Following on from the Care Quality Commission report on crisis care for people with mental health problems, it is clear that children and young people are not receiving the care and support they need (A&E staff attitudes to patients in mental health crisis ‘often shocking’, 12 June). We know that if they receive effective help at an early stage they probably won’t reach a mental health crisis in the first place.
Ten per cent of children and young people have a mental disorder, and many more are unhappy or dissatisfied with their lives. We know that a large proportion of these young people will not be accessing appropriate support when they first need it. This is likely to result in them only coming to the attention of services once they reach a crisis.
This is a big issue as 75% of mental health problems start in childhood. The long-term costs associated with childhood mental health problems are estimated to be £2.35bn and the short-term costs £1.58bn. The costs associated with adult mental health are even higher. The Centre for Mental Health has estimated that the economic and social costs of mental health problems in England in 2009-10 were £105.2bn.
If children and young people were given appropriate treatment when they first accessed help, even as a crisis intervention, it would reduce the risk of mental ill-health continuing into adulthood. To do this, we need to ensure that the whole health workforce is better able to support children and young people with mental health problems, regardless of how or where they seek help. Investment in this area would not only save lives and reduce the severe distress of experiencing mental health problems; it would also save money in the long run.
Professor Dame Sue Bailey Chair, Mick Atkinson Vice-chair, Children & Young People’s Mental Health Coalition
• The report on the lack of care for mental health patients facing crisis highlights yet again the lack of parity of esteem between mental and physical health in the NHS. Despite the rhetoric from politicians during the election, NHS spending on mental health was cut during the last government, and there are no signs that it will improve under this one.
Ian Arnott
Peterborough
• The CQC reported significant problems with current care for people suffering from mental health crises. The care received in A&E departments was of particular concern, with the report showing that of people who attended A&E with such difficulties, only 37% felt their concerns were taken seriously and listened to, 34% felt they were treated with compassion, and only 33% reporting not feeling judged by staff.
Part of the problem could be down to deficiencies in training in mental health problems in A&Es. In addition, there are often difficulties in the working relationship between mental health and A&E staff, in what is a high-stress environment, which can adversely affect patient care.
To help improve this situation, UCLPartners and North East London NHS foundation trust are working together with trusts across London on an initiative titled “Breaking down the Barriers”, which aims to bring together a range of healthcare professionals, such as nurses and doctors, from mental health services and A&E departments, and people who have experienced mental health crises, to learn jointly how best to manage such situations.
Funded by Health Education England, a major focus of the work is on establishing empathic relationships between all parties, so that we can all work better in relieving the distress of people with mental health difficulties.
Dr Tom Stockmann Fellow in medical education, North East London foundation trust
Dr Lindsay Banham Fellow in medical education, North East London foundation trust
Dr Mohan Bhat Director of medical education, North East London foundation trust and associate director of postgraduate medical and dental education, UCLPartners
• The Care Quality Commission report on people’s experiences of help, care and support during a mental health crisis makes surprising reading. Respondents said they felt that their concerns were taken more seriously, and they felt more listened to, by GPs, ambulance crews and the police than by crisis resolution home treatment teams, community mental health teams or A&E staff – ie by the staff supposedly with the relevant specialised training.
One way to understand this apparent anomaly is the negative side-effect of treatment guidelines that lead to under-resourced mental health services focusing on manualised interventions or technological fixes, which can have the effect of distancing specialist professionals from their spontaneous humanity which non-specialists more easily retain. This is not to undervalue the need for guidelines on evidence-based treatments at the right place and time, but at a time of crisis the priority need is for a warm, listening human being.
Specialists need to be able to recover and cherish their humanity.
Alison Summers
Chair, ISPS UK, on behalf of ISPS UK Trustees (UK network of the International Society for Psychological and Social Approaches to Psychosis)
