News about NHS children’s mental health services hit a new low point this month, with research by The House publication finding a quarter of a million children being denied help by the NHS in the last year.

The House research used FOI requests to NHS trusts across the UK and found that England has the worst data, with average community CAMHS waiting lists in February 2023 up by two-thirds in two years and children waiting on average 21 weeks for a first appointment. Across the UK waiting lists are up by 53% and the wait is 16 weeks, dropping to just three weeks in Wales. 

The chances of under-18s seeing a professional was also found to vary across the country, often referred to as a postcode lottery. The House’s research shows spending per child is four times higher in some parts of the country than others, while average waits for a first appointment vary by trust from 10 days to three years.

The record of Sussex Partnership Trust NHS Foundation Trust was highlighted by The House. It is the second biggest in the country with more than 30,000 referrals in 2022 across three counties.

The trust turned away almost 12,000 young people in 2022 and had an average wait for a first appointment of more than 20 weeks. It met just 6% of its target of 80% of cases seen within four weeks last December in Hampshire and 16% in Sussex, compared to 62% of its similar target for adults.

For those turned away, parents either pay up to £100 an hour for private therapy, if they can find it, or struggle on without professional help. The result is families torn apart by the disruption and stress, children missing years of schooling, and life chances dramatically reduced, and in too many cases loss of life.

Olly Parker, head of external affairs at the charity YoungMinds, told The House: 

“[The House’s] figures show the system is in total shutdown yet there is no clear government plan to rescue it. In the meantime, young people are self-harming and attempting suicide as they wait months and even years for help after being referred by doctors. This is not children saying, ‘I’m unhappy.’ They are ill, they are desperate and they need urgent help. We hear about parents sleeping on their children’s floors to keep them safe, children out of education for months and years while they wait for help. It is not an exaggeration to say it is life and death. How can we as a society allow this?”

The government announced plans in 2021 to implement a four week target for waiting times for mental health appointments as a national standard, however there is little sign of when this will be implemented and if it is implemented, it is unlikely that the standard can be met by the services in their current state.

This research by The House is the latest to be published in 2023, which paints a picture of a system that is letting down thousands and thousands of children. 

In January 2023 a report commissioned by Look Ahead Care, a charity that provides mental health services across England, found numerous examples of children in mental health crisis and attempting suicide several times before getting a bed in an inpatient unit in England. With some under-18s waiting to undergo a mental health assessment on a children or adult ward and then waiting “for days or weeks” for a bed in a Camhs unit.

The report also highlighted how under-18s are seeking help at A&E for serious mental health problems because mental health crisis services are inadequate, even though emergency departments are not set up to deal with them. The increased use of A&E was backed up by NHS data analysed and reported by the Labour Party, which found that children suffering mental health crises spent more than 900,000 hours in A&E in England in 2022 seeking urgent and potentially life-saving help.

In March 2023,  a report by the Children’s Commissioner for England painted a bleak picture of a system where over half of the children with a mental health disorder did not receive treatment in 2021-22, and there was little or no improvement in young people’s access to support, the quality of care they receive and their outcomes.

The report found in the best area in the country, Leicester, children receive treatment in an average of 13 days (between referral and second contact with the NHS), but in Sunderland that goes up to 80 days.

There is no doubt that demand for services far outstrips supply. Government data for 2021/22 shows a 39% rise in a year in referrals for NHS mental health treatment for under-18s to more than a million (1,169,515)

The pandemic certainly increased numbers, but factors such as social inequality, austerity and online harm, fueled growth before the pandemic and now continue to drive the crisis in mental health. Analysis of government data by the Centre for Mental Health found a strong link between poverty and young people’s poor mental health.

Looking beyond waiting lists, to what happens to a child with a serious mental health condition ‘lucky’ enough to get a place in a residential unit, the picture is also bleak.

Mental health outsourced

Years of bed cuts in the NHS (from 23,515 in 2011 to 18,152 in late 2022), means that those children who need an inpatient bed, are very likely to be treated in a private hospital.

