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  • • Nearly half of children in care have a mental health disorder
  • • 4.3 million children in the UK are living in poverty
  • • Nearly half of children in care have a mental health disorder
  • • 1.4 million children & young people have a probable mental health disorder
  • • 1 in 5 babies aren’t receiving their entitled health visiting check at one year old
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Children in most need of specialist mental health support often turned away because their situation is too unstable

  • Children with social work involvement for current concerns are more likely to be rejected by NHS mental health services compared to their peers, finds new research from Cambridge University and the National Children’s Bureau.
  • Overall, children from the most deprived areas are twice as likely to be rejected than those from the least deprived areas.
  • The Children’s Charities Coalition — Action for Children, Barnardo’s, The Children’s Society, National Children’s Bureau and NSPCC — has welcomed the report and urges the Government to take action to tackle poverty and reform children’s mental health and social care services.

An analysis by researchers at Cambridge University and the National Children’s Bureau of more than 71,000 children’s health records shows that despite it being well established that these vulnerable children are more likely to suffer mental health conditions, they are also more likely to be refused access to NHS Child and Adolescent Mental Health Services (CAMHS).

Consultations with practitioners, clinician interviews, and analyses of health records indicate that this may be because these children’s circumstances are considered too “unstable” for mental health support. However, existing evidence suggests that some treatments can be helpful even when a child experiences ‘instability’.

The findings, which have been welcomed by the Children’s Charities Coalition (comprising Action for Children, Barnardo’s, The Children’s Society, National Children’s Bureau and NSPCC), shed light on the links between children’s mental health, social care and deprivation.

Researchers have uncovered how children are more likely to be rejected by CAMHS than their peers if they have social work involvement for current concerns, whether that is because they are being supported by social workers generally or are on child protection plans.

Children on child protection plans are twice as likely to be turned away by NHS mental health services, while children with other general social work involvement are over three times as likely to be denied help compared to their peers. Children and young people who are living in care are less likely to be rejected in the NHS Trust at the heart of the study, which may be because it has dedicated services for children in care.

The traumatic impact of abuse and neglect increases the likelihood of children developing a range of mental health issues so children with current concerns known to social workers should be prioritised – yet concerningly these findings show the reverse.

Years of underfunding and rising levels of need have reduced capacity within CAMHS, hindering their response to children whose situations are considered too unstable to make the most of available services. Furthermore, mental health and children’s social care teams often do not have the systems and resources to join up their work when there are current concerns. The combined effect results in already vulnerable young people having their mental health systematically neglected.

The research also highlights how all children growing up in the most deprived areas are at risk of having their mental health needs going untreated, with those in the poorest localities twice as likely to be refused mental health support compared to those living in the richest neighbourhoods.

The analysis considers young people ‘accepted’ by CAMHS even if they are just offered an appointment; this is distinct from whether young people are able or willing to attend. Additionally, some children referred to CAMHS might not meet clinical thresholds, and other sources of support may indeed be more appropriate. However, poor outcomes suggest that lack of access to mental health support for many young people with social work involvement can have devastating implications.

The Children’s Charities Coalition is calling on the new Government to create a joined-up, cross-departmental approach to solve failings that see a care system at breaking point, soaring levels of child mental illness, and millions being swept into poverty.

The coalition is calling for strategic investment so that under-served groups of children and young people can access mental health support. This could include a tailored offer for children living in poverty, and a dedicated pathway for children and young people at risk of entering care, supported by professionals with an understanding of both social care and mental health.

Anna Feuchtwang, CEO of the National Children’s Bureau, said:

“Mental health services often require young people to be in a “stable place” to receive support. But these young people’s lives can be highly unpredictable, whether that’s because of poor parental mental health or being at risk of harm or abuse, or because of more practical issues like lacking the funds to take public transport to appointments. The net result is that these children may never get the support they need – a system that accepts this as an answer is clearly one in need of reform.

“The Government must look urgently at removing the systemic biases within our services for children that discriminate against those who are particularly vulnerable so they get equal opportunities to benefit from high-quality mental health support.”

