This report by the Education Policy Institute assesses the state of children’s mental health services in England. The research examines access to specialist services, waiting times for treatment, and provision for those children that are not able to receive treatment.
The report uses Freedom of Information (FOI) requests to providers of child and adolescent mental health services (CAMHS) and local authorities in England.
Key findings
Referrals to children’s mental health services
- The number of 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 3 per cent.
- Rejection rates remain high: as many as one in four children (24.2 per cent) referred to specialist mental health services were rejected in 2017/18. These rates have failed to improve substantially over the last 5 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.
- 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.
Waiting times for children’s mental health services
For those children with mental health problems who are accepted into specialist services, many face a lengthy wait before their treatment begins:
- The average median waiting time for children in 2017/18 was 34 days to receive an initial assessment and 60 days to receive treatment. This has been broadly stable over recent years for assessment times, but has improved a little for the longest times to treatment.
- Many children still face unacceptably long waiting times, and there are great disparities across providers. The longest wait for treatment reported by mental health service providers in England ranges from 188 days, to just 1 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 4 weeks, set out in its green paper on children’s mental health. Average waiting times are currently twice as long as this proposed standard.
CAMHS data deficiencies hinder progress
- There are many loopholes in the current system for reporting and disclosing data for CAMHS in England under Freedom of Information law, and 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.
- Broader, more consistent government accountability measures for reporting data on CAMHS are therefore urgently required, including clear definitions of who is eligible for treatment. Failure to compel universal reporting across service outcomes may impede government plans to improve mental health services for children and young people.
