99% of GP’s fear that young patients will come to harm while on the waiting list for mental health services
- 90% of GPs say that mental health services for children & young people are inadequate
- 99% fear that these young people may come to harm while waiting to access treatment
- 88% of GPs say it’s impossible or very difficult to access treatment for anxiety
- To help young people manage anxiety, stem4 launches Clear Fear, a mobile phone app based on evidence-based treatment approach
- GPs say:
- “Suicide amongst young patients appears to be on the increase. We need to have better resources to support them and their parents.”
- “There is a complete disintegration of service provision. Patients often come to see their GP as no other services are available. I feel I should refer to CAMHS, but often do this being aware that the response they will get will be minimal, inadequate, or even rejected.”
- “As a GP I have personal experience of the harm coming to 11-18 year-olds due to grossly inadequate mental health services. It is a disgrace and politicians are to blame. They come out with fine words but never follow with action or funding to provide care for these vulnerable patients.
- “CAMHS have not expanded their remit to see kids with mental health problems, although they still have the nerve to say “providing care 0-19”. Won’t see pre-school children or those over 16.”
90% of GP’s believe that mental health services for young people aged 11-18 are inadequate and that they have deteriorated over the last two years, new research has found1. This is up from a figure of 77% in 2016.2
Many GP’s (78%) now say they are worried that not enough of their young patients can access treatment for mental health.
Increasing numbers of young people are experiencing mental health difficulties; there are long waiting times for treatment; referral pathways are limited, and the consequence of strict eligibility criteria is that most children and young people are turned away by Child and Adolescent Mental Health Services (CAMHS). Virtually all doctors (99%) fear that that these young people may come to harm while waiting for specialist mental health treatment.
The survey of 1,000 GP’s for stem4, the charity which works to prevent mental ill health in teenagers, found that 9 out of 10 GP’s (90%) are seeing more young patients with mental health problems than two years ago, while two-thirds (64%) say they find it hard to give these young patients the time they need. Over the last two years:
- 9 out of 10 (86%) had seen a rise in the number of patients aged 11-18 suffering with anxiety
- 8 in 10 (81%) had seen an increase in young patients with depression
- 7 in 10 (68%) were seeing more young patients self-harming.
- Doctors had also witnessed an increase over the last two years in such mental health conditions as conduct disorders (54%), addiction (38%), and eating disorders (38%)
90% of GPs describe mental health services for children and young people as either extremely inadequate (37%) or very inadequate (53%). 82% said that services for the treatment of anxiety were the most inadequate; this was followed by depression (80%), self-harm (79%), conduct disorders (75%); eating disorders (69%), and addiction (67%).
When it came to help for anxiety problems, 88% of doctors said it was either impossible or very difficult for their patients to access treatment.
Emotional disorders such as anxiety and depression are among the most prevalent psychiatric disorders experienced in childhood and adolescence. Anxiety disorder rates increase with age and are more common in girls than boys. According to recent figures from NHS Digital’s survey ‘Mental health of children and young people in England 2017’, 7.2% of children aged 5 to 19 have an anxiety disorder; amongst 17 to 19-year-olds the percentage rises to 13.1% (one in eight), i.e. 20.3% of girls and 6.3% of boys.3
Since referral pathways are limited, two-thirds of doctors (68%) say they have no choice but to refer patients suffering with an anxiety disorder to CAMHS, even though they know most will be rejected. One third (32%) now only refer patients with the most severe anxiety disorders, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or anxiety with another mental health condition. Even though emotional disorders are more than twice as prevalent amongst children living in lowest-income households compared to children living in highest-income households (9,0% vs 4.1%), four in ten doctors (38%) tell parents to pay for their child’s treatment if they can afford to do so.
Other alternative actions taken by GP’s when dealing with young people’s mental health:
- 31% recommend patients contact a local charity;
- 31% provide patients with literature on Cognitive Behavioural Therapy (CBT) to help self-manage their condition;
- 30% refer patients to local NHS-commissioned talking therapy services. However, most doctors reported that these services had been closed down;
- 29% recommend they use one of the digital apps that have been approved by the NHS;
- 13% refer patients for counselling through their GP practice;
- 10% refer back to schools.