Girl, 17, looked after young person supported by NSPCC’s Childline:

“I spend all my time pretending to be ok, no other 17-year-old has to worry about so much at once. I was so excited to move into supported accommodation but keeping up with rent is a struggle. I have urges to go back to unhealthy ways of coping with it all, and I know counselling would help, but I’m going to age out of CAMHS before I get to the end of the waiting list.”

Girl, 14, looked after young person supported by NSPCC’s Childline:

“I struggle with my mental health, mood swings, depression, low self-esteem. I really really want help, but I was rejected by CAMHS because I wasn’t a danger to myself or going to hurt myself. I could never afford private counselling, my family can’t afford much as it is.”

Professor Robbie Duschinsky, University of Cambridge, said:

“For children who need it, mental health support is crucial. Children with current social work concerns or living in poverty are systematically more likely to be refused mental health services following referral. These are sad findings, and surprising to many of us. However, they may not be a surprise to children and families who need and use these services. Our research was prompted by discussions with people with lived experiences, who urged us to look at inequalities in access to mental health services for the most vulnerable groups of children. Their concerns have been borne out in the results described in this report.

“In collaboration with people with lived experience and mental health and social care practitioners, we have a programme of ongoing studies in this area. This includes examining what treatments are received by children with social work involvement and their effectiveness, and interviews with children with social work involvement about their experiences of mental health services. We look forward to reporting results from this work.”

Julia Mannes, NIHR Three Research Schools Fellow, University of Cambridge, said:

“Behind this data are real-life stories of children experiencing considerable psychological distress. They need and deserve specialist help but are too often turned away. This evidence will help policymakers shape systems that children and families can rely on for support.”

Taliah Drayak – an adult with experience of social work and mental health services as a child, and now a collaborator on the study at the University of Cambridge. She said:

“As a child you can’t access what you need without support, and when the adults in your life become barriers to accessing what you need, the message that you write upon your heart is I am not good enough, I do not deserve, and I am the problem. When the support services that are there to help only seem to help others and not you, you develop negative coping strategies that impede your wellbeing and capacity to achieve for life. Instead of first being a barrier, and then teaching children to be our own barriers, children need mental health services to be an inclusive beacon of hope and support.”

The findings are based on an analysis of over 71,000 records and case notes from a large mental health service in London. Findings are interpreted in light of practitioner engagement sessions and clinician interviews around the country, and work with a diverse group of experts-by-experience at every stage. These consultations have suggested that our findings for children with social work involvement for current concerns are generally indicative of the situation across England.

Recommendations

The report – from NCB and Cambridge University – insists that with the right policy interventions, investment and prioritisation, many more children can have the chance to thrive. Its recommendations have been designed with families and practitioners.

Children and young people with social work involvement, including those in need or receiving protective interventions, should have a dedicated pathway to CAMHS that is supported by both social care and mental health specialists: 

  • Mental Health Assessment: Any child in contact with social workers should be offered a specific assessment to understand their mental health needs. This should be co-designed with young people and families. They should also have the option to invite an advocate to their assessment. Additionally, wherever a child is placed in care, they should have access to CAMHS input or a CAMHS liaison to ensure their mental health needs are met.
  • Expertise in Both Social Work and Mental Health Needs: Services require adequate social work expertise and understanding of the unique needs of young people with all forms of social work involvement at CAMHS intake and assessment. Social workers being co-located within CAMHS teams and vice versa could facilitate this expertise.
  • Joining Up Services: Services should use a single, consistent identifier for all young people. This will promote joined-up working across agencies (e.g. health, education, social care), support information sharing and make it easier to identify what works for young people.

CAMHS needs more flexibility to better suit children and young people perceived to be in less “stable” situations: 

  • Serve Children Living in Poverty: CAMHS should be supported to develop a tailored offer for children living in poverty (e.g. transport vouchers), in coordination with anti-poverty organisations and local authorities.
  • Utilise the Diversity of Possible Therapies: CAMHS should be supported to provide a variety of therapies that do not require young people to have “stability”.
  • Build Trust: CAMHS should be resourced to offer at least one contact with young people on the waiting list, especially those with social work involvement for current concerns, in poverty, or in what are considered ‘unstable’ situations. This contact should introduce what CAMHS offers, explain its role, and outline what questions CAMHS may ask. This would build trust and confidence before attending support or assessments.

For more information visit: www.ncb.org.uk/coaches