Children's and adolescents' mental health and CAMHS - Health Committee Contents

1  Information

Children's and young people's mental health in 2014

8. One of the most frequent observations made to this inquiry from its outset has been the lack of reliable data about the state of children's and young people's mental health in 2014. The most recent figures for prevalence of common mental health problems in children and young people date from the 2004 ONS prevalence study, a study which up until 2004 had been conducted on a five-yearly basis. The recent NHS England review is still based on this out of date information:

    The best available estimates of the prevalence of mental disorders amongst children and young people are those from the Office for National Statistics surveys in 1999 and 2004. These found one in ten children aged between 5 and 16 years has a mental disorder. About half of these (5.8%) have a conduct disorder, 3.7% an emotional disorder (anxiety, depression), 1-2% have severe Attention Deficit Hyperactivity Disorder (ADHD) and 1% have neurodevelopmental disorders. The rates of disorder rise steeply in middle to late adolescence and the profile of disorder changes with increasing presentation of the types of mental illness seen in adults.[5]

9. The Chief Medical Officer's annual report for 2012, published last autumn, highlighted the need for a repeat of the ONS survey; it also cited other evidence suggesting a rise in levels of psychological distress in young people, and in particular increasing rates of self-harm:

    Self-harm rates have increased sharply over the past decade, as evidenced by rates of hospital admission and calls to helplines, providing further indications of a possible rise in mental health problems among young people. However, in the absence of up to date epidemiological data, it is uncertain whether there has been a rise in the rates of mental health problems and whether the profile of problems has changed[6]

10. The CMO also highlights the strong links between mental health problems and social disadvantage, with children and young people in the poorest households three times more likely to have mental health problems than those growing up in better-off homes.[7] Public Health England provide the following observations on young people's mental health and wellbeing drawn from other research:

    Analysis of the British Household Panel and Understanding Society survey [2011-12] shows that the rise in children and young people's wellbeing from 1994 to 2008 has curtailed and may be in reverse. Peak onset of mental ill health is 8 to 15 years. 10% of children have a mental health issue and half of lifetime mental ill health starts by age 14.

    The Health Behaviour of School-Aged Children Survey [2009-10] (HBCS) found that around 30% of English adolescents reported a level of emotional wellbeing considered as (sub-clinical) "low grade" poor mental health, that is they regularly (at least once a week) feel low, sad or down. This is higher among girls than boys…

    … Lesbian, gay, bisexual and transgender young people (aged 16-25 years) report higher levels of mental health problems, self-harm and suicidal thoughts. They experience more verbal, physical and sexual abuse and feel less accepted by their community.

    The Understanding Society survey results for 2011-12 suggest 85.5% of children belong to a social networking site. In England, the proportion of young people playing computer games for two hours or more a night during the week increased from 42% to 55% among boys and 14% to 20% among girls between 2006 and 2010. The same survey suggests 12.1% of children have been bullied four or more times in the last six months. In some areas more than 10% of children reported being bullied. Data from the Tellus survey stated one-third of pupils do not think their school is managing the problem well. Childline has reported an 87% rise in contacts related to online, cyber- bullying.[8]


11. The British Psychological Society is amongst many organisations to highlight the problems caused by the lack of comprehensive national data on the prevalence of mental health problems:

    We do not know the scale of the problem … we simply do not have accurate information from which to gauge the state of children and young people's mental health nationally. Information from ChiMat Intelligence Network March 2014 notes, "In summary the ability to provide robust national data to support local service planning is at best limited and planned improvements to this position have suffered from significant delays"[9]

12. Observations from CAMHS service providers strongly suggest that they are now operating in a considerably changed environment from the 2004 prevalence data, with many reporting dramatic increases in demand for their services:

    Demand continues to increase - 89% of respondents said there had been an increase in referrals over the last 2 years; percentages ranged from 20-70%. Many respondents noted a change in the mix of referrals seeing an increase in self-harm, complexity and severity.[10]

    Partnerships are reporting rising numbers of both routine and emergency presentations. Partnerships suggest an average increase of 25% in referrals to CAMHS tiers 2/3 since 2012, possibly due in part to the impact of regional and local cuts on community based services and third sector services.[11]

13. The Committee's witnesses on 1st April reiterated these impressions, noting increasing rates of self-harm, eating disorders, depression, conduct problems and autistic spectrum disorders[12].

