Not meeting the threshold for treatment was the most common reason for rejection. However, among those rejected were children who had self-harmed or experienced abuse.
And these figures – revealed in a report published on Sunday (October 7) – are likely to be much higher in reality because a number of CAMHS providers did not disclose their referral numbers to researchers.
The report, published by the Education Policy Institute (EPI), also warns that many providers do not follow up with those children rejected for treatment and so the outcomes are “often unknown”.
The report’s findings are based on the results of Freedom of Information requests to CAMHS providers in England. Of 60 requests, 54 responses were received, although some “disclosed information selectively” and with “incomplete data”. Requests were also sent to all 152 local authorities, with 111 responses being returned.
Overall, the number of referrals to CAMHS has increased by 26 per cent over the last five years. The 50 providers responding to the FoI requests reported a total of 264,733 referrals for 2017/18.
A number of rejections came about due to issues such as patient age (being over 18), inappropriate referrals, or not being from the right area. However, the most common reasons for rejection were not meeting treatment thresholds or the child not having a suitable condition – for example, not having a diagnosable mental health condition.
Only 24 of the providers reported their reasons for rejecting referrals in 2017/18 and the report found exclusion criteria including:
- Services that only accept self-harm referrals if accompanied by another mental health condition, like anxiety, depression or suicidal ideation.
- Weight thresholds for treatment for eating disorders, which contravene NICE guidelines, stating that single measures like BMI should not be used.
- Services requiring that the young person engage with early intervention services through schools, GPs or the voluntary sector before being accepted into specialist treatment.
- Services that did not provide support for children with family issues.
- Rejection of referrals for mental health difficulties associated with a normal reaction to recent life events, e.g. parental separation or divorce, bereavement or abuse.
- Rejection of referrals for mental health difficulties like anxiety or challenging behaviour that are only present in one area of life, e.g. at school or at home.
Specific examples uncovered in 2017/18 include one provider dramatically increasing its threshold for treating anorexia. Furthermore, many providers said they would reject young people engaging in mild to moderate self-harm as a coping strategy for strong emotions and difficult experiences and not associated with an underlying mental health condition. School nurses, counsellors or other school staff were deemed to be responsible for responding to these children.
Other common rejections included young people who are homeless, or those who have parents with problems including domestic violence, illness, dependency or addiction, as their needs should be met by children and young people’s services.
The report warns that many providers operate no or limited follow-up after referrals are rejected and only a minority contact other services deemed more appropriate.
The report states: “These findings raise concerns about what happens to children referred to, but not accepted into, specialist treatment. There is no national data collected on these children and young people, and no consensus on who is responsible for supporting young people with mental health problems, but without access to specialist treatment. The fact that self-harm is not always sufficient to trigger access to specialist services clearly signals that wider preventive services are needed.”
Furthermore, many areas lack alternative support or treatment options for rejected children. The report finds that a quarter of local authorities are phasing out vital mental health support services, including school-based counselling and family counselling services.
Examples of services being cut include 16 community-based universal or early intervention services, 13 school-based programmes to support children with mild to moderate mental health difficulties, and examples of family counselling and mental health support for looked-after children, those living with domestic abuse and other vulnerable or at-risk young people.
Elsewhere, the report finds that the average median waiting time in 2017/18 was 34 days to assessment and 60 days to treatment. However, it adds: “There is wide variation across providers; the longest median wait reported was 188 days and the shortest was one day.”
Whitney Crenna-Jennings, report author and a senior researcher at the EPI, said: “Our research finds no significant improvement in access to children’s mental services over the last few years, with a number of treatment gaps evident in a system that is coming under increased pressure from rising referral rates.
“As many as one in every four children referred are denied access to specialist mental health services, often because their condition is not deemed serious enough to warrant treatment. Those excluded from treatment include children and young people that have self-harmed or experienced abuse.
“With a significant number of local authorities phasing out crucial services that offer alternative support, these children may find it increasingly difficult to access any formal help at all”.
Commenting on the report, Anna Cole, inclusion specialist at the Association of School and College Leaders, said the rejections and long waiting times painted a “bleak picture” that was “all-too familiar to schools”.
She added: “The difficulty in accessing these vital services means that schools and teachers are frequently supporting and caring for young people in severe distress, even to the extent of having to take them to A&E because they have been unable to access timely specialist support.
“This problem is compounded by cut-backs to local authority services which results in schools having to put in place more support for young people with severe and complex needs – even though their own budgets have been cut to the bone. We need properly resourced specialist services with clear and consistent criteria on access and an immediate improvement in school funding.
“We also need to do more to understand the factors that are driving up the prevalence of mental health problems among young people. This is a complex area and there is no easy answer. But two issues which have caused us concern are the impact of social media use and misuse, and the impact of new harder GCSEs.”
- Access to Children and Young People’s Mental Health Services 2018, Education Policy Institute, October 2018: http://bit.ly/2C26YiA