by Dr Collette Isabel Stadler, Academic Clinical Fellow at the Primary Care Unit, University of Cambridge and GP Registrar
Last month, The Pulse journal published alarming figures obtained from 15 mental health trusts in the UK, revealing how access to Child and Adolescent Mental Health Services (CAMHS) is becoming increasingly restricted.
In 2015, only 39% of referrals to CAMHS resulted in treatment and 33% of patients were not even assessed by the organisation1. Such barriers to mental health care are of particular detriment to children in state care, a group with “a much higher prevalence of psychosocial adversity, psychiatric disorders, and far poorer life chances even compared to the most socioeconomically disadvantaged children in private homes”2.
If you are a 13 year old child in state care, your chances of having a significant mental health problem during adolescence is 49%, yet this is not always a catalyst for action3. Currently in the UK there is no standardised risk modification plan in place to provide for these patients, so our approach seems to be to do nothing. To think that there are children in state care, whose attempts at suicide and serious self-harm have not resulted in a referral to CAMHS, let alone sustained and systematic mental health intervention, is a most disconcerting thought. A one in two chance of psychological disease does not seem to be a sufficiently high risk to warrant an early preventative approach to patient care. Comparing this to the level of preventative measures delivered to a middle aged, overweight male whose chance of suffering a cardiovascular event within 10 years is 47% – and the gulf between preventative action in physical and mental health is striking.
My research is focused on health inequalities for vulnerable groups, in particular looked-after children (LAC). My Academic Clinical Fellowship at the PCU has enabled me to work with Professor Martin Roland and Dr Valerie Dunn (Institute of Psychiatry) exploring the cost to the public purse of looked-after children’s unstable care journeys”.
– Dr Collette Isabel Stadler, ACF, PCU
In a retrospective, secondary analysis of a sample of 27 Looked-after children (LAC) in Cambridgeshire, originally recruited for the TC-17 study4, we recently explored the wider societal costs of inadequate health care provision in the social care system. Using information extracted from LAC interviews and cross-referenced with social worker notes, all public services used by the LAC throughout their time in the care system were identified and costed. This included the use of social services, emergency mental health care, and youth justice.
Medical emergencies resulting from poor mental health such as emergency treatment following substance misuse or non-suicidal self-harm were particularly prevalent amongst those children who had received no routine mental health prevention input. Thus a lack of early and sustained preventative mental health interventions, ultimately led to more medical emergencies later on, at an increased cost to the taxpayer. This study only assessed the cost of healthcare for children still in care, but we know that the consequences of neglected mental illness in adolescence has aggravating effects stretching far into adulthood, thus further burdening the public purse.
Apart from the hard financial data, some of the personal tragedies experienced by those young people failed by our mental health provision have become apparent in the course of our study. Only a quarter of the LACs in our sample were referred and successfully engaged with CAMHS. Our study cohort included several teenagers whose care journeys had been particularly harrowing. Many of them had not received mental health input as a preventative measure nor as a reactionary measure following visits to A&E for serious self-harm. 7.4% of our cases had never been offered mental health input despite clear red flag signs of psychological distress, including substance misuse, self-harm, suicidal attempts, high levels of criminal activity, and social exclusion.
To contemplate that locally in Cambridgeshire in 2016, some of our most vulnerable children and adolescents with high risk factors for psychological illness are not receiving the mental health support that they require is distressing. Would we be as able to justify not prescribing statins or antihypertensives to a middle-aged vasculopath?
Becoming an Academic Clinical Fellow with the Primary Care Unit, University of Cambridge
About Dr Stadler
 Ford, T. et al (2007). Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. The British Journal of Psychiatry
 Meltzer, H. et al (2003). The mental health of young people looked after by local authorities in England. Office for National Statistics: London.
 Memarzia, J. et al. (2015). Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later. BMC Health Serv Res, 15: 185.