14. The lack of up-to-date information about the prevalence of mental health problems is not simply an academic issue - information about how many children and young people may be affected is essential for healthcare planning. The lack of information is causing significant problems for commissioners seeking to plan, improve and fund services in this area. Derbyshire County Council and North Derbyshire CCG stated in their written evidence that "we need to have reliable and up to date prevalence data" and that "the data gap is impacting on strategic decisions and planning."[13] The Minister agreed that prevalence data was "horribly out of date".[14] During the course of our inquiry, the Government announced that it had identified funding to repeat this survey, and the Minister repeated this commitment in oral evidence to us. Work will begin in the autumn, although the project is not likely to be completed until 2016.[15] While the Minister could not commit future governments to funding the survey on a continuing basis, he told us that in his view a long gap between surveys should in future be avoided, in order to "maintain a current understanding of the scale of the problem".[16]

Information about CAMHS services

15. The shortfall of information in this area is not confined to data on the prevalence of mental health problems amongst children and young people, but extends into information about service provision as well, including levels of demand, access and expenditure. The CMO recommends an annual audit of services and expenditure[17], and the NHS England report also highlights this-the best available national data on access times is provided by the CAMHS Benchmarking consortium, a voluntary network which does not include all providers, and the best available data on expenditure is from a recent Freedom of Information request made and analysed by a mental health charity:

    There is no recent data on estimated levels of need for the different elements of CAMHS including Tier 4 services. This depends not only both on prevalence but also other factors including the range of alternative services.[18]

    Information on access times for treatment in community CAMHS is not currently systematically available at a national level though it is understood that there is considerable geographical variation. Data from the NHS Benchmarking Report CAMHS (NHS Benchmarking Network, 2013) found that in 2012/13 amongst its members the maximum waiting times for specialist CAMHS Tier 3 average 15 weeks across the participating providers. This has increased from 14 weeks recorded in 2011/12. Waiting times for accessing urgent CAMHS Tier 3 had a 3-week median wait. This should also be seen in the context of the lack of crisis response services in CAMHS, with less than 40% of CAMHS in the benchmarking offering rapid access through crisis pathways.[19]

16. NHS England were able to provide more information in relation to Tier 4 inpatient services, reporting that both bed occupancy rates and numbers of reported admissions to Tier 4 units increased between 2012-2013, and that there was a rise in the number of inpatient beds available from 1,128 in 2006, to 1264 beds in January 2014. [20]

17. National data published in March by the HSCIC reveals that the number of children and young people being treated in adult mental health facilities is rising:

    In 2011-2012, 357 under-18s were treated on adult mental health wards in England, which went down to 219 in 2012-13. However, between April and November 2013 alone, the figure reached 250.[21]

18. The number of young people being detained in police cells under s136 of the Mental Health Act 1983 remains high, with 263 detained in police cells in 2012-13.[22]

Improvements to data on CAMHS

19. Again, data about CAMHS is a fundamental requirement for the safe and effective planning and delivery of healthcare, and lack of data causes problems for commissioners. Members of the Mental Health Commissioners Network described the lack of data as 'scandalous', and went on to argue that "the lack of current, good quality data means that commissioners and providers are working blind".[23] The Minister used a similar analogy, telling us that lack of data meant that "We have operated in many respects in mental health in a bit of a fog. We have not had access to the data-the information that other parts of the health system benefit from."[24] He went on to say

    Information drives change. If you have an understanding of what is actually happening across the system, rather than the fog we have worked in up until now in mental health, you can start to put pressure on the system to change.[25]

20. As well as recommending repeating the national psychiatric morbidity survey and the What About Youth? Survey, Public Health England make the following recommendations to "strengthen the collection, availability and use of data and intelligence to better inform local authorities, health services":

    ·  The Maternity and Children's Dataset should be implemented as soon as possible. This will provide a robust flow of data on referrals, activity, assessments, treatments and outcomes from CAMHS ….

