The NIHR has released new research into CAMHS referrals
The EN-CAMHS (Enhancing referrals to Child and Adolescent Mental Health Services) mixed-methods study aimed to understand the current problems with Child and Adolescent Mental Health Services (CAMHS) referrals and identify effective solutions to improve their success.
Overarching Conclusions and Recommendations:
- There is an urgent need to revise the CAMHS referral process.
- Children and young people should be at the centre of the referral process, focusing on their needs rather than just a diagnosis.
- Implementing a nationally standardised but locally configurable digital platform could address many of the current problems. This platform should provide clear information requirements, guidance for referrers, account for diversity, include input from young people and families, link to local resources, and offer transparency on referral progress.
- Improved public health messaging around psychological distress in young people is needed to reduce parental fear and promote understanding of alternatives to CAMHS.
- Future work should aim to co-design and evaluate a digital referral form linked to stakeholder resources to improve clarity, accessibility, and efficiency
Reference: Abel KM, Whelan P, Carter LA, Tranter H, Stockton-Powdrell C, Gutridge K, et al. Enhancing referrals to Child and Adolescent Mental Health Services: the EN-CAMHS mixed-methods study. Health Soc Care Deliv Res 2025;13(21). https://doi.org/10.3310/GYDW4507
The Ripple Effect: How CAMHS Referral Issues Impact Mental Health in Education
The EN-CAMHS study sheds critical light on the persistent challenges within Child and Adolescent Mental Health Services (CAMHS) referrals. Its findings paint a picture of a system struggling to meet the growing mental health needs of young people, with significant implications for the educational sector over the next 12 months.
The Current Landscape: A System Under Strain
The quantitative data from the study is stark: nearly one-quarter of the 497,502 children referred to NHS CAMHS between 2020 and 2021 had their referrals rejected. This translates to over 124,000 young people not accessing the support they sought. This high rate of unsuccessful referrals, coupled with the considerable variation across NHS Trusts (ranging from 5% to 31%), highlights a fragmented system. GPs are the largest source of referrals (approximately 43%), yet their referrals are more likely to be unsuccessful than those from educational or social care settings. This suggests a potential disconnect between primary care and specialist mental health services.
Furthermore, the qualitative findings reveal the underlying issues contributing to these figures. Confusion about CAMHS’s purpose, lack of transparency, poor communication, and long waiting times are pervasive problems. These issues create a cycle of distress for young people and their families. The perception that CAMHS is the “gold standard” means that when referrals are unsuccessful, families are often left feeling isolated and without alternative support, with 5 times higher unsuccessful referral rates for emotional and behavioral difficulties in some trusts. The study also found that younger children are more likely to have an unsuccessful referral across all Trusts, indicating a critical gap in early intervention.
Implications for Education in the Next 12 Months
The findings of the EN-CAMHS study have profound implications for mental health in education over the coming year:
Need for Enhanced Collaboration and Training: The study highlights the urgent need for seamless communication and interoperability between multi-agency services. In the next year, there will be an even greater impetus for schools to forge stronger links with local mental health charities, community services, and even general practitioners, to create more effective referral pathways and ensure young people are signposted to appropriate support, even when CAMHS is not an option. Furthermore, there will be a greater need for schools to provide enhanced mental health training for all staff to better identify, understand, and respond to student needs.
Increased Pressure on School-Based Support: With a significant proportion of CAMHS referrals being unsuccessful, schools will inevitably bear the brunt of unaddressed mental health needs. School counsellors, pastoral teams, and Special Educational Needs Coordinators (SENCOs) will likely see an increase in demand for their services as families seek alternative avenues of support. This could lead to an overburdening of already stretched school resources.
Deterioration of Student Well-being and Academic Performance: Long waiting times for CAMHS assessments and subsequent therapy mean that young people’s mental health difficulties often deteriorate before they receive specialist help. This can manifest in increased anxiety, behavioural issues, difficulty concentrating, and reduced engagement in learning. Teachers may observe a rise in students struggling academically and emotionally, potentially leading to increased absences and exclusions.
Heightened Stress for Educators: Teachers and support staff are often the first to identify mental health concerns in students. The current system, with its lack of clear referral pathways and feedback, can leave educators feeling frustrated and disempowered. In the next 12 months, this is likely to lead to increased stress and burnout among school staff as they grapple with supporting students whose complex needs are not being met by external services.
Challenges in Early Intervention: The finding that younger children are more likely to have unsuccessful referrals is particularly concerning for primary education. Early intervention is crucial for preventing mental health issues from escalating. If early referrals are consistently rejected, schools will need to find more robust internal strategies for identifying and supporting young children with emerging mental health difficulties.
Moving Forward: A Call to Action
The EN-CAMHS study’s recommendations for standardised digital platforms, clearer information, and improved communication are crucial. In the next 12 months, the educational sector must actively advocate for and participate in the co-design and implementation of these solutions. By putting children and young people at the centre of the referral process and focusing on their needs rather than just a diagnosis, we can hope to mitigate the adverse implications of the current system and foster a more supportive environment for mental health in schools.
The Team at AMHIE
1st July 2025
Additional Resources
Here at AMHIE we will be attempting to help combat the barriers that teams may be facing in reducing CAMHS referrals through increased resources and training. We have a range of training available for a variety of roles and phases that will help equip you to succeed in your role.
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