The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of children’s services, has called for significantly increased investment in mental health services and warned of a mental health pandemic as the impacts of Covid-19 on the young become clearer.
The call comes as new figures published today (7th September 2021) from Public Health Scotland indicate that at the end of June 2021, 1,686 children and young people had been waiting over a year for treatment from specialist child and adolescent mental health services (CAMHS) provided by the NHS. This figure represents a doubling from June 2020 (787).They also represent 14.4 per cent of those waiting for specialist treatment.
With already under-resourced and overstretched services facing overwhelming pressure due to increased demand, the SCSC has raised concerns over a potential “lost generation” of vulnerable children and young people whose mental health is being impacted by Covid-19.
Even prior to the pandemic cases of poor mental health were at unprecedented levels and there are a growing number of vulnerable children who cannot access adequate support. This was further reinforced by a recent blog post from Antony Clark, a director for public health watchdog, Audit Scotland, who noted that “serious concerns have existed for years”, and that action was now more urgent given the impact of the pandemic on young people.
Figures issued last month showed that self-harm among the young in Scotland was at its the highest level for 14 years and this is undoubtedly only the tip of the iceberg.3
While 4,552 children and young people were treated over the period April to June 2021 by CAMHS, only 72.6 per cent were seen within the Scottish Government’s waiting time target for the NHS of 18 weeks from referral to treatment (met for at least 90 per cent of patients).4 Nine out of 14 health boards failed to meet this target (full table in Notes to Editors).
A spokesperson for the SCSC commented: “These frightening statistics highlight the challenges ahead and while we welcome a commitment by the Scottish Government to increase investment in mental health services to 1 per cent of NHS spending over the next five years, we need this investment now.
“This increased investment should not however just apply to the NHS and one of the key problems is that early intervention support has not been available due to funding restrictions. Investing in early intervention limits the need for highly costly CAMHS and increasing resourcing in support services and intervention strategies must be a priority for this government.
“We have for some time raised concerns over a potential lost generation of vulnerable children and young people, whose mental health is being impacted even further by the Covid-19 pandemic. It is more important then ever that children can access the support they need, when they need it, irrespective of where they live.
“This is a crisis we can overcome, but it will require a similar energy and commitment to that demonstrated for Covid-19 if we are to achieve this and prevent many young people giving up on their futures.”
Cut in spend of £1,052 per pupil with ASN since 2012
‘Postcode lottery’ of spending between local authorities on ASN
Increase of just under 100,000 in the number of pupils with ASN since 2012
Cut in the number of ASN teachers to an all-time low
An alliance of leading independent and third sector organisations, the Scottish Children’s Services Coalition (SCSC), has called for greater resourcing to support children and young people with additional support needs (ASN), such as autism, dyslexia and mental health problems.
The call comes as new figures contained in a parliamentary answer reveal that spend per pupil with ASN has slumped dramatically, while the number of specialist teachers supporting them has dropped to a new low and the number of pupils with ASN has escalated dramatically.
The figures highlight that average spend per pupil on additional support for learning by local authorities in Scotland (primary, secondary and special education) has fallen from £4,276 in 2012 to £3,224 in 2020 (in cash terms).
This amounts to an overall cut in spending of £1,052 per pupil, representing a 24.6% drop.
Spend per pupil ranges from £1,737 in Edinburgh to £5,849 in the Shetland Islands, pointing to a ‘postcode lottery’ in spend across local authorities (see Notes to Editors for figures per local authority).
This fall is against the backdrop of an 82.9 per cent increase since 2012 in the number of pupils identified with ASN, from 118,011 to 215,897, amounting to 97,886 individuals. Those with ASNcurrently represent just under a third of all pupils (30.9 per cent).
Between 2012 and 2020 the number of full-time equivalent ASN teachers (publicly funded primary, secondary, special and centrally employed) has fallen from 3,389 to 2,836, a decrease of 553 teachers, representing a cut of 16.3 per cent and an all-time low.
Against the background of Covid-19 and its disproportionate impact on those with ASN, the SCSC has called for greater resourcing from both the Scottish Government and local authorities to ensure that those with ASN in Scotland’s schools receive the care and support they need.
