Falling number of NHS child psychiatrists provokes ‘deep concern

This article was taken from: https://www.theguardian.com/society/2017/sep/24/falling-number-of-nhs-child-psychiatrists-provokes-deep-concern

By: Denis Campbell Health policy editor

Shortage of mental heath specialists comes at same time as distress among children is rising, says Royal College of Psychiatrists

The number of NHS psychiatrists helping troubled children and young people in England is falling despite the growing demand for care, new official figures have shown.

The total number of psychiatrists working in children and adolescent mental health services (CAMHS) fell from 1,015 full-time equivalent posts in May 2013 to 948 in May this year. The figure includes all doctors working in CAMHS psychiatry, both consultants and trainees.

The Royal College of Psychiatrists, which uncovered the drop in NHS Digital’s most recent detailed breakdown of the NHS’s 1.4 million workforce, said it was “deeply concerning”. CAMHS teams are already struggling to keep up with the fast-rising number of referrals they are receiving for young people who have anxiety, depression, eating disorders or other conditions. Growing numbers of under-18s in England are self-harming, with the recent rise especially pronounced among girls.

“At a time when demand on mental health services is at its most acute, we are continuously finding that the supply is just not there. As more and more children and young people come forward with mental health problems, fewer and fewer specialists are available,” said Dr Jon Goldin, the vice-chair of the college’s faculty of child and adolescent psychiatry. “The government must show they are aware of the deficit of doctors working in mental health, and commit to a plan to address this deeply concerning imbalance,” said Goldin.

Many CAMHS teams are seeing experienced psychiatrists retire and are also having difficulty finding recruits to fill vacant posts, leading to a shortfall that is affecting the delivery of patient care.

The charity Young Minds warned that the dwindling CAMHS medical workforce could lead to children and young people waiting even longer to receive urgent treatment.

“CAMHS services are overstretched and leave many young people waiting for assessments or turn them away because the thresholds to access care are too high. So these figures showing a reduction in child psychiatrists are concerning,” said Dr Marc Bush, its chief policy adviser.

There is huge unmet need for support and treatment among distressed children. One in four children and young people referred to specialist mental health services are refused help and do not receive any NHS care, despite their mental distress, according to a report earlier this month by the Education Policy Institute thinktank. That equates to about 50,000 under-18s a year not getting vital help.

The state of children’s mental health has acquired a high profile politically in recent years. Theresa May has made it one of her main domestic policy priorities and has suggested that every secondary school could assign a teacher to help pupils with mental health needs and refer them on to NHS services. Jeremy Hunt, the health secretary, claimed last year that CAMHS was the most inadequate area of care across the whole range of services the NHS provides.

The proportion of under-18s refused help because they do not meet increasingly high thresholds for care imposed by local CAMHS teams has not fallen, despite the high-level political focus. Pushed by the Liberal Democrats, the coalition pledged to put an extra £250m a year into CAMHS between 2015 and 2020 to improve services.

Bush challenged ministers to deliver on pledges they have made. “Earlier this year the government committed to bringing in 2,000 more posts in CAHMS, as well as new jobs in crisis settings. Bringing in more staff and valuing and incentivising those who are overstretched or have left the profession is vital in improving mental health services for children and young people, and a welcome step,” he added.

The Education Policy Institute did find some evidence of recent improvements. The average waiting time for a troubled young person to be assessed fell from 39 days in 2015-16 to 33 days in 2016-17. Similarly, the delay in starting treatment fell from 67 to 56 days in the same period.