Fears have been raised over the welfare of vulnerable young people in Angus after new figures revealed more than a thousand under 18s have been forced to wait longer than three months for mental health treatment.
More than 2,157 young people in the county have been referred for mental health conditions since 2016, with 1,053 waiting longer than 12 weeks to receive care for a range of potentially life-threatening conditions such as a depression, eating disorders and anxiety.
Fewer than one in five of the Angus patients were treated inside the county, with more than 1,637 of the young patients asked to travel to other parts of Tayside for treatment.
The figures, released after a Freedom of Information request, do not include data for 2019, meaning the total is likely to be higher.
Kirstene Hair, Conservative MP for Angus, said the figures highlighted the “failings” in mental health treatment for young people locally.
Ms Hair has campaigned on improving treatment for eating disorders and other mental health issues.
She said: “These figures expose the failings in mental health treatment for young people here in Angus.
“The families affected are very often waiting for months on end for treatment, while patients routinely have to travel outside of Angus to get the help they need.
“It is not good enough. Waiting times must be addressed urgently if these young people are to get the immediate support and treatment they need,” she added.
The national target waiting time for treatment to begin is 18 weeks. Separate figures recently published by the Scottish Government for the first quarter of 2019 show only 57.9% of young NHS Tayside patients started treatment within that window. The national standard is 90%.
The Angus statistics, however, show some improvement locally. A total of 383 young people waited more than 12 weeks in 2016, 403 in 2017 and 267 in 2018.
Child and Adolescent Mental Health (CAMHS) clinics are available in three locations in Angus: Whitehills Health and Community Care Centre in Forfar, Carnoustie Health Centre and Links Health Centre, Montrose.
Children and young people in Angus who need specialist care are assessed and treated in the main Child Health Outpatient unit at Dudhope Terrace in Dundee.
An NHS Tayside spokeswoman said: “There has been a lot of work undertaken by staff to improve access to services for young people in Tayside over the past 12 months.
“We have been working closely with a Healthcare Improvement Scotland team to deliver an improvement plan which will reduce waiting times. This includes a full CAMHS service workforce review and recruitment drive to key posts, to ensure that the team are fully equipped to manage the service demand and enhance the experience for children and their families.
“We are determined to continue making improvements to ensure all our children and young people receive the best quality care without delays and we hope to reach the national standard in the near future,” she added.
Mental health services for children and young people are under pressure.
IT was heartening to see one of the first actions of the new Scottish Government Health Secretary, Jeane Freeman, being to recognise as “completely unacceptable” the fact that one in five children and young people seeking mental health treatment are having this rejected.
As an organisation that campaigns to improve mental health services, we have previously expressed our concerns over the increased demand on child and adolescent mental health services (CAMHS) and that fact that such a high number of these children and young people who are referred for treatment have it rejected, often with no explanation or with no alternative support provided. This leaves many thousands of vulnerable children and young people in a state of limbo.
An audit commissioned by the Scottish Association for Mental Health (SAMH) and NHS Information Services Division was undertaken on behalf of the Scottish Government to review this situation. What is clear from the recently published report is that for many of these young people their needs are not viewed as being severe enough to warrant CAMHS; however appropriate alternative support is lacking.
Many children, young people and their families highlighted that they have received a rejection letter within a very short timescale, and feel angry, aggrieved, cheated and let down due to a feeling that no proper assessment process has been undertaken.
More disturbingly, it appears that some clearly require treatment but this is being rejected, often without any face-to-face meeting with a specialist. In fact, only 31 per cent of those who undertook an online survey got a face-to-face assessment, and the majority were rejected on the basis of a written referral.
It was disturbing to read the harrowing first-hand accounts of the experiences of young people and their families. This includes some believing that they would not be seen unless they were suicidal or at risk of harm, and the impact that failure to get good enough treatment has on mental health, often with the situation for them worsening and then entering a crisis situation. There was evidence also of those who were self-harming, but whose condition was not deemed severe enough to warrant treatment. Situations such as this are wholly unacceptable.
It is pleasing to see the Cabinet Secretary fully accepting the 29 recommendations outlined in the report on these rejected referrals and create a new CAMHS Taskforce, headed by mental health expert, Dr Dame Denise Coia, backed with £5 million of investment to reshape and improve CAMHS.
One of the key recommendations in the report was the requirement for increased investment in CAMHS and the provision of alternative support services, for those who may not require CAMHS, with mandatory signposting to these. And yet we have seen cuts to these support services over the years. If we are to deliver the support these children and young people need we need greater investment not only in CAMHS, but in such alternative services.
It was heartening to also note the desire for a nationwide provision of schools-based services recognised. Investing a fraction of the mental health budget on school-based counselling services, for example, helps to keep children in school and avoid unnecessary and often stigmatising mental health diagnoses.
Issues around mental health represent one of the greatest public health challenges of our time and we urge the new Cabinet Secretary to put mental health at the very heart of the Scottish Government health agenda, providing the high quality mental health support that our children and young people deserve.
The incoming health secretary has set up a £5m taskforce to reshape and improve child and adolescent mental health services (CAMHS).
Jeane Freeman condemned the existing system for referring children and young people for specialist mental health treatment.
The announcement follows publication of a report on “rejected referrals”.
An audit was announced last year after NHS figures showed thousands of referrals were being rejected.