Dr Nihara Krause, Consultant Clinical Psychologist, founder of stem 4, and creator of ‘Clear Fear’, a new smartphone app designed to help young people manage their anxiety, said:
“Back in 2016, when stem4 last surveyed GP’s, we found that young people’s mental health services were at crisis point. Today’s figures indicate that the crisis continues unabated, and even though this Government has promised more funding, nothing much has changed, except that we now know that more children and young people have a mental health condition: one in nine between the ages of 5 and 16 today, compared to the one in ten revealed by previous research. New figures from NHS Digital (2018) now show especially worrying levels of emotional disorders (anxiety and depression) amongst young women aged 16 to 19. These now affect 22.4% of this group.”
“Head teachers are planning whole-school approaches to tackle the mental health crisis in our schools, and the government will pilot school-based mental health teams in 20% of schools across England over the next five years, but mental health resource remains elusive and progress slow. And where we once had access to highly trained therapists in the community, able to deliver evidence-based treatments such as CBT, in many local areas these services have been cut, denying access to expert treatment. These mental health services are particularly needed for those children and young people who present with more than one diagnosis, such as, for example, mixed anxiety and depression, or an anxiety disorder that underlies a disorder associated with substance misuse. The results of this survey suggest that GPs faced with limited referral pathways are being forced to refer to CAMHS, knowing that their patients are unlikely to meet the treatment criteria. Alternatively, they look to other community sources, or manage within their practice using self-help. If all else fails, they simply refer young patients back to their school to ask for help.”
stem4’s own operational evidence supports these new findings. Over the last 18 months, 120,000 young people in the UK have sought to overcome their urge to self-harm by accessing stem4’s mobile phone app, Calm Harm. 77% of them have been unable to, or have not sought treatment. A significant number of users are female and between the age range of 16-19.”
Dr Nihara Krause and stem4 say more needs to be done on a number of different levels to support children and young people with mental ill health:
- As a consequence of long delays in access to specialist resource, children and young people conditions worsen and are presenting with complex mental health needs. More specialist CAMHS services with high intensity specialists are urgently needed;
- Children and young people who have been on a waiting list for help require some sort of intermediate support which can help monitor and motivate change before they access treatment.
- Children and young people who are in the early stages of an anxiety disorder require increased access to specialist early intervention services. GPs and teachers are at the forefront of addressing this crisis and they need much more support. Dr Nihara Krause hopes that the Clear Fear app will provide children and young people with tools that can help them manage their anxiety at an early stage
- In addition, much can be done to prevent the development of an anxiety disorder through provision of easy-to-access support in dealing with a range of anxiety symptoms. This will help alleviate distress at an earlier stage and prevent the escalation of these symptoms into a disorder
stem4 launches Clear Fear, a mobile phone app based on an evidence-based treatment approach
In the absence of effective, early face-to-face treatments for anxiety disorders and to provide help for those children and young people on waiting lists, Dr Nihara Krause’s charity stem4, has created Clear Fear, a phone app conceived for the 10.5% of young people aged 11 to 19 who need to learn to manage their anxiety. Clear Fear is targeted at the digitally-minded young people of today, and unlike the 1000s of other health apps currently available for download, Clear Fear is based on a cognitive behavioural therapy (CBT) framework with design input from young people. CBT has been shown to be effective in treating anxiety disorders (Boettcher et al, 2013), and internet-based CBT is no less effective than face-to-face treatments in reducing anxiety and its associated symptoms (Olthius et al, 2015). CBT is recommended by NICE as the first-line treatment for anxiety disorders.
About Clear Fear
Clear Fear provides young people with a range of ways to manage anxiety. Designed by a clinician with ideas from young people, Clear Fear uses a cognitive behavioural framework to help users change anxious thoughts and emotions, alter anxious behaviours and calm fear responses. It also has helpful descriptions of the different ways in which anxiety becomes manifest, resources and a ‘grit box’ to boost resilience. It is recommended for young people aged 11-19 years but can be used by a younger group with the support of a parent or carer.
Clear Fear complements but does not substitute for the assessment and on-going support of a mental health professional.
Anxiety is an emotion we all feel. In many instances, it is a helpful alerting signal. Clear Fear helps users learn to separate helpful anxiety from anxiety that might be getting them down. Users should not expect to be completely free of anxiety, because we all need a bit of anxiety! Instead, users should aim to improve how they manage their anxiety.
