Number of children referred to mental health services rises by a quarter over 5 years, says EPI report

• Considerable increase in the number of children referred to mental health services – rise of 26 per cent in the last 5 years. 
• As many as 1 in 4 children referred to CAMHS in England were rejected. 
• A quarter of local authorities have phased out vital support services, including school-based mental health services, family counselling and support for those living with domestic abuse.
• Average waiting times for treatment have fallen – yet remain twice as long as the government’s new standard outlined in its mental health green paper.
• CAMHS data is often inconsistent and inaccessible, with many providers failing to produce basic information on services. Better government accountability measures for reporting data are urgently required.
   

A new report by the Education Policy Institute assesses the state of children’s mental health services in England. The research examines access to specialist services, waiting times for treatment, and provision for those children that are not able to receive treatment.

The report uses Freedom of Information (FOI) requests to providers of child and adolescent mental health services (CAMHS) and local authorities in England.

Key findings

Referrals to children’s mental health services

• The number of referrals to specialist children's mental health services has increased by 26 per cent over the last five years. This is a substantial increase, indicating that services are coming under increasing strain. This number has risen despite a population decrease of 3 per cent.
• Rejection rates remain high: as many as one in four children (24.2 per cent) referred to specialist mental health services were rejected in 2017/18. These rates have failed to improve substantially over the last 5 years.
• We estimate that there were at least 55,800 children not accepted into treatment in 2017/18. The real figure is likely to be far higher as a number of providers did not disclose referral numbers.
• The most common reason for referrals being rejected was that children’s mental health conditions were not serious enough to meet the eligibility criteria for treatment. Among those excluded by threshold criteria were young people who had self-harmed or experienced abuse. 
• Most providers do not follow up with children who have been unable to access treatment. The outcomes for these children are often unknown – with no consensus as to who is responsible for supporting them.
• Many areas of the country lack sufficient alternative services for young people who have not been accepted for treatment. As many as a quarter of local authorities have phased out vital support services, including school-based mental health services, family counselling and support for those living with domestic abuse.

Waiting times for children’s mental health services

For those children with mental health problems who are accepted into specialist services, many face a lengthy wait before their treatment begins:

• The average median waiting time for children in 2017/18 was 34 days to receive an initial assessment and 60 days to receive treatment. This has been broadly stable over recent years for assessment times, but has improved a little for the longest times to treatment.
• Many children still face unacceptably long waiting times, and there are great disparities across providers. The longest wait for treatment reported by mental health service providers in England ranges from 188 days, to just 1 day. On average, children in London experience the longest wait for specialist treatment (64 days) – while those in the South of England have the shortest average wait - 58 days.
• Significantly, current waiting times are far longer than the government’s new standard of 4 weeks, set out in its green paper on children’s mental health. Average waiting times are currently twice as long as this proposed standard.

CAMHS data deficiencies hinder progress

• There are many loopholes in the current system for reporting and disclosing data for CAMHS in England under Freedom of Information law, and many children's mental health providers did not provide basic information on access to services that we requested from them. Such practices greatly obscure our understanding of the state of services in England.
• Privatised service provision poses further barriers to transparency around publicly funded services, as independent providers are exempt from the Freedom of Information Act. 
• There may also be a risk of ‘gaming’ of waiting time standards from some providers. There is a danger that thresholds for securing treatment are raised to meet new standards on waiting times – denying more children access to support.
• Broader, more consistent government accountability measures for reporting data on CAMHS are therefore urgently required, including clear definitions of who is eligible for treatment. Failure to compel universal reporting across service outcomes may impede government plans to improve mental health services for children and young people.

Commenting on the new research, Whitney Crenna-Jennings, report author and Senior Researcher at the Education Policy Institute, 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”. 

Rt. Hon David Laws, Executive Chairman of the Education Policy Institute, said: 

"This report shows a significant increase in demand for children's mental health services over the last 5 years, even as many local authorities are having to cut back on the services they are providing - this is very worrying and could lead to increased access problems. 

"A large number of children referred to mental health services are already rejected for treatment, and the follow up for these children looks unsatisfactory. 

"It is also disturbing that many mental health providers seem unwilling or unable to provide even basic data on their services - the government should take steps to compel all providers to report regularly on their standards and performance, and this data should be collected and reported nationally. Until we can understand what is really happening on the front-line, it is difficult to say whether government rhetoric about improving mental health services is being matched by the real experience of children and families."
 

Notes to editors

• This report includes results from Freedom of Information (FOI) requests to providers of specialist child and adolescent mental health services (CAMHS) in England.
• FOI requests were sent to 60 public child and adolescent mental health services providers across England. We received 54 responses - a response rate of 90.0 per cent. However, several providers disclosed information selectively, with many too often reporting incomplete or unreliable data.
• The figure of 24.2% for referrals rejected was calculated after accounting for missing data. The raw figure was 21.1%, however due to eight providers failing to respond to requests for this particular data, and one provider reporting an implausible drop from our report last year (from 64.1 to 0 per cent), imputed data from our 2017 report was used, resulting in a rate of 24.2 per cent. This is well within the 95 per cent confidence interval for last year’s responses.
• FOI requests were also sent to all 152 local authorities. We received 111 responses, a response rate of 73.0 per cent.