A rejected referral occurs when CAMHS is assessed as inappropriate for the child or young person.
During the audit period in February, one in five referrals was rejected across all health boards.
It was found that decisions usually happened quickly, with most made on the basis of paper referrals rather than face-to-face assessments.
Further research gathered from seven health boards found two-thirds of their 285 rejected referrals included “signposting” to other services.
However there was a disparity between this and the views of children, young people and their families.
Of the 253 people who participated in an online survey of their experiences, only 42% felt they were signposted.
Meanwhile some reported signposting was “generic, unhelpful and often points to resources they have already explored”.
Some young people whose referral has been rejected reported a belief that they will not be seen by CAMHS unless they are suicidal or at immediate risk of harm.
The report recommended further research into the CAMHS system as a whole, work to close the gap in provision where it is not the most appropriate service, immediate changes to its assessment procedures, and ongoing data collection around rejected referrals.
Ms Freeman said: “Demand on mental health services is growing but far too many young people are being turned away from help or waiting too long to be seen.
“This report finds that, while CAMHS may not be the right path for some of those referred, young people are being rejected from treatment without proper explanation or being directed to more appropriate care.
“That is completely unacceptable.
“I am accepting the recommendations in this report and I am determined that our mental health service will be re-founded on the need to empathise, engage and explain how to get help to often very vulnerable young people.”
Mental health expert Dr Dame Denise Coia has been appointed to lead the taskforce, with initial recommendations for action expected over the summer.
The mother of a teenage girl who took her own life said she holds NHS Tayside responsible for her daughter’s death.
Ruth Moss’s daughter Sophie Parkinson died in 2014, aged 13, after “six years of really struggling and being in a system that let her down badly.”
Mrs Moss said she is “absolutely sure” Sophie would still be alive if she had been given appropriate medical care.
An independent inquiry into mental health services across NHS Tayside was commissioned earlier this month.
Mrs Moss, who is suing the health board, said she believed NHS Tayside’s Child and Adolescent Health Services (CAMHS) viewed two previous suicide attempts by Sophie as “childish cries for help”.
Mrs Moss told BBC Scotland that she believed the CAMHS risk assessment of Sophie was “hugely inadequate.”
She said: “I’m absolutely sure that if CAMHS had given a good standard of care, nothing exceptional, just standard of care, and had had some element of accountability throughout the process, then Sophie would be alive today.
“I hold NHS Tayside responsible for Sophie’s death. It’s made me angry, upset, hurt – a whole barrage of other feelings.”
Mrs Moss, who formerly lived in Liff, near Dundee, said her “bubby, brilliant child” had been referred to CAMHS when she was eight, after showing signs of behavioural problems and low self-esteem.
Mrs Moss, who is a nurse, said Sophie’s difficulties became “a lot, lot worse” as she grew older.
She said: “It was almost like that combination between hormones and mental health was a fatal one for Sophie.
“As Sophie’s condition worsened she started to see a trainee psychologist.
“It was at that point really that Sophie became very unwell and it was at that point I felt the services started to let us down.
“She self-harmed quite significantly.
“She tried to kill herself on two previous occasions and neither of those were really taken seriously by NHS Tayside.”
Mrs Moss, who now lives in Edinburgh, said Sophie was deemed unsuitable for in-patient care despite repeated requests.
She said: “I actually approached her psychologist and said Sophie needs to be admitted.
“The feeling I was left with was she wasn’t bad enough.
“Sophie had two previous (suicide) attempts and she self-harmed. In spite of all that information it wasn’t deemed appropriate.”
Miss Moss said while she had “nothing against” Sophie being seen by a trainee clinical psychologist, there needed to be a level of senior involvement in terms of risk assessment and children presenting as high risk.
She said: “That was lacking in Sophie’s case.
“I came out feeling that Sophie was let down by a service that didn’t take her seriously and didn’t take me seriously.”
Mrs Moss said that the “end result” of this was that Sophie took her own life.
She said: “The warning signs were there and in my view should have been picked up on by professionals that are in this every single day.
“I come from an acute setting where patient safety is paramount, patient care is paramount.
“If somebody is deteriorating on an acute ward there is a process for risk assessing that person and making sure that intervention happens.”
Mrs Moss said she believed the investigation following Sophie’s death was inadequate.
She said: “That was not robust and rigorous in my view. It tended to pick the things I’d complained about and answered them, but it wasn’t an independent review process.
“NHS Tayside investigate Tayside. Turkeys don’t vote for Xmas and there seems to be a flaw in that right from the start.
“We need a process here whereby parents of children who have died in the health service have an ability to find out what went wrong and be absolutely reassured that the investigation is robust.”
Mrs Moss said the forthcoming independent inquiry must include a “robust and rigorous investigation” of CAMHS.
She said: “I would also like the process for investigating deaths in mental health to be looked at to ensure there is a good investigatory process set up where a health board isn’t examining its own procedures, there’s an independent process in there that works when these deaths occur.”
Mrs Moss said she has kept in contact with Sophie’s friends and their parents.
She said: “When you lose a child you don’t just grieve the loss of that child at that time.
“I’ve watched them grow up, I watch them learn to drive, I watch them go to university.
“My child will never have that opportunity.”
An NHS Tayside spokeswoman said: “As this is a legal matter we are unable to comment.
“Every suicide is a tragedy and our thoughts remain with the family.”