Nearly all GPs worry that young people with mental health problems will come to harm because of difficulties in accessing treatment on the NHS, according to a survey.
The poll of UK family doctors found that 99% said they feared that under-18s would come to harm as a direct result of facing long delays to see a specialist and vital care being rationed.
Nine in 10 GPs said health and social care services for young people who have anxiety, depression, eating disorders and other conditions were either “extremely inadequate” (37%) or “very inadequate” (53%), and only 10% said they were adequate or good.
Many family doctors who took part in the survey, commissioned by the youth mental health charity stem4 and undertaken by MedeConnect Healthcare Insight last month, said that in their experience NHS child and adolescent mental health services (Camhs) often could not respond to a recent sharp increase in demand for care. Experts believe that social media, exam stress, poverty and family circumstances lie behind the rise.
Camhs providers were “overwhelmed”, delays could last as long as 18 months, and many denied treatment to young people, who had to be potentially suicidal in order to be seen, GPs said.
One said: “The delay is awful. Only the very severely affected are seen and then too little, too late. Patients are usually left to suffer, self-harm, or just get worse. They go to their local emergency department [A&E], get patched up and sent home and may get a referral to Camhs. But Camhs will find a reason why they are not bad enough to be seen, and the cycle continues. It’s an unfolding, heartbreaking tragedy.”
Another said: “It’s extremely frustrating. There is a lack of [treatment] options for most mental health issues affecting young people. Suffering for the patient and family is increased and in some cases deterioration to more severe problems is inevitable.”
The survey also found:
78% of GPs are worried that too few of their young patients can get treatment for mental ill-health.
86% have seen a rise in the last two years in the number of 11- to 18-year-olds with anxiety.
88% say it is impossible or very difficult for young people to get help with anxiety.
68% are seeing more under-18s who have self-harmed.
This year the government has made mental health a key priority, with Theresa May pledging to improve NHS care for troubled young people. Campaigners say patients who are left without treatment are more likely to deteriorate and may be at greater risk of harming themselves, having suicidal thoughts or trying to take their own life.
Norman Lamb, the Liberal Democrat former health minister, said young people were suffering because NHS services for troubled teenagers in many places were “dysfunctional”.
He said: “This survey lays bare just how broken children’s mental health services are in much of the country. Families are left in a state of acute anxiety, desperately hoping no harm will come to their child whilst they wait.
“It is a disgrace that so many children are turned away from services after a referral from their GP. Most disturbing of all is the finding that 99% of GPs fear that young people may come to harm whilst waiting for treatment.”
Labour’s Luciana Berger, said the “deeply troubling” findings showed that repeated pledges by ministers, including May, to improve mental healthcare for under-18s were “nothing more than vacuous warm words”. Delays in accessing care could have a “devastating” impact on young people, she said.
“In no other part of our NHS would you find 99% of GPs admitting that young people may come to harm while waiting for treatment – if they can access any help at all. The long-term consequences for every young person affected can be devastating. It’s socially, morally and economically illiterate for government to have made the choice not to properly fund these services.”
Dr Nihara Krause, a consultant clinical psychologist who founded stem4, said a lack of talking therapies for teenagers meant GPs were forced to refer young people to Camhs, which are meant to treat those with the most serious illnesses, despite knowing they may be rejected as ineligible.
“Where we once had access to highly trained therapists in the community, able to deliver evidence-based treatments such as cognitive behaviour therapy, in many areas these services have been cut, denying people access to expert treatment. GPs faced with limited referral pathways are being forced to refer patients to Camhs, knowing they are unlikely to meet the treatment criteria,” she said.
Almost two in five GPs (38%) said that, given the problems accessing Camhs care, they would recommend that patients whose families could afford it pay for private treatment.
Lamb said this was unacceptable. “Increasingly we are witnessing a growing divide between those with money who can pay for treatment and others who are just left waiting.”
NHS England sought to play down the findings. “This survey is ultimately based on the view of a tiny fraction of GPs – roughly just 3% – but the number of Camhs referrals is rising and the NHS is gearing up to meet that demand, with more children and young people seen than ever before, 22% more staff in services than five years ago and mental health front and centre in the NHS’s long-term plan,” a spokesperson said.
It has committed to ensuring that by 2020/21 35% of all under-18s seeking help get it, and it is adding another 150-180 inpatient beds for that age group and improving care for young people in crisis.
May has promised that further improvements to services, including giving schools a key role and introducing a new four-week waiting time for treatment, will be central to the NHS long-term plan, which is due to be published in early January.
A spokesperson for the Department of Health and Social Care said: “Supporting the mental health of our children and young people is a key priority for this government. We are ensuring that 70,000 more children a year have access to specialist mental health care by 2020/21. And we’re training a brand new, dedicated mental health workforce for schools to make expert mental health support available to a population of almost half a million young people.”