One in four children rejected for mental health treatment, despite increased government investment, says new EPI report

• Over a quarter (26%) of children referred to specialist mental health services in England were rejected in 2018-19 – a total of 133,000 young people. This includes young people who have self-harmed, experienced abuse, or have conditions such as eating disorders.
• Rejection rates vary considerably across the country: in London 17% of children referred to specialist services were rejected, while in the Midlands, East and South, rates are as high as 28%.
• For those that are able to access children’s mental health services, average waiting times for treatment are two months – twice the government’s target. In some areas of England, children typically wait as long as six months before they can access treatment. 
• The government is unlikely to succeed in meeting its national CAMHS waiting time target of four weeks by 2022-23.

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On Friday 10th January, the Education Policy Institute (EPI) will publish its Annual Report on access to child and adolescent mental health services (CAMHS). The study examines access to specialist services, waiting times for treatment, and provision for the most vulnerable children in England.

The research is based on new data obtained using freedom of information (FOI) requests to mental health providers and local authorities over the course of a year. This data is not published by the NHS.

The majority of lifelong mental health problems develop early on, during childhood or adolescence. The wider economic costs of mental ill health in England are vast, estimated at £105.2bn each year.

Key findings

Access to mental health services for children and young people

• Over a quarter (26%) of referrals to specialist children’s mental health services were rejected in 2018-2019. This amounts to approximately 133,000 children and young people.
• Rejection rates have not improved over the last four years, despite an extra £1.4bn committed from 2015-16 to 2020-21.
• There is considerable regional variation in England. On average, providers in London rejected 17% of referrals, compared to 28% in the South, the Midlands and the East, and 22% in the North.
• The most common reason given by providers for rejections included children’s conditions not being suitable for treatment, or because conditions did not meet eligibility criteria.

Waiting times for mental health treatment

• While nationally, the average median waiting time to begin treatment has fallen by 11 days since 2015, children still waited an average of two months (56 days) to begin treatment in 2019 – double the government’s four-week target. The government is unlikely to meet its target of four weeks by 2022-23.
• The longest median waiting times to receive treatment were in London (65 days) and the shortest in the Midlands and East of England (49 days). This is likely related to the high number of referrals accepted for treatment in London.
• Beyond regional averages, there are great disparities across local CAMHS providers, with many children facing unacceptably long waiting times. Median waiting times for treatment across mental health providers varied from just 1 day to 6 months (182 days).

Providers in England with the longest median waiting times for mental health treatment are:

• West London Mental Health Trust – 182 days
• South Tyneside and Sunderland – 129 days
• Alder Hey – 124 days
• Leeds Community Healthcare – 117 days
• Northumberland, Tyne and Wear – 116 days
• Birmingham Women’s and Children’s Hospital – 112 days
• Sussex Partnership – 100 days
• East London – 90 days
• Birmingham and Solihull – 87 days
• Cambridgeshire and Peterborough – 82 days
   

Mental health support for young people most in need

• Local commissioners and providers of mental health support services often fail to engage with the most vulnerable children and families. Local provision is patchy and lacks accountability, being dispersed across several organisations. Support for children with less acute, common mental health conditions, such as conduct disorders, as well as those in social care, is insufficient.
• There is also a lack of support among LAs for those transitioning from child to adult mental health services. FOI responses show that only a minority of LAs have specific services dedicated to supporting this important transition. 
• Government plans to boost the provision of mental health support in schools are a positive step for intervening in mental health problems earlier on, and supporting some of the most vulnerable children. However, they will not be rolled out nationally until 2022-23, and there is likely to be wide geographic variation in how they operate.

All mental health providers should be required to report regularly on their services

• There are multiple flaws in the current system for reporting and disclosing basic data on CAMHS in England, raising serious questions about transparency and accountability.
• Providers continue to give inadequate information on access to treatment, obscuring our understanding of the state of services and ability to monitor progress.  
• A universal system for reporting data on access to CAMHS, including a clear definition of children who are eligible for treatment, is urgently required. Failure to introduce stronger accountability measures may hinder the government’s plans to improve services.

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Commenting on the new findings, Whitney Crenna-Jennings, Senior Researcher at the Education Policy Institute (EPI) and author of the report, said:

“This research shows that the system for providing mental health support to children is operating under great strain. There is a vast treatment gap, meaning the needs of hundreds of thousands of young people in England are not being met.” 

“Denying children access to mental health treatment is likely to have major repercussions. As well as long-term health prospects, by hindering academic performance and development at an early age, mental ill-health also represents a key barrier to social mobility.”   

“The government should move towards a preventative approach to dealing with mental health problems, in order to tackle the rising demand for services. The evidence is clear that mental health problems should be dealt with early on in a child’s life, with high quality support available across health, education and local authority services.”  

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

“Young people continue to be deprived of access to specialist mental health treatment, despite the government claiming significant investment in mental health services over the past five years. Progress in improving access over this period has been hugely disappointing, and it is unacceptable that as many as one in four children referred to mental health services are being turned away."

“It is also deeply concerning that basic information on mental health providers’ services is not publicly available, and can only be obtained through multiple freedom of information requests. The government should compel mental health providers to report regularly on the state of their services, so that their performance can be properly scrutinised.”

Notes to editors

• The Education Policy Institute (EPI) is an independent, impartial, and evidence-based research institute that promotes high quality education outcomes, regardless of social background. We achieve this through data-led analysis, innovative research and high-profile events. Find out more about our work here. 
• This report is based on data obtained by EPI using freedom of information (FOI) requests sent to mental health providers and local authorities in 2019.
• FOI requests were sent to mental health providers in England in order to obtain data on access to CAMHS and median provider waiting times. 64 providers were contacted, with 62 responding: a response rate of 97%. See report methodology for further information.
• Information on mental health support and services for vulnerable children and young people was obtained through FOIs to local authorities in England. All 152 local authorities were contacted, with 131 responding: a response rate of 86%. See report methodology for further information.
• Report findings are based on the latest available data, from the 2018-2019 financial year.