Over the last few years, there has been a marked increase in the provision of mental health services in the UK. The availability and quality of these services remain dire in many areas, but campaigns to raise awareness of mental health issues have increased pressure to improve mental health care and have led to a decrease in the stigma surrounding treatment. In this article, I will discuss a glaring issue with NHS provision of mental health care that has been a point of contention for years but has not yet been resolved.
A young person in need of treatment for their mental health is generally referred to Children and Adolescent Mental Health Services (CAMHS). Theoretically, they will be provided with specialised mental health care. However, when that young person turns 18, they are no longer eligible for care under CAMHS. They are then either transferred to Adult Mental Health Services (AMHS) or are discharged back into the care of their GP. This seems like a relatively straightforward and seamless process on paper. However, in reality, CAMHS and AMHS are very different institutions. What many young people and their support systems do not find out until the last minute is that the threshold for treatment at AMHS is much higher than at CAMHS.
I first learned about this when it happened to me. I began receiving treatment from CAMHS roughly six months before my 18th birthday. This led to concerns from both my nurse and I that I would not benefit from treatment in such a short time frame before CAMHS effectively washed their hands of me. Still, erroneously, I presumed that, on turning 18, I would automatically be transferred to AMHS. I understood that there would potentially be a waiting list so I was prepared for a gap in my care, but I did not expect a sudden withdrawal of this care. Sympathetically, my nurse told me in no uncertain terms that there was a very good chance that I would not be accepted by AMHS as my problems were, and I quote, ‘not severe enough’. In that moment, the progress I had made in coming to terms with the fact that I was not broken or overreacting but that there was something chemically wrong with my brain, evaporated. I was not sick enough for AMHS, so the alternative was medication, self-referral to a charity offering counselling services or nothing. At a time in your life when you are struggling to make it through the day, the prospect of having to start from scratch with a non-specialised service is enough to put you off the idea of getting help completely. Indeed, CAMHS have no idea what happens to roughly half of the young people leaving their care (1). Every year, thousands of adolescents around the country find themselves in this situation.
Steps have been taken recently to try and resolve this issue, such as extending the maximum age of treatment by CAMHS to 25 in some areas of England. This is all very well and good, but it is neither a widespread nor a consistent measure. It does not act to effectively bridge the gap between CAMHS and AMHS and merely delays the inevitable. This is, of course, a symptom of two wider problems. The first is that mental health is not taken seriously enough. Political rhetoric just does not match the reality. Compared to other non-communicable illnesses, mental health is allocated just 11% of the NHS budget, despite accounting for around 23% of reported illnesses (4). The second is the absolutely criminal, immoral and systematic defunding of the NHS over the last decade. I admire the NHS and commend every single member of staff for doing their absolute best on a shoestring budget. However, we cannot ignore the issues within mental health provision that have little to do with budget and everything to do with a lack of understanding, bureaucratic inflexibility and regional inconsistencies in care. Early intervention costs the NHS less and is far more effective for the individual receiving treatment. It does not take a mental health professional to see that the system is broken and urgently needs a radical overhaul.
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