When it comes to mental health, sometimes a label helps

sad-boyCAMHS. Even the acronym sounds reassuring. A referral to Child and Adolescent Mental Health Services can feel like a lifeline to parents who are struggling to help their children and at a loss for what else to do. It can offer hope that someone will be ready to listen, to understand, and to provide a medical solution.

Unfortunately, for many families, this hope is in vain. After waiting many months for an appointment, thousands every year are told their children do not meet the criteria for treatment, sending them back to square one. And while it’s absolutely right that politicians scrutinise waiting times and call for extra funding for mental health services, this won’t help those who are rebuffed by Camhs.

There’s an understandable reluctance to attach labels to children who are struggling to cope. While recent decades have seen a huge leap in diagnoses of neurodevelopmental conditions such as autism, which are increasingly well understood, other diagnoses are more controversial and indeed even political. Take conduct disorders, the prevalence of which is thought to be seven per cent among boys aged five to 10 and three per cent among girls of the same age.

If a label is key to accessing the necessary NHS treatment … then surely the child’s best interests are served by attaching one

One only has to watch a couple of episodes of Supernanny to see how dramatically a child’s behaviour can be changed through the use of different parenting techniques and changes to their home environment. Parents who start off convinced their child must have Attention Deficit and Hyperactivity Disorder seem to be shown there is nothing “really” wrong with their children. But these problems are real, and if a label is key to accessing the necessary NHS treatment – generally not medication but theory-informed parenting support – then surely the child’s best interests are served by attaching one.

Getting it right for every child requires proper assessment, and parents may be required to act as tenacious advocates for their offspring while enduring scrutiny of their parenting abilities, their own mental health status and their wider personal circumstances. For those families who are already on the radar of social services – for example due to poverty, addictions or domestic violence – it might seem prudent to give up at the first hurdle and accept nothing can be done, regardless of how challenging the situation at home may become.

Assessing anyone for signs of mental illness is not a purely medical task but also a philosophical one

It’s clear more funding is desperately needed for Camhs, in order to cut waiting times that may represent a huge proportion of a child’s life. But assessing anyone for signs of mental illness is not a purely medical task but also a philosophical one. There are many potential explanations for an unhappy child, or a child who cannot concentrate, or a child who lashes out when challenged. We live in uncertain times, both globally and locally, and it’s far from clear that our collective wellbeing is being improved by the onward march of technology. If a child is being bullied at school, or struggling with their self-identity, or caring for a sick parent at home, it would be surprising if this didn’t manifest itself in some way. But it would also be ludicrous to expect a psychologist or psychiatrist to be able to wave a magic wand and fix things.

We teach children not to talk to strangers, so it’s little wonder many lack the trust, the confidence, or indeed the emotional vocabulary to articulate how they feel to an adult professional they’ve only just met. But – as the Scottish Children’s Services Coalition highlighted in The National on Monday, at the start of Children’s Mental Health Week – some 50 per cent of all mental health problems are established by the age of 14. These aren’t mere “growing pains” or passing phases, and delays to diagnosis risk leaving children vulnerable at the most crucial of times.

There has been a crescendo of campaigning work in recent years with twin aims: to reduce the stigma of mental illness and to ensure mental health care is not inferior to physical health care.

I’ve lost count of the number of stories I’ve heard of people being unexpectedly offered antidepressants after five-minute GP appointments

But while few would try to argue that broken brains should be given less attention than broken legs, there is an importance difference between these two branches of medicine. It’s not difficult to diagnose a broken leg, and the treatment plan tends not to involve months of trial and error. If a patient presents at the GP with symptoms of a mental illness, and no sign of any broken bones, it’s unlikely the doctor will put his or her healthy leg in plaster for good measure. But I’ve lost count of the number of stories I’ve heard of people being unexpectedly offered antidepressants after five-minute GP appointments. Patients presenting with period pain, or a flare-up of a chronic condition, or in one case a sore arm, being swiftly assessed as having “low mood” and offered a remedy. People experiencing difficulties due to bereavement, or relationship breakdown, or work stress, being offered a chemical “cure” for emotional responses that are part of the human condition.

Clearly, antidepressants should not be handed out freely to anyone who’s feeling a bit down, but the regular sounds of alarm over prescribing rates for under-18s may be misplaced. As adults, we don’t want to believe it should ever come to this for young people, who are supposed to be enjoying the fabled best years of their lives. But the stark reality is that some need help, and shouldn’t face a battle to get it.

A version of this article first appeared in The National.

Published by Shona Craven

Writer, editor, talking head

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