Mental health services ‘failing’ children with social care involvement, study reveals

Children and young people with social care involvement are being denied access to vital mental health services because their needs are deemed too “complex” or attributed to their living circumstances, according to new research led by the University of Cambridge.

The study, funded by the National Institute for Health and Care Research (NIHR), examined more than 20,000 case notes from Child and Adolescent Mental Health Services (CAMHS). It found that children with some of the highest levels of need were frequently rejected for support, with professionals often categorising their difficulties as “social” rather than “medical” or “psychological.”

Researchers discovered that CAMHS staff routinely justified rejections by pointing to unstable home environments, insecure legal status, or poor social conduct and relationships; all factors that can contribute to depression, anxiety, and other mental health challenges. In many cases, professionals suggested that “social stability” was a prerequisite for support, but the term was inconsistently applied and poorly defined.

The analysis, part of the COACHES project, involved academics working alongside people with lived experience of children’s social care and mental health services. It highlighted how limited resources and a diagnostic-led approach meant “complex” or resource-intensive cases were more likely to be turned away. Young people signposted to alternative services often returned to CAMHS with more severe needs, underscoring the inadequacy of lower-level interventions.

The findings build on earlier evidence showing that children with social care involvement are three times more likely to have their CAMHS referral rejected. They also reflect wider concerns about underinvestment in preventative support. In children’s social care, council spending on residential placements has overtaken early help for the first time, signalling a shift towards crisis-driven interventions.

The research team is calling for an immediate review of how “social stability” is used as a threshold for CAMHS access, and greater collaboration between CAMHS and social work teams, with shared expertise across disciplines.

Jack Smith, a co-author with lived experience of the care and mental health systems, said the findings reflect a system in crisis: “We are experiencing a mental health epidemic which feels especially cruel to children and young people. Whether it's cuts to funding and austerity decisions, burnt-out workforce, and long waiting lists with no access to life-saving care, we are failing the most vulnerable children and young people and sending them off into the world with two broken legs, expecting them to place first in the London marathon.

“It should be a moral duty, an act of humanity and a collective effort to fight for better care and services for children and young people suffering with their mental health.”


The study, published in Social Science and Medicine, draws on data spanning from 2007 to the COVID-19 pandemic. It shows how austerity and stretched services have left many children caught between systems, with families and young people themselves often bearing the burden when CAMHS withdraws or refuses support.