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.