Children with mental health problems are waiting up to 18 months to be treated, a government-ordered report will reveal next week, in an indictment of the poor care many receive.
A Care Quality Commission report into child and adolescent mental health services (Camhs) will warn that long delays for treatment are damaging the health of young people with anxiety, depression and other conditions.
The NHS watchdog will conclude that when under-18s in England do get help from the NHS, it is “caring”. However, it will voice alarm that so many of them encounter much difficulty once they are referred by their GP or a teacher at their school.
Experts at the CQC who have drawn up the report, due to be published next Friday, were surprised to find that accessing care took so long and delays occurred in so many parts of England. Children can wait months after referral before their initial assessment and then further months before they start treatment.
Children’s tsar savages NHS over 'unacceptable' mental health care
Long delays are leading to some children starting to self-harm or fall out of education, couples breaking up and parents having to stop working so they can look after their child, the charity Young Minds said. Statistics show that one in five children referred for treatment in England cannot be seen by overstretched child and adolescent mental health services, and some families end up seeking private care.
“Improvements have been happening in some areas, but we regularly hear from parents who can’t get a referral, with their GP telling them to seek a referral via their school and vice versa. We also hear from parents who have been waiting for months for an initial assessment, and whose children’s conditions have got worse during that time,” said Jo Hardy, the head of parent services at Young Minds.
“Some parents tell us that their children have started to self-harm during the wait or that they’ve dropped out of school, which not only has a big impact on their own education, but also means that one of the parents has to give up their job to look after them.
“We hear from parents who’ve separated because of the pressure the wait is putting on the whole family, or who talk about the damaging effect it’s having on their other children,” she added.
The report’s authors learned that many child and adolescent mental health service units were struggling to cope because rising demand for care coincided with worsening staffing levels, especially at weekends, which is undermining the quality of care patients receive. It will also highlight how bed shortages are forcing the NHS to send children sometimes hundreds of miles away from their home area in order to be treated.
Judge warns of 'blood on our hands' if suicidal girl is forced out of secure care
In August Sir James Munby, the president of the family division of the high court, said Britain would have “blood on its hands” unless the NHS found a bed for a 17-year-old girl, known only as X, who was at serious risk of taking her own life. He condemned the “disgraceful and utterly shaming lack of proper provision in this country” for young people struggling with mental illness.
“I welcome the CQC’s focus, including highlighting the very long waiting times and difficulty accessing care that too many children and young people endure,” said Dr Bernadka Dubicka, a psychiatrist and chair of the child and adolescent faculty of the Royal College of Psychiatrists.
Shortcomings in child and adolescent mental health services care mean some children end up experiencing a full-blown mental health crisis, she said.
“Although there has been some additional investment, money is not reaching the frontline, demand is increasing and children are being pushed into crises. Every day children and young people are being let down by the current inadequate provision across the system.”
The report was due to come out last week, but publication was delayed until next Friday after Downing Street intervened. No 10 asked the regulator to look into the state of mental health care for children and young people and made clear Theresa May’s keenness for the regulator to analyse an area of NHS care in which weaknesses have been causing acute concern to MPs, medical groups and families. The number of under-18s – especially girls – ending up in hospital as a result of self-harm has risen sharply over the past 10 years.
Self-harm among girls aged 13 to 16 rose by 68% in three years, UK study finds
May has taken a particular interest in children’s mental welfare as part of her focus on mental ill health as one of the “burning injustices” she has pledged to tackle. It was a key element of her “shared society” speech in January, which was the first detailed exposition of her beliefs and philosophy since she entered No 10 in July last year.
Jeremy Hunt, the health secretary, last year claimed that child and adolescent mental health services were “possibly the biggest single area of weakness in NHS provision at the moment” and said “we are letting down too many families and not intervening early enough when there is a curable mental health condition”. Anne Longfield, the children’s commissioner for England, last week said there was “shockingly poor support” for children with mental health problems.
