Case ‘X’ and young people's mental health: how do we move forward? By Andy Bell Concerns about mental health care for young people have been expressed many times in recent years, but few have been stated as strongly or heard as widely as the comments made yesterday by Sir James Munby in his judgement over the case of the 17-year-old girl ‘X’. Describing the difficulties in locating a secure bed for the young woman upon her release from youth custody, Sir James, the President of the Family Division of the High Court, spoke of his “shame and embarrassment…as a human being, as a citizen, and as an agent of the State” at the lack of services available for her despite her numerous suicide attempts and serious self-harm during her time in custody. One of the measures of any civilised society is how well it looks after the most vulnerable members of its society. If this is the best we can do for X, and others in similar crisis, what right do… the system, our society and indeed the State itself, have to call ourselves civilised? The honest answer to this question should make us all feel ashamed… If, when in eleven days’ time she is released from ZX, we, the system, society, the State, are unable to provide X with the supportive and safe placement she so desperately needs, and if, in consequence, she is enabled to make another attempt on her life, then I can only say, with bleak emphasis: we will have blood on our hands. Sir James Munby, President of the family division The case is a shocking and dramatic reminder of some of the severe pressures facing mental health services for children, young people and young adults. It places in sharp focus the limited supply of specialist beds for children and young people with the most acute needs (which leads some to be placed in either adult wards or in hospitals many miles from their homes and families) as well as the extreme vulnerability of children in the youth justice system, many of whom have serious and complex mental health difficulties. The case, and Sir James’s comments, have also provoked concern about the wider issues facing children and young people’s mental health services in England today. As well as secure beds for the most vulnerable, it is now widely acknowledged that mental health support for children and young people at every level needs to be improved and expanded to offer help when it is needed and before problems have escalated into a crisis. The case is a shocking and dramatic reminder of some of the severe pressures facing mental health services for children... which leads some to be placed in either adult wards or in hospitals many miles from their homes and families, as well as the extreme vulnerability of children in the youth justice system We know, for instance, that a large proportion of children who end up in the youth justice system, particularly young women, have longstanding mental health difficulties that have been present throughout their lives. Young women involved in gangs, for instance, are far more likely to have experienced trauma, abuse and neglect; to have had behavioural problems from a young age; to have had difficulties in school and very often been excluded; and to have been in local authority care. Many have had sporadic contact with child and adolescent mental health services (CAMHS). There is now extra government investment in mental health services for children, totalling £1.4 billion over five years following the 2015 Future in Mind strategy. When this investment gets to local services, it has the potential to extend the level of support that is available. This should ensure that earlier help is offered to children who are at risk of later crises without effective intervention. It will not, however, be enough to meet all of the need that exists or to complete the transformation that children and young people’s mental health services need to undergo. This investment will not be enough to meet all of the need that exists or to complete the transformation that children and young people’s mental health services need to undergo For that, we will need sustained investment beyond 2020 to build on the current strategy and keep making progress. We need a continued commitment to improving mental health support for children, young people and young adults: redesigning services in partnership with young people and families so that they offer relevant and helpful support in places where they feel comfortable. And we will need cross-government action, nationally and locally, to ensure that schools, health services, youth services and others come together to support those who are most vulnerable and who experience the biggest inequalities. The case of ‘X’ and the words of Sir James Munby have reinforced the need for concerted action to address children and young people’s mental health across the country. It is vital that these words are heeded and that young people like X are given the help and support throughout childhood, adolescence and beyond to have better mental health and a fairer chance in life.