Swamped NHS mental health services turn away children, GPs say | Mental health

Children and young people who are anxious, depressed or self-harming are being denied help from the flooded NHS child and adolescent mental health services, GPs have revealed.

Even those under 18 with an eating disorder or psychosis are denied care by overburdened CAMHS services, which insist they are not sick enough to warrant treatment.

In one case, a crisis team at CAMHS in Wales would not immediately assess the mental health of a suicidal child who had been prevented from jumping from a building earlier that day, unless referred in writing by the GP . In another, a CAMHS ward in the east of England refused to take in a 12-year-old boy who was found in his room in a ligature because the lack of marks on his neck meant that criteria had not been met. derivation.

The shocking state of care at CAMHS is laid bare in a survey for the youth mental health charity stem4 of 1,001 doctors across the UK who have sought urgent help for those under 18 with mental problems. CAMHS teams, already unable to cope with the growing need for treatment before Covid hit, have been further overwhelmed by the impact of the pandemic on youth mental health.

The findings, which Stem4 hs shared with The Guardian, also show that in some areas it takes two years for children and young people after being referred by their GP to start receiving help.

Mental health experts say the widespread inability of young people to access CAMHS care is causing their already fragile mental health to deteriorate further and then they self-harm, drop out of school, feel neglected and have to seek help at A&E.

“As a clinician, it is particularly concerning that children and young people with psychoses, eating disorders and even those who have just attempted suicide are doomed to such long waits,” said Dr. Nihara Krause, a consultant clinical psychologist who specializes in treats children and young people and is the founder of stem4.

“It is truly shocking to learn from this survey of GP experiences dealing with CAMHS services that so many vulnerable young people who desperately need urgent help with their mental health are forced to wait so long, up to two years, for care. they need immediately.

“Delay in treatment increases risk and you can expect problems in applying to study or work, relationship problems, other emerging comorbid mental health problems, for example, depression, with an increased vulnerability to self-harm, anxiety with attacks of panic, etc.”

Many GPs criticized the CAMHS provision in their area. Some said problems accessing services mean they are unsafe or even dangerous, because many under-18s get worse while waiting and may feel angry, ignored and disappointed to be left without specialist help. Nearly one in five (18%) of physicians surveyed know of a patient who has attempted or committed suicide after being denied care.

A handful of GPs said the situation was so bad that they had given up referring young people to CAMHS altogether and directed them to A&E instead, although that is not appropriate.

A family doctor in Yorkshire and the Humber said: “It is so appalling in our area that it might as well not exist. Patients only get support if their parents can afford it or if they are drinking bleach, and even then it is a matter of time if a referral to CAMHS will be accepted.”

The findings are “deeply concerning” and show the immense additional pressure Covid has placed on CAMHS, said Tom Madders, director of campaigns for YoungMinds.

“What these doctors are telling us echoes what we hear every day from parents, youth and professionals. Despite signs of progress in some parts of the country, support thresholds are alarmingly high, with thousands of young people turned away or put on long waiting lists.

“Without timely support, the needs of young people will often worsen, with many self-harming, dropping out of school or turning to A&E services in a crisis.”

Madders called for the creation of a network of “early support centres” across the UK so that GPs would have a place where they could refer those under 18 for quick help.

In one case, CAMHS in the Northwest refused a GP referral for a child with anorexia for including inadequate information, even though her body mass index was listed as only 16.

MedeConnect Healthcare Insights surveyed 1,001 associate, salaried, or substitute 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 in crisis (46%) or grossly inadequate (49%), up from 90% when stem4 conducted the same survey in 2018 and 85% in 2016

Half say that at least six in 10 referrals they make for anxiety, depression, conduct disorder and self-harm are routinely rejected because the youth’s symptoms are not considered serious enough, even though they only refer cases of higher risk.

One in four say 60%-100% of referrals for eating disorders and addictions are rejected

63% fear that young people will suffer harm due to lack of treatment, while 58% have seen patients’ symptoms worsen, forcing them to go to the emergency room.

Professor Martin Marshall, president of the Royal College of GPs, said the findings were “distressing and worrying”.

He added: “It is of utmost importance that if GPs refer these patients to specialist mental health services, these referrals are taken seriously and not dismissed without good reason.”

The Department of Health and Social Care did not comment directly on the findings. A spokesperson said: “We recognize the impact the pandemic has had on everyone, especially children and young people who have faced disruption to their home life and education.

“We have committed an additional £500m in 2021-22 to support those most affected, including £79m for mental health services for children, to accelerate the deployment of mental health support teams and expand community services. This builds on our commitment to expand and transform mental health services in England, supported by an additional £2.3bn per year by 2024, enabling hundreds of thousands more children to access support.

“We will launch a national conversation to inform the development of a new long-term mental health plan later this year.”

In the UK and Ireland, the Samaritans can be contacted by calling 116 123 or by emailing jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the Lifeline crisis support service is 13 11 14. Other international helplines can be found at www.befrienders.org.

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