Briefing for the Policing and Crime Bill

Report Stage, House of Lords, November/December 2016

Amendment 118: mental health assessment for child victims of exploitation and abuse

This amendment will improve support for child victims of sexual offences and other abuse by ensuring they are referred to have a mental health assessment when they come into contact with the Police. A mental health assessment carried out by a trained mental health professional, will ensure that their needs are identified so they can be referred to the appropriate services. This could be anything from peer support or other social interventions through to CAMHS if necessary.

Evidence to support this amendment

Research has found that up to 90% of children who experience abuse at an early age will develop a mental illness by the time they’re 18.[1]Abuse can derail a child’s development and can have long-term emotional and psychological consequences. Despite this, recent research from NSPCC and The Children’s Society has highlighted that abused children are not routinely getting access to the support they need:

  • Abuse on its own rarely triggers therapeutic support, as high clinical thresholds are often only met when children have severe mental health issues or are at crisis point. Evidence from The Children’s Society through an FOI to Mental Health Trusts focusing on Tier 3 CAMHS referral routes found that a third of referrals (28%) from vulnerable groups (including children in poverty, children in care and children who had experienced sexual exploitation or abuse[2]) were not accepted and of these 15% were not accepted without any further action[3].
  • Evidence from The Children’s Society report ‘Access Denied’ found that despite abuse being a major risk factor for mental health issues, less than half (47%) of mental health trusts identify children who have experienced sexual exploitation in referral and initial assessment forms and only 11% of trusts fast track access to CAMHS for this group. The report also showed that in some areas referral routes for mental health assessments are complicated.
  • A recent NSPCC analysis of Local Transformation Plans for Children’s Mental Health found that only 14% of plans contained an adequate needs assessment for children who have been abused or neglected and one third of Plans do not mention services to meet the needs of these children.
  • For young people who experience sexual exploitation, identifying them and their needs in the first place can be a particular challenge.

Key arguments in support of this amendment

  1. It fulfils commitments in Future in Mind

The Government has committed to implementing Future in Mind in full, which we welcome. Future in Mind sets the ambition to ensure “those who have been sexually abused and/or exploited receive a comprehensive assessment and referral to the services that they need, including specialist mental health services”. This amendment would deliver on that recommendation.

  1. The principle of Parity of Esteem was enshrined in law by the Health and Social Care Act 2012, and only supporting children once they have a clinical diagnosis is incompatible with this.

The Government have said that access to support for these children should be based on their clinical needs. However, Future in Mind states that ‘[T]he provision of mental health support should not be based solely on clinical diagnosis, but on the presenting needs of the child or young person and the level of professional or family concern.’

For physical health the benefits of intervening before clinical diagnosis with at risk groups is well known. For example, cervical screening is offered to all women over the age of 25. The current rate of cervical cancer is 12 cases per 100,000 women, and screening has led to a 7% annual decrease in cervical cancer cases, and it prevents an estimated 5,000 cases each year in the UK.[4] Comparatively, children who experience abuse are at a much greater risk of developing mental health problems. Waiting for a clinical diagnosis is an example of failing to deliver parity of esteem.

  1. We are not proposing that every child who has experienced abuse will need therapeutic mental health support, but without an assessment we cannot identify and meet their varied level of needs.

Just as screening for cervical cancer does not assume that all those screened need follow up cancer treatment we are similarly saying that not all children who have experienced abuse will require full mental health support. However, targeting at risk groups, which we know these children are, will help identify and address mental health needs early, just as cancer screening does with physical health.

If we are to properly address the unmet mental health needs of children who have experienced abuse, and prevent the escalation of mental health concerns, we must develop a robust system of identification – this should ensure that these children and those caring for and supporting them can access the support they need, including voluntary sector and social interventions for their emotional wellbeing, as well as clinical interventions.

  1. It will help us build up an evidence base for future commissioning

The importance of this assessment may be identifying risk factors for the young person, offering support to a carer or family member, referring onto local support services or the assessment may indicate a higher clinical need and a referral to CAMHS. This amendment is not suggesting that all of these young people need a CAMHS referral, but rather their holistic mental health needs should be assessed.

The lack of reliable data on how many children need support as a result of experiencing the trauma of a sexual offence contributes to the fragmented and inadequate commissioning of services. Using data from these referral pathways will help develop an understanding nationally and locally for the needs of these children in the local area and inform future commissioning.

For further information, please contact:

Lucy Capron: or 020 7841 4494

Abbie Gillgan: 02037729291

1

[1]Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005), Minnesota Longitudinal study of risk and adaptation.

[2] p.44

[3] p.7

[4] NHS England