VITAL SIGNS – BMJ Column (2018)

Each working day begins with an email from the paediatric ward, informing me of the number of children admitted overnight in various states of mental distress. Most commonly these are young people who have self-harmed or attempted suicide. These are paediatric emergencies. 

Previously, numbers of these acute presentations felt practically and emotionally ‘manageable’: resources could be swiftly mobilised from a community team to help understand, contain and modify the triggers for these crises.

Sadly, admission rates are soaring, and the daily email now brings a potent mixture of anxiety, frustration and deep concern. The more cases, the more stretched and less effective the response.

It’s a pattern seen across the country, with increased rates of self-harm, and possibly an associated increase in diagnosable mental illnesses. The additional morbidity is multifaceted and poorly understood, a rise of social media and cyberbullying, increasing academic pressures, uncertain employment prospects, and political instabilities are all postulated. More research is urgently needed.

If one thing can be for certain, it’s that we continue to overlook and underfund the mental health of children. 90% of mental health funding goes to adults, despite 20% of our population being under 18. It’s a false economy, since we fail to intervene early with psychological difficulties which can predictably develop into enduring adult mental illnesses.

It’s exasperating, and embarrassing. When young people require inpatient psychiatric care, specialist beds cannot be found, typically for days, not infrequently for weeks. We are forced to send children hundreds of miles away from home. Waiting lists for generic assessments remain heartbreakingly, inexcusably long, with GP referrals rejected in vast numbers. It is perverse that children must get sicker before they meet thresholds to be seen, but there are simply not the staff to deliver.

This is not an isolated challenge. Colleagues in children’s social care are similarly inundated with distressing referrals they cannot attend to adequately. Often these are one and the same cases, children having harmed themselves to unconsciously provoke a professional response.

I often tell colleagues to sit tight. This mismatched period of impossible demand to limited resource will pass. But this feels an increasingly misguided exercise in self-deception.

On the back of years of systemic cuts, we have been promised new investment. However, research has shown that a lack of ring-fencing allows local services to use any ‘new’ money to plug gaps elsewhere, and it does not reach the front line. Morale suffers, and recruitment and retention problems confound existing difficulties.

It’s a shame, not least because the work itself is wonderful, fulfilling, and for many of our patients, life changing. If it weren’t, I for one would not be able to continue. As a society, we must do better, for the sake of the children.

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