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It is time for the discrimination against young people with mental illness to end
For last year’s words belong to last year’s language. And next year’s words await another voice. And to make an end is to make a beginning.” TS Elliott.
My number-one professional wish for the new decade is that the Child and Adolescent Mental Health Services (CAMHS) and Child and Adolescent Psychology Services (CAPS) are accessible to those who need them. When compared with more complex problems like poverty, homelessness and the global refugee crisis, timely access to child mental health services should be achievable. But like the 10,000 homeless and the 70 million refugees, we have come to regard the 7,000 children aged under 17, waiting years for a CAPS appointment and the 2,250 waiting for a first-time CAMHS assessment as simply statistics, the result of circumstances beyond our control. And unlike the sight of a single child begging on a Dublin street, or a three-year-old Syrian boy lying dead on a beach in Greece, statistics rarely move the human heart.
Yet, every one of those children has a story and every one of those parents face their own crisis every day; that of keeping their child safe from the threatening demons that constitute mental illness. These parents and children cannot post a photograph of themselves or tell their story to the media, nor should they have to, which is why when I refer these families for expert care, I try to tell their story for them, in as much detail as possible, in the hope that it might move someone to find a way to help them.
But most of the time, this is not the case. What has been happening with increasing frequency is that the ‘multidisciplinary team’ discuss the ‘case’ and decide that it does not ‘meet the criteria for their service’. Many GPs have received similar letters from both CAMHS and CAPS, in response to the stories they have told. Stories of depression, self-harm, anxiety, post-traumatic stress, emotional problems as a result of autism, feelings of failure due to ADHD. Stories of children caught in the grip of eating disorders, who could be saved from years of suffering if they only had access to specialised treatment. Children robbed of their childhood for the want of counselling, cognitive behavioural therapy, family therapy or medication.
Every week I sit with parents who, as well as trying to keep their children safe, are full of shame and guilt because their child is suffering psychological distress. We may say that there is no longer significant social stigma attached to mental illness. We may even believe this, but this is not the message we give when we tell these children that we do not have specialist services for them. We may say that there is no discrimination against mental illness sufferers, but not prioritising the one-in-10 young people who are afflicted, is discrimination. Discrimination by the very people that are responsible for their care.
When I explain to families that I cannot provide what they need, that there are no psychological treatments available, that there are long waiting lists for assessment, I have to look away so that I do not see the fear and disbelief on their faces. I know that the hint of prejudice and discrimination that had been hovering over their heads, like the low murmurings of a swarm of bees, has just grown louder and that they have felt the first of many stings, that of rejection. That they no longer need to worry about social stigma, because self-stigma has taken its place, alongside low self-esteem, loss of confidence in the future and hopelessness. Because stigma and prejudice are evidenced in the way resources are allocated and young people’s mental health has been chronically under-resourced.
As GPs, we have a new sub-group of patients — parents of children who have mental illness and who are awaiting treatment. Parents who have to stand by helplessly as their children miss out on education, friendships and joy. Parents who have found their child ringing the Samaritans, late at night, when they thought the house was sleeping, because they did not know what else to do.
I often wonder what would happen if the child, parents, policy-makers and politicians were present at those multidisciplinary meetings. Who would tell these families they do not ‘meet the criteria?’ How could they say that our health system cherishes all children equally, including those with mental illness?
So, as the old decade closes and a new one begins, perhaps we could start by acknowledging that we do NOT have a mental health service for young people. That this discrimination needs to end and that the beginning of a new decade may be a good time to start to correct this. Wishing you all a happy and a prosperous New Year.