A spokesperson for the SCSC commented: “It is vital that those with ASN get the care and support they need, especially during and as we come out of the current Covid-19 crisis. This is also key if we are to genuinely close the educational attainment gap as we know that those with ASN disproportionately come from lower income families and areas of deprivation.
“Such a situation is clearly challenging in an environment of austerity and evidence of cuts in spending per pupil with ASN and in the number of specialist teachers supporting this group.
“It is vital that the Scottish Government and local authorities work together to provide the necessary resourcing to address the needs of those children and young people with ASN, who represent some of the most vulnerable individuals in our society. “
The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of children’s services, has called for the Scottish Government to urgently increase mental health spend in its budget.
The call comes as new figures published today (2nd March 2021) from Public Health Scotland indicate that at the end of December 2020, 1,560 children and young people had been waiting over a year for mental health treatment.
These figures are the worst on record and represent a near tripling from December 2019 (589).
The SCSC has urged greatly increased investment in services for children and young people to tackle a current mental health pandemic. It has also called for a ‘national crusade’ as referrals begin to return to pre-lockdown levels.
The call comes amid growing concerns over a ‘lost generation’ of vulnerable children and young people, whose mental health is being impacted by the pandemic. Even prior to the pandemic cases of poor mental health were at unprecedented levels and there are a growing number of vulnerable children who cannot access services.
However, just over 50p in every £100 of the NHS budget is being spent on specialist child and adolescent mental health services (CAMHS). A frighteningly low figure even though mental health services are literally creaking at the seams due to greatly increasing demand.
The figures from Public Health Scotland also indicate that only four Scottish health boards are meeting the Scottish Government’s waiting time target of 18 weeks from referral to treatment over the quarter to December 2020. One out of four individuals are not being seen within this already lengthy 18-week target.
While 4,091 children and young people were treated over the period October to December 2020 by child and adolescent mental health services (CAMHS), only 73.1 per cent were seen within the 18-week waiting target and only four health boards met this target.
The SCSC has warned that mental health services will face an overwhelming and unprecedented pressure due to pent-up demand created by the Covid-19 lockdown, coupled with a cut in youth support services. This could potentially lead to a ‘lost generation’ of vulnerable children and young people who are missing out on the support they vitally need.
A spokesperson for the SCSC commented: “These latest figures are deeply troubling and point to a highly challenging environment for both our young people and our mental health services.
“We welcome the fact that the Scottish Government is intending to invest more than £1.1 billion in mental health services overall, but significantly greater funding is needed to address the current crisis facing our children and young people.
“While referrals are beginning to return to pre-lockdown levels, it is vital that children and families are provided with the support they so desperately need, especially given the impact of the pandemic on mental health. The fact that more than 1,500 of our most vulnerable children have been waiting more than a year for treatment in this respect is deeply disturbing.
“We would urge the Scottish Government to look to not just the NHS, but the third sector and other private sector organisations to play a key role in this, renewing its focus on prevention and early intervention.
“Our mental health services must receive the funding they vitally need or we face having a ‘lost generation’ of vulnerable children and young people.”
A leading charity and coalition of leading organisations has expressed its disappointment that special schools are not set to re-open and has urged the Scottish Government to reconsider its position. It has also urged that teachers and support staff at these schools be among the priority groups being vaccinated.
The call has been made by Kindred, an advocacy organisation supporting parents of children with complex needs. Its director, Sophie Pilgrim, has written to the Scottish Government’s deputy First Minister and Cabinet Secretary for Education, John Swinney MSP, urging it to reopen special schools to full time-placements who want to return.
The Scottish Children’s Services Coalition, an alliance of leading organisations that campaigns to improve services for vulnerable children and young people has also given its backing to the call.
In England, Wales and Northern Ireland special schools have remained open, whereas in Scotland there is a patchy picture, with some local authorities keeping all special schools open while others are offering pupils a few days at school each week, or no provision at all.
In addition, some independent grant-aided special schools appear to have closed altogether and reverted to ‘on-line’ learning for their children, even though it is evident that many of the children cannot engage in this form of learning.
In her letter, Ms Pilgrim has expressed her concern that with this second lockdown, children’s physical and mental health is also degenerating as they are not able to access the therapy and support required.
