Children’s access to specialist NHS mental health services in England remains “a postcode lottery”, with huge differences in spending and referrals depending on where families happen to live, according to a report.
Overall, it said referrals of children and young people dropped as a result of disruption caused by the pandemic, at a time when more of them were struggling with mental health than ever before.
The report by the children’s commissioner for England said that in 2020-21 a total of 497,502 referrals were made to child and adolescent mental health services (CAMHS) compared with 539,000 the previous year, as children became less visible to professionals such as GPs and teachers who usually make referrals.
For those children accepted for treatment, the commissioner’s report said average waiting times fell from 43 days in 2019-20 to 32 days in 2020-21, though there were wide variations across England, and a third of children accepted on to waiting lists were still waiting for their treatment to begin.
It is the commissioner’s fifth annual report on children’s mental health services in England, which looks at spending, access and waiting lists in 2020-21, based on data from NHS Digital and NHS England, and sheds light on the impact of the pandemic.
Although referrals went down, demand increased, with one in six children suffering from a probable mental health condition, up from one in nine in 2017. As a result only about a third of children (32%) were able to access treatment, the report said.
Spending on children’s mental health services went up 4.4% in real terms, but some clinical commissioning groups (CCG) chose to spend significantly less than others. The highest spend per child in 2020-21 was by NHS Isle of Wight CCG at £165, followed by Norfolk and Waveney (£152) and west London (£138). The lowest was Halton at £16 per child – down from £25 in 2019-20 – followed by Trafford and Redbridge, both at £41.
Other data shows the proportion of children failing to access services because referrals were closed before starting treatment decreased to 24%, down from 27% in 2019-20 and 36% in 2018-19. Again there is wide variation, with just 8% of referrals in NHS East Sussex closed before treatment, compared with 41% in east and north Hertfordshire.
Based on five key indicators, including spending on children’s mental health as a percentage of total financial allocation, mental health spend per child and total number of children’s referrals as a proportion of the under-18 population, Wakefield, Tees Valley and Heywood, Middleton and Rochdale were the top three performing CCGs. West Sussex, Coventry and Rugby and Oxfordshire were the lowest.
The children’s commissioner for England Dame Rachel de Souza said increasing investment was making a difference. “More children have been accepted into treatment and for some children waiting times have reduced. However, there is still more to do. Some children are still waiting a long time for their treatment to begin, and many are still not accepted on to waiting lists.
“There is still wide variation between local areas on what is being achieved. For example, the percentage of children waiting for treatment at the end of the year varied greatly between local areas: from as low as 14% in NHS Castle Point and Rochford and NHS Mid Essex, to 78% in NHS East Sussex.”
Commenting on the findings, Mark Russell, chief executive at the Children’s Society said: “It’s clear many children need support following successive lockdowns, so it’s really concerning that referrals to CAMHS fell, with some children out of sight of professionals able to identify concerns.
“Since then, following the first year of the pandemic, NHS Digital data shows there has been a surge in referrals, including for really severe mental health crises. Even before the pandemic, our research had highlighted a deeply distressing decline in children’s wellbeing, with potentially disastrous consequences.
“While shorter waiting times to access treatment are welcome, the children’s commissioner’s analysis shows that far too many children are still being turned away.”
The Department of Health and Social Care said the government was expanding healthcare services with an extra £2.3bn a year by 2024.
“We recognise the impact the pandemic has had on everyone, especially children and young people who have faced disruption to their home lives and their education,” a spokesperson said. “That is why we have committed an additional £500m this year to support those most affected, including £79m for children’s mental health services.”
