a considerably changed
environment from the 2004 prevalence data, with many reporting
dramatic increases in demand for their services:
Demand continues to increase - 89% of respondents
said there had been an increase in referrals over the last 2 years;
percentages ranged from 20-70%. Many respondents noted a change
in the mix of referrals seeing an increase in self-harm, complexity
and severity.[10]
Partnerships are reporting rising numbers of
both routine and emergency presentations. Partnerships suggest
an average increase of 25% in referrals to CAMHS tiers 2/3 since
2012, possibly due in part to the impact of regional and local
cuts on community based services and third sector services.[11]
13. The Committee's witnesses on 1st April
reiterated these impressions, noting increasing rates of self-harm,
eating disorders, depression, conduct problems and autistic spectrum
disorders[12].
14. The lack of up-to-date information about the
prevalence of mental health problems is not simply an academic
issue - information about how many children and young people may
be affected is essential for healthcare planning. The lack of
information is causing significant problems for commissioners
seeking to plan, improve and fund services in this area. Derbyshire
County Council and North Derbyshire CCG stated in their written
evidence that "we need to have reliable and up to date prevalence
data" and that "the data gap is impacting on strategic
decisions and planning."[13]
The Minister agreed that prevalence data was "horribly out
of date".[14] During
the course of our inquiry, the Government announced that it had
identified funding to repeat this survey, and the Minister repeated
this commitment in oral evidence to us. Work will begin in the
autumn, although the project is not likely to be completed until
2016.[15] While the Minister
could not commit future governments to funding the survey on a
continuing basis, he told us that in his view a long gap between
surveys should in future be avoided, in order to "maintain
a current understanding of the scale of the problem".[16]
Information about CAMHS services
15. The shortfall of information in this area is
not confined to data on the prevalence of mental health problems
amongst children and young people, but extends into information
about service provision as well, including levels of demand, access
and expenditure. The CMO recommends an annual audit of services
and expenditure[17],
and the NHS England report also highlights this-the best available
national data on access times is provided by the CAMHS Benchmarking
consortium, a voluntary network which does not include all providers,
and the best available data on expenditure is from a recent Freedom
of Information request made and analysed by a mental health charity:
There is no recent data on estimated levels of
need for the different elements of CAMHS including Tier 4 services.
This depends not only both on prevalence but also other factors
including the range of alternative services.[18]
Information on access times for treatment in
community CAMHS is not currently systematically available at a
national level though it is understood that there is considerable
geographical variation. Data from the NHS Benchmarking Report
CAMHS (NHS Benchmarking Network, 2013) found that in 2012/13 amongst
its members the maximum waiting times for specialist CAMHS Tier
3 average 15 weeks across the participating providers. This has
increased from 14 weeks recorded in 2011/12. Waiting times for
accessing urgent CAMHS Tier 3 had a 3-week median wait. This should
also be seen in the context of the lack of crisis response services
in CAMHS, with less than 40% of CAMHS in the benchmarking offering
rapid access through crisis pathways.[19]
16. NHS England were able to provide more information
in relation to Tier 4 inpatient services, reporting that both
bed occupancy rates and numbers of reported admissions to Tier
4 units increased between 2012-2013, and that there was a rise
in the number of inpatient beds available from 1,128 in 2006,
to 1264 beds in January 2014. [20]
17. National data published in March by the HSCIC
reveals that the number of children and young people being treated
in adult mental health facilities is rising:
In 2011-2012, 357 under-18s were treated on adult
mental health wards in England, which went down to 219 in 2012-13.
However, between April and November 2013 alone, the figure reached
250.[21]
18. The number of young people being detained in
police cells under s136 of the Mental Health Act 1983 remains
high, with 263 detained in police cells in 2012-13.[22]
Improvements to data on CAMHS
19. Again, data about CAMHS is a fundamental requirement
for the safe and effective planning and delivery of healthcare,
and lack of data causes problems for commissioners. Members of
the Mental Health Commissioners Network described the lack of
data as 'scandalous', and went on to argue that "the lack
of current, good quality data means that commissioners and providers
are working blind".[23]
The Minister used a similar analogy, telling us that lack of data
meant that "We have operated in many respects in mental health
in a bit of a fog. We have not had access to the data-the information
that other parts of the health system benefit from."[24]
He went on to say
Information drives change. If you have an understanding
of what is actually happening across the system, rather than the
fog we have worked in up until now in mental health, you can start
to put pressure on the system to change.[25]
20. As well as recommending repeating the national
psychiatric morbidity survey and the What About Youth? Survey,
Public Health England make the following recommendations to "strengthen
the collection, availability and use of data and intelligence
to better inform local authorities, health services":
· The
Maternity and Children's Dataset should be implemented as soon
as possible. This will provide a robust flow of data on referrals,
activity, assessments, treatments and outcomes from CAMHS ….
