Modern medicine increasingly judges itself by long-term outcomes. In cancer care, we routinely compare treatments according to whether patients survive longer. In cardiology, we ask whether interventions prevent future heart attacks and extend life. This long-term data allows healthcare to continually improve.
Child and adolescent mental health services are different. Long-term outcomes have received little attention. Success, instead, is largely judged using measures such as waiting times, access targets and short-term symptom improvements.
These are important indicators of service performance. But they cannot tell us whether children’s lives have actually improved beyond the very short term.
Child and Adolescent Mental Health Services (Camhs) were founded on the idea that helping children early could change the course of their lives. Yet we rarely measure whether that actually happens.
A new study my colleagues and I conducted provides one of the most detailed long-term pictures to date of the clinical outcomes for young people who attended Camhs in the UK. By linking NHS records across Scotland, we followed every child born between 1991 and 1998 – almost half a million people – from birth until age 32. We identified everyone who attended Scottish Camhs before age 18 and tracked their subsequent use of inpatient and outpatient adult mental health services into adulthood.
Forty per cent of children who attended Camhs went on to use specialist adult mental health services. That figure rose to nearly half (49%) among those who first attended Camhs as teenagers, between the ages of 13 and 17.
When it came to inpatient psychiatric admissions, the most intensive – and costly – form of mental health services, nearly half of all hospital bed days for people between the ages of 18 and 32 were for people who had, earlier in life, attended child mental health services. Similarly, in outpatient adult mental health clinics, more than 40% of appointments were for former Camhs patients.
These findings do not mean that attending Camhs causes adult psychiatric illnesses. Rather, they illustrate something mental health experts have long recognised: the roots of serious mental illness often begin in childhood. But despite this, we know very little about whether Camhs interventions actually reduce the risk of later mental illness or improve long-term outcomes.
This is not because Camhs treatments are necessarily ineffective. It could be the case that outcomes would have been worse for these young people had they not attended Camhs. The problem is we simply don’t know. And if we hope child mental health services can improve lifelong outcomes, we need to measure whether they actually do.
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A way forward
Scotland, as it happens, is well placed to answer these questions. Its world-leading health data infrastructure already makes it possible to securely link child and adult health records over decades. The foundation is there. What is needed now is to build on it: to make routine long-term follow up a standard part of how we evaluate child mental health interventions.
Instead of evaluating interventions only at the end of treatment, we could routinely examine outcomes one year, five years and even ten years later, after patients have left Camhs. Just as cancer care has transformed itself by learning from long-term outcomes, child mental health could use routinely linked health data to identify what interventions genuinely improve lives in the long term.
This would not require new technology – Scotland already has the systems in place. It simply requires a commitment to use them. And the potential payoff is enormous: a child mental health system that can genuinely learn from its own outcomes, continuously improving care for future generations.
Waiting times matter, access matters and short-term improvements matter. But these tell us about how well services are functioning today. They do not tell us whether they are changing tomorrow.
If nearly half of adult psychiatric hospital care is being delivered to people who attended child mental health services, we should be asking a much bigger question: are we changing the course of people’s lives, as Camhs was always intended to do? Until we routinely measure long-term outcomes, we simply will not know.
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