Society’s most vulnerable children are more likely to be turned away from NHS child and adolescent mental health services (CAMHS) because their situations are too 'unstable' according to new research from the University of Cambridge and the National Children’s Bureau.
The findings come from the COACHES study which has been funded by the National Institute for Health and Care Research (NIHR) and looked at more than 71,000 children’s health records. Its findings have been welcomed by the Children’s Charities Coalition, which is made up of:
- Action for Children
- Barnardo’s
- The Children’s Society
- National Children’s Bureau
- NSPCC
Findings
Researchers found that children are more likely to be rejected by CAMHS if they have social work involvement, regardless if that is because they are just being supported by social workers or if they are on a child protection plan.
The latter are twice as likely to be turned away from NHS mental health services compared to their peers – those with other social work involvement are three times more likely to be rejected.
Children in care, however, are less likely to be rejected. The researchers say this is because the NHS trust which the research focuses on has dedicated services to children in care.
The inequality can be seen in the nation’s most neglected areas too, as children in the poorest localities are twice as likely to be refused mental health support compared to their peers in the most affluent areas.
These findings come from child health records as well as case notes from a large mental health service in London.
Taking into account engagement and interviews with practitioners and clinicians, the researchers say their findings for those with social work involvement are reflective of the situation up and down the country.

Recommendations
The research authors say that children with social care involvement should have a dedicated pathway to CAMHS which is supported by both the social care sector and mental health experts.
Other recommendations include placing social workers within CAMHS teams and vice-versa, introducing a tailored offer for children living in poverty (i.e., transport vouchers) in collaboration with anti-poverty organisations and local authorities, and implementing a variety of therapies that do not require young people to have ‘stability’.
Additionally, CAMHS should be given the requisite resources so they can reach each young person on the waiting list at least once – especially those with social work involvement, living in poverty, or considered ‘unstable’.
The researchers define instability in this case as those in situations that would be too chaotic or challenging to be conducive to successful or effective engagement with CAMHS.
Finally, services should use a single and consistent identifier for all young people to promote more joined up work, and any child in contact with social workers should be offered a mental health assessment to better understand their needs.
This should come with the option of inviting an advocate to their session, while those in care should also be offered CAMHS input or a CAMHS liaison to ensure their needs are met too.
Reaction
CEO at the National Children’s Bureau, Anna Feuchtwang, said: “The Government must look urgently at removing the systemic biases within our services for children that discriminate against those who are particularly vulnerable so they get equal opportunities to benefit from high-quality mental health support.”
The National Children’s Bureau led the call for children’s needs to be put at the centre of integrated care system strategies earlier this year.
Julia Mannes, NIHR Three Research Schools fellow, University of Cambridge, commented: “Behind this data are real-life stories of children experiencing considerable psychological distress. They need and deserve specialist help but are too often turned away. This evidence will help policymakers shape systems that children and families can rely on for support.”
“Our research was prompted by discussions with people with lived experiences, who urged us to look at inequalities in access to mental health services for the most vulnerable groups of children,” added the University of Cambridge’s Professor Robbie Duschinsky. “Their concerns have been borne out in the results described in this report.”
Prof Duschinsky and his collaborators have more studies in this area, including what treatments children receive and their effectiveness, as well as interviews with children involved with social work about their experiences of mental health services.
“We look forward to reporting results from this work,” he said.
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