The CQC’s review of the evidence comes as the government prepares to publish a green paper on children’s mental health, which is intended to lead to what ministers, mental health experts and children’s campaigners say are overdue major improvements in care.
A CQC spokesperson said: “We have been tasked by the government to identify the strengths and weaknesses of the healthcare system to support children and young people’s mental health and help improve understanding of the pathways that they follow and the obstacles that they face. We will publish the first stage of this thematic review next week.”
Claire Murdoch, the mental health director for NHS England, said: “It is factually unarguable that after years of underinvestment, NHS funding for young people’s mental health services is now going up. In the past year alone, the figures show young people’s mental health spending has gone up by £100m.”
But she added: “But NHS England has also been explicit about the scale of unmet need, which recent improvements have inevitably only been able to begin to tackle.”
This page gives information about carrying out DBS checks on your care home staff and obtaining Disclosures for carers, health visitors or those in the care sector. If your organisation requires criminal record checks on staff because you are undertaking care services, you can Register your organisation now to carry out checks straight away.
Who needs a DBS Check within a Care Organisation?
Whether you are running a Care Home, a Nursing Agency or Health Visitor Service, you will need to decide what level of check is required on staff members and volunteers. A majority of these roles involve Personal Care so an Enhanced Level Check, with a Barred Lists check would be appropriate.
To assist with the decision-making process, we have created some webpages relating to Regulated Activity for working with both children and vulnerable adults. You must register with the Care Quality Commission (CQC) for each of the Regulated Activities that you undertake. The CQC have created a webpage designed to assist with this process, with a brief description of each activity involved. Included in this decision-making process should be policies on supervision, the opportunity for contact with children/vulnerable adults and other measures in place to prevent harm.
Some common job roles that you may wish to run checks on include:
- Care Home Manager
- Registered General Nurse (RGN)
- Care Assistant
- Mental Health Nurse
- Administration staff
- Bank staff
- Social worker
As part of their inspection process, the Care Quality Commission (CQC) ensure that the organisation complies with Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2012. As part of this process they can request evidence that a suitable DBS Disclosure was obtained when an employee was appointed to a role, and prior to being allowed to work unsupervised with children and/or vulnerable adults.
Our systems are specifically designed to comply with these regulations and we have confirmed with the CQC that they will accept a specifically designed “Preview Disclosure Notice”. This can be printed from your own ‘Client Area’, as a record of the check requested. We can also tailor the account to match any recheck policies you have within your organisation to ensure your staff Disclosures are kept up to date.
Portability of Disclosures
For more information about this topic please read our page on Disclosure Validity.
The DBS have developed the Update Service which was designed to improve the portability of Certificates. Our FAQ includes a link to using the DBS Update Service which has been written to clarify the process and help you evaluate how to best introduce the service to your organisation.
Registration with CQC and further guidance
For initial registration with the CQC the designated manager or organisation lead should have carried out a check directly with the CQC. If not, please go to the CQC Homepage . There you will be provided with all the guidance required to obtain your initial DBS check that the CQC will request, as part of the Registration Process.
Most care organisations will need to decide for themselves who to run additional DBS checks on, as part of their Safeguarding Policy and using the CQC guidance provided on their website. You then run checks on your existing and new staff via an Umbrella Body organisation. To do this, you can simply register with DDC and we will call you back, so you can start the checking process immediately.
Working on Care Home Sites
The guidance relating to those working on care home sites, but not directly providing a care role, was changed when the new eligibility information on Regulated Activity was introduced. This means that a Care Home for Adults is no longer classed as a ‘Specified Place’. It is now much more important the role being undertaken by the employee is evaluated in line with DBS guidelines.
For those working in a care home, even on a temporary basis, the role should be evaluated using our specific guidance for Regulated Activity with Adults. Care Homes for children (and similar settings) are still classed as ‘Specified Places’ and should be evaluated for frequency and access to children using the Regulated Activity with Children webpages.