Children with social work involvement more likely to be rejected by CAMHS

An analysis by researchers at Cambridge University and the National Children’s Bureau of more than 71,000 children’s health records shows that despite it being well established that these vulnerable children are more likely to suffer mental health conditions, they are also more likely to be refused access to NHS Child and Adolescent Mental Health Services (CAMHS).

Consultations with practitioners, clinician interviews, and analyses of health records indicate that this may be because these children’s circumstances are considered too “unstable” for mental health support. However, existing evidence suggests that some treatments can be helpful even when a child experiences ‘instability’.

Researchers have uncovered how children are more likely to be rejected by CAMHS than their peers if they have social work involvement for current concerns, whether that is because they are being supported by social workers generally or are on child protection plans.

Children on child protection plans are twice as likely to be turned away by NHS mental health services, while children with other social work involvement are over three times as likely to be denied help compared to their peers. Children and young people who are living in care are less likely to be rejected in the NHS Trust at the heart of the study, which may be because it has dedicated services for children in care.

The traumatic impact of abuse and neglect increases the likelihood of children developing a range of mental health issues so children with current concerns known to social workers should be prioritised - yet concerningly these findings show the reverse.

“I spend all my time pretending to be ok, no other 17-year-old has to worry about so much at once,” one looked-after young girl said. “I was so excited to move into supported accommodation but keeping up with rent is a struggle. I have urges to go back to unhealthy ways of coping with it all, and I know counselling would help, but I’m going to age out of CAMHS before I get to the end of the waiting list.”

Years of underfunding and rising levels of need have reduced capacity within CAMHS, hindering their response to children whose situations are considered too unstable to make the most of available services. Furthermore, mental health and children’s social care teams often do not have the systems and resources to join up their work when there are current concerns. The combined effect results in already vulnerable young people having their mental health systematically neglected.

The research also highlights how all children growing up in the most deprived areas are at risk of having their mental health needs going untreated, with those in the poorest localities twice as likely to be refused mental health support compared to those living in the richest neighbourhoods.

Professor Robbie Duschinsky, from the social science team at the University of Cambridge that worked on the research, said that mental health support is ‘crucial’ for these children.

“Children with current social work concerns or living in poverty are systematically more likely to be refused mental health services following referral. These are sad findings, and surprising to many of us. However, they may not be a surprise to children and families who need and use these services. Our research was prompted by discussions with people with lived experiences, who urged us to look at inequalities in access to mental health services for the most vulnerable groups of children. Their concerns have been borne out in the results described in this report.

“In collaboration with people with lived experience and mental health and social care practitioners, we have a programme of ongoing studies in this area. This includes examining what treatments are received by children with social work involvement and their effectiveness, and interviews with children with social work involvement about their experiences of mental health services.”

The analysis considers young people ‘accepted’ by CAMHS even if they are just offered an appointment; this is distinct from whether young people are able or willing to attend. Additionally, some children referred to CAMHS might not meet clinical thresholds, and other sources of support may indeed be more appropriate. However, poor outcomes suggest that lack of access to mental health support for many young people with social work involvement can have devastating implications.

“Mental health services often require young people to be in a ‘stable place’ to receive support. But these young people’s lives can be highly unpredictable, whether that’s because of poor parental mental health or being at risk of harm or abuse, or because of more practical issues like lacking the funds to take public transport to appointments,” Anna Feuchtwang, Chief Executive Officer of the National Children's Bureau said. “The net result is that these children may never get the support they need – a system that accepts this as an answer is clearly one in need of reform.

“The Government must look urgently at removing the systemic biases within our services for children that discriminate against those who are particularly vulnerable so they get equal opportunities to benefit from high-quality mental health support.”