The dire state of care for children with mental illnesses is revealed today, as figures show the numbers arriving at A&E departments with psychiatric conditions has risen to nearly 20,000 a year â€“more than double the number four years ago.
Experts say a chief cause is an absence of out-of-hours community care for vulnerable under-18s, with children being advised to attend A&E after 5pm. The scale of the problem is proving to be a significant extra burden on already struggling emergency departments. The NHS recorded the highest ever number of A&E attendances, and 111 and ambulance calls over the last 12 months.
According to official data released yesterday, total emergency admissions via major A&E departments have also risen by 44% between 2004-05 and 2014-15, prompting NHS England to appeal for people who can do so to stay away from A&E over the busy new year period.
Professor Keith Willett, the national clinical director for acute care, said: â€œA&E experiences a surge in the days following Christmas and the new year. Younger, fitter people can help our hardworking NHS doctors and nurses by only attending if itâ€™s absolutely necessary.â€
The number of attendances of children at A&E with psychiatric conditions is up 8% to 18,673 in 2014-15, compared with 17,278 last year. That is double the 9,328 total of 2010-11. The number then going on to hospital wards has also risen: last year there were 12,309 admissions of under-18s in which the primary diagnosis was â€œmental and behavioural disordersâ€, against 12,126 the previous year.
Sarah Brennan, chief executive of YoungMinds, a charity working with children with mental illnesses, said the impact on A&E departments of running down child and adolescent mental health services (CAMHS) should have been foreseen. â€œSupport in the community needs to be provided for children, young people and their families when they start to struggle, so that we can prevent the intense suffering that a mental health crisis can cause,â€ she said. â€œThey shouldnâ€™t have to turn to hospital services in desperation because there is no other support available.â€
The new figures only add to the evidence of the crumbling state of childrenâ€™s mental health services. A YoungMinds investigation last year found more than half the councils in England had cut or frozen budgets for child and adolescent mental health between 2010-11 and 2014-15. A health select committee report last year warned that â€œin many areas early intervention services are being cut or are suffering from insecure or short-term fundingâ€. This month it was revealed that the number of children being placed on adult wards because of a shortage of beds on childrenâ€™s wards had increased by 10% this year.
The government says it will invest Â£143m to improve childrenâ€™s mental health services in England this year, less than the Â£250m it had been expected to spend. Officials say it will make up the deficit later in the five-year parliament.
Luciana Berger, appointed to Jeremy Corbynâ€™s shadow cabinet as a minister for mental health, said the government had broken its promises. â€œIt is appalling that more children are showing up at A&E with mental health problems because they arenâ€™t getting the help they need early enough,â€ she said. â€œThe government claims to be making mental health a priority, but they have already broken their promise on funding for childrenâ€™s mental health services this year. On their watch, early intervention services are being stripped back, professionals are being told to do more for less, and more children are becoming so ill they need hospital care.â€
Nicola Mattocks, 18, from Croydon in south London, who has been diagnosed with borderline personality disorder, recurring depression, post-traumatic stress and social anxiety, said that it had become common for community services to advise that young people attend A&E during out-of-office hours.
Mattocks, now an activist for YoungMinds, said: â€œI was being seen by CAMHS and they always said that if you feel unsafe, go to A&E if it is out of hours, and that happened a lot because that tended to be [when] I would feel unsafe. That is the time when you start to think about things and you are alone. The people who work at CAMHS are amazing, but they are so underfunded.â€
A spokeswoman for NHS England admitted mental health services had been â€œthe poor relationâ€ in the past but insisted there would be a turnaround. She said: â€œLocal clinical commissioning groups report halfway through this year that while their overall funding will have gone up by 3.7%, they will be increasing mental health spending by 5.4%, a decisive move towards parity of esteem.
â€œWhatâ€™s more, the NHS is for the first time in 25 years planning on introducing clear waiting-times standards for mental health care, beginning in April.â€