It notes that parents single-handily cannot provide that treatment and therapy for the children, without the support of the schools, highlighting that attendance at a special school goes beyond a child not getting an education, it is the therapeutic support that those children are getting and the respite support for the parents. The charity has heard that some children are being very violent towards their parents or their siblings, behaviours which are very hard to unlearn
Parents of children with complex needs are also in many cases experiencing physical and mental breakdown, impacting on their long-term capacity to care for their children.
In Scotland there is a presumption of mainstreaming, meaning that only children with the most complex needs are given a place within specialist provision, which is delivered through a rigorous process of assessment. There is no doubt that all these children would be classed as vulnerable and these are children who cannot be left alone and unsupervised and some require 2:1 care.
The UK Government has stated: “Special schools should continue to welcome and encourage pupils to attend full-time where the parent/carer wishes for their child to be able to attend. Special post-16 settings should continue to welcome and encourage students to attend as per their usual timetable where the young person wishes to attend. [1]
On these grounds, special schools have been kept open in the other nations of the United Kingdom.
Sophie Pilgrim commented: “We are really disappointed that special schools are not set to reopen. As a charity we have been speaking to parents of children with complex needs and they tell us that their children’s physical and mental health is degenerating because they are simply unable to maintain therapy and support within the home environment.
“The weather is now too cold for many parents to take children out. Added to a loss of routine, this has created further stress and anxiety for these children, often leading to challenging behaviour not seen before. Many parents in turn are sleep deprived and often neglecting their own medical and care needs.
“Special schools have a vital role to play, providing respite from care for parents, as well as therapy, education and social engagement for our most vulnerable children. Without these reopening we will pay a heavy price as a society.
“We would urge that Scotland follows the lead shown by England, Wales and Northern Ireland and we re-open our special schools to full time placements for those who want to return.“
Kenny Graham from the Scottish Children’s Services Coalition also backed this call: “There is a current patchwork approach to opening special schools across Scotland and we fully add our support to this call by Kindred to ensure that these are fully reopened.
“Many of those we are supporting are finding the current situation incredibly challenging, with greatly increased social exclusion through being at home.
“The loss of routine has proven extremely difficult for many, impacting in many cased on both the children and their parents. It is vital for those who want to, that they have the opportunity to return to school and have full access to the care and support they feel they need.”
Claudia’s son Christian is 11 years old and has complex needs, uses a wheelchair and is visually impaired. He also has respiratory problems, but the most difficult issue is his uncontrollable seizure activity. Christian is fed by tube, requires constant suction and needs an apnoea monitor during the night because sometimes he stops breathing.
Christian normally attends Oaklands School in Edinburgh but is now at home full-time.
Claudia has two other boys (aged 14 and 15) to look after and her husband is working at home.
Christian gets a day of respite at Calareidh, which is an NHS facility supports the needs of children with very complex needs.
Claudia however notes she is:
“Really struggling to do the physiotherapy, hydrotherapy and various sensory therapies that Christian needs and I feel that I am unable to fully meet his care needs. These were previously done at the school and with another lockdown, everything has stopped with a huge impact on Christian’s engagement and progress.”
Juggling Christian’s needs, medical, personal care, therapy and education with home-working and home-schooling his older brothers is also challenging because each one needs a dedicated space, so that means that Christian and Claudia have to be in only one room for most of the day. Christian would be developing better at school because the staff are trained to help in his development and Claudia is concerned that she can do a fraction of what they do at school.
Claudia believes all special schools should be open, with precautions in place, and offering children full provision during lockdown.
Kirsty Watt, Edinburgh
Eilidh Watt is 13 years old and has complex needs including learning disability and Autism Spectrum Disorder. Her mum, Kirsty Watt, is a single parent.
Eilidh is non-verbal, has balance and coordination problems and is tube-fed. She has intractable epilepsy and can experience as many as 10 seizures a day, with her oxygen needing to be monitored. Each night Kirsty stays up until 11.30pm or 12 to ensure that Eilidh’s tube-feeding has been completed.
Eilidh is usually up at least once in the night and sometimes on three occasions. Kirsty has to be up again at 7am to try get her ready for the school bus.
