Once again the Guardian inspires me! This time it is an article around mental health provision for young people and their experience once they reach the age of eighteen.
It is well worth a read and the link is below:
https://www.theguardian.com/society/2019/mar/20/abandoned-at-18-the-young-people-denied-mental-health-support-because-they-are-adults
Before I start though I must provide some balance to my own argument. I have personal experience of CAMHS (Child and Adolescent Mental Heath Services) and these experiences have been completely positive. I make some general statements below that I stand by, but also know that the vast majority of the people who do the hard work in the NHS in client facing roles care deeply about what they do and the people who seek them out for help and support. My ire is much more reserved for the management in the various CAMHS, IAPT (Improving Access to Pyschological Therapies) and CMHT (Community Mental Health Team) teams around the country who appear to care more about stats, finance and their careers than the staff that work for them and the children in their care.
The following blog is solely based on my professional experience of what can happen when the main focus of management is not on the client and more on the needs of the organisation supporting them. There are thousands of people in the NHS who help people make lasting positive changes to their lives and I need to stress that I am not just conscious of this, but deeply thankful for them being there.
So, back to the article! For me this bites into the heart of one of the core issues around mental health support in the NHS right now:
Money
The day they hit their eighteenth birthday, kids suddenly stop being a young person (or young adult) and become an ‘adult’. What a difference a day makes!!
As soon as they hit eighteen, they no longer find relatively easy access to mental health support and they are suddenly thrown into the grown-up reality of the NHS and get put on an ever lengthening waiting list for support.
Why does this happen, why is there no organised and planned transition? Again:
Money
The pot of money that pays for young people and young adults is completely separate to the pot of money to the one they are entitled to as an adult.
The NHS is drowning in a sea of debt, bad management and ludicrously expensive consultancy fees (as we no longer have people from Europe willing to risk working in our country and so the NHS is forever going to be understaffed, hence huge consultancy bills) so the people in charge of the pot of money for young people are fiercely protective of it. This leads them to cut adrift everyone under their care as they come of age. This is a bit like the film Logan’s run, except people are left wondering why they have suddenly been abandoned by the people they have worked with for years and are now stuck on a waiting list to see a completely over worked and burnt out psychologist for ten minutes. I suppose this is slightly better than those reaching thirty in Logan’s Run who are forced into machines that blows them up, but I think the risk of harm to the patients in real life is just as serious.
It is not surprising so many people at this point descend into some form of mental health crisis and need urgent care and support (that costs maybe four times more than the care they should be getting after transitioning to adult services), and more NHS money is lost because the people in management positions cannot see beyond next weeks budget and they don’t give a damn about the patients their decisions effect.
Most of the young people I have worked with, particularly looked after children, or children in care have had some form of issue around attachment. By dropping these vulnerable kids in the way they do, it is almost inevitable they will in some way harm them, through a process of re-experiencing or even worse re-traumatising the poor soul who has just lost their main support network and had it replaced with a piece of paper with an appointment on it for next year.
I left my role working with children between the ages of 13-18 because of these kinds of broken systems we were forced to accept without being able to challenge. I had one client who was clearly autistic, but the psychologist in charge of his case refused to test him saying she did not believe it was necessary. We all knew the real reason was that if the client was diagnosed it would cost them double what they were paying already to put in the extra support the client needed.
The client was having regular ‘meltdowns’ at school and at home and even though their behaviour and emotional state was deteriorating I could do nothing to put appropriate support in place as all my recommendations and pleas for support were ignored or refused.
Eventually the placement broke down and the child was forced into another different environment, surrounded by new people and places which for someone with emotional issues, mental health problems and autism is akin to torture.
It was at this point I made the ethical decision to resign my position as I felt the organisational structure of where I worked, and the organisational structure of the NHS meant I could not guarantee the safety of my clients.
The organisation did not change and closed down. The NHS has not changed, and it has not shut down. It plods along, disorganised and burning out the people working on the ground every day who are doing everything they can to try to improve their patients lives within the restrictions, both financial, managerial and organisational, that are imposed on them.
I know I am supposed to be positive here, but this has pretty much been my experience since I started working in the mental health field fifteen years ago and I am not confident of change any time soon.
It needs to happen though and hopefully psychotherapists and counsellors will find a way to have more of an influencing voice on those who make the ‘big’ decisions. If they did listen to us as a profession, they would most likely find that their services improve and actually start to cost less as people get all the way well and do not need to come back into the service ever again.
How good would that be for all concerned? I am thinking very!!