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Child mental health services at breaking point

Children face long waits because services can't cope with rising demand

Mark Gould

Monday, 08 October 2018

A new report* reveals that specialist children's mental health services are unable to cope with the demand. The report, by the Education Policy Institute (EPI), reveals that referrals to specialist children’s mental health services has increased by 26 per cent over the last five years.

"This is a substantial increase, indicating that services are coming under increasing strain. This is also despite a population increase of only three per cent," the report notes.

Mental health service providers say the report reaffirms claims that mental health services are seriously under-resourced, and that the long-term NHS investment plan must put this right.

And as many as one in four children (24.2 per cent) referred to specialist mental health services were rejected in 2017/18. The report's authors say rates have failed to improve substantially over the last five years.

"We estimate that there were at least 55,800 children not accepted into treatment in 2017/18. The real figure is likely to be far higher as a number of providers did not disclose referral numbers."

The most common reason for referrals being rejected was that children’s mental health conditions were not serious enough to meet the eligibility criteria for treatment. Among those excluded by threshold criteria were young people who had self-harmed or experienced abuse.

The EPI says most providers do not follow up with children who have been unable to access treatment.

"The outcomes for these children are often unknown – with no consensus as to who is responsible for supporting them."

Many areas of the country lack sufficient alternative services for young people who have not been accepted for treatment. As many as a quarter of local authorities have phased out vital support services, including school-based mental health services, family counselling and support for those living with domestic abuse.

For those children who are accepted into specialist services, many face a lengthy wait for treatment: The average median waiting time in 2017/18 was 34 days to receive an initial assessment and 60 days to receive treatment. The EPI says waiting times have been broadly stable over recent years for assessment times, but has improved a little for the longest times to treatment.

The longest wait for treatment reported by mental health service providers in England ranges from 188 days, to just one day. On average, children in London experience the longest wait for specialist treatment (64 days) – while those in the South of England have the shortest average wait – 58 days. Significantly, current waiting times are far longer than the government’s new standard of four weeks, set out in its green paper on children’s mental health.

The EPI found "many loopholes" in the system for reporting and disclosing data for child and adolescent mental health services in England under Freedom of Information law, and it said many children’s mental health providers did not provide basic information on access to services that we requested from them: "Such practices greatly obscure our understanding of the state of services in England."

Privatised service provision poses further barriers to transparency around publicly funded services, as independent providers are exempt from the Freedom of Information Act.

There may also be a risk of “gaming” of waiting time standards from some providers. There is a danger that thresholds for securing treatment are raised to meet new standards on waiting times – denying more children access to support.

Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, said it really is vital to focus attention on prevention and treatment at an early age.

“We know there is great work going on in children and young people’s mental health services and our members are providing excellent and often innovative services.

“But still too many young people are being let down and being told they do not fit the criteria for specialist treatment.

“We recognise there is work that needs to be done – investment is planned to increase the number of children and young people with a mental problem accessing treatment to 35% in 2020/21. Clearly we have a long way to go before all children with mental health problems get the help they need.

“Services are lacking the funding they need. We have the opportunity to put things right through the long-term NHS investment plan – which is why it is vital that mental health gets its fair share of this funding.”


*Access to children and young people's mental health services- 2018. Education Policy Institute, October 2018.

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