Vulnerable adolescents face sharp drop in mental health service access

Some of the most vulnerable children and young people are failing to get access to mental health support despite much higher levels of need, according to new research from the University of Cambridge.

Despite children and young people on child protection plans or in care being significantly more likely to have serious mental health issues, less than one in five of these individuals had contact with mental health services in a given year.

In England, just under one in five (18%) children or young people are estimated to have a probable mental health disorder. A third of mental health problems start before 14 years, so getting timely access to appropriate mental health services is a key priority. Yet, fewer than half of children and young people with a probable mental health disorder get a referral.

Nearly 50,000 children and young people are on child protection plans and 84,000 are in care. Often because of their background and circumstances, which can involve abuse and neglect, these individuals are at increased risk of mental health difficulties. Previous studies have suggested that up to half will experience mental health problems at a clinically significant level.

Researchers at the Department of Public Health and Primary Care, University of Cambridge, analyzed data from NHS Digital for all children and young people in England referred to or receiving support from mental health services between April 2026 and March 2021. Their findings are published in Child and Adolescent Mental Health.

During this period, almost 2 million children and young people were in contact with mental health services, with figures rising year-on-year. The most common referral reasons were anxiety (13%), 'in crisis' (10%), depression (7%), neurodevelopmental conditions (6%) and self-harm (6%). The primary reason for referral was not recorded in two-thirds (67%) of cases.

Children on child protection plans or in care were found to be two to three times more likely than their peers to have contact with mental health service, yet the report's authors say that only around 9-18% of these children had contact with mental health services in a given year.

One possible reason is that child and adolescent mental health services (CAMHS) can be hesitant to accept referrals for children and young people involved with children's social services, leading social services and families themselves to bear the brunt of shortcomings in mental health provision.

Recent research by the team found that individuals in this group were often rejected from mental health services as their needs were viewed as too complex or relating to their social situation. For example, one 12-year-old girl living in residential care who had been referred to CAMHS due to a suicide attempt was deemed too complex to receive intensive specialist support. In another case, a 12-year-old boy was brought into A&E after a suspected overdose and running away from his new foster placement; his access to CAMHS was rejected as it was judged that his problems related to his social situation, and hence a matter for child social services.

Professor Robbie Duschinsky, Head of the Child Health & Development Research Group at the Primary Care Unit, University of Cambridge, said: "Through our work, we've encountered countless cases of children and young people with mental health difficulties not being offered treatment because their living situation is judged too complex or a matter for child social services."

The team also found that contact with mental health services appeared to plateau or decline at ages 17-18, despite late adolescence being a high-risk period for mental illness. They suggest several possible reasons for this, including a lack of advocacy for children and young people at this age, but also that at this age young people who do not want to engage with mental health services will have their wishes respected.

Additionally, there was evidence of health inequalities among different groups, with children and young people who identified as Asian or Black less likely to be in contact with mental health services than might be expected based on population estimates.

Dr Barry Coughlan from the Department of Public Health and Primary Care at the University of Cambridge, the study's first author, said: "We're seeing a steady increase in demand for mental health services in England, but many children and young people – and in particular, some of those who are most at risk – are not getting the referrals or the support they need.

Many mental health problems first arise during teenage years, so it's crucial that we do everything we can to support people at this vulnerable age. If we're not able to intervene and help young people when they first need it, these risk becoming long-term mental health problems that affect them long into adulthood, and often becoming increasingly severe, including self-harm and attempted suicide."

Dr. Barry Coughlan, Department of Public Health and Primary Care, University of Cambridge

There was some evidence – though not fully conclusive – that children and young people on child protection plans or in care were more likely to be in contact with mental health services in 2020-21 compared to the previous period (2019-20). This suggests that the impact of COVID-19 and the associated public health measures was felt more sharply by these vulnerable individuals.

The researchers say this is the first time that child mental health data from NHS Digital has been used for research and shows the power of routinely collected data to highlight significant health inequalities.

The research was funded by Wellcome and the British Academy. Professor Duschinsky is a Fellow and Director of Studies at Sidney Sussex College, Cambridge.