Wait bearing

When Jane Smith* first started hearing voices in her head she was just eight years old. The voices would tell Smith to harm herself by walking into busy roads or breaking bones in her body, but when her adoptive mother tried to get support, Smith was placed on a waiting list that was four years long.

While Smith and her family waited for an appointment at their local Child and Adolescent Mental Health Services (CAMHS) centre, their relationship rapidly deteriorated. Smith says she never truly accepted her parents, and her mental health problems made their relationship complicated.

“The wait was getting more and more stressful for me because the voices were coming more often,” says Smith, now 17. “I said to my mum you need to do something urgently because I can’t wait any longer. My mum pushed and pushed and eventually I got put to the top of the list, but because I’d waited so long I didn’t want the counselling.

“The four years I waited to be seen by CAMHS were stressful. The voices told me to smash a window, break my hand, walk into cars and buses. When I walked over bridges it would tell me to jump off a bridge.”

Eventually Smith was referred for weekly counselling sessions at a centre in Greater Manchester.

“By the time I got the help I didn’t want it because I’d waited for so long,” she says. “I went for four years and I just went because I couldn’t be arsed with school.”

Smith stopped seeing CAMHS in 2015 and eventually decided to move out of her family home. She now lives in Manchester Foyer, a supported living complex for young people under the age of 25, where she has been able to access support from Manchester-based mental health charity 42nd Street.

“When I moved out I realised I had anger problems and the voices started coming back again. I was referred to 42nd Street – I was waiting a long time for that as well. It was around three months. I was getting more worked up, angry and frustrated.

“I realised I had anger problems and the voices started coming back again.”

“I got there and told myself I would use the service. I was put on a 12-week counselling programme for one hour a week, and I’ve calmed down a lot more. I’m starting to do what the counsellor said, which is if I get angry I reflect on what I have done after it has happened, say what the consequences are and say how I could have improved those consequences. The counsellor focused on what my triggers were.

“I’ve been close to doing what the voices have told me to do but I am very strong in that way – I can pull myself back. I’ve been very close to self harming. I even did it on holiday. My voices were telling me there’s a massive rock there, just cut yourself. So I did. I had massive lines from where I scraped the rocks and I had to cover it.”

Smith’s story is not unusual. Between 2010 and 2015, spending on children’s mental health services fell by nearly £50 million – more than 6 per cent. Research last year by the Association of Child Psychotherapists (ACP), British Association for Counselling & Psychotherapy (BACP), British Psychoanalytic Council (BPC) and UK Council for Psychotherapy (UKCP) highlighted the “extremely concerning” state of mental health services for children and young people.

Of the more than 3,000 NHS counsellors, therapists and psychoanalysts who took part in the survey, 84 per cent said it has become more difficult for children to access the help they need, with children now required to have more severe levels of illness in order to get help.

For Smith the wait was life-changing. Although she has now learned to manage her mental health, she believes the length of time she was forced to wait significantly contributed to the breakdown in her relationship with her parents.

“If I’d got help when I wanted it and when I desperately needed it, I think everything would be a lot better, especially with my mum and dad,” she says. “Because I wasn’t getting the help I needed I snapped at them more. I didn’t understand where they were coming from but ever since moving out I realise that I shouldn’t have targeted my mum and dad.”

Adele Travis is the manager at Manchester Foyer. Owned by St Vincent’s Housing Association, the Foyer houses 61 young people and helps them with education, finance, job seeking and emotional support. At the end of last year, the Foyer announced it was launching a fund to help young people with mental health problems needing immediate emergency intervention.

Named “Julie’s fund” after Julie Hesmondhalgh, who has worked with the Foyer since 2016, the £10,000 fund will allow the Foyer to employ an on-site counsellor for 25 hours a week.

Travis says: “Often our young people are placed on waiting lists that can last up to five or six months. This wait can be critical. We decided to start fundraising so that we can carry out emergency intervention because there have been so many cuts to funding, the money just isn’t coming through.

