"Under-resourced, over-stretched." This is how a paediatric doctor has described the state of Britain's children's mental health services (1).
In the wake of the COVID-19 pandemic, there is a glaringly obvious concern for parents, teachers, doctors and psychologists: our children's mental health.
There is a problem.
The NHS have reported a 39% rise in children needing treatment for mental health conditions in the UK: from 839,570 in 2020-21 to 1.1 million in 2021-22. (2)
Children are some of the most vulnerable people in our population, and yet they are often forgotten by government policy and health budgets.
The current national children's mental health system is mainly made up of CAMHS: children and adolescent's mental health services. For children to access this service, they often need a referral from a GP. CAMHs provides a wide variety of specialist services, from therapy, inpatient services and medication, and can help treat a range of mental illnesses, such as anxiety, depression, trauma and eating disorders.
There are private options- therapists, counsellors, and educational psychologists- but these are often expensive, and we know that the children with the highest need for support most likely come from those low socioeconomic backgrounds; homes that cannot afford to jump the waiting lists and seek private services. (3)
Services like CAMHS were efficient in meeting the population's needs when they were first established in the late 1990s, but almost 3 decades later, the needs of today's children has exponentially grown beyond anybody's predictions. Although funding and workforce has increased over the years, it is simply not in line with its user growth.
Even before COVID-19, children's mental health referrals were overwhelming. In 2018, a public health report found evidence of low staffing and long waiting times among many CAMHS services- primarily a combination of lack of government funding and a consistent and constant high volume of incoming patients. (4)
As you can imagine, CAMHS has understandably struggled to cope with the pandemic, where mental health needs have rocketed, and many staff had to isolate, with waiting lists only growing and backing up, and chances of receiving support deemed a "lottery" (1)
An article by the Independent in January 2022 describes how "the pandemic came along and it has just been like throwing a bomb into the whole thing". (1)
This rise of almost 100,000 children a year (2) desperately needing mental health support has proven inevitable challenges.
Despite promises from the UK government of multi-million pound NHS investments and limits on wait times, there are no signs of the sizeable change needed within CAMHs that children, and mental health professionals, are desperate for.
As time goes on, and children are left untreated, this problem isn't going anywhere- if anything, it's looking like it'll only get worse.
This leaves us with the question: what other options are there?
After years of government funding promises that haven't been met, we can't wait much longer. CAMHs can only do so much with what they have: we must explore and consider other accessible options to support our children and their mental health, before it is too late.
Here is a discussion of increasingly viable and convenient options that can be explored as alternative support during these overwhelming times.
Virtual technology is a viable and available option to expand children's mental health services that has been explored and rapidly advanced in recent years.
Technology can open so many doors when it comes to accessibility.
Telephone and video healthcare appointments can remove geographical barriers and potentially reduce waiting times by distributing caseload evenly across areas.
Free mindfulness and wellbeing apps are something that almost everybody can access. For some individuals, using low level mental health interventions on their own mobile phones may prevent them from needing higher level care later on, reducing the strain on the NHS in the future. (5)
Virtual support from online charities, apps and websites may mean children can access mental health support without involving their parents; this is especially great for LGBTQ+ and transgender youth, a population that we know are disproportionately vulnerable to mental health difficulties, who may not able or comfortable to tell and involve a parent or carer about their worries. Early help and support can reduce anxiety and depression in transgender teenagers (6), so virtual services may make a huge difference to this population.
With long waiting lists for services like CAMHs, it is important to consider what can be done on a local, smaller level for children. The most obvious place to start is in schools: children spend 30 hours a week here, all year round.
Encouraging "time to talk": designating time out of the school day with extra vulnerable children (or all children, if time allows) to talk about home life, personal problems and worries with a trusted adult may allow children the outlet they need to reduce effects of anxiety and depression. We know that 'bottling things in' can negatively impact mental health, so by providing routine time to do the opposite, letting it out, can empower children's wellbeing.
Training all staff on early signs of difficulty in children may be the difference between a child receiving preventive, personal support or high level treatment.
Promoting self-awareness for children regarding their own mental health: schools proactively informing about wellbeing, educating children on their mental health, and encouraging discussions and open conversation can be a great start. If children understand their emotions and know what to do and who to speak to when they face difficulties, it can prevent many children from falling deeper into a mental illness.
There are obvious barriers such as school funding, staffing levels, and time and resources, but exploring and adapting school level interventions will make a potentially life-changing difference to some children.
Promoting mental wellbeing and supportive practices at home can have wider knock-on effects for children, in their childhoods and later on. Home is the central hub of most things in an individual's life: this includes mental health.
As a parent, having open and honest conversations about mental health with your children is vital. By introducing the concept of looking after your brain from early on, children will be prepared for any anxieties, worries, and difficulties they may face as they grow up, and be therefore more resilient, as they will have a better understanding of their emotions.
Creating a safe, welcoming environment for children to disclose their feelings without prejudice and judgement is essential. For a child, home is usually the safest place, so they may feel more inclined to talk about their wellbeing here, rather than at school.
For government, schools and communities: educating parents on the importance of all this is essential. Some parents may not understand the need for discussion around mental health, as they may not have received it themselves in their own childhood- which is why, now more than ever, it is so important to promote and inform parents wherever they may access.
After all: mental health starts at home (4).
To conclude: CAMHs is an excellent and essential service that supports and treats a vulnerable population. However, due to recent events surrounding the pandemic, their funding is limited for the amount of service users they support. This has led to long wait times, low staffing, and general inaccessibility for many who need it.
This issue needs to be addressed by governments, schools, and communities, who should consider other options of supporting their children's mental health in the midst of a difficult time. Using technology, school systems, and early home support, we can help tackle this problem together: it may make a huge difference to a child's life.
If yourself or a child you know needs extra support with mental health, please explore these resources:
Anna Freud Youth Wellbeing Directory (find mental health support near you) https://www.annafreud.org/on-my-mind/youth-wellbeing/
Samaritans: 116 123 / www.samaritans.org
The Independent: article by Zoe Tidman (2022). https://www.independent.co.uk/news/health/child-mental-health-waiting-times-b1972830.html?amp
Reiss (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415852/
Technology and the future of mental health treatment: https://www.nimh.nih.gov/health/topics/technology-and-the-future-of-mental-health-treatment#:~:text=Anonymity%3A%20Clients%20can%20seek%20treatment,cost%20less%20than%20traditional%20care.
Budge, S. L., Adelson, J. L., & Howard, K. A. S. (2013). https://doi.org/10.1037/a0031774