Major drop off in referrals to children’s mental health services

Birmingham Women’s and Children’s Foundation Trust which runs child and adolescent mental health services for Birmingham, has seen a 50 per cent reduction in referrals since the covid-19 crisis first struck in March, sources have confirmed.

Speaking with HSJ, Bernadka Dubicka, chair of the child and adolescent faculty at the Royal College of Psychiatrists said: “In some areas the drop off is probably more.

“Where I am, before the covid-19 crisis we were getting about 40 referrals a day and in the week 30 March we were getting less than 10 a day. We were overloaded with referrals prior to this and it was really difficult to process them but the week after the crisis it dropped off to very few.”

It is not clear why referrals to services have dropped. In most cases referrals to CAMHS will be made by a child’s GP or school, however, some services do run a self-referral option. 

Talking about the impact Dr Dubicka said: ”We don’t know which direction this is all going to go in terms of future referrals, this might be the calm before the storm, it’s difficult to tell, but we need to try and prevent a future escalation as much as we can.

“I think the message is that services need to be offering as much as they can remotely during these difficult times, and letting families know about what resources are out there already. There is a lot of additional online support and information as well such as Young Minds, Kooth and Minded.org.uk. We have to see how things pan out in the coming weeks, whether we do start to see an escalation in presentations is very difficult to know.”

The news comes amid national concerns patients needing serious medical care not attending emergency departments or missing vital appointments, which has prompted NHS England to set up a taskforce to monitor the impact. 

Reductions in CAMHS referrals also come as most services have closed routine face to face appointments due to covid-19 risks. However, not all services are able to provide digital or phone consultantion to children and their families yet.

Dr Dubicka said there were differences in what CAMHs services offered across the country, adding the “variability [in access] is probably due to a lot of factors, including how well staffed services were in the first place and rates of self-isolation. The other variability will be how well-equipped services are in terms of remote consultations…Some trusts don’t have electronic records or electronic prescribing which makes it much harder. Even when you do have access to electronic records there’s such an overload on the system it can be hard to access. “

In a statement to HSJ, Alex Borg, director of mental health services, and Elaine Kirwan, deputy chief nurse, mental health services for BWCHFT said: “We anticipate that this will be temporary and are monitoring the situation carefully preparing to scale up the service for any rapid rise in referrals.

“Our services, continue to be well placed to deliver inpatient care and treatment to the young people of Birmingham. Despite the challenges that covid-19 present, we continue to adapt to ensure continuity of treatment and therapy. It’s really important that any young person who feels psychologically distressed, anxious or feels they need help accesses the support available to them via our website.”

Decrease in IAPT

Several commissioning leads also said they had seen a drop off in referrals to IAPT services. In both West Yorkshire and East London sources said they had seen a 30 per cent reduction.

The reductions come as NHS England prepares to ramp up IAPT services. In a letter sent on 26 March, seen by HSJ, NHS England’s national director for mental health, Claire Murdoch, advised commissioners and region leads to prepare IAPT services for “increased demand, both immediately and into the future; likely to come in waves with different focuses, eg impact of self-isolation, PTSD, bereavement, trauma”.

The letter added services should ”continue to grow the IAPT workforce which will be required to deal with mental health implications of covid-19”. 

However, according to the letter commissioners are not currently required to assure performance against the national IAPT standards.

A spokesman for NHS England and NHS Improvement said: “Patients have rightly responded to the expert advice on staying at home, but they should seek medical help whenever they need it and talking therapies and CAMHS, which are maximising digital options and developing 24/7 phone lines, are still open for business and can help prevent escalating to crisis point.”