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Regulator warns of ‘ticking time bomb’ in mental health services for the young

Short staffing, underfunding and severe treatment delays have made mental health services for children and young people a “ticking time bomb”, the health regulator has warned.

The Care Quality Commission (CQC) said a record high of nearly half a million – 496,897 children and young people in England were waiting to access or undergoing mental health treatment in November 2023.

These children face an average waiting time of 40 days from referral to treatment, the regulator’s Monitoring the Mental Health Act report said citing 2021/22 Children’s Commissioner data.

Chris Dzikiti, director of mental health at the CQC, said: “Half a million children are receiving or waiting for mental health care and are having to wait on average 40 days to access care, but often much longer – with many reporting a deterioration in their mental health while waiting and some attempting to take their own life.

“Without access to good, timely care, children with mental health needs are at increased risk of harm and in some cases suicide. This issue is a ticking time bomb, and we will face the consequences if it’s not resolved.”

The report, which was produced following conversations with 4,515 patients and 1,200 carers, said many children had been placed in settings such as adult wards or general children’s wards, which had exacerbated their distress.

Staff shortages were found to result in isolation, poorer quality of care, reduced access to activities and therapy, an increased risk of inappropriate restraint, and abuse directed towards both patients and staff.

An increased reliance on agency staff to fill vacancies was also deemed detrimental to therapeutic relationships and the provision of personalised care to patients, as well as harmful to the mental health and wellbeing of permanent staff.

In June 2023, NHS England set out plans to increase the number and proportion of NHS staff working in mental health, primary care and community care by 73% by 2036/37.

It also aimed to increase training places for mental health nursing by 93% to more than 11,000 places by 2031/32.

Though the health regulator was “encouraged to see attempts to improve staffing”, it was “concerned that this is not enough to address the current shortfall”.

Mr Dzikiti said: “While staff are working hard, staffing shortages can make it extremely challenging to deliver personalised high-quality care.

“A larger, permanent workforce is needed to reduce pressures on overburdened healthcare workers, supported by improved community support and consistent funding to help struggling providers.

“Without these measures, people won’t get the mental health support they need – and the consequences, particularly for children and young people, could be devastating.”

A lack of suitable accommodation also led to people, particularly those with autism or learning disabilities, being unnecessarily detained in hospital and a significant number of patients being placed far from home, some for years at a time.

The report, which interviewed people with experience of being detained, stated that racial inequalities persist in care.

Detention rates for black or black British people under the mental health act were more than three and a half times higher as a proportion of the population than white ethnic groups, down from four times higher the previous year.

The Mental Health Act 1983 is the legal framework that authorises hospitals to detain and treat people who have a mental illness.

The number of community treatment orders issued, where supervised treatment is given in the local community, was also eight times higher for black or black British people than for white ethnic groups.

The report also said: “During our visits, we have seen examples of a lack of respect for LGBT+ patients, for example services not respecting patients’ choice of pronoun.”

It added: “Using wrong pronouns and names (or making assumptions) can make people feel unsafe or untrusting of staff, and have a detrimental effect on their care.”

Mr Dzikiti said: “Black people are still far more likely to be detained under the Mental Health Act.

“This is a longstanding inequality which everyone involved in the delivery and oversight of mental health services must put measures in place to address, starting with implementing the Patient and Carer Race Equality Framework (PCREF).

“Without this commitment, there will be no change and black people will continue to be overrepresented among those being detained.

“CQC will continue to monitor, raise, and work to mitigate issues of unequal and inappropriate treatment.”

More people than ever before are now in contact with NHS services for support with their mental health, with almost five million patients in contact with services in 2022/23, including 1.1 million children and young people, according to the latest data from NHS England.

An NHS England spokesperson said: “The NHS is treating more young people than ever before with latest figures showing 48% more children and young people accessing mental health support since 2019/20, and the health service is expanding this provision as quickly as possible within the current five-year funding arrangements to meet rising demand.

“We know there is more to do to which is why plans are also in place to ensure more than one in every two pupils in schools and colleges are covered by an NHS mental health support team offering early support by spring 2025 – significantly ahead of the original target.”

A Department of Health and Social Care spokesperson said: “We are committed to expanding community mental health services so children and young people can access the services they need.

“Over the 12 months to January 2024, 758,000 people aged under 18 were supported through NHS-funded mental health services — a 32% increase on the 12 months to March 2021.

“We are also addressing the long-standing health disparities that exist in many areas and communities, including through programmes to support trusts and providers in reducing racial inequalities within their services.”