It took Sir James Munby, President of the High Court’s Family Division, to issue a damning warning before an NHS bed was recently found for a suicidal teenager who was at significant risk of self-harm. This case has once again highlighted the sad state of affairs for mental health provision in the UK but, unfortunately, and tragically, it is difficult to be optimistic for change any time soon.
During the recent election campaigns rival politicians decried that mental ill-health and/or associated support services was a “burning injustice” (Conservatives), “the biggest unaddressed health challenge of our age” (Labour) and “stretched to breaking point” (Liberal Democrats). With such cross-party consensus it seems ludicrous that we still find ourselves in an intolerable situation whereby some of the most vulnerable members of our society are left without the support which they require.
As somebody who represents survivors of abuse, many of whom have found themselves in situations of acute mental health crisis at one point or another in their lives, I frequently speak to clients who feel that they have nowhere to turn and nobody to talk to. The provision of mental health services is a postcode lottery, with some people being placed on excruciatingly long waiting lists for NHS therapeutic services which are ultimately limited in scope and time.
Currently I am representing survivors that range in age from those barely older than toddlers to people almost into their 70’s; and yet almost all face a distinct lack of tailored support for their individual needs.
The Independent Inquiry into Child Sexual Abuse (IICSA) recently released a Rapid Evidence Assessment of the impacts of child sexual abuse on survivors and those that are closest to them. It pulls together various studies and makes for stark reading. Notably 57% of young people subjected to abuse suffered with depression and survivors of child sexual abuse are six times more likely to make an attempt of suicide.
The need for adequate mental health provision for those affected by abuse is clear, but this is not a new concern.
The IICSA report notes that there has previously only been one study into the costs of child sexual abuse specifically, and that this was published by the NSPCC in 2014. Whilst the personal costs of abuse are clearly immeasurable, and the economic costs will never be accurately known for various reasons, the NSPCC report suggests that child abuse costs the economy approximately £3 billion a year. Of that £182 million is attributable to health provision, including child and adult mental health services, child suicide and self-harm and adult physical health concerns including alcohol and drug misuse.
The cost and scale of the issue therefore cannot be understated. However in May this year, following a survey of 3,000 NHS staff undertaken by the Association of Child Psychotherapists, it was reported that 84% of those questioned felt that it had become more difficult for children to access support and 33% said that their workplace was either downsizing or being closed. It led to senior figures suggesting that children’s mental health services within the NHS were in crisis.
Time and time again survivors of abuse tell us that the system is broken. When they reach the end of the lengthy waiting list and finally receive therapy most can expect a standard course of treatment, no more or no less than the person in front of them in the queue. For some this “one size fits all” approach has had a detrimental impact upon them; effectively opening a can of worms and shortly thereafter leaving them without adequate support to go about their daily life. It is a desperate situation and, in my experience, one of the key motivators in survivors of abuse seeking legal advice for a claim for compensation.
But this should not be read as a criticism of NHS staff, some of whom have empathetically explained why support services for survivors of abuse within the NHS are inadequate. Charities are often being left to pick up the slack, but with increasing demand and diminishing funds they cannot be expected to bridge such a huge gap.
In July 2016 the Government recognised the issue and announced a £550,000 grant funding for charities assisting survivors of sexual abuse; but with the NSPCC report highlighting how health services for survivors of abuse costs almost £500,000 a day, it isn’t difficult to see that this grant would diminish quickly in the overstretched and under-resourced third sector.
The child at the centre of Sir Munby’s judgment required treatment specific to her needs, and without this support her life could potentially have been cut short. He was right to say that society would have “blood on our hands” if they failed a child who was known to pose a risk to herself.
Without further funding it is inevitable that for some of those who do not have such a respected advocate to speak out on their behalf their mental health support will be inadequate for their needs and they will slip through the net. Even when suicidal ideations or thoughts of self-harm are not a concern the unmet support needs are likely to continue to have a detrimental impact, with many survivors of abuse describing how they are left to live a life they are not happy with, and how untreated issues can also impact upon their families and communities.
It is therefore more important than ever to continue the conversation surrounding mental ill-health, and to continue to push for reform and further funding for mental health services so that no more people are failed.
This article was first published by Open Democracy.