Children in deprived areas less likely to access mental health support, study finds

Children and young people living in the most deprived areas of England are less likely to access specialist mental health services and more likely to experience poorer outcomes after referral, according to new research led by the University of Nottingham.

The study, published in the British Journal of Psychiatry, found significant socio-economic inequalities in access to child and adolescent mental health services (CAMHS), with children from deprived neighbourhoods more likely to have referrals rejected and less likely to show improvement a year after referral.

Researchers also found younger children, particularly those aged under 11, were less likely to receive support, raising concerns about missed opportunities for early intervention.

The findings are based on new analysis from the STADIA study, a large multi-centre randomised controlled trial involving 1,225 children and young people referred to CAMHS across eight NHS trusts in England. The study followed participants for 18 months and examined referral outcomes, care received and clinical progress.

Professor Kapil Sayal, from the School of Medicine at the University of Nottingham and chief investigator of the study, said growing demand for mental health support was increasingly outstripping available services.

“The prevalence of mental health problems in children and young people has increased considerably over recent years and far exceeds service capacity, meaning that many children and young people with significant needs are unable to access specialist help, requiring processes for triage and prioritisation of when, where and how care might be delivered. With this data, we wanted to investigate the factors which influence access to and receipt of mental health services, care offered and the outcomes following referral.”

The mental health of children and young people, particularly emotional disorders such as anxiety and depression, has become an increasing public health concern, with researchers noting rising levels of need and help-seeking in recent years, particularly since the COVID-19 pandemic.

Despite this, the study found limited improvements in outcomes following referral to specialist services. At 12 months after referral, 61% of children and young people still met the criteria for requiring mental health intervention.

Researchers said the findings highlighted broader concerns about inequalities in access to evidence-based care and the ability of services to meet demand.

Professor Sayal said the scale and design of the STADIA study allowed researchers to explore key questions around who receives support and whether services are improving outcomes.

“As a large nationally representative study, these new analyses of the STADIA data enable an investigation of referral acceptance, receipt of care and clinical diagnoses, and clinical outcomes. It addresses crucial questions for families, referrers, clinicians, and policymakers: Who gets seen? Who gets offered help? Who gets better?”

The study found that children and young people living in more deprived areas faced greater barriers to accessing care, despite evidence showing higher levels of mental health need in disadvantaged communities.

Professor Sayal added: “Our findings identify significant inequalities in accessing care and underline the urgent need to reconsider current models of CAMHS service provision.”

Researchers said the findings were particularly timely given the ongoing Department of Health and Social Care independent review into mental health conditions, and called for renewed attention to how children and young people access specialist mental health support.