Children are now waiting more than a year for mental health treatment, the president of ADCS has warned
"Families are under acute stress and breakdown with children ending up in a social care system that was never designed to meet their mental health needs.” Steve Crocker, president, Association of Directors of Children’s Services
The NHS is “not doing a very good job” for children, Steve Crocker, president of the Association of Directors of Children’s Services (ADCS), told the organisation’s conference last week.
Crocker pointed out that children now typically wait four months for a mental health assessment and over a year for treatment. It was “simply not good enough”, he said. He told delegates that under the ICS reforms, there was an “ongoing risk that the needs of children are sidelined by the ongoing pressure in acute adult services”.
He added that he would like to see “more collaboration” from the new integrated care systems, which are now on a statutory footing.
Describing the House of Lords amendment ensuring each ICS has a children’s strategic lead was a welcome development, he said, but asked whether it went far enough.
Crocker told the Local Government Chronicle: “Children’s mental health should be a priority for every ICS in the country. I can’t imagine any reason why any ICS would not do that.”
He has been calling for a national review of children’s mental health services since becoming ADCS president in April, and told delegates he has had “significant support” in this “from all sectors” but there had been “no action” from the NHS.
The current NHS target for 35% of schools to have a mental health support team, and the national community treatment target of 35% are “nowhere near ambitious enough”, Crocker said. “An access target of 35 per cent in children’s social care would be unthinkable – can you imagine? – I just don’t understand why this is acceptable elsewhere.”
The clinical model upon which services are designed also “no longer serves us well,” he argued, adding that “access to hospital treatment beds for mental health has almost halved”.
Crocker also criticised the NHS waiting list model, saying “something that was designed to ration hip replacements does not work for children in acute distress”.
He said that the crisis in meeting children’s mental health needs “threatens to overwhelm the social care system. What does anyone think happens when children are waiting 16, 20 weeks for an assessment or over a year for treatment? Families are under acute stress and breakdown with children ending up in a social care system that was never designed to meet their mental health needs.”
The crisis “threatens to undo any good work” stemming from Josh MacAlister’s Children’s Care Review, published in May, Crocker added.
Other children’s services directors used the conference to their concerns about children’s mental health. One said that the criteria for mental health support was too narrow: “When young people finally get to assessment, they discover the very narrow criteria that applies means they cannot get access to services. Or if you sneak through that grouping, you discover that having a history of substance misuse, an unstable life or an inability to attend appointments means you’re then discarded from those services. The cumulative effect leaves young people in crisis and they end up in our system, where we don’t have the professional expertise to help them.”
Mental illness among children is a growing problem, with one in six children aged 5-16 likely to have a mental health problem. The NHS is simply not coping with the weight of demand – children should not have to wait a year or more for treatment. Crocker is right to draw attention to the narrow criteria for allowing access to mental health support and right, too, to point out that this lack of support places an unfair burden on the social care system. The whole process of referral, diagnosis and treatment needs an urgent overhaul.