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

Sarah Jonas asks what effect will large scale cuts to local authority social care budgets have on child and adolescent mental health services.

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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.