    ·  ….that work is undertaken to determine the optimum way of collecting CAMH service and expenditure/budget mapping data

    ·  there is a need to triangulate the data on wellbeing, mental illness, self-harm and suicide to better understand the national picture and effectively target resources. The National Mental Health Intelligence Network should start to address this.[26]

21. Planned improvements in this area have been subject to delays, as David Wells, the Associate Director of the National Child and Maternal Health Intelligence Network explained:

    Historically more detailed information was available about activity and services from the Children's Services Mapping project which was discontinued in 2010 on the basis that the data collected would be replaced by the secondary user CAMHS dataset.

    There have been significant unexpected delays in the flow of the data from the secondary users dataset which was originally expected in 2012. The present position is that data collection commenced in sites from April 2013 and funding was identified for the necessary hardware to enable data flow to the HSCIC.

    Procurement of the hardware lies with NHS England and HSCIC. The last published date for data flow to commence was Summer 2014 and first reports should have been available from Autumn 2014 though this is now subject to further potential delay.

    In summary the ability to provide robust national data to support local service planning is at best limited and planned improvements to this position have suffered from significant delays.[27]

22. The HSCIC website now states the following information in relation to this:

    On 11th July, HSCIC obtained high level agreement from NHS England to fund the infra-structure required for the Maternity and Children's Data Set, which includes the CAMHS data set, as well as Maternity and Child Health data sets. We hope to procure the required hardware soon, and are currently in the process of re-planning go-live dates. We will advise on the CAMHS go-live date once it is confirmed.[28]

Conclusions and recommendations

23. The Committee is deeply concerned that the most recent ONS data on children's and young people's mental health is now ten years old, as up-to-date information is essential for the safe and effective planning of health services. We welcome the Government's commitment, made during the course of this inquiry, to fund a repeat of the ONS prevalence survey. It is essential that this survey is not a one-off, but is repeated on an ongoing basis. We recommend that the Department of Health/NHS England taskforce adds the issue of the quality of ongoing data to its terms of reference.

24. Not only is there a lack of data on children and young people's mental health, but also a worrying lack of comprehensive and reliable information about children's and adolescents' mental health services, including referrals, access and expenditure. In the words of the Minister, CAMHS services have been operating in a "fog", and efforts to improve data availability have been subject to delays. This is unacceptable. Ensuring that commissioners, providers and policy-makers have access to up-to-date information about all parts of CAMHS services-from early intervention up to inpatient services-is essential. We recommend that this is a priority for the Department of Health/NHS England taskforce.

5   NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report, 10 July 2014, p14  Back

6   Department of Health, Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays chapter 10 p3 Back

7   Department of Health, Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays chapter 10 p2 Back

8   Public Health England (CMH0085) paras 3.1-3.8 Back

9   British Psychological Society (CMH0133) p3 Back

10   British Psychological Society (CMH0133) p4 Back

11   Professor Peter Fonagy (CMH0216) p4  Back

12   Q3-4 Back

13   Derbyshire County Council (CMH0192) Executive Summary Back

14   Q337 Back

15   Q340 Back

16   Q340 Back

17   Department of Health, Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays Chapter 1 p9 Back

18   NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report, 10 July 2014, p15  Back

19   NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report, 10 July 2014, pp15-16 Back

20   NHS England, Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report, 10 July 2014 p86; admissions, p46; occupancy, p52 Back

21   'Children admitted to adult mental health wards 'rising', BBC news website, 11 March 2014 (accessed October 2014)  Back

22   New map of health-based places of safety for people experiencing a mental health crisis reveals restrictions in access for young people, CQC news release, 16 April 2014 (accessed October 2014) Back

23   Mental Health Commissioners Network (CMH0122) 6f Back

24   Q368 Back

25   Q445 Back

26   Public Health England (CMH0085), para 4.8 Back

27   The Royal College of Psychiatrists (CMH0173) Annex D  Back

28   Child and Adolescent Mental Health Services Data Set, HSCIC website, (accessed 6th October 2014) Back

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Prepared 5 November 2014