One in four referrals to CAMHS rejected

Report warns that one quarter of young people with mental health problems are being turned away from specialist mental health services

Published on 8th October 2018

One in four children referred to specialist mental health services were rejected in 2017/18, a report has unearthed.

A new report by the Education Policy Institute based on Freedom of Information requests which assessed the state of children’s mental health services in England found that 24.2 per cent of children referred to specialist mental health services were rejected in 2017/18. These rates have failed to improve substantially over the last five years.

"A conservative estimate of the number of rejected referrals in the latest year is 55,800, but the true number will be higher than this due to providers that did not respond. There is also wide variation between providers, with some rejecting approximately half of all referrals and some reporting that they rejected fewer than one per cent of young people referred this year," said the report.

"There is no consistent measure of how many young people are not accepted into treatment making it difficult to compare across providers. Some may only offer certain tiers of services, include a wider category of young people in their response or filter referrals to other services in ways that result in them not being recorded as ‘rejected'," it added.

Only a quarter of children with a diagnosable mental health problem are currently in contact with CAMHS, according to prevalence estimates from 2004. The government’s target of getting 70,000 additional children in treatment would increase this to a third. Meanwhile, evidence suggests the prevalence of mental health difficulties among children and young people has risen over the last 15 years.

According to newly collected data, the number of referrals to specialist CAMHS has increased by 26 per cent over the last five years. However, the population of young people aged 18 and under increased by 3 per cent over the same period indicating that the rate of referrals has increased substantially.

The government’s 2018 prevalence survey due to be published this month will provide the first detailed and robust national assessment of levels of mental health difficulty at clinical levels since 2004.

The most common reasons provided for rejecting a referral were that the young person’s condition was not deemed serious enough to meet eligibility criteria for specialist treatment or that their condition was not suitable for specialist CAMHS intervention.

Providers’ documented criteria for accepting referrals indicate that many services are limited in their scope, with strong exclusion criteria in some areas. Some providers reported that they would not accept young people into treatment without evidence that they had engaged with other services. Others reported they would not accept those who only demonstrated mental health difficulties in one area of life, e.g. at school or at home, or those who demonstrated a ‘normal’ reaction to life events like parental divorce, bereavement or abuse.

In some cases, trauma associated with social care experiences is not supported by CAMHS on the assumption it must be dealt with by social care authorities, effectively excluding the most vulnerable children from specialist mental health treatment.

Overwhelmingly, providers reported no or limited follow-up after a referral was deemed inappropriate. Only a minority contacted other services that they thought were more appropriate and a small minority checked whether the young person had accessed other support.

However, new data showed that there are not always good alternative services in place for young people not accepted into specialist treatment. A quarter of local authorities who responded to the FOI request reported decommissioning or no longer providing services related to young people’s mental and emotional well-being.

The report also looked at waiting times and found that the average median waiting time reported in 2017-18 was 34 days to assessment and 60 days to treatment. There is however wide variation across providers - the longest median wait reported was 188 days and the shortest was 1 day.  Waiting times across providers are not necessarily comparable, as some providers may only offer certain specialist services.

Maximum waiting times in 2017-18 were 267 days to assessment and 345 days to treatment.

The report also warns that the quality of the data provided to the EPI makes it very difficult to accurately assess service quality and whether provision is changing across the country. Provider data is too often incomplete or unreliable and several providers which had previously sent us their data reported that they were unable to this year. In some cases, these were providers with very high referral rejections.

Private providers are exempt from the Freedom of Information Act, meaning that data could not be obtained from them in relation to public services they provide.

The report concludes that timely and high-quality specialist care will always be necessary, and more needs to be done to ensure it is in place across the country.
A successful approach must include:
1. A concerted strategy to build up the capacity of the CAMHS workforce.
2. Ensuring that funding is in line with current prevalence estimates and that all committed funding is ring-fenced for CAMHS and reaches frontline providers.
3. The introduction of new national compulsory data reporting on key access and outcome measures. Accountability measures must be accompanied by consistent and stable thresholds for access to treatment across all providers.

However a wider focus should be reducing demand for services and to work towards that there should be a concerted child poverty reduction strategy, access to high quality early intervention services in all areas and a well-staffed and experienced teaching and support workforce in all schools to support pupils with additional needs.

Cllr Anntoinette Bramble, Chair of the Local Government Association’s Children and Young People Board, said: "This report reinforces the urgent need for a root-and-branch overhaul of children’s mental health services, and for the NHS to work with councils to develop a system that says yes, rather than no, to children when they ask for help.

“Councils across the country work hard to ensure children and young people can access the support they need, however with children’s services facing a £3 billion funding gap by 2025, this is getting increasingly difficult.  

“As a result, many councils are being forced to cut early intervention work, including youth services, which helps children avoid reaching crisis point, perform better at school and avoid mental health issues in later life.

“This has been compounded by government cuts to councils’ public health funding, which also helps young people to get the best start in life.

“Our Bright Futures campaign is calling for councils and schools to be given the funding to offer independent mental health counselling so children have access to support as and when they need it. Government should also release the £1.7 billion promised for CAMHS services to ensure adequate and sustainable funding for local areas," she concluded.

Access to children and young people’s mental health services – 2018

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