Researchers based at UCLPartners and at the Anna Freud National Centre for Children and Families are investigating possible interventions to support young people while they are waiting for clinical mental health support, so they don’t have to reach the front of the waiting list before their recovery can begin.
When a child or young person is referred to Child and Adolescent Mental Health services (CAMHS) for issues such as anxiety, low mood or self-harm, treatment may not start for several months or, in some cases, over a year. As well as ongoing distress to the young person, the delay can compound their problems, leading to further distress and more intensive treatment.
‘You’ve got a moment of opportunity, if you intervene early, to help things before they escalate,’ says child mental health expert Professor Miranda Wolpert MBE. ‘Without that early input, things can develop into a negative spiral: a young person feels so low that they’re not going to school, then they don’t see their friends, then they lose contact with people… and everything starts to fall apart.’
Miranda is leading the Referrer Support Project as part of her role at UCLPartners involving colleagues at the Anna Freud Centre. The project is investigating what support is available to young people during that waiting period (and for those who choose not be referred), focusing on what is provided by the referring agency – schools, GPs, social services or other community services. This, in turn, is leading them to look at what resources these referrers have access to, so they can give young people the support they need.
Project officer Rosa Town explains: ‘GPs are responsible for as many as 80 per cent of all CAHMS referrals. Neither GPs nor schools feel they have easy access to resources to help young people and parents once a referral has been made, but GPs appear less likely to view this as their role. Instead, they focus on assessing risk and managing the process, and want better communication from CAMHS such as updates on waiting lists, to help them do that.’
Once more detailed findings emerge, the team plans to develop some form of support – perhaps a digital resource – to support GPs, schools or both to support young people on CAHMS waiting lists. The project may also open up new pathways, says Rosa: ‘There’s a real possibility that in some cases CAMHS might not be the best answer. If, having referred the young person, the school or GP engaged them in a shared decision-making process around their preferences and values, there might be self-care or social prescribing options that could meet their needs either while they wait or instead of CAMHS.’
This relates to a wider issue, says Miranda: ‘The system is set up at the moment for referrers to say, “I’m not a mental health professional, I don’t really know what’s wrong or how best to help you. Wait for these magic people in CAMHS: they’ll be able to help you.” So in fact the person gets less support once they are on the list, when they could be accessing things to help. Then as they wait, the expectations of the young person and their family build and build, but when they finally receive treatment, it may not be all those things: after leaving active treatment with CAMHS, about 50 per cent of young people show improvement.
So this project is also about re-conceptualising that conversation, says Miranda: ‘Rather than saying “You’re waiting for this gold standard and everything else is second best”, we can say “You’re on the list, but this may not be the only answer, and there may be other things you can try while you’re waiting.”’
Having gathered the data, the team will be developing a resource to help plug the gap. ‘Ultimately, we want to empower frontline practitioners, whether schools, GPs, social workers or health visitors, to know what the range of available options are and how to support someone,’ says Miranda ‘If we could support referrers, they wouldn’t feel so helpless,’ she says, ‘and nor would the young people.’
This project forms part of UCLPartners work on healthcare innovations that use data and those that focus on improved care for mental health.