Swamped NHS mental health services turning away children, say GPs

Exclusive: survey lays bare extent of help denied by CAMHS to under-18s who are struggling mentally

Children and young people who are anxious, depressed or are self-harming are being denied help from swamped NHS child and adolescent mental health services, GPs have revealed.

Even under-18s with an eating disorder or psychosis are being refused care by overstretched CAMHS services, which insist that they are not sick enough to warrant treatment.

In one case, a crisis CAMHS team in Wales would not immediately assess the mental health of an actively suicidal child who had been stopped from jumping off a building earlier the same day unless the GP made a written referral. In another, a CAMHS service in eastern England declined to take on a 12-year-old boy found with a ligature in his room because the lack of any marks on his neck meant its referral criteria had not been met.

The shocking state of CAMHS care is laid bare in a survey for the youth mental health charity stem4 of 1,001 GPs across the UK who have sought urgent help for under-18s who are struggling mentally. CAMHS teams, already unable to cope with the rising need for treatment before Covid struck, have become even more overloaded because of the pandemic’s impact on youth mental health.

The findings, which stem4 hs shared with the Guardian, also show that in some areas it takes children and young people two years after being referred by their GP to start receiving help.

Mental health experts say young people’s widespread inability to access CAMHS care is leading to their already fragile mental health deteriorating even further and then self-harming, dropping out of school, feeling uncared for and having to seek help at A&E.

“As a clinician it is particularly worrying that children and young people with psychosis, eating disorders and even those who have just tried to take their own life are condemned to such long waits”, said Dr Nihara Krause, a consultant clinical psychologist who specialises in treating children and young people and who is the founder of stem4.

“It is truly shocking to learn from this survey of GPs’ experiences of dealing with CAMHS services that so many vulnerable young people in desperate need of urgent help with their mental health are being forced to wait for so long – up to two years – for care they need immediately.

“Delayed treatment increases risk and you can expect problems in application to study or work, relationship issues, other emerging co-morbid mental health issues, for example depression, with increased vulnerability to self-harm, anxiety with panic attacks and so on.”

Many GPs were scathing about CAMHS provision in their area. Some said problems accessing services means they are unsafe or even dangerous, because many under-18s get worse while they wait and can feel angry, overlooked and let down by being left without specialist help. Almost one in five (18%) of doctors surveyed knows of a patient who has tried to, or taken, their own life after being refused care.

A handful of GPs said the situation was so bad that they had given up referring young people to CAMHS altogether and instead instructed them to go to A&E, even though that is not appropriate.

One family doctor in Yorkshire and the Humber said: “It is so appalling in our area it may as well not exist. Patients only get support if their parents can afford to pay for it or they are drinking bleach, and even then it’s touch and go whether a referral to CAMHS will be accepted.”

The findings are “deeply concerning” and show the immense extra pressure Covid has put on CAMHS, said Tom Madders, the director of campaigns at YoungMinds.

“What these GPs are telling us echoes what we hear every day from parents, young people and professionals. Despite signs of progress in parts of the country thresholds for support are alarmingly high, with thousands of young people being turned away or put on long waiting lists.

“Without timely support young people’s needs will often worsen, with many self-harming, dropping out of school or turning to A&E services in crisis.”

Madders called for the creation of a UK-wide network of “early support hubs” so GPs have somewhere they can send under-18s to get rapid help.

In one case, CAMHS in the north-west rejected a GP’s referral for a child with anorexia for including inadequate information, even though their body mass index of just 16 was stated.

MedeConnect Healthcare Insights surveyed 1,001 partner, salaried or locum GPs for stem4 between 4 March and 1 April and the survey was regionally representative. It also found that:

• 95% of GPs say that CAMHS services are either in crisis (46%) or very inadequate (49%) – up from 90% when stem4 ran the same survey in 2018 and 85% in 2016

• Half say that at least six in 10 referrals they make for anxiety, depression, conduct disorder and self-harm are routinely rejected because the young people’s symptoms are deemed not severe enough, even though they only refer the most at-risk cases

• One in four say that 60%-100% of referrals for eating disorders and addictions are rejected

• 63% fear young people will come to harm due to lack of treatment while 58% have seen patients’ symptoms worsen, forcing them to go to A&E

Prof Martin Marshall, the chair of the Royal College of GPs, said the findings were “both distressing and concerning.

He added: “It’s of paramount importance that if GPs refer these patients to specialist mental health services that these referrals are taken seriously and not dismissed without good reason.”

The Department of Health and Social Care did not comment directly on the findings. A spokesperson said: “We recognise the impact the pandemic has had on everyone, especially children and young people who have faced disruption to their home lives and education.

“We have committed an additional £500m in 2021-22 to support those most affected, including £79m for children’s mental health services, to accelerate the rollout of mental health support teams and expand community services. This is on top of our commitment to expand and transform mental health services in England, backed by an extra £2.3bn per year by 2024 allowing hundreds of thousands more children to access support.

“We will be launching a national conversation to inform the development of a new long-term mental health plan later this year.”

In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.


Denis Campbell Health policy editor

The GuardianTramp

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