Commissioner demands ‘urgent reform’ after damning review of child mental health services

A major review of children’s and young people’s mental health in Northern Ireland has called for urgent reform of services and support.

With concerns around lengthy waiting times, problems accessing services and reliance on the use of medication to treat patients, the Northern Ireland Commissioner for Children and Young People (NICCY), Koulla Yiasouma, said: “We are delivering yesterday’s services for today’s children.”

“The system is under pressure and must reform urgently to respond to the scale of need and complexity of issues our children and young people have, to support their families and to allow the professionals working within the system to care for our children effectively.”

The Commissioner launched her Review in June 2017 which has been the most extensive engagement with children and young people about their direct experiences of accessing, or trying to access, support for their mental health. It considered the whole system, from support provided by GPs, the education system, the Voluntary and Community Sector, specialist mental health services, A&E and hospital care. It also heard from parents, carers and professionals working within the system.

Speaking on the launch of ‘Still Waiting – A Rights Based Review of Mental Health Services and Support for Children and Young People in Northern Ireland’, Koulla (pictured) said: “I have found the system wanting in areas such as lengthy waiting times, the high proportion of children not being accepted to specialist services, problems with access to services for children with learning difficulties, or drug and alcohol issues, unacceptable failings in the care of children in mental health crises, and reliance on the use of medication to treat mental ill health. However, all these areas can be addressed if prioritised – even now without an Executive.

“Even though many young people told us about the challenges they faced in accessing the right support, 8 out of 10 said they would encourage others to seek help for their mental health and we have certainly found professionals going ‘above and beyond’ to support young people within extremely stretched resources.

“I want to stress that if you are a child or young person and you are experiencing difficulties with your mental health, it is important that you talk to an adult you trust who will help you.” 

The title ‘Still Waiting’ refers to the length of time young people wait before seeking help, and the time it takes for them to receive the right support.

Koulla continued: “Children wait to ask for help, they wait to receive the right support and we all wait for systems to catch up with how young people need that support to be provided.”

The Department of Health announced its plan to reform the system in 2012 with the introduction of the ‘Stepped Care Model’*

The Review also considered the data collected and held by the system.

“I welcome the recent announcement that the Department of Health will fund Northern Ireland’s first study to assess the mental health needs of our children and young people. However, I would question how we have been planning and commissioning services when we are not yet fully aware of the exact needs of our children” said the Commissioner.

“My Review found alarming gaps in how the system collects operational data including but certainly not limited to, reasons why young people are not being accepted to specialist mental health services, if or to where they are referred on, or how long they have to wait for that alternative support.”

The Review considered money spent on child and adolescent emotional and mental health support across the system, including early intervention and prevention services, something which has not been done before.

Koulla said: “It is widely understood that spend on mental health is inadequate, particularly when considering the impact the legacy of the conflict continues to have on mental health, including those generations seemingly not directly affected.

“My Review found that approximately £31 Million is spent here on children’s emotional wellbeing and mental health services which represents 0.8% of our overall health budget, equating to less than 1 penny in every pound. This lack of investment is very short sighted.

“We know that half of all adult mental health issues begin by age 14 and 75% by age 18. We spend only £45 per young person on statutory mental health services in Northern Ireland, compared with £163 per adult. If we invest earlier and get young people the help and support they need, we will not only save money, but have a huge impact on the mental health of our people throughout their lives”

The Commissioner concluded: “Children and young people’s mental health has been one of my key priorities since taking up post. I initiated this Review because of the young people who approached me when I visited their schools, the parents who approached me in the supermarket and the professionals who approached me when I visited their workplace. All urged me to do something about mental health services and support for children and young people.

“Yes we need more money to reform this system effectively and children and young people’s emotional and mental health needs to be prioritised within Health spending. However, ‘Still Waiting’ has also found there are very practical actions Government Departments and their agencies can take now to make sure that children and young people get the right support, at the right time. This must be a system which invests in promoting good mental health, prevents poor mental health developing and can respond quickly and appropriately to young people when mental health problems develop”

A spokesperson for the Department of Health said: “We welcome publication of this report and it is clear that NICCY has invested much effort into this timely piece of work. 

“This is a complex and challenging area, where need is continually evolving and demand is increasing. Dedicated colleagues right across the system work tirelessly with limited resources to deliver high quality services.

“However, we know we can and must do better.  Through our transformation programme, the Department and the senior leadership team of the HSC are committed to delivering real and meaningful improvements.

“Nowhere is this more important than in meeting the mental health needs of our young people. This report makes a key contribution to this process and we look forward to working with the Commissioner going forward, and indeed with young people and their families, to make improvements and deliver better services.”

Read the Review report here and an infographic here.

_{Picture (c) Northern Ireland Commissioner for Children and Young People.}