Mental health services failing children, Cambridge study reveals

Young people with social care involvement rejected by mental health services because their needs are too ‘complex’ or caused by their current situation, new research shows

Children and young people who have experienced social care interventions are often rejected by Child and Adolescent Mental Health Services (CAMHS) due to the same factors that may be contributing to their poor mental health, an analysis of case notes has shown. 

Earlier findings have documented that children and young people with social care involvement are three times more likely to be rejected by Child and Adolescent Mental Health Services (CAMHS).

Now, new research funded by the National Institute for Health and Care Research (NIHR), sheds light on the reasons why children with some of the highest levels of need are being rejected for psychiatric support. 

Professionals often cited ‘social factors’ like an unstable home environment, insecure legal status, poor social conduct, and relationships – which can all cause anxiety, depression and poor mental health - for justifying rejection.

And they claimed that the young person’s needs were due to their ‘social’ context, rather than ‘medical’ or ‘psychological’ issues.

It appeared that professionals felt that ‘social stability’ was needed for young people to be accepted by CAMHS, but it was unclear what this meant and the term was applied inconsistently across cases.

The analysis of case notes, examining over 20,000 case notes relating to 70 people, is part of COACHES project, a collaboration between the University of Cambridge, the National Children's Bureau, Kingston University, King’s College London, the British Association of Social Workers, and the Care Leavers Association.

It was conducted by a team of researchers and people with lived experience of children’s social care and mental health services.

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

The case notes cover the years following austerity measures and include the COVID pandemic and lockdowns.

The research found that, with limited resources, ‘complex’ or resource-intensive cases tended to be rejected and that services tended to approach mental health from a biological, diagnostic-led perspective rather than taking social factors such as family circumstances, bullying, or immigration status into account.

When signposted to other services, young people often returned to CAMHS with escalating needs, indicating that lower-level interventions were insufficient to support their mental health needs.

The findings of this study align with other research indicating that public resources are failing to go into supportive help for children and families, and instead are forced into late-stage crisis interventions. This is in line with council spending on children’s social care services, where residential care spending surpassed early help for the first time last year. 

The paper’s authors are calling for:

• A review of ‘social stability’ as the basis for mental health access
• Better integration of child and adult mental health services to adequately support all members of a family
• Teams to have both social work and CAMHS expertise and improved joined-up workingbetween the services

Jack Smith, co-author with lived experience of children’s social care and mental health services, said: “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.”