April 24, 2013 by Protect Our NHS
When Services Cost Too Much – The Death of a Child and Adolescent Mental Health Service
As a former probation officer I came across many young people with mental health problems who, had they not been supported as children, would have ended up in the criminal justice system. And adults whom, had there been a service to support them, might not have.
Prison costs “too much”.
Vulnerable boys with a continuing risk of developing serious mental health problems as adults become a suicide risk.
Suicide costs “too much”. To the victim, his or her family, the wider community.
How much does it cost to prevent a life of incarceration? Indeed to save a life?
This article is about the short-sightedness of closing a service that does that.
When politicians say a particular client group, or a certain public service costs too much, you can bet your bottom dollar, or pound, it’s code for that service being a target for cuts. What should be asked is why a service costs a lot. Note, I don’t say costs “too much”. The costs too much complaint recently plummeted to its nadir when a county councillor said ‘disabled children cost too much and should be put down’.
As global and the Coalition’s austerity measures start to bite, it is clear that it is poorer communities, and more vulnerable people who are most affected by cuts. The Joseph Rowntree Foundation is monitoring the impacts of austerity on Britain’s poorest.
In 1995, two key documents, A Handbook on Child and Adolescent Mental Health and Together We Stand, paved the way for the development of a Child and Adolescent Mental Health Service (CAMHS) within a four-tiered framework for planning, commissioning and delivery. As CAMHS has developed over nearly two decades it has specialised in providing help and treatment for children and young people with emotional, behavioural and mental health difficulties at four levels or tiers.
Tier 3 is a specialised service for children and young people with more severe, persistent and complex disorders. The team might include child and adolescent psychiatrists, social workers, clinical psychologists, community psychiatric nurses, child psychotherapists, occupational therapists, art, music and drama therapists. When tier 3 is not able to help, a referral is made to tier 4. This provides intensive intervention for children and young people with complex mental health difficulties, the most serious having access to day units, highly specialised in-patient and out-patient teams, and neuro-psychiatric teams.
The local NHS has deemed that the Lumsden Walker Tier 4 CAMH Service costs “too much” and as such will close in May 2013. As a result staff morale is very low. Up to 20 people, mostly part-time workers, will be redeployed and a small number will take MARS – the NHS’s mutually agreed resignation scheme – packages. There will be no compulsory redundancies.
Lumsden Walker began as an inpatient service almost 30 years ago and evolved in to what it is today – a successful, uniquely specialised day service that really works. The current multi-professional team includes clinical psychologists, child psychotherapists, therapy assistants, a specialist teacher, infant mental health specialists, an occupational therapist, family therapist and a child psychiatrist. They work with children and their families, assessing needs, doing home visits, schools visits, thorough assessments for possible autism spectrum condition (ASC), attention deficit hyperactive disorder (ADHD) where needed, emotional and behavioural difficulties, and difficulties with schooling. They also provide solid support for the wider family, including parent support groups, Webster Stratton parenting programmes, family therapy, Freedom Programme, and thorough assessments of the parents’ mental health needs and someone for them to talk to or telephone. The children they work with are aged between 5 and 12 years old with complex mental health difficulties. These families have previously not felt able to attend Tier 3 CAMHS, or have been hard to engage. Lumsden Walker is, in a way, a last chance for them to be helped and to engage – and in the majority of cases, Lumsden Walker succeeds and is able to offer intensive support and assessment where other services have failed.
What parents say works about Lumsden Walker Service is the focused work, offered several times a week, by a team of dedicated and very experienced clinicians who have the time and expertise to really listen to them, thoroughly assess their children’s needs, and offer support, to overcome their difficulties. Many families have said that without this service they don’t know what would have happened to their children and that the family would have split up.
Such difficulties can lead to mental health disorders in young people and adults, difficulties attending school, making friends etc. These difficulties can be about a child’s struggle to:
• to manage ordinary life situations such as school and family life;
• to manage the development of relationships within the family and outside the family;
• to concentrate; to sit still;
• to join in the peer group and to enjoy aspects of ‘being a child’ and exploring the world with ‘wonder and curiosity’;
• To be able to develop a way of managing their emotions and behaviour; of managing their anger and frustration;
• to demonstrate a capacity for ‘resilience’ i.e. ways of coping with adverse situations and the ordinary ‘ups and downs’ that life can bring.
And similar sorts of difficulties in parents and older siblings can have a profound impact on children in the family situation. It is very unusual that a child will have problems in isolation from their parents, or of others who are close to them both physically and psychologically.
The Lumsden Walker team works with these struggling, often hard to engage families – birth families and also adoptive and foster families. It undertakes preventive work, on an average of six months intervention (parent support groups; help with school placements, family therapy, psychological and psychiatric assessments if required etc). It is the only specialised Tier 4 CAMHS service in the South West.
When it closes, all these children will be referred back to an already extremely stretched Tier 3 service unable in the most part to be able to offer the kind of intensive support these families desperately need. In reality no one will pick up these families, and they will struggle at best, and at worst the family may fall apart, the child stop attending school, and may end up eventually in the prison system.
It is an integrated service. And integration is the current buzzword in the new NHS. But in the new NHS, facing billions of pounds of cuts, as in Bristol, the reality is the opposite.
No, the problem for the Lumsden Walker service is that it costs “too much”. Yes, the immediate costs of staff redeployments into backfilling posts in the NHS will save money, but what exactly are the savings in terms of future costs. Annual cost for the service are between £400,000 and £500,000.
The majority of the children the Lumsden Walker service works with are boys. What is their possible future? Young Offender Institutions? Prison? Who knows? The Lumsden Walker team with their specialist, successful service plays an important preventive role too, not just supporting and helping children and their families, but preventing the worst outcomes of future mental illness.
We are talking here about saving money in the future.
According to Michael Spurr, NOMS Chief Operating Officer, at any one time 10% of the prison population has ‘serious mental health problems’. According to the Mental Health Foundation reports this is an underestimate. The Prison Reform Trust reports that 72% of male and 70% of female sentenced prisoners suffers from two or more mental disorders.
The annual cost of keeping an adult in prison is £40,000. Hard to believe, but the cost of incarcerating a young offender is even higher. Each young person jailed costs £100,000 a year and an extra £40,000 in indirect costs to society once they are released
Another issue to ponder is the high rate of suicides amongst young men. The deaths of young men in car accidents or from knives or guns attract intense media scrutiny, as well as attention from politicians, but it is suicide that is the biggest killer of men under the age of 35 in the UK. The highest rate of young male suicide is among the poorest. Proportionately, four times as many young men in social class five (the bottom) kill themselves as those in social class one. There is a high association of suicide with unemployed young men. They are on a slippery slope – losing jobs, relationships, any sense of a worthwhile future.
So what savings are being made by the closure? Certainly not future savings.
No, the Lumsden Walker Tier 4 CAMHS, a service targeting some of the most vulnerable children in society, is simply being closed because it “costs too much”.