Intended for healthcare professionals

Rapid response to:

Analysis

High integrity mental health services for children: focusing on the person, not the problem

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1500 (Published 03 April 2017) Cite this as: BMJ 2017;357:j1500

Rapid Response:

Investment in child mental health research is required to enable the development of more effective personalised interventions.

Wolpert and colleagues are right to highlight the limitations of the current evidence base for treatment in child mental health [1]. That child mental health is ''everybody’s business'' [2] has long been the mantra of clinicians working in the field so that recognizing the pivotal role the wider community plays in children’s wellbeing is uncontroversial, but this is only part of the solution, attention also needs to be directed to the capacity of services to offer effective interventions and the development of a scientific knowledge base to underpin treatment decisions.
In few areas of healthcare would disinvestment in clinical services [3] be tolerated at a time of rising demand (a 44% increase in CAMHS referrals over the last 4 years compared to a 7% increase in A&E referrals over the same time period [4]). This has inevitably impacted on services’ ability to offer interventions which are known to achieve good outcomes for young people and their families. However, in order for genuine progress to be made, investment in the development of more effective targeted treatment interventions is urgently required. We are currently involved in a research project funded by NIHR to develop personalised interventions for the quarter to a third of families who fail to benefit from parent training programmes as recommended by NICE [5]. Yet projects such as this are the exception and the science of personalised interventions in child mental health is in it’s infancy [6,7]. Mental health research in general is underfunded relative to overall disease burden and the vast majority of this funding is directed towards underpinning research with only a tiny proportion allocated to therapeutic interventions research (between 4 and 6%) [8]. If these were physical health difficulties, such poor investment in services and research would not be tolerated.

1.Wolpert M, Vostanis P, Martin K, Munk S, Norman R, Fonagy P et al. High integrity mental health services for children: focusing on the person, not the problem BMJ 2017; 357 :j1500
2. Ford T, Hamilton, H, Meltzer H, and Goodman R. Child Mental Health is Everybody's Business: The Prevalence of Contact with Public Sector Services by Type of Disorder Among British School Children in a Three-Year Period. Child and Adolescent Mental Health 2006; 12: 13–20
3. http://www.cypnow.co.uk/cyp/news/1152865/camhs-spending-cut-by-gbp35m-in...
4. NHS benchmarking network
5. Scott S, Dadds MR. Practitioner review: when parent training doesn't work: theory-driven clinical strategies. Journal of Child Psychology and Psychiatry 2009;50(12):1441-50
6. Ng MY, Weisz JR. Annual research review: building a science of personalized intervention for youth mental health. Journal of Child Psychology and Psychiatry 2016;57(3):216-36
7. Scott S. Commentary: finding out the best way to tailor psychological interventions for children and families--a commentary on Ng and Weisz (2016). Journal of Child Psychology and Psychiatry 2016;57(3):237-40
8. UK Mental Health Research Funding: MQ Landscape Analysis. MQ; 2015. Retrieved from www.joinmq.org/research

Competing interests: No competing interests

22 April 2017
Eilis M Kennedy
Consultant Child and Adolescent Psychiatrist and Director of Research and Development
Dr Rob Senior, Consultant Child and Adolescent Psychiatrist and Medical Director, the Tavistock and Portman NHS Foundation Trust
The Tavistock and Portman NHS Foundation Trust
120 Belsize Lane, Hampstead NW3 5BA