· ….that
work is undertaken to determine the optimum way of collecting
CAMH service and expenditure/budget mapping data
· there
is a need to triangulate the data on wellbeing, mental illness,
self-harm and suicide to better understand the national picture
and effectively target resources. The National Mental Health Intelligence
Network should start to address this.[26]
21. Planned improvements in this area have been subject
to delays, as David Wells, the Associate Director of the National
Child and Maternal Health Intelligence Network explained:
Historically more detailed information was available
about activity and services from the Children's Services Mapping
project which was discontinued in 2010 on the basis that the data
collected would be replaced by the secondary user CAMHS dataset.
There have been significant unexpected delays
in the flow of the data from the secondary users dataset which
was originally expected in 2012. The present position is that
data collection commenced in sites from April 2013 and funding
was identified for the necessary hardware to enable data flow
to the HSCIC.
Procurement of the hardware lies with NHS England
and HSCIC. The last published date for data flow to commence was
Summer 2014 and first reports should have been available from
Autumn 2014 though this is now subject to further potential delay.
In summary the ability to provide robust national
data to support local service planning is at best limited and
planned improvements to this position have suffered from significant
delays.[27]
22. The HSCIC website now states the following information
in relation to this:
On 11th July, HSCIC obtained high level agreement
from NHS England to fund the infra-structure required for the
Maternity and Children's Data Set, which includes the CAMHS data
set, as well as Maternity and Child Health data sets. We hope
to procure the required hardware soon, and are currently in the
process of re-planning go-live dates. We will advise on the CAMHS
go-live date once it is confirmed.[28]
Conclusions and recommendations
23. The Committee is deeply concerned that the
most recent ONS data on children's and young people's mental health
is now ten years old, as up-to-date information is essential for
the safe and effective planning of health services. We welcome
the Government's commitment, made during the course of this inquiry,
to fund a repeat of the ONS prevalence survey. It is essential
that this survey is not a one-off, but is repeated on an ongoing
basis. We recommend that the Department of Health/NHS England
taskforce adds the issue of the quality of ongoing data to its
terms of reference.
24. Not only is there a lack of data on children
and young people's mental health, but also a worrying lack of
comprehensive and reliable information about children's and adolescents'
mental health services, including referrals, access and expenditure.
In the words of the Minister, CAMHS services have been operating
in a "fog", and efforts to improve data availability
have been subject to delays. This is unacceptable. Ensuring that
commissioners, providers and policy-makers have access to up-to-date
information about all parts of CAMHS services-from early intervention
up to inpatient services-is essential. We recommend that this
is a priority for the Department of Health/NHS England taskforce.
5 NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report,
10 July 2014, p14 Back
6
Department of Health, Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays
chapter 10 p3 Back
7
Department of Health, Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays
chapter 10 p2 Back
8
Public Health England (CMH0085) paras 3.1-3.8 Back
9
British Psychological Society (CMH0133) p3 Back
10
British Psychological Society (CMH0133) p4 Back
11
Professor Peter Fonagy (CMH0216) p4 Back
12
Q3-4 Back
13
Derbyshire County Council (CMH0192) Executive Summary Back
14
Q337 Back
15
Q340 Back
16
Q340 Back
17
Department of Health, Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays
Chapter 1 p9 Back
18
NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report,
10 July 2014, p15 Back
19
NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report,
10 July 2014, pp15-16 Back
20
NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report,
10 July 2014 p86; admissions, p46; occupancy, p52 Back
21
'Children admitted to adult mental health wards 'rising', BBC
news website, 11 March 2014 (accessed October 2014) Back
22
New map of health-based places of safety for people experiencing a mental health crisis reveals restrictions in access for young people,
CQC news release, 16 April 2014 (accessed October 2014) Back
23
Mental Health Commissioners Network (CMH0122) 6f Back
24
Q368 Back
25
Q445 Back
26
Public Health England (CMH0085), para 4.8 Back
27
The Royal College of Psychiatrists (CMH0173) Annex D Back
28
Child and Adolescent Mental Health Services Data Set, HSCIC website,
(accessed 6th October 2014) Back
|
