School counselling key in mental health battle

Written by: Pete Henshaw | Published:
Image: Adobe Stock

The children’s commissioner wants to see more funding and incentives for in-school counselling and other low-level mental health support. Pete Henshaw takes a look

Depending on where they live, children suffering from mental health problems face waiting times of up to four months for treatment – with one in three nationally not getting the help they need.

The state of children’s mental health services, a report from Anne Longfield, England’s children’s commissioner, says some progress has been made but that mental health provision is still the “poor relation” of NHS services, with a postcode lottery compounding problems.

Mental health spending per-child varies wildly by NHS area – from as much as £191 to as little as £14 – and the report warns that a significant number of children are missing out on treatment.

It says that low-level support in the community, such as school-based counselling, can play a crucial role but that coverage remains variable.

NHS figures from 2017 show that 12.8 per cent of children and young people aged five to 19 have at least one mental health disorder – this equates to more than one million children.

However, only around three per cent of all children were referred to Child and Adolescent Mental Health Services (CAMHS) in 2018/19 – equating to about one in four of those with a mental health disorder. In addition, more than one third of children who are referred to CAMHS do not receive treatment.

In 2018/19, 398,346 children were referred to CAMHS. Of these, 135,430 did not enter treatment, 74,130 entered treatment within six weeks, 56,688 after waiting for six weeks, and 131,878 were still on the waiting list at the end of the year.

The report states: “This is a key concern for the children we meet, who repeatedly tell us about being ‘turned away’ or ‘refused’ treatment. Last year 34 per cent of children who were referred didn’t go on to enter treatment, compared to 36 per cent the previous year. However, because overall referrals have also increased, the total number of children referred to NHS services who did not go on to receive treatment has risen by more than 10,000.”

How many children get the treatment they need varies depending on area. In some places, a large majority get treatment, including four areas where it is more than 90 per cent – Southwark, Croydon, Corby and Lambeth. However, in other areas the figure is much lower, including in 10 areas where it is more than half, such as in Knowsley (64 per cent) and North Hampshire (55 per cent).

In some areas, children wait three weeks for treatment while in other areas they wait four months. Overall, children waited an average of eight weeks (or 53 days) in 2018/19, down from 57 days in 2017/18.

It means that low-level mental health services are being left to pick up the pieces, including in-school services. However, these are patchy, often being delivered and paid for out of each school’s own funding.

The report finds that 61 per cent of schools now have in-house counselling support, although little is known about the quality of these services. Half of schools now have a mental health lead on their staff.

The three barriers to improving in-school provision, it says, are difficulties commissioning local services, funding and internal capacity.

The government has committed to providing in-school Mental Health Support Teams in 20 per cent of areas by 2024, which is estimated will reach 80,000 children. The report emphasises the important, beneficial role played by low-level support services in schools – such as counselling, cognitive behavioural therapy, art therapy, and family support services.

It states: “Only a third of children with a clinically diagnosable mental health need are accessing NHS treatment, this leaves about 760,000 children with a significant mental health need but not accessing ‘specialist treatment’. By 2024/25 this figure should have dropped below half a million.

“But there are also children with … ‘pre-diagnosable’ conditions. Even if specialist mental health services expand to where they think they would need to be by 2028, this still leaves about 1.2 million children who would benefit from some form of mental health support. We don’t know how many of these children are getting some support.”

It says that the government has failed to clarify who should provide and fund “important low-level services such as in-school and community counselling”. It says that giving autonomy over low-level services to local NHS areas has effectively made these services “optional”.

The report adds: “There is too little incentive in place for local areas to invest, too little accountability as to what is delivered and often too little funding available – for example, for schools to buy-in school counselling for all children who need it.”

Overall, the report says that spending on mental health services is rising, with 161 NHS areas increasing spending in 2018/19. On average per-child spending nationally has gone up from £54 to £59 in real-terms. This means an additional £50 million has been spent resulting in an extra 53,000 children receiving treatment.

However, the report says that CAMHS remains the “poor relation” of NHS services – £750 million was spent on services in 2018/19, out of a budget of £76 billion. Ultimately, children account for 20 per cent of the population, but only 10 per cent of total mental health spending goes to services for young people – the NHS spends £225 per adult but only £92 per child.

Children’s commissioner Anne Longfield said: “There is still a chasm between what children need and what is being provided. We are still a decade away from a decent mental health service for all children.

“The government doesn’t have a plan for a comprehensive service in every area and there is still no commitment to a counsellor in every school, which would make a huge difference.

“Most areas are still spending less than one per cent of their budget on children’s mental health services, and the postcode lottery of care means some areas are years ahead of others in improving services.”

Further information

The state of children’s mental health services, Children’s Commissioner, January 2020: http://bit.ly/2u212EO


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