Children and young people who are anxious, depressed or self-harming are being denied help from NHS mental health services for overwhelmed children and young people, GPs have revealed.
Even under-18s with an eating disorder or psychosis are denied care by overstretched CAMHS services, who insist they are not sick enough to warrant treatment.
In one case, a CAMHS crisis team in Wales would not immediately assess the mental health of an actively suicidal child who had been prevented from jumping from a building earlier the same day, unless the GP make a written recommendation. In another, a CAMHS service in the east of England refused to treat a 12-year-old boy found with a ligature in his bedroom because the absence of marks on his neck meant his referrals were n had not been fulfilled.
The shocking state of CAMHS care is laid bare in a survey for young people’s mental health charity stem4 of 1,001 GPs across the UK who have requested urgent help for those under 18 years who have mental difficulties. CAMHS teams, already unable to cope with the growing need for treatment before Covid hit, have become even more overstretched due to the impact of the pandemic on the mental health of young people.
The results, shared by stem4 hs 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 the widespread inability of young people to access CAMHS care leads to an even greater deterioration in their already fragile mental health, then self-harming, dropping out of school, feeling neglected and having to ask for help. helping A&E.
“As a clinician, it is particularly disturbing that children and young people with psychosis, eating disorders and even those who have just attempted suicide are condemned to such long waits,” said Dr Nihara Krause, consultant clinical psychologist specializing 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 mental health help are forced to wait so long – until to two years – for care they need immediately.
“Delayed treatment increases risk and you can expect problems applying to study or work, relationship problems, other emerging comorbid mental health issues eg depression, with increased vulnerability to self-harm , anxiety with panic attacks, etc.
Many GPs were scathing about the provision of CAMHS in their area. Some said problems accessing services mean they are unsafe or even unsafe, as many under 18s get worse while they wait and may feel angry, neglected and disappointed with be left without specialist help. Nearly one in five (18%) of physicians surveyed know of a patient who has attempted suicide or committed suicide after being denied treatment.
A handful of GPs said the situation was so bad they had given up on referring youngsters to CAMHS altogether and instead asked them to go to A&E, even though it was not appropriate.
A family doctor from Yorkshire and the Humber said: ‘It’s so appalling in our area it might as well not exist. Patients only get help if their parents can afford to pay or if they drink bleach, and even then it’s unclear whether a referral to CAMHS will be accepted.
The results are “deeply concerning” and show the immense additional pressure Covid has put on CAMHS, said Tom Madders, director of campaigns at YoungMinds.
“What these general practitioners tell us echoes what we hear every day from parents, young people and professionals. Despite signs of progress in some parts of the country, thresholds of support are alarming, with thousands of young people turned away or placed on long waiting lists.
“Without timely support, the needs of young people often worsen, with many cases of self-harm, dropping out of school or seeking A&E services in a crisis.”
Madders called for the creation of a UK-wide network of ‘early support centres’ so that GPs have a place they can refer under-18s for rapid help.
In one case, CAMHS in the North West rejected a GP referral for a child with anorexia for including inadequate information, even though his body mass index of just 16 was listed.
MedeConnect Healthcare Insights surveyed 1,001 partner, salaried or locum GPs for stem4 between March 4 and April 1 and the survey was regionally representative. He also found that:
95% of GPs say CAMHS services are either in crisis (46%) or very inadequate (49%) – up from 90% when stem4 conducted the same survey in 2018 and 85% in 2016
Half say that at least six out of 10 referrals they make for anxiety, depression, conduct disorder and self-harm are consistently rejected because young people’s symptoms are not deemed severe enough, even though they only refer cases most at risk
One in four say 60% to 100% of recommendations for eating disorders and addictions are rejected
63% fear young people will be harmed due to lack of treatment while 58% have seen patients’ symptoms worsen, forcing them to visit the emergency room
Professor Martin Marshall, president of the Royal College of GPs, said the results were “both distressing and concerning.
He added: ‘It is of paramount importance that if GPs refer these patients to specialist mental health services that these referrals are taken seriously and not unreasonably dismissed.’
The Department of Health and Social Care did not comment directly on the results. A spokesperson said: “We recognize the impact the pandemic has had on everyone, especially children and young people who have faced disruption in their family life 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 deployment 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, supported by an additional £2.3bn a year by 2024, giving hundreds of thousands more children access to support.
“We will launch a national conversation to inform the development of a new long-term mental health plan later this year.”