A recent audit on Child and Adolescent Mental Health Services (CAHMS) in Scotland, has found that 1,528 young people had their referral rejected in the one-month period of investigation. In response to the audit, the Scottish Government’s health secretary, Jeane Freeman, heavily criticised her own government, calling the current rejection system “completely unacceptable” before stating that all recommendations of the audit would be met.

Referrals made without face to face assessment

The figure of rejections equates to one-fifth of referrals not being accepted. Furthermore, the audit found that “most decisions are made on the basis of paper referrals, without a face to face assessment.” Just 31% of young persons who took part in the audit said they had an in-person assessment.

One parent who took part in the research is quoted as saying “I don’t see how they can reject anybody without seeing them.”

While 66% of those who received a rejection was given signposting, those service users and caregivers who took part in the audit said that “signposting is generic, unhelpful and often points to resources they have already explored.” Others did not receive any signposting which resulted, among other outcomes, in some asking for another referral and some doing nothing.

Early intervention important

Another finding is that among those who have been rejected from CAMHS, a number of them “report a belief that they will not be seen by CAMHS unless they are suicidal or at immediate risk of harm.” Research shows that early intervention is important in mental health care and therefore this finding is particularly concerning if children and young people think that help will only be given to them in the most serious circumstances.

Indeed, one participant in the audit said that they had had three referrals rejected before a fourth referral was requested by A&E staff after the person had tried to take their own life.

The audit was carried out by Scottish mental health charity, Scottish Association for Mental Health (SAMH), in collaboration with the Information Services Division (ISD) of the NHS. SAMH collected qualitative data of interviews, focus group discussions, and surveys from participating young people and families. Information Services Division (ISD) Scotland, on the other hand, carried out a quantitative investigation of rejected referral figures (for February 2018) from NHS Boards.

It was commissioned by the government in 2017 in response to high numbers of CAMHS referral rejections being found in the 2016-2017 period and amongst calls for an audit by SAMH and Barnardo’s Scotland. It is part of the Scottish Government’s Mental Health Strategy 2017-27.

Concern was also highlighted by SAMH in 2017 as to the waiting times of those who were seen by CAMHS.

Since the end of 2014, the maximum waiting time for CAHMS in Scotland has been 18 weeks but this has not always been met with SAMH reporting last March that one-fifth of referrals received help after more than 18 weeks.

Scottish Health Secretary, Jeane Freeman, in commenting on the audit’s release on Friday, expressed criticism of how referrals are currently dealt with and highlighted that “while CAHMS may not be the right path of some of those referred, young people are being rejected from treatment without proper explanation or being directed to more appropriate care. That is completely unacceptable.”

New CAMHS Taskforce to be established

As a result, she is accepting all the 29 recommendations set out by the audit, is allotting £5 million to MH services for children and young people in Scotland, and is establishing a new CAMHS Taskforce which is to be headed by Dr Dame Denise Coia and will “examine the whole approach to mental health services.”

Some of the recommendations include the undertaking of further research, improving the referral system to meet the needs of those using it, and reviewing the current CAMHS model.

The present audit comes not long after Barnardo’s Scotland issued a report on CAHMS referrals which highlighted five main reasons they found for a rejection outcome from CAHMS based on information gained from staff working in Barnardo’s centres around Scotland. This included “lack of stability” in the children and young peoples’ lives, “lack of engagement” with CAMHS by children and young people, and, similarly to the views expressed by some children and families in the government-commissioned audit, that “symptoms [were] not severe enough.”

The chief reason given for referral rejection in the government-commissioned audit was that the referral was deemed "unsuitable" as it did not meet the NHS health board’s criteria. When asked whether there was satisfaction in the explanation of referral rejection, 66% of respondents to the online survey element of the audit said "no."

Responses to the announcement

In response to the Scottish Government’s announcement, the Chief Executive of SAMH, Billy Watson, has commented: “Our hope was that this audit would provide substantive evidence as we seek to achieve positive change in the services and support that thousands of young people need. We are delighted that the recommendations have been accepted and welcome the announcement of a new CAMHS Taskforce that includes £5m of investment.”

Additionally, the Director of Barnardo’s Scotland, Martin Crewe, has praised the message of the Scottish Government and stated that “No child or young person should have to experience a mental health [VIDEO] crisis because they didn’t get the help and support they needed early on.”

CAMHS around the UK

It was reported early last week that CAMHS services were failing young people, with a report carried out by the UK Association of Child Psychotherapists (ACP) branding the services a “silent catastrophe” due to underfunding, services being reduced, and changes in service design, as reported in The Guardian.

With this latest announcement of funding from the Scottish government, improvement is possibly on its way but will remain to be seen until the recommendations are put in place. Further planning is expected later this summer according to the Scottish government’s statement.

If anyone is concerned about any themes mentioned in this article and would like someone to talk to, please call Samaritans on 116 123 (UK and Ireland), email jo@samaritans.org, or visit the Samaritans website to find out where the closest branch is.