Guardian: Swamped NHS mental health services turning away children

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GPs have disclosed that children and young people who are nervous, sad, or are self-harming are being denied care from the NHS' overburdened child and adolescent mental health services.

Even children under the age of 18 who have an eating problem or psychosis are being denied treatment by overburdened CAMHS agencies, which claim they are not sick enough to undergo therapy.

In one situation, there was a crisis. Unless the GP issued a documented referral, the CAMHS team in Wales would not investigate the mental health of an actively suicidal youngster who had been stopped from jumping off a building earlier that day.

Read more: Medical experts say depression to become a largest global health crisis

In another case, a CAMHS agency in eastern England refused to accept a 12-year-old kid who was discovered with a ligature in his room because the lack of any markings on his neck meant that the referral requirements 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 mentally struggling under-18s. 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.

Deteriorating mental health 

According to mental health professionals, young people's inability to receive CAMHS care is causing their already fragile mental health to deteriorate even worse, leading to self-harm, 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 specializes 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 the 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 critical of CAMHS services in their community. Some have said that challenges gaining access to services make them hazardous or even dangerous because many under-18s deteriorate while waiting and can feel angry, neglected, and let down by being left without specialized support. Almost one-fifth (18%) of doctors polled know of a patient who attempted or committed suicide after being denied care.

A few GPs indicated that the situation was so severe that they had stopped referring young people to CAMHS and instead instructed them to go to A&E, which is not acceptable.

Who can get help, who can't? 

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 advocated for the establishment of a UK-wide network of "early support hubs" where GPs may refer under-18s for immediate assistance.

In one case, CAMHS in the northwest denied a GP referral for a kid with anorexia due to insufficient information, despite the child's body mass index being only 16.

In numbers

- 95% of GPs believe CAMHS services are either in crisis (46%) or extremely insufficient (49%), up from 90% in 2018 and 85% in 2016.

- Half report that at least six out of every ten referrals for anxiety, depression, conduct disorder, and self-harm are consistently denied because the young people's symptoms are regarded insufficiently severe, despite the fact that they exclusively refer the most at-risk patients.

-  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.