Collette Isabel Stadler: How poor provision of mental health services adds to the risk burden for children in care

If you are a 65 year old male smoker with hypertension, hyperlipidaemia, and a family history of cardiovascular disease, the QRISK calculator informs a physician that your chances of having a heart attack in the next 10 years are 47%. Health professionals leap into risk modification and disease prevention mode; you are referred to smoking cessation programmes, offered dietary and lifestyle help, and prescribed statins and antihypertensives. The approach is aggressive and holistic. I am proud of the UK’s approach to physical illness prevention on all levels.

If you are a 13 year old child in state care, your chance of having a significant mental health problem during adolescence is 49%, yet this is not always a catalyst for action. Currently in the UK there is no standardised risk modification plan in place to provide for these patients. Almost inexplicably, a one in two chance of having a mental disorder does not seem to be a sufficiently high risk to warrant early and sustained psychological intervention as primary treatment or secondary prevention.

This crisis in mental health provision in the UK is worsening. Recently Pulse published some alarming figures obtained from 15 mental health trusts in the UK, which demonstrate how access to child and adolescent mental health services (CAMHS) is becoming increasingly restricted. In the past two years on record we have regressed on many of the crucial metrics. In 2013 44% of referrals to CAMHS resulted in treatment and in 2015 this number had fallen to 39%; during that same year, 33% of referrals were not even assessed by CAMHS.

The idea that any vulnerable young person might pluck up the courage to consult with their GP about their mental health, only to then be blocked further down the referral process from seeing a specialist, is rather disturbing. It is particularly distressing when it is a member of a vulnerable group—a child placed in state care—where there is a much higher prevalence of psychosocial adversity, psychiatric disorders, and far poorer life chances even when compared to the most socioeconomically disadvantaged children in private homes.

Failing to provide appropriate and timely mental health interventions for this vulnerable group incurs grave psychosocial sequelae for that individual and increases the future economic burden on the NHS. For example, the healthcare interventions required to treat an 18 year old attending A&E after severe drug abuse, physical assault, and a concomitant mental health breakdown cost far more than the preventive measures taken for the 13 year old visiting their GP.

The government has pledged to allocate an extra £250m a year for the next five years to improve CAMHS provision. Whether or not this money reaches the frontline and enables practitioners to expand capacity within CAMHS remains to be seen, but the onus is on us all, as a country, to ensure that we do not turn a blind eye to our vulnerable young people.

Collette Isabel Stadler is an academic GP ST1 in Cambridge. Her research interests focus on health inequalities, particularly for vulnerable groups of the population. She has a particular interest in the health of looked after children and care leavers. 

Competing interests: None declared.

  • Sally Hall

    A very thought-provoking and timely piece, especially given that many CCGs across England are currently in consultation on the future shape of their child and adolescent mental health services. Proper resourcing is key.

  • Katherine Read

    The overlap between these two groups that suffer from both social and medical budget cuts is a tragedy. If society is judged on how it treats its most vulnerable then things are looking bleak. As a GP registrar in Norfolk the children I refer can be waiting months and it isn’t good enough.

  • Anam Anzak

    Very interesting read! From my own observations as a neurosurgical trainee, a noticeable proportion of my young patients with traumatic brain and spinal cord injuries come from unsettled social situations and/or have a history of psychiatric episodes. Providing them with the support they need at an earlier stage would certainly help avoid the development of these worst case scenarios!

  • Emma Rogers

    An innovative blog that clearly illustrates the importance of adjusting the focus of health policy to ensure that the needs of the most vulnerable groups in society are met. Increasing CAMHS could help to dramatically transform the health prognosis and life trajectory of vulnerable young people in care/care leavers. Having worked in settings supporting the health/social care needs of young people in care I cannot emphasis enough the importance of early intervention approaches.

  • Fiona Place

    The statistics are certainly terrifying. It is most worrying that for mental health the idea of ‘prevention is better than cure’ doesn’t seem to apply.

  • Rachel Taylor

    I am sad to read this, but glad Dr. Stadler is taking the time and effort to make people aware of the issue.
    These children are our future, they need to be in good health all round.

  • Jenny Rumney

    This is a very well-written and insightful article. I think other professionals such as teachers, social workers, etc would also find it informative and useful.

  • Miranda Jefferies

    An insightful and articulate contribution to the field. The concept of risk stratification for these children is an interesting and novel idea.

  • Galina Kolomiytseva-Peek

    I entirely agree with Dr Stadler that “Failing to provide appropriate and timely mental health interventions for this group…. increases the future economic burden on the NHS”. As I am currently working in the Community Mental Health Services, I see a lot of evidence that if the problem of mental health is not solved in childhood, it will persists into adulthood and will likely get worse often leading to person’s unemployment and even disability, using more resources and care later on in adult life. I support Dr Stadler’s point of view that investing money and developing children’s mental health services now will save money on health and social care in the long term.

  • shan He

    Thank you for the article and for raising awareness of the system problems in dealing with young people facing mental health. The next step is action. Can we hold people accountable? That will require a much coordinated action from the community as well as the frontline staff.

  • Laura Aruparayil

    Many thanks to Dr Stadler for this excellent post raising awareness of the needs and challenges facing our children in care. We need to continue to champion this vulnerable group, not settling for the creation of a new ‘normal’ for these children wherein we expect and accept that poor mental health and general health outcomes are ‘just the way it is’. We thank our colleagues in CAMHS for their ongoing dedication through many complexities regarding mental health provision and access. Investing in these children now can mitigate against a lifetime of mental, emotional, physical and social challenges.