Of almost one million children and young people referred to mental health services in 2022/23, some 270 000 – more than 1 in 4 – were still waiting for support at the end of the year.
NHS data obtained by the children's commissioner for England shows that the average wait for a second contact (which is usually when support begins) for these children and young people was 142 days – including 32 000 who had been waiting for more than 2 years.
Of those whose reasons for referral were known, the most common issues were:
- Anxiety (19.6%)
- ‘Reaching crisis’ (10.1%)
- Neuro-developmental conditions excluding autism (6.6%).
- Depression (5.8%)
- Self-harm (4.7%)
- Conduct disorders (3.2%)
- Adjustment to health issues (2.9%)
- Eating disorders (2.9%)
- Suspected autism (2.7%)
However, concerningly, 34.4% of cases were recorded as reason ‘unknown’.
The disturbing picture is painted in a report from the children's commissioner. It finds that 949 200 children and young people – roughly 8% – had active referrals to Child and Adolescent Mental Health Services (CAMHS) in the 2022/23 financial year. This is up from 2021/22 when there were 734 000 active referrals.
Of the 949 200, 305 000 entered treatment, with an average waiting time of 35 days – although this ranged hugely from 47 000 or so entering treatment within 4 weeks to 6 300 entering treatment after a wait of more than 2 years.
Of the 305 000, the most common age groups were 13 to 15 (113 000), 10 to 12 (73 000), 16 and 17 (53 000) and 7 to 9 (44 000).
Meanwhile, 372 800 had their referrals closed before accessing CAMHS, leaving 270 300 who were still waiting by the end of the year (March 2023).
The report reveals geographical differences when it comes to waiting times – with young people waiting for an average of 147 days for treatment in Sunderland and 133 days in Portsmouth. This compares to just four days in Southend.
And the data also reveals that boys and younger children are among those waiting the longest. The report states: ‘Older adolescents are more likely to self-harm, attempt suicide and experience acute mental health problems as a consequence of alcohol and substance misuse than younger children. Similarly psychosis and eating disorders requiring acute intervention are more likely to present in late adolescence.
‘This increased prevalence of mental health presentations requiring urgent assessment or treatment among older children could explain the shorter waiting list for this cohort. Younger children are more likely to present to mental health services with behavioural problems, for which the waiting time for assessment is longer.’
The report warns that while £997m of NHS money was spent across England on CAMHS in 2022/23 – an increase from £922m the year before – this is just a 1% rise year-on-year in real-terms once inflation is taken into account.
The fundamental truth outlined in the report is that demand for children's mental health services ‘continues to outstrip the availability of support’.
It comes at a time when NHS research estimates that 1.4 million children and young people aged 8 to 17 have a probable mental health condition. This compares to separate NHS data shows that only 678 400 children and young people had at least one contact with CAMHS in 2022/23.
‘Of those whose reasons for referral were known, the most common issues were anxiety, ‘reaching crisis’, neurodevelopmental conditions (excluding autism), depression, and self-harm. However, concerningly a third of cases were recorded as reason “unknown“.’
Children's commissioner Dame Rachel de Souza is now calling for a national target of no more than four weeks' waiting time for an initial assessment and no more than another 4 weeks for support to begin.
She also wants increased support for children who do not reach the threshold for CAMHS, including through Early Support Hubs, Mental Health Support Teams (MHSTs), and via school counsellors.
And she wants a new 10-year plan for children and young people's mental health as well as reforms to the Mental Health Act.
It comes after the NSPCC recently criticised the slow roll-out of the MHST initiative.
MHSTs support the mental health needs of children and young people in primary, secondary and further education (ages 5 to 18), providing early intervention on issues such as mild to moderate anxiety. Delivery is led by the NHS and there are currently around 400 in operation, with another 100 due to come online from April 2024.
The initiative was first announced in 2018 but has a target of reaching 50% of pupils by April 2025, which the NSPCC said last year ‘lacks the sense of urgency needed’.
Data released by the Department for Education earlier this year shows that as of 2022/23, 28% of schools and colleges (about 6 800) are covered by a MHST and 35% of pupils.
Dame Rachel said: ‘This generation of children have faced uncertain and challenging times like no other generation before them – they are bombarded with negative world news, and many are exposed to the harmful impact of the online world. Against this backdrop, it's unsurprising that so many children and young people are continuing to experience issues with their mental health.
‘Children are still waiting far too long to access the support they need, and for too many children the speed at which they can access support is still down to the luck of where they live.
‘With the right early support, many children would not need access to mental health services.
‘It is shocking to see so many children being referred to mental health services because they have reached crisis point. Many problems we see in children's mental health services stem from local and national leaders failing to prioritise children's mental health.
‘We need fresh, long-term thinking when it comes to children's mental and emotional health and wellbeing.’
Commenting on the report, Geoff Barton, general secretary of the Association of School and College Leaders, said it was ‘shocking’ that so many young people require mental health support.
He continued: ’This appears to be attributable to a cocktail of problems – very high levels of child poverty, toxic content on social media platforms, the sheer weight of high-stakes exams that have resulted from government reforms, and a special educational needs system which is underfunded and under pressure.
‘We have to get better both at providing access to specialist services needed by children and young people who are suffering from mental health problems, and dealing with the root causes of those mental health problems.
‘At the moment, we are, as a society, too often failing to fulfil our responsibility to protect and support the next generation.’
FURTHER INFORMATION
For more details or to download the report from the children's commissioner for England, entitled Children's mental health services 2022-23, visit www.childrenscommissioner.gov.uk/resource/childrens-mental-health-services-2022-23