Is CAMHS the only way?
The current system for a UK primary school pupil to receive NHS treatment for a mental health illness is via a referral to the Children and Adolescence Mental Health Service (CAMHS) Waiting times to access treatment can vary dramatically with some children waiting up to 24 months (Quality Care Commission, 2017) This system of “identifying and referring student to an external support service” (Askell-Wiliams & Lawson, 2013) is dependent on the exterior services having sufficient capacity to keep up with demand.
The UK Government aims to increase access to the NHS Children and Adolescence Mental Health Service (CAMHS) through increased spending; their aim is to provide mental health care to 35% of referred children by 2021 (NHS, 2015) This is a welcome improvement but still leaves 65% of children needing care without treatment. The slow progress in improving mental health services for children has been described by the Health Secretary as “The weakest area of current NHS provision.” (Children's Commissioner, 2017) Frith (2016) reports that CAMHS turns away 23% of children referred to them, these children are still in need of mental health treatment, but do not meet the threshold for being accepted by CAHMS. Murphy (2012, p. 7) reports thresholds for treatment from CAMHS being too high, leading to children “falling through the net.” These are the children whose mental health could be supported by in-school Health Mentors.
Further research shows that if treatment [for mental health issues] is not received there are higher rates of failure at school, family dysfunction, prison and unemployment. (American Academy of Pediatrics, 2004) These findings are being mirrored In the UK children with “children with an emotional disorder are more likely to smoke, drink and use drugs than other children, they are more likely to fall behind in education and experience unemployment.” (Frith, 2016, p. 6) It is clear therefore that failure to prevent and treat mental health issues at the earliest possible point is creating a potential for lifelong problems. Early prevention is recognised as important in dealing with mental health. Murphy (2012, p. 6) reports that “Intervening early in the course of a disorder can reduce the risk of later disorder and has the potential to generate savings for services and society.” Further evidence to support this view comes from (Wahbeck, 2015) who states “preventative interventions reduce the incidence and prevalence of some mental disorders” Despite this, currently only 0.7% of the NHS budget goes on children’s mental health, with only 16% of that being spent on early prevention. (Kessler R. , 2010)
We currently have well-meaning dedicated and professional teachers, untrained in mental health, trying to deal with pupils’ mental health problems when they are already buckling under the weight of their teaching workload. (Griva & Joekes, 2003) This exact point was highlighted by the Quality Care Commission (2017) “The problem of gaining access to specialist help is contributed to and compounded by the fact that those who work with children and young people (in schools, GP practices and A&E, for example) do not always have the skills or capacity to identify or support the mental health needs of children and young people.” McKenna & Zwolinsky observed that using mentors [or counsellors] to deal with mental health issues “help deal with issues that school staff either was unable to address or didn’t have time to handle.” (2015, p. 14) This point is powerfully emphasised by children “Teachers understand, but not as well as counsellors.” And “I would rather not talk to my teachers about issues that worry me, I think it needs to be a different person.” (Dept for Education, 2016, pp. 34-36)
There are clear advantages of using a school-based mental health professional. Economically, spending on counselling as an early intervention is prudent; the estimated cost of mental health to the UK economy is £105bn per year. (NHS England, 2016) In 2012/13 the cost to the NHS of treatment for mental health illness was £700 million (6% of the total mental health budget) yet only 25% of referred children receive treatment (Public Health England, 2016) Every £1 spent on counselling in primary schools results in £6.20 in terms of improved long-term outcomes. (Pro Bono Economics, 2017) Over 4,500 children in 251 primary schools received counselling through Place2Be, a UK based counselling charity. The estimated benefit of the counselling included reduction of truancy, smoking, depression, crime and a higher expectation of employment and wages. The estimated benefit of the counselling was £25.9m with a cost of delivery of £4.2m. Other advantages include the convenience to families of not having to take time off work and interrupt education to visit clinics
Research for the department for education and skills looked at how CAMHS and schools can work more effectively together (Pettitt, 2003) Its findings showed that by using in-school counsellors “had resulted in an increase children’s happiness and wellbeing, and there was a measurable improvement in behaviour.” The recommendation was to provide more in-school work by CAMHS staff and highlighted the provision of “preventative and early intervention mental health service for children” However despite the success of the trial this model was not rolled out nationally.
A Health Mentor or in-school counsellor, who has training and experience in dealing with low level mental health can also negate the neurological damage caused by adverse childhood experiences. Toxic stress in children caused by traumatic events effects brain development and leads to poor behaviour as well as physical mental illnesses later in life (Bellis, et al., 2017) having an adult who can help build resilience can turn toxic stress into tolerable stress, and therefore help prevent life-long problems.