Children’s mental health support suffers from fragmentation, says CQC

Poor collaboration, fragmented services and data gaps mean many children and young people face long waiting times to access mental health services, a Care Quality Commission (CQC) report has found.

The phase one report from the CQC’s review of child and adolescent mental health services (CAMHS) found “widespread issues with accessibility” of specialist services and wide variation in waiting times across England.

It also found that despite 85% of local areas committing to prioritising mental health support for looked-after children, some services are refusing referrals for children in care unless they have a permanent placement.

In one instance highlighted in the report, the CQC said a young person who was hearing voices and had other mental health issues was unable to access support because he was in residential care rather than ‘settled’ accommodation.

The report said other vulnerable children, including young offenders, child refugees and unaccompanied asylum seekers, also experienced problems in accessing CAMHS.

Fragmented care

The CQC also found that a lack of alignment between services in the wider mental health system, including social care, was identified as a key reason why children could be left without the mental health support they need at the right time. “Poor collaboration between organisations can lead to fragmented care that fails to address children and young people’s needs as a whole,” it said.

The report said that based on its inspections of CAMHS that mental health support is better in areas where agencies work together. Examples of good practice included co-location of professionals and weekly multi-agency meetings that enabled not only better coordination of care but also the sharing of expertise.

The CQC’s review also found wide variation in waiting times around the country and noted that some mental health services lacked systems to review the risks to children and young people on their waiting lists despite prolonged waits meaning that some children’s mental health could deteriorate to a crisis point before they got access to services.

Staff turnover

The quality of data available on CAMHS was also found to be poor through being too reliant on voluntary self-reporting from providers and often excluding information from social care and other parts of the wider mental health system. It added that staff turnover in all parts of the system had a detrimental effect on young people with mental health conditions.

Councillor Richard Watts, chair of the Local Government Association’s Children and Young People Board, said the report highlighted the urgency of improving mental health services for young people.

“At the moment we have a mental health system that still says no rather than yes to children when they ask for help with problems such as depression, anxiety, family issues and bereavement,” he said.

“Mental health must be put on the same footing as physical health. Greater investment is needed in community-based preventive services, such as counselling in schools, which gives children and young people the support they need and keeps them out of hospital in the first place.”

The second phase of the CQC’s review of CAMHS, which was initiated by prime minister Theresa May in January, will focus on why the quality of mental health services is so variable and what can be done to improve access and quality. The CQC will publish the final report from its review in 2018.