pills and apps are not the solution

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It’s no surprise to learn that GPs in England are increasingly prescribing antidepressants to children, breaking National Institute for Health and Care Excellence (Nice) guidelines. Pressures on children’s mental health services mean access to specialist treatment on the NHS is more difficult than ever. Similarly, a Nice decision to recommend the use of cognitive behavioral therapy apps as a treatment for young people underscores the lack of any other way to meet the growing demand.

NHS guidelines are clear: those under 18 should only be prescribed antidepressants in conjunction with talk therapies and with the approval of a psychiatrist. The only exception is cases of obsessive compulsive disorder. But long waiting lists and unmanageable workloads mean many children struggle to access the kind of help they need – and the kind of attention from trained professionals that is most likely to improve them. . Staff at mental health services for overwhelmed children and adolescents describe a situation in which nearly all of clinicians’ time is spent identifying problems and managing risks – and very little directly helping children.

Referral thresholds have been raised so high, in an effort to conserve scarce resources, that in some cases, children in great distress or at risk have been denied care because they did not meet the criteria. An investigation earlier this year yielded shocking examples, including a service that refused to take care of a boy who was found with a ligature in his room.

The government is facing demands for a public inquiry, after an inquest found three teenage girls were rejected by a mental health trust in the North East of England. Christie Harnett, Nadia Sharif and Emily Moore committed suicide within eight months in 2019-20, after receiving inadequate care. Maria Caulfield, the Minister of Mental Health, acknowledges that this sequence of events was not one-time, and the families are right to insist that lessons must be learned.

But no investigation is needed to establish that children’s mental health services are at – and in some cases beyond – breaking point. Where budgets have been increased, they have in many cases been used to employ mental health education practitioners, working in support teams, with only 60 days of training. These staff can make a contribution. But they are not qualified to deal with the kinds of complex family conditions and circumstances (including mentally ill parents and domestic violence) that growing numbers of young people face.

Some young people may be helped by the new apps, although the evidence so far is weak and the recommendation is pending consultation. There may be occasions when a child’s GP sees no alternative to a prescription for antidepressants. But the Nice guidelines are evidence-based and exist for a reason. If children are so ill that a GP thinks they need pills, the NHS should be able to refer them to talk therapy. After the disruption to education caused by the Covid pandemic, the rapid diagnosis and treatment of young people with mental disorders should be a national priority. The next generation must be helped to grow up healthy.

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