When large sums of money are announced in public services there are two questions to ask yourself: (1) What is the money worth in the context of the existing system?; and (2) What will it be spent on?
Over the weekend, the Lib Dems said there will be £1.25billion for “children’s mental health services”. This money is to be over 5 years, equating to £250million per year.
Piecing together various bits of news (BBC, Mind) it seems some of this funding will also go on supporting pregnant women and new mothers with their mental health (i.e. perinatal mental health services) and doubling funding for veterans’ mental health services.
Let’s answer our first self-posed question: what is this worth?
Spending specifically on children’s mental health services has been cut by 6.4% since 2010. In 2009/10 some £766m was spent on children’s mental health, which by 2012/13 was £717m – a cut of £49m.
As NHS England and the Minister for Care Services, as source of these figures, make clear, this is only direct spend on children’s mental health services. The figures don’t include local authority spend on the same, where we know 60% of local councils have frozen or cut their children’s mental health spend since 2010/11. Nor do these figures include spending on adult mental health. We know this is relevant because (a) this is where perinatal and veterans mental health funding comes from, and (b) problems in children’s mental health mean that young people are often treated on adult mental health wards. Looking only at local authority mental health spending, this has been cut by £210m since 2009/10. (The question of levels of adult mental health spending in the NHS is questionable; at best, it has stayed static over the last year having been cut by 2.3% in real-terms between 2011-12 and 2013-14.)
In this context, £250m a year doesn’t seem so much, though any money is, of course, welcome.
What about our second question: what will this money be spent on?
Inevitably, given its provenance ahead of the Budget, details of how this money will be spent are unclear. The intention, though, seems to be for it to go on “early intervention schemes to stop children developing serious and potential fatal mental illnesses”. Such early intervention is to include therapy sessions, family support work, better training for clinicians and the development of help via websites and online apps.
This is better than I expected, though we should raise a word of warning: given the almost universal focus on children’s inpatient beds it will be hard for providers to not funnel this money into more inpatient beds. We should keep a close eye on where this money goes.
One suggestion I’d like to see is that at least some of the money should be ear-marked for use as Personal Health Budgets, including as part of the Integrated Personal Commissioning programme. Both the PHBs and IPC programmes have explicit focus on mental health and children and young people, and we know that this route leads to more control and more flexible solutions that can meet individual needs. We also know it can join up fragmented systems, and is likely to divert money away from institutionally biased provision.
Money is a blunt tool. Even if it’s questionable whether the amount of money being pledged to something is worth much, we should also ask how it will be spent and ensure it’s used not just to prop up more of what went before. The money to be pledged in the Budget on children’s mental health is a particularly acute case in point.
 – The Lib Dem press release also says funding will go to “extend access to services for children under five and those with autism and learning disabilities”, which is strange to say the least.
 – I think it is worth noting just how difficult it is to get hold of spending figures on children’s mental health. The Health Select Committee’s recent report on children’s mental health services noted (paragraph 15 here http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/342/342.pdf (pdf)) there is a “lack of information about service provision, including demand, access and expenditure” and that the best source of such information is currently voluntary. The spending figures found by Young Minds took an FOI request!