Changes in CAMHS: parity or warm words?

It’s been a big week for children’s mental health. Yesterday saw the publication of a major taskforce report, today sees the budget announcement of extra money for mental health services. Does this mean England is now on the right track to achieve mental health services on a par with their physical health counterparts?

Let’s talk about the money first. The latest estimate of NHS spending on children and adolescent mental health services (CAHMS) is around £700m. If £200m of the extra £250m announced today in the budget ends up being added to CAMHS (some funding will go towards maternal mental health services, services for veterans and online therapy to employment benefit claimants), this would represent an increase of around 30%, described by Young Minds as a ‘sea change’.  

But more money needs to be accompanied by changes to services. Future in mind, the report from the government’s children and young people’s mental health and wellbeing taskforce, proposes a set of sweeping changes for CAMHS services. They’ve clearly engaged carefully with children, young people, their families and professionals in CAMHS – and the proposals make a great deal of sense.

The money and the report are both positive developments. However, the real question is not whether this represents progress, but whether such progress is enough to counter the challenges mental health faces.

Is the new figure of NHS spending of around £900m sufficient to treat our children and young people in need? Unfortunately, the information we have on need and services is not good enough to answer this question, but my feeling is that it may not be.

Spending on CAMHS services has traditionally been shared between the NHS and local authorities. The new money identified should mean the proportion of NHS spending on CAMHS moves from 0.6% to around 0.8%. However we don’t know what local authorities spend on mental health, or how much they have cut in recent years.

There is no ‘magic answer’ for the right ratio of funding mental health services versus physical health services, or children and young people versus adults. Part of the issue is the lack of sufficient data to support the necessary quantitative analysis of their relative burden of disease, cost and potential benefit.

To get an idea of scale, we could consider the total cost to public services of children’s mental ill-health. For conduct disorders (clinically diagnosable behavioural problems in young people and affecting 5.8% of children aged 5-16), the additional cost each year to public services is £5,000 per child. A simple calculation suggests these children are costing public services in the region of £2.2bn a year. Other child mental health problems also cause substantial lifetime costs to the public sector, and of course there is the suffering of the children and young people affected by these issues. Mental health problems in children and young people are likely to be costing public services several billion pounds each year.

The taskforce report is obviously aware of financial constraints. There are a number of optimistic assertions about what can be delivered with no money – for instance a warm and encouraging welcome for children and their families, greater involvement in services, and a positive attitude and culture in services. As our work on person-centred care shows this is by no means easy, and is best accomplished when there is a core team to support it locally (which means money), alongside senior leadership and a supportive context (which means services not stretched to breaking point).

Critically, the report was published without an impact assessment (the standard document which sets out costs and benefits of government policy). Apart from a small number of new commitments – such as piloting of improvements, and links between schools and mental health services – there is a distinct lack of firm actions. The dynamic here is that firm actions require firm investment, the bill for which is likely to be significantly beyond the resources available.

I’ve previously argued that evolutionary change in mental health is not enough. Some of the new proposals for change are suitably radical – a tier-less care system, home-based treatment pathways, real involvement of young people, and an end to cliff-edges at transition. As a starter for 10, here is what would give me confidence in real change:

• A post-election, fully costed commitment to implementing transformation in CAMHS services.
• High quality data on services both in the NHS and in local government, with transparency of funding, coverage and outcomes. The CAMHS dataset will now start being collected ‘no later than 2016’ – this is a long time to wait.
• Support for local areas in transforming their mental health offer for children and young people. This includes practical support in making changes, funding for transformation (perhaps as part of a broader transformation fund), and moral support for clinicians and managers leading change.
• Honest conversations about the trade-offs to be made in spending a greater proportion of NHS funding on children’s mental health. In financially constrained times increased funding in mental health will be linked, at least in the short term, to less funding in physical health services.
• Local authorities and CCGs championing transformation of services, and making the political and clinical case locally for change.

Rhetoric on parity of esteem has been strong in recent years, but the government has struggled to convert this in to changes on the ground. I hope that this is a turning point, and from now on it will be unacceptable to support our children and young people so poorly.

Felicity is a Senior Policy Fellow at the Health Foundation, www.twitter.com/FelicityTHF