The capacity crisis in CAMHS is putting vulnerable young people at serious risk, say GPs

A new national survey of GPs from youth mental health charity stem4 has found that the state of children and adolescents' mental health service (CAMHS) has deteriorated to “unsafe” levels over the past six years.?

Written by Edward Gould-Brown

In a previous survey conducted by stem4 in 2016, GPs raised the alarm about increasing pressures on mental health services due to steady rises in the numbers of young people requiring treatment, combined with historic underfunding. Yet despite the Government allocating ￡1.4 billion in extra investment between 2015-21, as predicted over the last four years, referrals have increased, and service capacity has further diminished.

This week, it has been revealed that most of the GPs surveyed by stem4 (95% of 1001) believe that mental health services for children and young people are critically failing to such a level that many describe their local CAMHS practices as unintentionally, but actively, “dangerous”.

Referral denial or delay is putting the mental health of young people at risk

Most respondents said that their local services were currently “unsafe” due to the now routine practices of putting young people on lengthy waiting lists for up to two years and of the outright rejection of some patient referrals.

Data showed that half (53%) of GPs had experienced CAMHS, rejecting at least 60% of referrals for patients exhibiting behaviours of anxiety, depression, and self-harm, as their symptoms were not deemed severe enough. While a quarter of GPs said at least 60% of referrals for patients with eating disorders and addictions are rejected, and 10% said half of all patients with psychosis are denied access to treatment.

GPs give their experience of the state of CAMHS

One GP from Wales stated: "I have had children with psychosis and severe self-harm outright rejected. I was recently told that only a written referral would be accepted for a child actively suicidal (stopped from jumping off a building earlier that day). The crisis team would not accept the patient for same-day assessment. The only safe option was to direct to A&E for safety, which is not ideal or appropriate."

While a GP from the East of England told researchers: "Services are resistant to take any referrals. Example: 12-year-old found to have ligature in his room. [I] was told [the] threshold for referral was not met as [there were] no marks on his neck."

“There are literally no CAMHS services available. Referrals that do get accepted still have a 2-year waiting list.” Commented another GP from South West England.

There needs to be an “expansion” of youth mental health services to increase capacity

Because of the widespread treatment delay and denial:

• 58% of GPs have witnessed symptom escalation
• 74% said it has led to multiple appointments at their practice
• 54% have now undertaken continuing professional development in mental health to try to help their young patients.

Moreover, many survey respondents suggested that there needs to be a “complete overhaul” of the presently “atrocious” and “inadequate” state of youth mental health provision. Sharing this view, Dr Nihara Krause, Consultant Clinical Psychologist, founder of stem4, said:

"It is truly shocking to learn from this survey of GPs' experiences of dealing with CAMHS services that so many vulnerable young people in desperate need of urgent help with their mental health are being forced to wait for so long – up to two years – for care, they need immediately. As a clinician, it is particularly worrying that children and young people with psychosis, eating disorders, and even those who have just tried to take their own life are condemned to such long waits. CAMHS needs to undergo a major expansion in order to meet the serious and growing mental health needs that young people under the age of 21 have."