Intended for healthcare professionals


Mental health services are failing children and adolescents

BMJ 1999; 319 doi: (Published 02 October 1999) Cite this as: BMJ 1999;319:872
  1. Gavin Yamey
  1. BMJ

    Improvements are urgently needed in the provision of mental health services to children and adolescents, according to Children in Mind, a report published by the Audit Commission.

    The report provides evidence that one in five children and adolescents suffer from a wide range of mental health problems, including emotional, conduct, and eating disorders. This proportion has been increasing in industrialised countries since the second world war.

    The commission audited the current purchasing and provision of specialist services by sending questionnaires to commissioners and providers and by a caseload survey and diary of involved professionals. It reviewed 60% of commissioning health authorities and over 90% of NHS provider trusts.

    There was a sevenfold difference in the amount of spending by health authorities on specialist services for children. This variation “showed little relation to local needs, as measured by the ‘Jarman Scale’ of socio-economic deprivation” and was explained by historical spending patterns.

    As well as this variation in resources, the audit found that trusts differed greatly in the level and mix of staff they deploy, but this did not represent any systematic response to needs. Almost 120 posts for child psychotherapists existed in the audited trusts of England and Wales, but these were unevenly distributed, with nearly half in the London NHS regions.

    The report criticises the poor links between specialists and other agencies Only 1% of specialists' time is spent supporting primary care professionals and social workers, and one quarter of trusts delivering specialist services had no real liaison or joint working with general practitioners.

    Long waiting times for assessment and poor emergency cover were found in some regions. Over a third of trusts “felt that they could not respond effectively to young people presenting in a crisis.”

    The commission urges health authorities to take the lead in reviewing resources, staffing arrangements, and links between primary and secondary care. It also recommends that priority should be given to assessing local needs and developing services of proved effectiveness underpinned by modern information systems.

    “Mental health services can make a major contribution to the support of young people,” said Andrew Foster, controller of the Audit Commission. “Our report shows that the design and delivery of these services may not be keeping pace with a rapidly changing agenda. Most importantly, health bodies, councils, social workers, GPs, and schools need to work together to provide better, more timely support for young people and their families.”

    • The Department of Health last month announced £20m ($32m) of targeted funding over the next year to improve services for children and adolescents. Health minister John Hutton said, “This investment will help to ensure that vulnerable children right across the country have access to a proper level of service.”

    Children in Mind is available from Audit Commission Publications (tel 0800 502030), price £20.

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    Health authority spending on mental health shows little relation to level of need