“Many of our young people are from quite traumatic backgrounds. There need to be services there to pick them up and offer them support. The services that we work with are great but they are stretched to capacity. Young people often have to wait up to 11 weeks for a phone assessment.”

Twenty-three-year-old Asia Cassidy has lived in the Foyer for 18 months. Cassidy applied for a place after sofa surfing with friends and family, and has experienced depression. In April 2017 she was referred for counselling but did not get an appointment until the end of October.

“There were days when I felt low and couldn’t get out of bed. I’d spend all day in my pyjamas,” she says. “I’d turn my phone off. I was depressed. When I went to the doctors they told me they would put me on medication. I couldn’t sleep at all. I couldn’t eat. I lost a lot of weight. I felt really sick. It lasted for about two months. There are still days when I feel low but the night time is the worst because you think about everything. I was prescribed sleeping tablets. They did work a bit, but now there are days when I stay up until three in the morning and I sleep in the day, so that’s a day wasted.”

Cassidy says living in the Foyer has significantly improved her mental health and things could be worse if she was on her own. “I would think about self harm and would probably do it again if I was on my own. I think my mental health could have got worse in the time that I had to wait for an appointment.”

Aisha Quadeer also lives in the Foyer. Quadeer has suffered from anxiety since she was a child and has experienced suicidal thoughts. Now 18, she has been on a waiting list for counselling at 42nd Street since last summer but learned ways to help alleviate her anxiety in the meantime.

“When I’m anxious I can’t sleep. I start playing with my hair and using my hands a lot. I’ve been through depression. I’ve had suicidal thoughts and have had for quite a few years now. I don’t like being depressed. My friends don’t like seeing me upset and they try to encourage me to get involved more and meet new people, which I have done. I’ve started running every week, and I’ve beat my own record every time. My friend is also teaching me to play guitar.

“I have found ways to clear my mind, but I do think the waiting lists for counselling are very long. I do still think I would benefit from some support.”

In 2017 the government announced plans to invest £300 million to enable children and young people to access mental health support. The proposals include introducing a four-week waiting time for youngsters needing specialist support and new mental health support teams in schools. It is hoped around one in four schools in England will have this provision in place by 2022, but campaigners say it is long overdue.

Tom Madders, director of campaigns at child and adolescent mental health charity YoungMinds tells Big Issue North that although the government has pledged to decrease waiting times, more needs to be done in the long term. “While the quality of care that CAMHS provides can be excellent, it is often desperately hard to access these services, with many children and young people facing unacceptable waiting times,” he says.

“Every day we get calls to our helpline from parents whose children have been waiting months for an appointment, and who don’t know where to turn. Sometimes their child has started to self-harm, become suicidal or dropped out of school during the wait.

“While the government has proposed to introduce four week waiting time targets, these will not be rolled out across the country until 2022. And with just one in four children with mental health problems currently receiving support from CAMHS, there will need to be additional, long-term funding to make these targets achievable.”

*Name has been changed

Photo: Aisha Quadeer says she’s found ways to manage her depression herself because waiting lists are too long (Rebecca Lupton)

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Mental health – the facts

Twenty per cent of adolescents may experience a mental health problem in any given year.

Fifty per cent of mental health problems are established by age 14 and 75 per cent by 24.

Ten per cent of children and young people (aged 5-16) have a clinically diagnosable mental problem, yet 70 per cent of them have not had appropriate interventions at a sufficiently early age.

Three in four children with a diagnosable mental health condition do not get access to the support that they need.

The average maximum waiting time for a
first appointment with CAMHS is six months and nearly 10 months until the start of treatment.

CAMHS turns away nearly a quarter (23 per cent) of children referred for treatment.

The cost to the economy of all-age mental health problems is estimated at £105 billion a year – that is roughly the cost of the entire NHS.

Sources: Mental Health Foundation, World Heath Organisation, Archives of General Psychiatry, Office for National Statistics