Study reveals shocking delays in child mental health care

Children and young people with high levels of mental health needs are struggling to receive the help they need, or to have their difficulties recognised, according to a new study.

The STADIA trial, which is published in the Journal of Child Psychology and Psychiatry, was led by experts from the School of Medicine at the University of Nottingham, and was funded by the National Institute for Health and Care Research (NIHR).

The large study, which spans different parts of England, involved 1,225 children and young people with emotional difficulties who had been referred to Child and Adolescent Mental Health Services (CAMHS) for help, and followed them up over 18 months to see how they got on.

The children and young people in this group were found to have high levels of mental health needs, with 67% scoring very high for at least one emotional disorder, most commonly depression or an anxiety disorder. Despite this, only 11% received a clinical diagnosis of an emotional disorder from CAMHS.

Only 44% of children and young people had their referral to CAMHS accepted, and 35% required a re-referral to CAMHS, suggesting that there were delays in receiving help.

One year after their referral, these children and young people did not seem to improve. Their mental health difficulties continued to remain at a severe level over this period, with high levels of self-reported and parent-reported mental health symptoms, functional impairment, and self-harm thoughts and behaviour, even at 12 months follow-up.

At 18 months follow-up, less than half (47%) had been offered any treatment or intervention from CAMHS.

We are very concerned that many children and young people with high levels of mental health needs, particularly conditions such as depression and anxiety disorders, for which NICE-recommended evidence-based interventions are available, are struggling to access help and have their difficulties appropriately recognised. One year is a very long time in a child’s life – delays in accessing the right care mean that their difficulties and distress, and the associated impact on their day-to-day lives and activities, are being unnecessarily prolonged.”

Kapil Sayal, School of Medicine, STADIA

The results of the study also found that:

• The completion of an online standardised diagnostic assessment tool by young people and parents, soon after the referral had been received by CAMHS, did not impact on receiving a clinical diagnosis from CAMHS.
• Online/digital approaches to diagnostic assessment are highly acceptable to families and young people who have been referred to CAMHS, which suggests a way forward for offering and optimising access to the right help and support – as long as there is sufficient investment in CAMHS to properly implement this.

Professor Sayal adds: “It needs to be kept in mind that the time period of the study (reflecting referrals to CAMHS between 2019 and 2021) spanned the COVID-19 pandemic, with associated national lockdown and school closures – a time when many children and young people experienced greater levels of uncertainty, stress and mental health difficulties. Over the past few years, referrals to CAMHS have gone up considerably, which unfortunately has meant that not everyone who could benefit from support has been able to receive timely help and support.”

Colleen Ewart, Parent and STADIA Co-investigator and Patient & Public Involvement lead said: “Sadly, the stories I hear from young people and their parents or carers still echo our family experience of 15 years ago. We can and must do better for this generation of children and young people and those to come. Reducing delays in accessing the right help and quickly is essential to save untold suffering (often life-long) for children, young people and their families.”

The research was funded by the National Institute for Health and Care Research (NIHR), and led by Nottinghamshire Healthcare NHS Foundation Trust, the University of Nottingham and the Nottingham Clinical Trials Unit, in partnership with other NHS Trusts.