Mental health services for children and adolescents

Editor—The announcement of Professor Aynsley-Green's appointment as national director for children's healthcare services, follows on the important government decision to establish a national service framework for children's services, announced last year.¹ It is around 18 months since the BMJ published an article by Aynsley-Green et al pointing to the neglect of children at a policy level.²

This neglect applies in a great measure to the mental health services for children and adolescents. These services—despite recent much heralded ringfenced modernisation monies, now discontinued after only two years—have long waiting lists for outpatient services and inadequate numbers of beds for mentally ill young people, who end up inappropriately on adult wards and paediatric units.

Child mental health professionals have been encouraged by the decision of the Health Secretary, Alan Milburn, to include child and adolescent mental health services, along with maternity and social care services, within the national service framework. These services were excluded from the recent national service framework for mental health. Most regard the framework for children's services as the proper place to consider the changes to strategy, workforce, structures, and resources that are urgently needed to meet the mental health needs of the nation's children. A study conducted by the Office for National Statistics showed that 10% of children and young people in England and Wales have an identifiable mental health disorder. The commonest conduct disorder, reported by Scott et al to be amenable to parenting training, costs the patient, his family, and society dear—in economic terms, by the age of 28 years, 10.00 times higher than those with no problems.³ Not all these young people with mental health disorder need or will access specialist mental health services for children and adolescents. But the findings underline the importance of creating health, education, and social care services that, together with the communities in which our families live, will be appropriately funded to combat stigma, promote emotional wellbeing, and address the hitherto unmet mental health needs of the children.