A new study has revealed significant delays in the access to mental health services for children and young people with high levels of emotional distress. The research, known as the STADIA trial, shows that many children with severe mental health issues, such as depression and anxiety, are either not receiving the help they need or are experiencing long waiting times for treatment. The study, which was published in the Journal of Child Psychology and Psychiatry, was led by experts from the University of Nottingham’s School of Medicine and funded by the National Institute for Health and Care Research (NIHR).
The STADIA trial involved 1,225 children and young people who had been referred to Child and Adolescent Mental Health Services (CAMHS) in various parts of England. These children were followed up over an 18-month period to assess how they progressed and whether they received the care they needed. The study participants all had emotional difficulties, and many scored very high for at least one emotional disorder, primarily depression or anxiety.
Despite the high levels of emotional distress reported, the study found that only 11% of the children received a clinical diagnosis from CAMHS. Additionally, only 44% of the referrals to CAMHS were accepted, and 35% required re-referrals, indicating significant delays in accessing care.
The findings of the study highlight troubling trends in the accessibility and timeliness of mental health care for young people:
High Mental Health Needs: Of the children involved, 67% had severe emotional difficulties, with depression and anxiety being the most common disorders.
Low Diagnosis Rate: Despite these high levels of distress, only 11% were diagnosed with an emotional disorder by CAMHS, raising concerns about the recognition of mental health conditions.
Delays in Accessing Help: Only 44% of the children and young people had their referral accepted by CAMHS, with 35% requiring a second referral. These delays suggest significant barriers to timely care.
No Improvement After One Year: One year after their initial referral, the mental health challenges of these children remained severe. Symptoms, including functional impairment and self-harm thoughts and behaviors, persisted even at the 12-month follow-up.
Inadequate Treatment: At 18 months, less than half (47%) of the children had received any treatment or intervention from CAMHS.
Kapil Sayal, a professor at the University of Nottingham’s School of Medicine and lead author of the study, expressed deep concern over these findings. “We are very concerned that many children and young people with high levels of mental health needs, particularly conditions like depression and anxiety for which evidence-based interventions are available, are struggling to access help and have their difficulties appropriately recognized,” he said. “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, are being unnecessarily prolonged.”
The study underscores the long-term impact that delays in mental health care can have on children, prolonging their suffering and affecting their development.
The study also examined the effectiveness of online diagnostic tools in improving access to mental health care. It found that completing an online standardized diagnostic assessment, both by the young people and their parents soon after referral, did not significantly change the chances of receiving a clinical diagnosis from CAMHS. However, the study suggested that online and digital approaches to diagnostic assessment were highly acceptable to families and could help optimize access to support, provided there is sufficient investment in CAMHS to implement these solutions effectively.
Professor Sayal pointed out that the time period during which the study was conducted (spanning from 2019 to 2021) overlapped with the COVID-19 pandemic, which brought additional challenges, such as national lockdowns and school closures. This period saw an increase in the number of mental health referrals to CAMHS, further exacerbating the delays.
Colleen Ewart, a parent and co-investigator in the STADIA trial, echoed the urgency of addressing these delays. “Sadly, the stories I hear from young people and their parents still echo our family experience of 15 years ago,” Ewart said. “We can and must do better for this generation of children and young people and those to come. Reducing delays in accessing the right help quickly is essential to save untold suffering (often lifelong) for children, young people, and their families.”
The STADIA trial’s findings reveal an urgent need for reforms in the UK’s child mental health care system. The delays in treatment, coupled with insufficient access to proper diagnostic and therapeutic interventions, are causing significant distress for many children and young people. The study calls for greater investment in CAMHS and the adoption of digital tools to enhance accessibility, while also advocating for a quicker, more efficient system to address the mental health crisis among children and adolescents.
This research was supported by a grant from the National Institute for Health and Care Research (NIHR) and was led by the Nottinghamshire Healthcare NHS Foundation Trust, the University of Nottingham, and the Nottingham Clinical Trials Unit in collaboration with several NHS Trusts.
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