The Guardian view on children’s mental health: pills and apps aren’t the solution
It is no surprise to learn that GPs in England are increasingly prescribing antidepressants to children, breaking National Institute for Health and Care Excellence (Nice) guidelines. The pressures on children’s mental health services mean that accessing specialist treatment on the NHS is harder than ever before. Similarly, a decision by Nice to recommend the use of cognitive behavioural therapy apps, as a treatment for young people, points to the lack of any other way to meet rising demand.
The NHS’s guidelines are clear: under-18s should only be prescribed antidepressants in conjunction with talking therapies, and with the approval of a psychiatrist. The sole exception is in cases of obsessive compulsive disorder. But long waiting lists and unmanageable caseloads mean that many children are struggling to access the kind of help they need – and the kind of attention from qualified professionals that is most likely to make them better. Staff in overstretched children and adolescent mental health services describe a situation in which almost all clinicians’ time is spent identifying problems and managing risks – and very little of it directly helping children.
Thresholds for referrals have been raised so high, with a view to conserving scarce resources, that in some cases children who are seriously distressed, or in danger, have been refused care because they do not meet criteria. A survey earlier this year threw up shocking examples including a service that refused to take on a boy who had been found with a ligature in his room.
The government is facing demands for a public inquiry, after an investigation found that three teenage girls were failed by a mental health trust in north-east England. Christie Harnett, Nadia Sharif and Emily Moore took their own lives within eight months in 2019-20, after receiving inadequate care. Maria Caulfield, the minister for mental health, acknowledges that this sequence of events was not a one-off, and the families are right to insist that lessons must be learned.
But no inquiry is needed to establish that children’s mental health services are at – and in some cases beyond – breaking point. Where budgets have been increased, they have in many cases been used to employ education mental health practitioners, working in support teams, with just 60 days’ worth of training. Such staff can make a contribution. But they are not qualified to deal with the kinds of complex conditions and home circumstances (including mentally ill parents and domestic violence) that growing numbers of young people are dealing with.
Some young people may be helped by the new apps, although the evidence so far is weak and the recommendation is pending a consultation. There may be occasions where a child’s GP
sees no alternative to an antidepressant prescription. But the Nice guidelines are evidence-based and exist for a reason. If children are so unwell that a GP believes they need pills, the NHS ought to be able to refer them for talking therapy. After the disruption to education caused by the Covid pandemic, prompt diagnosis and treatment of young people with mental health conditions should be a national priority. The next generation must be helped to grow up healthy.
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