This is the 2020/21 edition of State of Care
During the pandemic, there has been a significant increase in concerns around children and young people’s emotional wellbeing and mental health.
As part of our programme of provider collaboration reviews, we have been looking at how systems have responded to the challenges of the pandemic to provide mental health care and support for children and young people. Many of our initial findings align with the section that follows, and we will be publishing the full findings of our review in November 2021.
In February 2021, Young Minds published a survey of almost 2,500 young people aged 13 to 25 with a history of mental health needs, conducted during a period of national lockdown in early 2021. This demonstrated the devastating impact of the pandemic on many young people, with some respondents reporting that they had started self-harming again, were having panic attacks or suicidal thoughts, or were losing motivation to carry out basic tasks or to look after themselves. Of the young people who responded, 67% believed that the pandemic would have a long-term negative effect on their mental health.
This is supported by data from Childline. From 1 April 2020 to 31 March 2021, the service carried out 73,088 counselling sessions about mental or emotional health. More than 5,500 of these sessions were with children aged 11 or younger, an increase of nearly a third (29%) compared with the year before.
A review of emerging evidence conducted by the Centre for Mental Health in early 2021 highlighted the unequal effects of COVID-19 on young Black men. It found that across many key areas the disparities faced by young Black men are widening including mental health, educational outcomes and employment prospects.
As a result, it is unsurprising that there has been a significant increase in demand for children and young people’s mental health services. In a short pulse survey of 35 mental health trust leaders conducted by NHS Providers in May 2021, all respondents said that the demand their trust or local system was experiencing for children and young people’s services was significantly or moderately increasing compared with six months previously.
The same survey showed that the majority of trust leaders were concerned about their trust or local system’s ability to meet the level of anticipated demand for children and young people’s mental health care in the next 12 to 18 months.
‘A little boy stuck in the middle’
Kate has three children, including Sam who is nine years old. He is severely dyslexic and his mental health is currently poor.
Kate tried to get a self-referral to child and adolescent mental health services (CAMHS) for Sam for his low mood, low self-esteem and self-harming by biting himself. CAMHS responded that Sam did not meet the threshold of need.
Kate paid privately for an educational psychologist to assess Sam, who recommended that she apply for Sam to attend a specialist school, as mainstream school had been linked to his trauma. The local authority turned this down at application and at a further tribunal. Sam has subsequently been home schooled for the last 21 months.
Kate re-approached her GP because Sam wasn’t sleeping and was suffering with night terrors. Kate’s GP helped her complete a self-referral form again to CAMHS. The response from CAMHS was that there were too many children with a greater need and the waiting lists are too long.
Kate is exhausted and says the experience has affected her mental health. She feels that responsibilities just keep getting passed on to different people, which means that “there is a little boy stuck in the middle not getting the help he needs”.
Interview with a member of the public
Our inspectors have had a particular concern about demand for children and young people’s eating disorder services. This was supported by a May 2021 report from the All Party Parliamentary Group on eating disorders, which highlighted that, since 2015/16, eating disorder services had received far more referrals than had originally been expected and commissioned. Similarly, in the May 2021 NHS Providers survey there is evidence that a significant proportion of mental trust leaders are concerned about meeting this demand.
The impact of the pandemic has exacerbated these concerns. In September 2020, reported that the pandemic has had an unprecedented impact on those affected by an eating disorder. It reported that demand for its helpline services had increased by 97% in the previous six months compared with the same period last year. This is supported by the NHS Confederation August 2021 report, Reaching the tipping point, which showed that the number of young people completing an urgent pathway for eating disorders had increased by 141% between quarter four in 2019/20 and quarter one in 2021/22.
Generally, problems for children and young people were compounded by the closure of schools during the pandemic, which play an important role in the early identification and support of children and young people with mental health needs.
Between September 2020 and April 2021, Mind conducted research into the experiences of young people affected by mental health problems at secondary school. This found that young people couldn’t get support when they needed it or received inadequate support that did not meet their needs. The report highlighted that secondary schools struggle, with minimal resources and over-stretched staff, to support young people with behaviour that is resulting from their mental health. Our forthcoming provider collaboration review report will point to some examples of good collaborative working with schools and mental health support teams by local health and care systems.
Problems with accessing child and adolescent mental health services (CAMHS) are not new, but have been made worse by the pandemic. Our children’s services team reported that a national shortage of specialist inpatient beds had led to a number of children and young people being inappropriately admitted to general paediatric wards or adult wards for prolonged periods of time. Not only does this have an impact on the ability of services to meet the needs of the children and young people who are inappropriately placed, but we have also heard how staff feel traumatised if they have to restrainvery distressed young people when this is nottheirarea of practice.
Because of the challenges with securing CAMHS beds, in our learning disability provider collaboration review we heard that some learning disability and mental health teams supporting children and young people in one area had tried to address this by offering more intensive home support. This had highlighted the importance of earlier intervention at home, and the positive impact that avoiding inpatient care could have for the child or young person.
In terms of children’s access to health care generally, our children’s services team have highlighted how reductions in access to services during the pandemic meant that routine developmental checks may have been missed or delayed, therefore reducing opportunities to provide early intervention. Children’s health staff were often redeployed to support COVID-19 functions, with a knock-on effect on access to treatment.
Our children’s services team also noted that the reduction in face-to-face contacts and the increase in virtual working led to children and young people being less visible to health services. They have heard concerns about levels of safeguarding referrals regarding non-accidental injuries.