A newly published report highlights that children and young people with significant mental health needs struggle to receive appropriate help or recognition of their difficulties within health services. The STADIA trial, reported in Health Technology Assessment, was led by researchers from the University of Nottingham’s School of Medicine.
Design And Scope
This large, multi-site study took place across England and followed 1,225 children and young people referred to Child and Adolescent Mental Health Services (CAMHS) for emotional difficulties over an 18-month period. Participants exhibited substantial mental health challenges: two-thirds (67%) scored very high for at least one emotional disorder, most commonly depression or an anxiety disorder. Yet, CAMHS assigned a clinical diagnosis of an emotional disorder in only 11% of cases.
Access And Delays In Care
The study revealed substantial barriers to timely care. Only 44% of referrals were accepted by CAMHS, and 35% of cases required a re-referral, indicating delays in receiving help. By 12 months post-referral, the cohort’s mental health difficulties remained severe, with persistent symptoms reported by youths and parents, ongoing functional impairment, and continued thoughts of self-harm.
At 18 months, just under half (47%) of participants had received any treatment or intervention from CAMHS. These findings raise concerns about the capacity of CAMHS to meet the needs of children and young people with high levels of emotional distress.
Expert Commentary
Professor Kapil Sayal, STADIA Chief Investigator and a member of the University of Nottingham’s School of Medicine, expressed concern that many youths with high mental health needs—particularly for depression and anxiety disorders for which evidence-based NICE guidance exists—struggle to access appropriate care and have their difficulties properly recognized. “One year is a very long time in a child’s life,” he said. “Delays in accessing the right care mean that distress and its impact on daily life are prolonged unnecessarily.”
Key Findings Beyond Access
Additional insights from the study include:
An online, standardized diagnostic assessment tool completed by young people and parents soon after CAMHS referral did not alter the likelihood of receiving a clinical diagnosis from CAMHS.
Parents, caregivers, and youths frequently described ongoing desperation for help due to persistent symptoms and their impact on daily life.
The online diagnostic tool was valued by families for helping them understand symptoms, and the resulting report was sometimes used as evidence to support needs with schools or general practitioners.
Digital diagnostic approaches are highly acceptable to families referred to CAMHS, suggesting a potential path to improve access to appropriate support—provided CAMHS investment keeps pace with demand to enable proper implementation.
Professor Sayal notes that referrals to CAMHS have risen substantially in recent years, particularly since the pandemic. This surge has coincided with limited capacity, delaying timely help for many who could benefit. Dr. Louise Thomson, STADIA qualitative and implementation lead, emphasized that hearing the experiences of families helped illuminate what they hope and expect from CAMHS referrals, especially regarding diagnostic clarity, and how this contrasts with clinicians’ preferred approaches in CAMHS.
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