Over the past couple of months, we have been out and about looking at and talking about the issues in health, social care, housing and justice with the children and young people, the families of rejected referrals and a significant number of young people from the youth commission and other organisations. What has come up from everyone, which led to my recommendations, was complete consensus about the issues and the fact that the problems with mental health for children and young people in Scotland are increasing exponentially. That is not related to the incidence or prevalence of serious mental illness—that is unchanged. The rise is in emotional distress in young people at school, arising from issues around bullying, body image, depression and anxiety. That has increased massively and we have a huge amount of data on it from the Scottish surveys.
The other area that has been causing significant issues in Scotland concerns neurodevelopmental disorders, including Asperger’s, autism and attention deficit hyperactivity disorder, and the varying provision for those. Sometimes the provision is in CAMHS, but sometimes it is in paediatrics, outside CAMHS. Those two areas have grown significantly, which accounts for the massive increase in referrals, not just to CAMHS but across the system.
The recommendations look at child and adolescent mental health in a completely different way, dividing it into four strands. One strand is about neurodevelopmental disorders. Those require quick assessment, which children are struggling to get at the moment, specialist support from the third sector, and input from acute paediatrics. The problem with community paediatrics at present is that it is having to move back into the acute system, so there is a dearth of community paediatrics. The support needed in that neurodevelopmental pathway is specialist, and it is mainly those families that are in the rejected referrals report. There are serious issues about how we are managing neurodevelopmental disorders in Scotland.
The second strand is a generic strand of emotional distress, which is about supporting children in schools by putting additional input into schools, the third sector and primary care. That needs to be a third sector that is focused on mental health problems. Although we believe in universal third sector services for children and young people, they have to pick up mental health problems and that is the big gap in the generic strand.
The third strand is specialist mental illness, which is the province of CAMHS teams. It has to have fast-track referral, with assessment either immediately or at least within four weeks; that is the aspiration in the task force.
Finally, people told us about a group that we call the at-risk children—children who are born into poverty, physical abuse, sexual abuse or families with addiction problems, many of whom end up in care. The responses to those children need to be supportive services that are much more wrap-around and far more generic, because those children are very traumatised and over-anxious and often act out some of the issues.
The strands come from what people told us—they are not my recommendations. We are now putting them into work programmes to deal with, because the responses in each of those areas are very different. Part of the issue in CAMHS is that people are not getting the right service at the right time and in the right place. It is the job of the task force and our delivery plan to tackle that. The recommendations have found favour across the board with COSLA, with the third sector and in health. People recognise those strands as a good way to commission services.
Moving away from the conceptualisation, however, another issue for me is that of growing a workforce. Although there is a workforce out there, at the moment when people cannot employ a fully trained psychiatrist or clinical psychologist, they freeze the post. However, there is an enormous number of psychologists out there who require only a one-year MSc. We have doubled the number of people in training this year and there will be 19 new members of staff coming out. There is therefore a workforce—despite the issue that people raise about not being able to provide a service because they do not have a workforce. There is a different workforce, and it will include the third sector, primary care and probably a lot of psychology and nursing.
The final issue for me is related to resource. The Government is completely committed to CAMHS, there is cross-party commitment to child and adolescent mental health, the policy is great, and the commitment of the people on the ground who are delivering the service is great. However, children up to the age of 24 are one third of the population of Scotland and the resource has to be targeted at that group of individuals. We have to highlight and call out the issue that although everyone is taking cuts, mental health services—particularly child and adolescent mental health services—are, proportionately, taking bigger cuts than everyone else. Mental health services are not a priority on the lists of the community planning partnerships and we need to call that out. We need to say that there is no use in putting new resource in the front door if it is being frozen at the back door. That is the biggest issue at the moment.