ADCS comment: children’s mental health thematic report

The Association of Directors of Children’s Services (ADCS) today, Wednesday 2 November, publishes a thematic report on children’s mental health using data included in the ADCS Safeguarding Pressures Phase 8 research, which will be published in full later this year.

This thematic report draws together returns from 125 local authorities, 21 interviews with directors or assistant directors of children’s services and supplements this with existing data to provide further evidence of a crisis in children’s mental health. The report adds to the growing body of evidence highlighting a children’s mental health system in need of urgent attention, investment and change.

Over the years much focus has been placed on improving mental health support for children and young people which is welcome, yet it is clear this agenda requires more attention from central government, mental health commissioners and providers working together at a national level, with sufficient long term investment, for the benefit of children. We need this now more than ever as these findings show the volume, the complexity of needs and the overlap with children’s social care services has surged since the Covid-19 pandemic.

The research shows:

• Increased prevalence and demand for mental health services, particularly amongst adolescent aged children along with a high number of children experiencing significant trauma and those with neurodiversity. Emotional disorders, specifically anxiety, depression and eating disorders are also rising as is self harm, suicide and suicidal ideation

• The proportion of children’s social care assessments where children’s mental health is a factor increased from 9.1% in 2017/18 to 13.6% in 2021/22. Parental mental ill-health increased from 20.5% to 24.5% over the same period

• 46% of responding local authorities said there was ‘never’ or ‘rarely’ enough child and adolescent mental health service (CAMHS) provision in the right places to effectively support children

• 79% of respondents stated that there were ‘never’ or ‘rarely’ enough NHS Tier 4 inpatient beds in the right places to effectively support children, with the most severe and complex needs

• 74% of respondents felt there were ‘rarely’ or ‘never’ sufficient therapeutic safe placements in the right places to effectively support children. When placements were available, 35% felt they were not of adequate quality

• Many local authorities plug gaps in provision but putting in additional services to meet demand, including boosting funding for mental health support teams (MHSTs) so they reach across as many schools as possible in their area

• Nearly all responding local authorities have commissioned bespoke packages of wrap around support for children at a significant cost. One local authority reported spending £600,000 last year on bespoke purchased therapeutic work for children in their care who could not access CAMHS.

Steve Crocker, ADCS President, said: “Poor mental health can have a devastating and long-lasting impact on children and their families. Ensuring children get the right support and services at the earliest opportunity is crucial to improve outcomes, help build resilience and avoid crises later. However, children face unacceptable waits for support, some are told they are too ill, or not ill enough, to access local services, contributing to their escalating needs. Children’s mental health services were even identified as a specific concern for the Care Quality Commission in its latest State of the Nation report. Local authorities are doing all we can to respond to the situation, including by stepping in when children cannot access the support they need, but this comes at a cost. The current system is not working for children, it threatens to overwhelm the social care system and will damage children’s life chances, it needs change.

He went on to say: “As a nation we must look differently at ways to build emotional resilience, support good wellbeing and treat mental ill health including by considering the needs of children and families holistically. We need commitment from all partners to improve the way we support children with their mental health and wellbeing, we must do better for them. Waiting lists for treatment of over a year are completely unacceptable for children in distress. A national review of children’s mental health services is urgently needed. The review could usefully consider how to tackle workforce shortages, focus on strengthening collaboration and accountability across all partners in the system and clarify their roles and responsibilities as well as considering the specific needs of vulnerable groups, including children in care. Access to mental health support for some of our most vulnerable children and young people who require inpatient services has long been an issue and is emphasised by these findings. In some areas it takes too long to access these beds or they are just not available, despite these children experiencing extreme distress. There has been a reduction in NHS Tier 4 beds at a time when need is increasing with no alternative community based offer forthcoming. We need to completely rethink this part of the system.

Steve Crocker concluded: “The country is facing many competing challenges, including rising levels of child and family poverty and a worsening cost of living crisis, which places many children and their families at risk of poor mental health. The demand seen in the last two years is forecasted to grow exponentially, worsening outcomes for children into adulthood and placing further pressure on children’s social care services. Children keep telling us mental health is their number one priority, we must listen to them and we must do better for them. Their mental health must be a national priority. The warnings in this and many other reports must not go unheeded, children’s lives depend on it.”


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