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[LONDON, 30 November 2007] - Inequality in the provision of child and adolescent mental health (CAMH) services has increased over the last seven years, despite government policy to the contrary, according to a survey published in the December issue of the Psychiatric Bulletin.
In 1999, CAMH in-patient provision was unevenly distributed across England, largely due to a concentration of units managed by the independent sector in London and the South East of England. Since this survey was undertaken, a National Service Framework has been published that sets out standards and milestones for achieving an equitable CAMH service, and increased funding has been made available. A repeat of the 1999 bed count survey was conducted in 2006 to see whether change had occurred in response to government policy. The survey covered both the NHS and independent sector provision, but excluded residential settings managed by local authorities, and independent sector units not devoted to mental health services. It was found that between 1999 and 2006 the total number of units in England has risen from 72 to 91, and the number of beds provided from 844 to 1128 (an increase of 284). Sixty-nine per cent of the increase in bed numbers is a result of new beds opened by independent sector providers. Consequently the percentage of total bed provision managed by the independent sector has risen from 25 per cent to 36 per cent. Regions with the highest number of beds in 1999 have increased bed numbers to a greater degree than areas with the lowest number of beds in 1999 (8.3 v. 3.6 beds per million population). Eating disorder services are confined to four of the nine English regions, with 4 units in London accounting for 75 of the 113 beds available The 183 secure and forensic beds provided by 12 units are located in six regions. The number of forensic and secure beds has increased by 325 per cent and 105 per cent (16 to 68, and 56 to 115) respectively. However, in units that admit only children under the age of 14, there has been a 30 per cent reduction in beds available (123 to 86). In 2006, a higher proportion of NHS beds were short-stay, with a target length of admission of between 6 and 8 weeks, than was the case in 1999. The independent sector has increased its market share of eating disorder beds from 75 per cent to 82 per cent, and of general adolescent beds from 15 per cent to 27 per cent. This sector has a virtual monopoly of secure psychiatric beds. The main indicator of the problem with CAMH provision in England has been the high proportion of young people with mental disorder who are admitted to paediatric or adult psychiatric wards because no CAMH bed is available. Further, an even distribution of CAMH beds across the country, so that young people are placed within reasonable travelling distance of their family, is one of the recommendations both of the Department of Health and of the National Institute for Clinical Excellence. This survey shows that not only is provision very unevenly distributed, but that the inequality has increased. Despite an overall increase in bed numbers, four regions of the country are still well below the minimum of 20 beds per million population recommended by the Royal College of Psychiatrists. The researchers speculate that this might be partly due to fragmented and local commissioning, and the effects of market forces operating as a result of increasing privatisation. In-patient services for children under the age of 14 face an uncertain future, they say. Further information
pdf: http://www.rcpsych.ac.uk/pressparliament/pressreleases2006/pr970.aspx