Today the Education Policy Institute's Independent Mental Health Commission publishes its final report. This is the culmination of a year's research to understand and explore progress and challenges in the transformation of children and young people's mental health care.
One in 10 children aged between five and 16 have a mental health problem. That's the equivalent of three in every classroom. Yet children's mental health has always been known as the 'Cinderella of the Cinderella of the NHS', receiving just 0.7% of the total NHS budget, or about 6% of overall spending on mental health.
The Mental Health Commission found that services are, on average, turning away 23%, or nearly one in four, of the children and young people referred to them for treatment by their GPs or teachers. It also identified a postcode lottery of waiting times, with wide variation in average waiting times for different providers, from two weeks in Cheshire to 19 weeks in North Staffordshire. The average wait was two months to treatment, but that conceals hidden waits of ten months or more.
In March 2015, the government published a strategy, Future in Mind, which aimed to transform children's mental health services, alongside announced investment of £1.25billion over the next five years. The Education Policy Institute has analysed progress in delivering this strategy since then. Every area was asked to develop a 'local transformation plan' as a condition of receiving their share of the funding. The EPI analysis of the plans found wide variation in the quality of plans across local areas. Of the 121 published plans, only 18 areas (15%) had 'good' plans. 58 plans (48%) 'required improvement' and 45 plans (37%) 'required substantial improvement'.
The Education Policy Institute also identified significant barriers to the delivery of the strategy. For example, providers are struggling to recruit staff to fill essential posts. Eight out of 10 trusts, 83%, which responded to an Education Policy Institute Freedom of Information request stated that they had experienced recruitment difficulties. The same proportion had had to advertise posts on multiple occasions to fill roles. Mental health nurses were the most difficult profession to recruit, followed by consultant psychiatrists. These recruitment challenges had led to an 82% increase in expenditure on temporary staffing in the last two years. In 2015-16 nearly £50million was spent on agency staff by 32 trusts, up from £27million in 2013-14.
Moreover, not all of the investment reaching frontline services. Only £143million of an expected £250million was released in the first year, and of that only £75million was distributed to clinical commissioning groups (local health leaders). It is not yet clear how much of this has been spent on frontline services, but reports from mental health providers indicate that they have not yet seen this increased investment.
For 2016-17, £119million has been allocated to clinical commissioning groups, but this has been included in their general budget, so there is a risk that it will be spent on other priorities.
It is also important to consider this additional investment in the wider context of funding for the whole system. Cuts to local authority early intervention services will have an impact on child and adolescent mental health because these specialist NHS services are part of a wider system which includes local authority funded early intervention support. When those services are cut, the referrals to specialist services increase. The Care Quality Commission has found that reductions in funding, including to non-NHS services, have contributed to increased waiting times.
The Commission is therefore calling for a new Prime Minister's Challenge on children and young people's mental health. Based on David Cameron's Dementia Challenge, this would cover research and prevention, early intervention, and increasing access to high quality services.
On research and prevention, the Commission's recommendations include the establishment of a new Research Institute to fund research into understanding mental health. It also calls for a strategy to empower young people to live safe digital lives.
On early-intervention, the Commission recommends a national programme on mental health and wellbeing within schools. This would include training for teachers and mental health featuring on the school curriculum as part of updated, statutory PSHE lessons.
To increase access to high quality care, the Commission urges the government to withhold funding for those areas who cannot demonstrate that they have robust plans to improve services. They should also have to provide evidence that they are investing all the additional funding in children's mental health and not offsetting cuts elsewhere. The Commission also calls for a new national waiting time standard: that no one should wait more than eight weeks for treatment.
Mental health problems can seriously affect young people's life chances, holding them back in their education and increasing their risk of ill health and unemployment in adulthood. The government has rightly prioritised improving access to care. The Commission's recommendations aim to ensure that this issue remains at the top of the policy agenda over the next five years and beyond.
Emily Frith is the Director of Mental Health at the Education Policy Institute