We Need Accountability to Address Parity of Esteem in Children & Young People’s Physical and Mental Health

1 December 2016

This week, the House of Lords debated  what the government is doing to ensure parity of esteem between mental and physical health. In other words, how is the government going to ensure that mental health is taken as seriously as physical health?  Parity of esteem is enshrined in law as part of the Health and Social Care Act 2012.  Many people campaigned hard to get it into legislation, so it is essential that it is fully embraced and put into practice, so that all the hard work to get it into law wasn’t in vain.

The phrase ‘Cinderella Service’ was used a lot across the house, five times to be precise - an acknowledgement of the historic lack of funding and prioritisation of mental health services. This is particularly true for children and young people’s mental health services, which have been referred to as the Cinderella of Cinderella services.  

Those who seek to tell us that things have changed often point to the recent funding released with the best of intentions. The cold hard truth however, is that this funding isn’t always making it to front line services, partly because it is not ring-fenced. This is despite NHS Clinical Commissioners asking Government to ring fence it because there are so many competing pressure on the NHS. The case for parity of esteem may be accepted at a national level but at a local level it doesn’t seem to have the same traction.

Whilst parity of esteem was only enshrined in law in 2012, we’ve been talking about it since the 1950’s. As Baroness Tyler noted, the Royal Commission of 1957 said that “Most people are coming to regard mental illness and disability in much the same way as physical illness and disability”. 60 years have passed yet we still haven’t seen progressive attitudes towards mental health translated into changes that amount to parity of esteem.

As highlighted in the debate, we seriously need a cultural change in the way the system is planned, commissioned and delivered, rather than just more structural changes.  Many Lords talked about policy such as the Mental Health Strategy.  This was a good policy document, but was never fully implemented.  We now have Future in Mind, which lays out a blue print for a whole systems approach to Children and Young People’s Mental Health Services (CAMHS), but it also needs to be implemented. Baroness Hollins asked an important question to the Minister about whether Government would commit to not signing off any Sustainability and Transformation Plans that do not have a clear plan for improving children and young people’s mental health.

This is important as we know that 1 in 10 children and young people have a mental disorder, and 75% of adult mental health problems begin before the age of 18.  Early intervention and providing appropriate support when problems first arise is more effective – both clinically and economically – let alone the moral case of preventing or reducing distress. So why is it that this knowledge isn’t being translated into the kind of action we need to address this?

Just last week the Royal College of Psychiatrists laid bare the extent of underfunding in Child and Adolescent Mental Health services in some areas. Their report shed light on the huge disparity in funding across the country, the direct result of having no centralised accountability. Some areas were found to be spending less than £5 per head on services compared to better performing areas which spend over £100 per head. The devil may well be in the detail regarding these figures, but they certainly do not paint a good picture of how the money Government has invested has been used.

These figures may sound abstract but they have a very concrete impact on the nation’s young people. The Children’s Commissioner for England 2016 report found that 28% of children and young people referred to CAMHS were not allocated a service – with wide variation between areas. A further 79% of CAMHS services have access thresholds which restrict children and young people accessing their service – only accepting the most severe cases.

We have to remember to keep children and young people and their families at the centre of this debate. It isn’t just about systems and agencies arguing over money.   Just this week, the World at One had a special on this subject, which included some distressing cases where young people are not getting the support they need. 

The solutions to this complicated system will not be easy.  It will require money and commitment and an ability to untangle the complicated way in which we deliver CAMHS.  Children and young people’s mental health is having its day in the sun, in that it is a priority for Government.  Just this week, Dr Sarah Wollaston, Chair of the Health Select Committee announced a new inquiry into the role of education in promoting emotional wellbeing. So people are beginning to look at the wider system around children and young people’s mental health and wellbeing.  We all need to make sure that the recommendations from these reports are fully implemented across the country, so no child is left behind.

What we urgently need to make this a reality is a champion to simplify and untangle things before the system collapses. It needs someone who will not only take on accountability for bringing about change, but who has the power and resources to do the job. We need someone to take control. Given the urgency and criteria, who better than Theresa May.

This year at the Conservative Party Conference, the Children and Young People’s Mental Health Coalition proposed the idea of a ‘Prime Minister’s Challenge’.  The Education Policy Institute’s Commission also recommended a National Prime Minister’s Challenge on Children and Young People’s Mental Health.

This is what the Children and Young People’s Mental Health Coalition would like this Challenge to include:

  • Putting children, young people and their families at the centre
  • Being about all babies, children and young people from conception – 25 years.
  • Implementing a whole systems approach  - as put forward in Future in Mind
  • Focusing on prevention and early intervention as well as specialist services
  • Mentally healthy communities that can provide social scaffolding to support children and young people and build positive social identities
  • Having a values based approach which addresses all stakeholders’ viewpoints
  • Seeing schools as a hub for improving children and young people’s mental health and providing easy access to targeted support when needed.
  • Developing the whole children and young people’s workforce to make this a reality

The previous Prime Minister saw great success with his Dementia Challenge, and with funding from Number 10, we’re confident that the current Prime Minister could deliver similar successes for Children and Young people’s mental health.  It’s time for a radical approach to children and young people’s mental health; it’s time for the Government led by the Prime Minister to deliver the change that means real parity.