Child Mental Health:
A Messy State of Affairs
On a daily basis, the increasing burden of child mental health is evident on the general paediatric wards. As the weekend progresses, a sad collection of disillusioned self-harming teenagers and children ‘too’ difficult to manage at home sit in acute beds awaiting Monday morning and that much sought after child psychiatry review. This acute need has a knock-on effect on outpatient services where waiting lists are described in terms of ‘years’ not ‘weeks. We wouldn’t allow the same to happen for asthma or diabetes, so why do we put so little emphasis on mental health?
Personally, I suffered a little teenage ‘angst’ growing up, as did many of my peers, but I can’t recall child mental health problems being as rife as they are today. So what’s changed? Or have things? Why are our mental health services struggling to provide for these children and what can we do to improve things?
Child mental health problems have most definitely increased. Statistics show that the number of children who present to the emergency department with a psychiatric problem has more than doubled since 2009. That’s since I started working as a doctor! 1 in 4 young people in the UK are thought to experience suicidal thoughts and half of all lifetime cases of mental illness are believed to start before the age of 14. There are many more staggering statistics on the youngminds.org.uk website illustrating the sheer scale of the problem but all of them draw me to one overwhelming conclusion. Childhood is the time to get mental health right yet sadly we continue to get it wrong.
So what is it about today’s society that breeds and nurtures mental health problems. There are many theories: In our modern materialistic culture, the pressure to look perfect and live the perfect lifestyle is ever increasing. Social media creeps into our consciousness 24/7 reminding us of our deficiencies as people portray ‘sugar coated’ images of their own ordinary lives. Although bullying can occur anywhere, cyberbullying is becoming an increasingly prevalent and hidden problem.
Children are also becoming sexualised at a much younger age and maybe they’re just not quite ready for that confusing adult world. Family breakdown is endemic. In the rapidly changing world of growing up when parents are the only constant, this can be devastating.
“ It is not the strongest of the species that survives, nor the most intelligent. It is the ones that is the most adaptable to change” – Charles Darwin
Are children today less resilient? It’s certainly a fashionable topic! If we don’t allow children to make mistakes and learn independence at a young age, surely they will cope less well when difficulties inevitably crop up down the road? However this might not necessarily be the case as children today experience different demands and pressures to those even ten years ago. Is it more true that we the adult population are failing them through inappropriate safeguarding and a lack of support and understanding? Increasing numbers of children have reported experience of domestic and sexual violence. Surely we have a duty to protect them from this.
Frankly, our service is underfunded, understaffed and overwhelmed. Government spending on CAMHS services in England has fallen by 50 million per annum (6% in real terms) since 20102. BBC Wales Investigation in 2014 revealed that the Welsh child and adolescent mental health services (CAMHS) were functioning at 20-40% of the recommended staffing level1. In an area where children don’t necessarily need drugs or investigations, dedicated time is clearly the most vital but least available resource.
Deep down I’m a realist and I know that a CAMHS fairy godmother isn’t going to wave a wand and magic up a perfectly resourced service. Possible solutions? I’d be happy to hear some. Making better use of primary mental health care services would certainly help but is there a place for paediatric trainees to expand their skill set? Should all general paediatric training incorporate some child psychiatry experience so that we can adopt the role of the CAMHS team when children present acutely? Just a thought and would be happy to hear yours. Either way, we need to find a solution as our current services continue to crumble…