Clear Fear helps in a number of different ways. It can:
- Help you deal with your emotions through helping you to express yourself, to stay calm with the aid of breathing and mindfulness exercises, or to laugh and smile!
- Help you to manage your worries. This can be achieved with ‘worry warriors’, which serve to change your thoughts, by putting worries away in a ‘worry box’, so that you can focus on other more productive thoughts, or by learning to solve worries one step at a time.
- Help you to learn how to react to worries. When we are worried, we often either avoid doing things or we overdo things. The Clear Fear app helps you to make goals for change and even rewards you for success.
- Help you manage the physical responses to anxiety. This section helps you to set exercise goals, reminds you to eat a balanced diet, helps you make time to relax, and provides some helpful tips on sleeping well, also encouraging you to set some sleep goals.
In addition, Clear Fear:
- Helps you boost your resilience with some helpful tips from the ‘grit box’.
- Gives helpful information on the different ways in which anxiety can show
- Shows you how to create a personal ‘safety net’ – things you can think and things you can do, such as keep safe with a handy list of people you can call and emergency numbers.
- Has an emergency section, explaining how to deal with a panic attack, and an information section with a range of resources and self-monitoring techniques to help you keep track of triggers and change.
Clear Fear has in part been funded by a Tech for Good grant from Comic Relief and the Paul Hamlyn Foundation, and by generous donations from individuals and an anonymous trust.
In 2016, Dr Krause, created Calm Harm a mobile phone app to help young people stem the urge to self-harm. Calm Harm received NHS approval in June 2017, and since then has recorded over 900,000 downloads. After using the app, 93% of users reported that the urge to self-harm had declined. Calm Harm has won several awards and has been featured in the London Design Museum. The highest number of users of the app are female with 41% between the ages of 15-19. Given this is the age when emotional disorders such as anxiety rise in girls, it is hoped that Clear Fear will provide much- needed help and support. This is further confirmed by user feedback on Calm Harm where many have written in to say they are using Calm Harm to help them manage anxiety. If this is the case, then Clear Fear will help target their symptoms even more specifically. For more information, please visit www.stem4.org.uk.
Clear Fear and Calm Harm are available for free on Apple and Google Play. Following an independent evaluation of Calm Harm as part of the National Information Board app endorsement process, the app has been available for download on NHS Choices since July 2017. Follow Calm Harm and Clear Fear on Twitter and Instagram @calmharmapp, @clearfearapp and Facebook.com/calmharm or Facebook.com/clearfear
- Ends –
Notes to editors
For queries or interview / case study requests/regional breakdown across the UK, contact:
Penny Lukats – 07775 992350 firstname.lastname@example.org
- Survey of 1,000 regionally representative GP’s across the UK carried out by MedeConnect Healthcare Insight between 14th and 28th November 2016. Last accessed 18.12 18
- Survey of 300 GP’s across the UK, A Time Bomb Waiting to Explode, May 2016 https://stem4.org.uk/wp-content/uploads/2017/12/A-Time-Bomb-Waiting-to-Explode.pdf. Last accessed 18.12.18
- NHS Digital’s survey ‘Mental health of children and young people in England 2017’, MHCYP 2017: Emotional disorders – Tables. Last accessed 18 12 18
A sample of the 622 comments received from the doctors surveyed:
- “There is just a complete disintegration of service provision, and patients often come to see their GP as no other services available. I feel I should refer to CAMHS but often do this being aware that the response they will get will be minimal, inadequate – or even rejected.”
- “Under-resourced – CAMHS are overwhelmed”
- “There are no other services locally except CAMHSs, which is very poor and no IAPT services like in adults, which is needed for children with competition for services.”
- “Almost impossible to get people seen locally by CAMHS unless in the very severe end of the spectrum of illness.”
- “Extremely frustrating, there is a lack of options for most mental health issues affecting young people. Suffering for the patient and family is increased and in some cases deterioration to more severe problems is inevitable.”
- Referrals get bounced all over the place and then rejected. This all takes months, and in the meantime, the patients’ condition worsens. The provision is very limited.”
- “CAMHS are not interested unless the patient is suicidal. It seems there is a massive gap in support for this age group. They also discharge patients as soon as they are 18. It’s really sad as GPs are sometimes under qualified to deal with often very complex issues in this age group and feel helpless when a CAMHS referral is turned down. It is an age group we struggle to prescribe in without experience. Often these patients will be under safeguarding or have social issues too. It would be good if there was a one stop shop for them.”
