Pathways into child and adolescent mental health services for anxiety and depression: The role of social and educational factors

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Anxiety and depression are increasingly prevalent among young people and significantly impact their lives. However, research on the referral pathways into Child and Adolescent Mental Health Services (CAMHS) for young people with these disorders, and how these pathways vary according to socio-demographic characteristics, remains limited. Moreover, few studies have examined whether educational factors are associated with these referral pathways. Therefore, this study aimed to examine the relationships of sociodemographic and educational characteristics with CAMHS referral pathways for anxiety disorders and depression. We used routinely collected educational data linked with CAMHS records from South London and Maudsley NHS Foundation Trust, focusing on young people aged 12-17 years with clinical diagnoses of anxiety disorders and depression (N = 4,169). Using multinominal logistic regression, we identified that referral pathways to CAMHS are associated with various sociodemographic and educational factors. Specifically, youth with lower educational attainment, school exclusion, or SEN status, were more likely to be referred to CAMHS through education. This suggests that educational services may be a key referral pathway for young people in need of mental health support for anxiety and/or depression and referring to CAMHS. However, Black young people, those who speak English as an additional language (EAL), individuals eligible for free school meals (FSM), and young people under the care of local authorities were more likely to be referred via social care or youth justice services. Also, older young people, females and those under the care of local authority showed a higher likelihood of being referred via emergency services rather than primary care. These findings highlight that efforts to identify problems earlier through primary care or education services could benefit for those young people who are more frequently referred via emergency or social care/youth justice routes. Further research is needed to examine the potential under-utilisation of certain referral pathways by specific groups, in order to improve accessibility and ensure that more young people can access effective mental health care.

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