Who's paying for mental health services for young people?

While the government continues to assure us it will protect health funding, large scale cuts have already been made to local authority social care budgets. These cuts will have an impact on integrated health and social care services. We identified this in our recent report on adult social care funding, where we called for joint policy and funding arrangements.

So what effect will these cuts have on child and adolescent mental health services (CAMHS)? In 2009/10 almost a quarter of CAMHS funding came from local authorities, but a recent YoungMinds' survey revealed that more than half of commissioners will be cutting their funding in 2011/12. The largest cuts were seen in local authority funding, with up to 25 per cent cuts reported by some local authorities.

This begs the question: how can we prevent vulnerable young people with both health and social care needs from falling into a funding gap?

Since 2003 the Department of Health has distributed CAMHS funding via local authorities (initially as a ring-fenced grant and now as part of the ongoing personal social services grant within the local authority revenue support grant). This year – for the first time – no guidance was given for local authority CAMHS spend. And while money was initially allocated to support the development of comprehensive CAMHS services, an analysis of local authority budget-setting shows evidence of allocations being confined to designated statutory areas of responsibility, such as 'looked after children'.

This jars with recent government policy on early intervention for children and adolescents with mental health difficulties (see the Department of Health's No health without mental health strategy) – where the government acknowledges that half of all mental illness starts before the age of 14. There is a significant case for securing comprehensive CAMHS funding to enable early intervention. But how can the government ensure this happens?

A start would be to strengthen joint accountability for outcomes. However, defining and measuring outcomes in CAMHS is challenging. Accountability requires measures that are responsive to change over time, yet the outcomes that really matter – such as reductions in rates of illness in adulthood and rates of crime and improvements in life chances in adulthood – are not readily available until years later.  There is a real need to develop usable intermediate outcome measures for CAMHS across health and social care that link to these long-term goals.

It is also imperative that responsibility for these joint outcomes is the core business of organisations in both health and social care and are not seen as discretionary. Government policy needs to clearly set out how it intends for this to happen. With the end of local strategic partnerships, local area agreements and the comprehensive area assessment, it seems this job will fall to health and wellbeing boards. Hopefully these organisations will see CAMHS as an important priority and ensure that vulnerable children will get the funding they need regardless of who is paying.

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Comments

#537 Daniel
Trustee

As trustee of a small voluntary organisation which provides mental health services, I am struck by how difficult it is to get statutory sector commissioners interested in our two young people's projects. By contrast we run five older adult / dementia projects, all of which are county council funded.

#540 Neil Chadborn
Public health research and engagement
Healthy Cities CIC

I feel that children and young people should have a separate outcomes framework. As you mentioned there are special and complex issues with children which are not suitable for other frameworks. I think there is a big risks with this outcomes-driven system, that complex issues won't get funded, because outcomes are so difficult to define, let alone measure and commission for.

#550 Nigel Skellett
Lincolnshire PCT

There is an increasing clinical evidence base for early intervention. See the current BMJ 2011, 343, where Thomas Insel, director of the NIMH in the US reports a 50% onset of mental health symptoms by the age of 14 in studies and is saying that early intervention is vital for management.

#551 Nigel Skellett
Lincolnshire PCT

There is an increasing clinical evidence base for early intervention. See the current BMJ 2011, 343, where Thomas Insel, director of the NIMH in the US reports a 50% onset of mental health symptoms by the age of 14 in studies and is saying that early intervention is vital for management.

#7524 Sheleen Noakes
Mum
The family

Today I have a meeting with my local MP to discuss funding for CAMHS as I feel the waiting lists are way too long and I want to know what can be done to help speed up the process. My daughter has waited for a year for an initial assessment for possible autism and only received the assessment due to intervention from my MP.

#41428 ngela
retired
not applic

A year wait is unforgivable and the gov must wake up and realise the long term savings they will make by early help and intervention. My grandson cannot get an appointment because his parents are getting divorced and when a court is involved children cannot be seen or helped by CAHMS - another outrage and DISservice to our children

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