- “I don’t think the services had planned for this explosion in anxiety disorders and are not equipped to handle the workload and the flashback is to us making us GP’s more frustrated and the NHS look inadequate. I am embarrassed when I have to ask them to go privately but if they love their children, that’s the fastest way to get 1. a diagnosis and 2. treatment. We need telephone/skype triage by a qualified consultant conversant in the different manifestations of the condition in children (a lot of people assume it presents in same way as adults but doesn’t) that can be done within 2 weeks max to identify the patient’s needs and signpost them. sounds like a waste of resources? not really as if you get it right in the beginning then the pressure is spread through ALL the services. The Government needs to VERY QUICKLY commission charities like MIND and SAMARITANS to be able to take on 11-18-year olds. They are being discriminated in service provision in the 21st century and no one thinks that is wrong and should be corrected IMMEDIATELY. A parent told me that she feels more secure getting treatment as an adult in the NHS than her child and its true. They are being streamlined”
- “Social media has huge negative impact so feel big companies should do more to help.”
- “CAMHS do their best to dodge any referral that isn’t “PROPER MENTAL ILLNESS”. They have not expanded their remit to see kids with mental health problems although they still have the nerve to say “providing care 0-19”. Won’t see pre-school children or those over 16.
- “School send parents to GP and CAMHS decline the referral advising GP to refer to school.”
- “Services in my area (North) such as waiting time and resources are appalling.”
- “Need shorter waiting times for access to talking therapies.”
- “The delay is awful only the very severely affected are seen and then too little too late. Patients are usually left to suffer, self-harm, or just get worse because they go to local ED and get lots of tests and maybe admitted and just wound up by a health system that cant view the person as a whole, they self harm and there’s no time to deal with it in ED, and they get patched up and sent home, may get a referral, but CAMHs will find a reason why they are not bad enough to be seen, and the cycle continues. It’s an unfolding heart- breaking tragedy.”
- “Those aged 15-17 seem to have the least options available – too old for paediatric, too young for adult services.”
- “Locally we have a single point of access to CAMHS. Vast majority of young people signposted to voluntary sector.”
- “I feel very uncomfortable as I have limited resources to deal with this cohort of patients who are very vulnerable.”
- “Under resourced and over stretched. Especially difficult accessing for 17yr olds -feeling they are waiting so can pass onto adult services.”
- “There is no provision of counselling or CBT for children in the same way there is for adults, the only option is to refer to CAMHS – when the referral is either rejected or the patient would wait 6 months or more to be seen.”
- “Support for children with mental health is becoming appalling due to lack of funding and people available to help. Referrals are constantly being rejected with little or no other places to refer children to. Patients, parents and GPs are stuck between a rock and a hard place!”
- “Suicide amongst young patient’s appears to be on the increase. We need to have better resources to support them and parent’s/guardians.”
- “I am very concerned about the mental health of todays younger children and adolescents. The provisions for their services are very poor and difficult to refer / obtain advice, with very lengthy waiting times (> 18 months in some cases). This is not acceptable.”
- “As a GP I have personal experience of the harm coming to 11-18-year olds due to grossly inadequate MH services. It is a disgrace and politicians are to blame. They come out with fine words but never follow with action or funding to provide care for these vulnerable patients.”
- “Needs more funding we can’t drive all this awareness about mental health then when people consult tell them there is nothing unless they are about to harm themselves significantly or someone else!”
- “I feel somewhat cynical about the current Government’s attempts to tackle mental health problems in young people. In my professional experience, I have found their promises on funding services properly to be empty or simply inadequate.”
stem4 is a Wimbledon-based, award-winning charity that supports teenage mental health through mental health promotion. It provides evidence-based mental health education, builds resilience, enhances motivation to change and signposts the way to early intervention. stem4 focuses on commonly occurring mental health issues in teenagers, including eating disorders, anxiety, depression, self-harm and addiction. The charity works with students, parents and teachers in secondary schools, and with health professionals such as GPs and school nurses through its conference programme and through digitally-delivered workshops suitable for PHSE in schools. stem4 is also included in the Royal College of GP toolkit.