Children with high-level mental health needs are being left without specialist care, after almost half of referrals are rejected by NHS child and adolescent mental health services (CAMHS).
In a trial set up to test a new online assessment tool within CAMHS, researchers were instead shocked to find that 44% of children and young people were batted back to the GP.
The study of 1,225 children in eight trusts dotted around England found 35% of the five-to-17-year-olds required a re-referral to CAMHS delaying their care.
GPs told Pulse they were not surprised by the figure, with services having nowhere near the capacity needed to meet demand.
Half of those taking part in the National Institute of Health and Care Research-funded study were asked to fill out an online assessment tool to see if this would improve diagnosis.
Writing in the Journal of Child Psychology and Psychiatry, the researchers who followed the children and young people for 18 months said it appeared to make no difference to the care ultimately received.
But their findings highlighted the difficulties children, young people and their parents were having in having their needs recognised by services.
They found that despite the high rate of referrals being rejected, 67% scored very high for at least one emotional disorder, most commonly depression or an anxiety disorder.
Yet only 11% received a clinical diagnosis of an emotional disorder from CAMHS.
One year after their referral, these children and young people did not seem to improve with their mental health difficulties continuing to remain at a severe level with functional impairment, and self-harm thoughts and behaviour.
At 18 months follow-up, less than half (47%) had been offered any treatment or intervention from CAMHS, the researchers said.
Study leader Professor Kapil Sayal, professor of child and adolescent psychiatry said: ‘We are very concerned that many children and young people with high levels of mental health needs, particularly conditions such as depression and anxiety disorders, for which NICE-recommended evidence-based interventions are available, are struggling to access help and have their difficulties appropriately recognised.
‘One year is a very long time in a child’s life – delays in accessing the right care mean that their difficulties and distress, and the associated impact on their day-to-day lives and activities, are being unnecessarily prolonged.’
Professor Azeem Majeed, professor of primary care and public health at Imperial College London said the findings were concerning but ‘unfortunately not surprising’.
‘GPs regularly see children and young people struggling with significant mental health difficulties yet facing substantial barriers to accessing specialist support through CAMHS.
‘The 44% referral rejection rate in the study is an indicator of how overstretched CAMHS services are.
‘GPs often spend considerable time supporting families, gathering information, and making carefully written referrals, only to have them rejected. This is frustrating both for clinicians and, more importantly, for the young people and families who are left without the help they need.’
He said the high re-referral rate also shows how many children are left in limbo trying to access care and shows the need for investment in CAMHS services.
‘This often means GPs must manage complex mental health cases within primary care, despite the lack of specialist resources or alternative services.’
Dr Richard Cook, a GP in West Sussex said the referral rejection figure matched his experience. ‘CAMHS do not offer a useful service and the waiting list is huge. A major overhaul is needed.’
Dr Selvaseelan Selvarajah, a GP in London, said: ‘The results do reflect our experience of CAMHS services. Children’s mental health services, like many other parts of the NHS are underfunded. There are also shortages of child psychiatrists and mental health practitioners. The referrals are likely to be going up as well. As a result, children and parents do find it challenging to access the service in a timely manner.
‘There is a higher threshold for acceptance of patients so this means GPs can end up caring for many young people with mental health concerns when referrals are rejected. Whenever, we have had patients accepted, the care has been great. Acute psychiatric care has also been supportive locally. I would fully endorse investment in CAMHS services so that they can be expanded to care for all referred children on time.’
A Department of Health and Social Care spokesperson said: ‘Too many children and young people are waiting too long to access the mental health care they need.
‘We will recruit 8,500 additional mental health workers, provide young people with access to a specialist mental health professional in every school and a Young Futures hub in every community.’
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They could have simply asked any passing GP their experiences of referrals to CAMHS, if they actually cared.
its closer to 95%!
Pretty much every referral sent to CAMHs is left waiting without any care or real support for extended periods of time, even when seriously depressed or anxious, and unable to attend school. Even if self harming or suicidal, only a small number get any real practical help and consultant review.
This is the biggest area of disgracefullly poor care in the NHS – and it is for the most vulnerable our children.
Needs a huge influx of consultant and junior grade medical staff as the rest of the team is already overfilled with support staff and tea ladies trying to provide care without actually doing so.
At 18 months follow-up, less than half (47%) had been offered any treatment or intervention from CAMHS. This is the real headline. No service could possibly keep being assessed and recommissioned performing like this for years could it??? The journalism missing here is to expose the decision makers responsible who continue to have pay rises and new assistants….. Come on pulse – dig a bit deeper!!!
44% rejected means a whopping 56% accepted. Really????? Where are these mythical places in which a CAMHS referral isn’t automatically rejected, do tell, I’m jealous!
Most of my colleagues haven’t had a referral accepted in years.
CAMHS has long been considered a sick joke by GPs, many of whom gave up trying in all but the most urgent cases.
Oh, but don’t mark it urgent, otherwise you’ll be called back and bullied/harangued/shamed into downgrading to routine…..even if an absent colleague made the original referral.
I accept that CAMHS is not fit for purpose, but if they put as much effort into assessing children’s mental health as they do in ruthlessly rejecting and doggedly downgrading GP referrals they would be the envy of the NHS.
But what really sticks in the craw is the way they make their exclusion criteria so ridiculously strict virtually no poor soul can get in, then crow about meeting their waiting targets……a doddle when so many are rejected.
And of course monkey see, monkey do……other specialties jealously observing CAMHS have duplicated their rejection policy (under the guise of A&G), and so they too can easily hit targets by bouncing everything back to the hapless GP.
Referral Rejection….perfected by CAMHS, copied by everyone.
R Reeves MP and K Stammer PM should put an increase on taxation of the PROFITS of big companies, multinationals,
energy firms and banks, (instead of targeting poor pensioners and causing increasing energy and water costs and costs of daily essentials to consumers and underfunding important parts of the NHS). The billionaires and multimillionaires, and huge companies, even if taxed higher, will always find a way to make good profits, but at least increasing the taxation of their vast PROFITS will benefit this country by helping to fund things like CAMHS a bit more (and what about helping adult health too?) and help reduce costs of the essentials of daily living. Are they a Labour Government or not? or are they simply ‘BigBusiness’ ? (Just like the ousted 14-year Conservatives, we all got so fed up with). I thought Labour were on the side of people and the NHS.
Also, why are there not better caps put on things like the costs of this country’s government building construction and infra-
structure and rail-construction final costs as well as greater fines,penalties on these companies for completion time-delays.
Rachel Reeves and Stammer PM need to take note: actions will speak louder than words: greater Taxes are needed from the great vast PROFITS of Billionaires, Big Companies and Multinationals and Banks: even then, they’ll still be hugely rich indeed
because they will always find a way to increase their profits: so Labour should not be too concerned about taxing them more.
My teenager daughter was discharged from CAMHS a week after an admission with an overdose. This was following 2 questions: Have you self harmed in the last 5 days:No; Do you want us to talk to your parent/carer: No. Discharge.
My teenager was discharged from CAMHS with 2 screening questions:
Have you self harmed in the last 5 days – No
Do you want us to talk to your parent/carer – No
This was 7 days after an admission with an overdose of analgesics.
Says everything.
Let’s be honest Sam, although I agree with much of what you’ve said, that was a bit of a political rant rather than anything to do with CAMHS referrals.
The CAMHS referrals are poorly triaged but most likely by inexperienced clinician. It is a poorly funded service.
If children are sorted early the burden of care will increase into their adult life with astronomical costs in poor MH provisions as I know from experience!