Thousands of vulnerable children missing out on mental health support

Thousands of vulnerable children and young people are missing out on mental health support despite having much higher levels of need, new research from the University of Cambridge suggests.

Researchers found that children and young people on child protection plans or in care were two to three times more likely than their peers to be referred to mental health services, yet only around 9-18% had contact with mental health services in a given year.

The findings highlight concerns about the barriers faced by children whose mental health needs intersect with their social circumstances. Researchers suggest that child and adolescent mental health services (CAMHS) can sometimes be hesitant to accept referrals involving children and young people who are also receiving support from children's social services.

Recent research by the Cambridge team found examples of children being rejected by mental health services because their needs were considered too complex or were viewed as relating primarily to their social situation.

In one case, a 12-year-old girl living in residential care was referred to CAMHS following a suicide attempt but was deemed too complex to receive intensive specialist support. In another, a 12-year-old boy was taken to A&E following a suspected overdose and running away from a new foster placement, but his access to CAMHS was rejected because his difficulties were judged to relate to his social situation and therefore to be a matter for children's social services.

Professor Robbie Duschinsky, Head of the Child Health & Development Research Group at the Primary Care Unit, University of Cambridge, said: “Through our work, we’ve encountered countless cases of children and young people with mental health difficulties not being offered treatment because their living situation is judged too complex or a matter for child social services.”

The researchers analysed NHS Digital data covering children and young people in England who were referred to or received support from mental health services between 2016 and 2021. During this period, almost two million children and young people came into contact with mental health services, with the number increasing year-on-year.

An estimated 18% of children and young people in England have a probable mental health disorder, while around a third of mental health problems begin before the age of 14. However, fewer than half of children and young people with a probable mental health disorder receive a referral.

The study found that anxiety was the most commonly recorded reason for referral, accounting for 13% of cases, followed by being ‘in crisis’ at 10%, depression at 7%, neurodevelopmental conditions at 6% and self-harm at 6%. The primary reason for referral was not recorded in 67% of cases.

Around 50,000 children and young people are currently subject to child protection plans and 84,000 are in care. Previous research has suggested that up to half of children in these groups experience mental health problems at a clinically significant level, reflecting the increased risks associated with experiences including abuse and neglect.

The researchers also identified a decline or plateau in contact with mental health services at around ages 17 and 18, despite late adolescence being a high-risk period for mental illness. They suggest this could partly reflect a lack of advocacy for young people at this age, as well as the fact that young people who do not wish to engage with mental health services are more likely to have their wishes respected.

The study also found evidence of inequalities between ethnic groups, with children and young people identifying as Asian or Black less likely to be in contact with mental health services than might have been expected based on population estimates.

Dr Barry Coughlan, from the Department of Public Health and Primary Care at the University of Cambridge and the National College of Ireland, and the study’s first author, said: “We’re seeing a steady increase in demand for mental health services in England, but many children and young people – and in particular, some of those who are most at risk – are not getting the referrals or the support they need.

“Many mental health problems first arise during teenage years, so it’s crucial that we do everything we can to support people at this vulnerable age. If we’re not able to intervene and help young people when they first need it, these risk becoming long-term mental health problems that affect them long into adulthood, and often becoming increasingly severe, including self-harm and attempted suicide.”

There was also some evidence, although the researchers said it was not fully conclusive, that children and young people on child protection plans or in care were more likely to have contact with mental health services in 2020-21 than in 2019-20. The researchers suggest this could indicate that the impact of COVID-19 and associated public health measures was felt particularly sharply by these groups.

The researchers say the study is the first to use child mental health data from NHS Digital for research purposes, demonstrating the potential of routinely collected data to identify health inequalities and gaps in access to services.