Stick with us: Tackling missed appointments in children’s mental health services

Even today, there is still stigma for young people seeking treatment from mental health services. For the most vulnerable however, this can be just one of many barriers they face in seeking help for their mental health. Long waiting times, cost of travel, problems at home, and the consequences of traumatic experiences can
all make it difficult for young people to engage with a system that can seem distant, only responsive to crisis, and massively overstretched.

The result of these challenges in engaging with Child and Adolescent Mental Health Services (CAMHS) is often missed appointments. When children and young people miss an appointment, it can be a critical warning sign that they are at serious risk. It can be a sign that the system is not working for them. It can be a sign that they need extra support to be ready to engage in treatment. We cannot safeguard and help young people with mental-ill health if we cannot see them.

Too often, however missed appointments are seen as just an unavoidable consequence of a struggling system, or in the worst instances as the fault of vulnerable young people themselves.

This needs to change. If we do not properly engage our most vulnerable young people in their treatment and make mental health services work for them, we are
storing up problems for the future, at great cost to both society and to young people themselves.

Our analysis finds that approximately 157,000 appointments with specialist Child and Adolescent Mental Health Services (CAMHS) were missed by children and young people in 2016. As well as the direct impact of this on the children not receiving the help that they need, they also have a substantial economic impact –
costing specialist children’s mental health services over £45m a year.

Our previous research has found that it can be extremely difficult for children and young people to meet the thresholds required to access CAMHS. We estimate that
each year around 30,000 children and young people are turned away from children’s specialist mental health services. For those who are accepted as requiring treatment, our new data suggests that are waiting on average 58 days for an assessment and a further 41 days to begin treatment. Imagine coping with serious mental ill-health for that length of time – it is no surprise many young people give up on accessing CAMHS.

The response from CAMHS to missed appointments can be equally worrying. This report reveals that a significant proportion of missed appointments are not followed up on and that thousands of children and young people are discharged from services as a result of repeatedly missing appointments. This means that for many young people, their mental health needs are likely to deteriorate and may even reach crisis point. There are examples in Serious Case Reviews where young people have died in similar circumstances and repeat missed appointments have been identified as an important weakness in the safeguarding response the children in question received.

Our findings explore the effectiveness of approaches that are currently used in areas to help improve attendance such as arranging appointments in partnership with children, young people and their families. We also explore the role advocacy services play in supporting young people to get their needs heard, and in securing young people access to the help they require.

In order to improve access to children’s mental health services and reduce the frequency of missed appointments we need action from both national and local decision makers. National Government should make it mandatory for providers to follow up when a young person misses an appointment. This will end the current postcode lottery and ensure that no child is turned away and left at risk. Local decision makers should look to pilot new and innovative ways of making CAMHS more accessible for young people, for example through delivery in non-clinical settings and at flexible times that suit young people.

The problem of missed appointments is a symptom of a service that is struggling to engage some very vulnerable young people. Every professional, whether teacher, social worker, or mental health professional has a duty to safeguard the children in their care. In order to do this they must ensure they engage with them on an ongoing basis. Solving the problem of missed appointments will result in better services, better outcomes, and will help keep our young people safe.