Improving mental health treatment for young people in Scotland

What are CAMHs?

Child and Adolescent Mental Health (CAMH) services provide a range of treatments for a variety of mental health conditions including Attention Deficit Hyperactivity Disorder (ADHD), anxiety, behaviour problems, depression and early onset psychosis.

The majority of services are outpatient and community based and provided by a wide range of mental health professionals including psychiatrists, mental health nurses, clinical psychologists, child psychotherapists, occupational therapists and other allied health professionals.

What targets exist for CAMHS?

The Scottish Government requires the NHS in Scotland to measure the time people wait for treatment and this includes people waiting for CAMH services.

From December 2014 the Scottish Government has set a standard for the NHS in Scotland to deliver a maximum wait of 18 weeks from a patient’s referral to treatment for specialist CAMH services (Prior to December 2014 the target was 26 weeks).

The Scottish Government has determined that the CAMH services standard should be delivered for at least 90% of patients.

Why is it important that children and young people can access mental health services quickly?

The importance of early intervention cannot be understated -­ there is a weight of evidence to show that the longer someone is left without support and access to treatment the worse the outcomes are.

People are more likely to experience relapses, and they have a greater chance of being admitted to hospital, so reaching young people early on can make a significant difference to their lives.

Indeed, quick access to support and treatment is considered so important that during the 2016 Scottish elections the Scottish Association for Mental Health (SAMH) issued a challenge to all political parties based on the principle of ‘Ask once, get help fast’ and that Scotland’s next Mental Health Strategy is one which prioritises prevention and early intervention.

It is estimated that around 10% of children and young people in Scotland have mental health problems that are so significant they impact on their daily lives.

Following the introduction of the 18 week target in December 2014, the period January 2015 to June 2016 (latest available data) a total of 26,614 children and young people were seen by CAMH services.

However, more than one in five were not seen within the 18 week timescale set by the Government, with a total of 5,891 patients seen after waiting longer than 18 weeks.

While almost five thousand young patients had waits longer than the target time of 18 weeks, some have had extremely long waits.

Since the introduction of the 18 week target, over 608 children and young people had to wait more than 53 weeks to be seen.

For most patients, ISD Scotland explain, the start of their Referral to Treatment (RTT) period will begin with the receipt of a referral from a general medical practitioner, a paediatrician or other CAMH professional.

However a referral to treatment period may also start with service requests from a social worker, educational psychologist, health visitor, school nurse, or any other professionals where NHS boards have approved these mechanisms locally.

A referral can also be made as a self-­referral by a patient to the above services, where these pathways have been agreed locally by NHS Boards.

In the period since the 18 week target was introduced, almost one in five referrals for CAMHS services have been rejected, with over 9,000 cases being affected.

Given the recent rising trend Scottish Labour is calling for a review of the rejected referrals to ensure no child or young person is missing out on treatment they should be receiving.

The Scottish Government list of Local Delivery Plan (LDP) standards includes “90 per cent of young people to commence treatment for specialist Child and Adolescent Mental Health services within 18 weeks of referral”.

Scottish Labour believes that the importance of quick access to mental health services particularly for children and young people is essential and that there will be no removal or downgrading of the CAMHS targets.

What will Labour do to support children and young people’s mental health?

• Review of rejected referrals

• Guaranteed access for every secondary school to a qualified and appropriately experienced school counsellor

• Using the tax powers of the Scottish Parliament to stop the cuts to public services and invest instead

As well as protecting existing mental health targets, Labour believes that mental health must be give the same priority as physical health, with an NHS shaped to offer access to appropriate mental health treatment in the same manner -­ getting the right care in the right place at the right time is vital.

Scottish Labour’s 2016 Manifesto included a commitment to invest in community mental health professionals trained in talking therapies to widen access as part of a package to end the scandal of missed waiting times.

We remain committed to securing these mental health professionals to work with people of all ages in Scotland’s communities.

But we also recognise that for future wellbeing we need to invest now in the building blocks of people’s lives, and that starts with our children and young people.

Scottish Labour recently revealed that the number of educational psychologists working in Scotland has fallen by 10% in the past three years.

The Scottish Labour manifesto made a clear commitment to invest in more educational psychologists, recognising their importance to good mental wellbeing, social, emotional and behavioural development, and to raise educational standards.

For young people, we also know that addressing anxiety, welfare and low level mental health issues in the classroom can be hugely beneficial.

Scottish Labour is calling on the government to ensure that all secondary schools in Scotland have access to a qualified and appropriately experienced school counsellor, providing accessible counselling to young people who need it.

The proposals carry benefits both as part of helping young people deal with some mental health issues and also as a preventative measure, with around 86% of children and young people in the Welsh Government’s school based counselling programme not requiring onward referral to specialist help after completing an average of five counselling sessions.

These very direct investments in Scotland’s public services would begin to offer faster and helpful support for young people’s mental health.

SAMH’s recent ‘Worried Sick’ report on the experiences of poverty and mental health stated that “Socio-­economic deprivation is a key factor in determining health outcomes for people across Scotland, and it is clear from decades of research that poverty can be both a determinant and a consequence of poor mental health”.

It is therefore a matter of public health for the government to halt its programme of austerity, by using the powers of the Scottish Parliament to ask the wealthiest to pay their fair share of tax and stop the cuts to schools and local services.

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