In my role as an NHS psychiatrist I work on wards in an inpatient unit, as an on-call doctor, and I also treat adults and children who have been referred to me by A&E staff because I’m also part of a liaison psychiatry service – a mental health team attached to an emergency department.
I see a fair number of under-18s who have presented in distress at A&E in a mental health crisis seeking support and have been brought in by their family, friends or an ambulance crew.
Some of these young people have a severe enduring mental illness, like a first episode or recurrence of psychosis, perhaps because they’ve not been taking their medication. A second group have committed self-harm or had suicidal thoughts or have tried to take their own life, and therefore may have severe injuries. They can be brought in from home, school or a public setting.
And a third group of emergency mental health presentations are young people with depression, low mood or behavioural challenges. In those cases their diagnosis is often less clear. They’re usually struggling because of a range of stresses they’re facing, whether that’s socially or educationally.
These young people are often desperate and they all need help. But it’s worrying that often they’ve not been able to access the help they need. Quite often a young person has been referred to NHS mental health services but then waited over a month or even over two months – and sometimes it can be many months – to see someone.
The trouble is that waiting is damaging. Those young people are very unwell to start with and their mental health gets worse while they’re waiting. With mental health conditions, the longer you wait for care after first displaying symptoms, the harder you become to treat. While a young person is waiting for treatment they can have difficulty establishing and maintaining friendships, struggle at school and become more and more socially isolated. Their entire life chances can be blighted if their problems aren’t treated urgently and properly.
Sometimes not getting help for depression or an eating disorder, for example, worsens their mental health to the extent that their mental state is altered so much that they can do harm to themselves or to others because they feel they can’t get the support they need. I see young people who have self-harmed by cutting themselves or tried to take their own life.
A&E is a difficult place for young people in a mental health crisis because emergency departments are busy, noisy places. Worryingly, the numbers of under-18s who end up there has been going up, in particular because of the pandemic. And the waiting times for mental health care outside hospitals seem to be getting worse.
These are very vulnerable young people whose health is fragile. Often they’re scared. They want to feel better but they need someone to help them make sense of what’s going on. It’s the duty of NHS mental health services to give them help quickly so they start to recover. But that’s where I feel that unfortunately we are falling short at the moment, by making them wait for care.
Waiting times for care are what worries me the most because these young people need timely care so their condition doesn’t get any worse. Mental healthcare for under-18s at the moment is clearly inadequate. As a country we are letting young people and their families down by having such inadequate mental health care. I’m not a parent. But if I had a child and were seeking mental health support for my son or daughter, I would be very worried.
* The writer is an NHS psychiatrist in a city in England
As told to Denis Campbell
