Youth mental health often unrecognized in health care

Children and young people with high levels of mental health needs are struggling to receive the help they need, or to have their difficulties recognized, according to a newly published report.

The STADIA trial, which is published in the Health Technology Assessment journal, was led by experts from the School of Medicine at the University of Nottingham.

This large study, which spanned different parts of England, involved 1,225 children and young people with emotional difficulties who had been referred to Child and Adolescent Mental Health Services (CAMHS) for help and followed them over 18 months.

These children and young people had high levels of mental health needs, with 67% scoring very high for at least one emotional disorder—most commonly depression or an anxiety disorder. Despite this, only 11% received a clinical diagnosis of an emotional disorder from CAMHS.

Only 44% of children and young people had their referral to CAMHS accepted, and 35% required a re-referral to CAMHS, suggesting that there were delays in receiving help.

One year after their referral, these children and young people did not seem to improve. Their mental health difficulties continued to remain at a severe level over this period, with high levels of self-reported and parent-reported mental health symptoms, functional impairment, and self-harm thoughts and behavior, even at 12 months follow-up.

At 18 months follow-up, less than half (47%) had been offered treatment or intervention from CAMHS.

Professor Kapil Sayal, from the School of Medicine and the STADIA Chief Investigator said, “We are very concerned that many children and young people with high levels of mental health needs, particularly conditions such as depression and anxiety disorders, for which NICE-recommended evidence-based interventions are available, are struggling to access help and have their difficulties appropriately recognized.

“One year is a very long time in a child’s life—delays in accessing the right care mean that their difficulties and distress, and the associated impact on their day-to-day lives and activities, are being unnecessarily prolonged.”

The results of the study also found that:

• The completion of an online standardized diagnostic assessment tool by young people and parents, soon after the referral had been received by CAMHS, did not impact on receiving a clinical diagnosis from CAMHS.
• Parents, caregivers and young people frequently expressed their desperation for help and support due to the ongoing impact that mental health symptoms were having on their lives.
• The opportunity to complete the online standardized diagnostic assessment tool was welcomed by young people and parents as it gave them some understanding of the symptoms and experiences, and the generated report they received from the tool was sometimes used as evidence of their needs with other services, such as schools or their GP.
• Online/digital approaches to diagnostic assessment are highly acceptable to families and young people who have been referred to CAMHS, which suggests a way forward for offering and optimizing access to the right help and support—as long as there is sufficient investment in CAMHS to properly implement this.

Professor Sayal adds, “Over the past few years and especially since the pandemic, referrals to CAMHS have gone up considerably, which unfortunately has meant that not everyone who could benefit from support has been able to receive timely help and support.”

Dr. Louise Thomson, from the School of Medicine and the STADIA qualitative and implementation lead said, “Hearing the experiences of parents, caregivers and young people helped us to better understand their hopes and expectations for a CAMHS referral, particularly around receiving a diagnosis, and how this contrasted with the preferred approach of clinicians we spoke to in CAMHS services.”