With the recent spate of cuts, mental health care is one of many fields which is finding it hard to maintain quality services. According to Sue Elliston, a Professional Medical Adviser for Public Health Wales, "everybody is struggling", although a focus on essential services means other sectors are being overlooked.

 

"Mental health continues to be one of the Cinderella services," she says, "so it's always struggled for funding. And NHS Wales has to save. Over three years it's got 25% less budget. In some places, mental health provision will be really good and in others it won't be so good."

 

Location is not the only factor that plays a big part in the provision of mental health care. Children and young people are especially disadvantaged by a lack of age-appropriate services in Wales.

 

Huw Lewis, the Welsh Minister for Education and Skills, appeared to recognise this last year. In December, he agreed "to the commissioning of a feasibility study on extending age appropriate counselling to the Primary phase for Year 5 and below." This followed the School Standards and Organisation (Wales) Act 2013, which gave Welsh ministers the power to force local authorities to provide independent counselling for children who hadn't yet reached Year 6.

 

In other words, the government is trying to find out if it can afford to enforce its own legislation. Or at least, that's how it appears.

 

Mr Lewis did not respond to a request for an interview. It is not known what progress, if any, has been made on the proposed feasibility study.

 

History would suggest that little has been done in the months following the announcement. The Welsh government's national strategy for school-based counselling services was published nearly six years ago in April 2008. The move was a response to the findings of the Clywch Inquiry Report, published four years earlier still in 2004.

 

Sue concedes that mental health "has come up the agenda in the last few years" as the importance of mental wellbeing becomes more apparent. However, the disappointment of seeing schemes fall by the wayside is nothing new: "Unless you've got a champion who's really pushing it, then there's so many services and so many reports that are produced and then they die a death. Nobody has the will to do it, and of course the politicians change. You don't have the continuity for things to keep being pushed through."

 

Jackie James, a leading mental health figure in North Wales and the Principal Health Development Specialist for Public Health Wales, understands this frustration all too well. Describing the workings of the NHS, she explains: "It grinds very slowly. It is the image of turning round an oil tanker, you know? It takes a long while. It is a very complex beast, and every time you just about get to understand how it all works, somebody restructures it. Or the minister changes, and so there's a complete change of policy direction."

 

Three people have served as Minister for Education and Skills in the last five years. Assembly Member Leighton Andrews took over from Jane Hutt in late December 2009. Huw Lewis assumed the role in June 2013. All three represent the Labour Party.

 

"It's quite… it beggars belief at times, actually," she says. "How much of government policy is around one minister and how much of it is around good sense and evidence."

 

Even though only two parties – Labour and Plaid Cymru – have shared power since the Welsh Assembly's creation in 1999, the exchange of individual ministers, never mind governments, seems to be enough to dramatically change the health service's priorities.

 

It goes some way to explaining why the provision of mental health services has taken so long to progress. Asked if the ten years since the Clywch Inquiry Report was a long time by NHS standards, Jackie replies: "You would think so, but the way that government and service development works, it's not that long. I wish it were otherwise."

 

It is difficult to envisage a system that would avoid the disputes over politics and finance. Many see the framework as a non-negotiable entity, although Jackie argues that departments must do more to recognise when spending in one area will save money in another: "I think there is a focus on essential services, but there is also an eye to 'If we invest now, how much can we save in the future?' And that's where this kind of work really would pay off. If you invest in children's health and emotional health in the early years then they will be healthier and productive in their later years.

 

"If one invests in interventions that saves money elsewhere, then in the round, everybody should be happy. But we're a long way from that. This is people's lives you're playing with."

 

According to a study by mental health charity MindFull, one in five children experiences symptoms of depression. Nearly a third are thought to have considered or attempted suicide by the age of 16.

 

However, as Jackie notes, the context of the findings is important: "Far, far more people will think about suicide or think about being dead as a solution than would ever actually contemplate going through with it. It's almost a normal thought at difficult times. If it's a fleeting thought, you'll probably not find anyone reach 16 without having thought of it."

 

 

 

 

 

 

 

 

 

 

For those at risk, the figures underline the importance of spotting and treating problems as early as possible. "If you invest in children under three [years old], you might think there's little you can do. But there's a huge amount. If children are at that very young age developing behavioural problems, particularly ones that aren't sorted out at that stage, they will go on and they will fail educationally, and they will fail socially."

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As the case is often argued for children, failure to invest in their mental wellbeing while they are young may well prove to be more expensive in the long run, both in terms of finance and personal development.