The Look Ahead Care report found that:

Private operators now provide most of the mental health inpatient care for children and young people who are deemed unwell enough to need a bed, but these cost up to £4,200 a week – far more than on the NHS.”

The past few months have seen an investigation by The Independent and Sky News into one of the largest private providers, the Huntercombe Group (now Active Care Group), finding that even if a child is found a bed, they may not be safe or receive the care they need.

In late 2022, The Independent and SkyNew began making public the findings of their investigation. In a series of articles based on witness testimony, documents obtained by Freedom of Information request and leaked reports, they uncovered a shocking catalogue of issues in the units run by Huntercombe including sexual abuse, sedative medication as a form of control, excessive restraint, and inappropriate force used in relation to tube feeding.

Just one of Huntercombe’s hospitals, Taplow Manor in Maidenhead, was behind 57% of the 2,875 sexual incidents and assaults reported to England’s CAMHS over the past four years. Reported incidents can range from sexually inappropriate language to serious sexual assault and rape. 

Police are also investigating the death of a young girl at Taplow Manor Hospital and the alleged rape of a child involving two staff members

Whistleblowers spoke of such chronically low staffing levels that patients were routinely neglected, including being left alone to self-harm. The investigations have resulted in 50 patients coming forward with allegations of “systemic abuse” and poor care, spanning two decades at children’s mental health hospitals run by the organisation.

The Independent/Sky News investigation prompted the government to launch a “rapid review” into inpatient mental health units. Yet this failure to keep children safe in private mental health units and treat them with compassion and dignity has been going on for many years.

Although the investigation focused on the Huntercombe Group, other private mental health hospitals, including Cygnet Healthcare, The Priory and Ramsay Elysium which dominate the market, have all been found to have provided poor care, including inadequate care leading to deaths in recent years, with hospital units closed or rated ‘inadequate’ by the CQC.

In January 2023, the BBC reported that three women had died at the Priory Hospital Cheadle Royal near Stockport in a three month period in early 2022, Beth Matthews, Lauren Bridges and Deseree Fitzpatrick, with the coroner citing neglect and failings by the hospital. This is just the latest in a long list of issues in recent years.

Cygnet has been repeatedly criticised by the CQC for unsafe and poor care. Most recently in March 2023 a Joint Domestic Homicide Review and independent mental health homicide investigation reported that the decision to discharge Jonathan MacMillan from a Cygnet Health Care unit in Maidstone into the community was ‘flawed’. Following his release MacMillan stabbed his father to death in June 2019. The review found that the assessments completed while he was detained at Cygnet Health Care were inadequate. 

As with The Priory, this is just the latest reported incident of a long list of problems at the company’s hospitals over the years. There were so many reported problems at the company’s hospitals, that in April 2021, NHS England singled the company out for a highly critical letter saying it will ‘not tolerate failures’. 

Over the past two years, inquests have been held on three deaths at Elysium Healthcare hospitals, which found failings by staff at the clinics.

These companies are being paid millions by the NHS for their services. The Priory received £440 million from the NHS and £179.8 million from UK social services in 2021, Cygnet, which is almost entirely dependent on NHS contracts, had revenue of £500 million in that year, and Elysium received £97.2 million in 2021 almost exclusively from the NHS.  In 2021, The Priory reported profit of £109.7 million and Cygnet a profit of £26.3 million.

Whatever the outcome of the review into private mental health units, it certainly will not be able to rapidly increase the number of beds in mental health units, and so the NHS has no other option but to use those in the private sector.

This is a round-up of the latest reports and revelations in recent months that show the terrible state of children’s mental health services in this country. Unfortunately, these reports, dire statistics, and shocking revelations, follow the previous few months of shocking statistics and reports, which followed….you get the picture.

The situation has been going on for years with thousands and thousands of under-18s denied access to help leading to their future if not being destroyed, then certainly made more of a struggle and making it harder to fulfil their full potential. Imagine what those children could have achieved if only sufficient investment had been made over the past 13 years in supporting them, listening to them and treating them.

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