From being at Braidburn special school full time, which was a real godsend for the family, she is now at school in Edinburgh three days a week and has two night of respite care each week,
Kirsty notes that “Being at school is very important for those with special needs as they have a routine and home learning has left Eilidh incredibly unsettled and her behaviour can become quite unsettled.”
Maya James, Edinburgh
Maya’s son Dillan (above) is 10 years old and is at Prospect Bank School. He is now attending school only two days a week following the lockdown.
Maya has three children and says that she is able to explain to the other children about Coronavirus including her youngest who is 4 years old.
Dillan however has no understanding and with the loss of routine “his whole world has collapsed, he is very distressed and has become aggressive.”
Maya says the family is not coping and there is nowhere to take the children.
An alliance of leading providers of services to vulnerable children and young people has called on the Scottish Government to ensure that those with complex and high-level needs receive the support they are legally entitled to.
The call from the Scottish Children’s Services Coalition (SCSC), which campaigns to improve services for these children and young people, comes as the latest statistics highlight a dramatic decline in the number of children with additional support needs (ASN), such as autism, dyslexia and ADHD, receiving a so-called co-ordinated support plan (CSP).
Despite a Scottish Government promise that there would be no reduction in the proportion of pupils receiving them since their introduction in 2004, there has been a significant fall in the number of pupils with CSPs, from 3,448 in 2012 [1] to 1,534 in 2020 [2], amounting to a drop of 55.5 per cent (publicly funded primary, secondary and special schools). This is a reduction from 2.9 per cent to 0.7 per cent of those with ASN and currently amounts to 0.2 per cent of the pupil population.
This is against the background of an almost doubling in the number of those with ASN from 118,034 in 2012 to 226,838 pupils in 2020, amounting to 32.3 per cent of pupils.
In May 2019, the Scottish Government announced that it will review the use of CSPs, which the SCSC had also called for, but despite this being more than 18 months ago, this has yet to be published.
A CSP is a legal document, the only education plans that are legal documents, requiring services such as education, health and social work to work together to give a child or young person the support they need. It provides some guarantees of entitlement to additional resources and legal redress, placing statutory duties on local authorities to review and ensure the provisions contained within it are being met.
While those with ASN come disproportionately from the most deprived neighbourhoods, they have a lower proportion receiving a CSP when compared with those from the least deprived neighbourhoods.
This raises concerns that those from deprived communities who are entitled to a CSP are not receiving this required legal support.
Local authorities are more reluctant to provide a CSP than previously, viewing them as cumbersome and time-consuming. They instead prefer to use other types of plans, such as Child Plans, which are not legally enforceable. Many local authorities are now not providing them unless the parents or carers request them, reinforced by the fact that cuts in health, education and social work services mean that authorities are reluctant to provide such support.
Parents or carers on the other hand believe statutory plans are important to ensure the needs of children and young people are properly recorded and reviewed.
This is in contrast with England where the number of those receiving an education, health and care plan (EHCP), the CSP equivalent, is 3.3 per cent of the pupil population, fifteen times the rate of that in Scotland and is on the increase and amounts to 27.3 per cent of those with special education needs (SEN).[3]
This is an important difference between the countries. While more than a quarter of SEN pupils in England have a statutory support plan, less than one per cent of ASN pupils in Scotland have equivalent legislative protection.
A spokesperson for the SCSC commented: “It is clearly of some concern that we are experiencing a decline in the use of CSPs, which are designed to support those with the most complex needs.
“This is despite an increase in the numbers of those requiring such support and is in contrast with south of the border where the number of those with the equivalent of a CSP is more than a quarter of those with special educational needs while in Scotland it is less than 1 per cent for those with additional support needs.
“The disparity in those with a CSP between those in the least and most deprived areas is troubling, as if we are to close the educational gap, it is key that we target the resourcing to those in the most deprived communities.
“We are also concerned about the disparities that exist between local authorities on such support, which clearly raises concerns about how such a policy is being implemented and a lack of standardisation of who is identified as having ASN and who get a CSP.
“It is vital that the Scottish Government urgently publishes its review of CSPs, which has now been ongoing for more than 18 months and working with local authorities ensures that those who require a CSP get it, making parents and carers aware of their legal rights.”
