Spending on child mental health services in England down in over third of local areas

Real-terms spending on children’s mental health services in England has fallen in more than a third of local areas, a report has found.

A study by the Children’s Commissioner warned that youngsters in need of low-level treatment face a “postcode lottery” of provision.

Low-level mental health services provide preventative and early intervention support for problems such as anxiety, depression and eating disorders.

It can include school nurses or counsellors, drop-in centres or online counselling services to help prevent conditions developing into more serious illnesses.

Researchers found £226 million was allocated for low-level services in 2018/19, just over £14 per child.

Around half of this funding comes from local authorities (LAs) and half from NHS sources.

Total reported spending across all areas in England increased by 22% between 2016/17 and 2018/19 in cash terms, and by 17% in real terms.

Spending per child in this period increased by 20% in cash terms and 16% in real terms.

But the report found that very high-spending areas were masking a larger proportion of low-spending areas, and that wide variations existed across the country.

While 58% of areas reported a real-terms increase in spend per child between 2016/17 and 2018/19, more than a third of areas (37%) saw a real-terms fall.

In 2018/19, the top 25% of local areas spent £1.1 million or more on low-level mental health services, while the bottom 25% spent £177,000 or less.

Reported spending per child in 2018/19 was higher in London and the North East but lower in the East Midlands, the East of England and the South East, the report found.

In London, LA spending per child was £17.88, compared with just £5.32 in the East of England.

The report concluded that in areas where spending had fallen, it was often driven by reduced LA spending.

From 2016/17 to 2018/19, only around a third of areas saw LA spending per child increase in real terms and nearly 60% of areas saw it fall.

Researchers gathered spending data from all LAs and almost all NHS clinical commissioning groups (CCGs) to produce the report.

Cash figures refer to actual amounts reported while real-terms numbers take inflation into account.

The report called on the Government to repeat the exercise to monitor local areas’ progress and to put pressure on LAs and the NHS to create joined-up plans to support children who do not require specialist care.

Anne Longfield, the Children’s Commissioner for England, said: “This report reveals for the first time the postcode lottery facing the increasing number of children suffering from low-level mental health conditions like anxiety and depression.”

She said it was “extremely worrying” that areas were reducing real-terms spending on “vital services”.

“The children I speak to who are suffering from conditions like anxiety and depression aren’t asking for intensive inpatient therapeutic treatment, they just want to be able to talk to a counsellor about their worries and to be offered advice on how to stop their problems turning into a crisis.

“The NHS 10-Year Plan has made children’s mental health a top priority, but it won’t succeed unless children with low-level mental health problems are offered help quickly and early.

“Local authorities are under huge financial pressure and many are doing a good job, but those who are spending barely anything on low-level mental health cannot continue to leave children to struggle alone.”

A Department of Health and Social Care spokesman said: “Investing in our children’s mental health is a priority for this Government and we are transforming services through the NHS Long Term Plan, backed by an extra £2.3 billion a year, so that 70,000 more children a year have access to specialist mental health care by 2020/21.

“Early intervention is vital key and we’re going further, piloting a four-week waiting time standard for treatment, training a brand new dedicated mental health workforce for schools across the country, and teaching pupils what good mental and physical health looks like.”

Anntoinette Bramble, chair of the Local Government Association’s Children and Young People Board, said “significant funding pressures” were forcing councils to cut early intervention services.

She said children’s services face a funding gap of £3.1 billion by 2025 and public health services had seen cuts of £700 million.

“If we are to improve provision of preventative and early intervention services then it is vital the Government adequately funds these in the forthcoming Spending Review,” she added.

Emma Thomas, chief executive of mental health charity YoungMinds, said the report’s findings were “deeply concerning”.

“We work with young people who say that getting the right mental health support from a youth worker, school counsellor or local charity saved their lives,” she said.

“While extra money for specialist NHS services is of course welcome, it’s better for everyone if young people can get help before their needs escalate or they hit crisis point.”

She called for “clearer and more consistent data” to improve the “patchy” reporting of local services and help commissioners make informed decisions.

Dr Bernadka Dubicka, chair of the child and adolescent faculty at the Royal College of Psychiatrists, said the report showed many young people are not getting help they need “to stop falling into crisis”.

She highlighted the closure of around 1,000 sure start services in the past decade and the reduction of health visitors and school nurses.

“By the time young people reach specialist child and adolescent mental health services they often have significant mental health problems which could have been avoided with the right help much earlier on,” she added.

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