New research from the University of Cambridge has revealed that many children and young people in England who are under child protection plans or in care are not receiving the mental health support they need. The study found that only 18% of these children had contact with mental health services in a given year, despite being at a much higher risk of experiencing serious mental health issues. In England, it is estimated that 18% of all children and young people have a probable mental health disorder, with about a third of these problems developing before the age of 14. However, fewer than half of those with a disorder received a referral to mental health services. Around 50,000 children and young people are on child protection plans, and 84,000 are in care, with previous research suggesting that up to half of them may have mental health problems that are clinically significant. The study, published in the journal Child and Adolescent Mental Health, analyzed data from NHS Digital covering referrals and contacts with mental health services between April 2016 and March 2021. During this time, nearly 2 million children and young people had contact with mental health services, with the number of contacts increasing each year. The most common reasons for referral included anxiety (13%), being in crisis (10%), depression (7%), neurodevelopmental conditions (6%), and self-harm (6%). However, in two-thirds of cases, the primary reason for referral was not recorded. Children on child protection plans or in care were found to be two to three times more likely than their peers to have contact with mental health services. Yet, only 9% to 18% of these children had contact with services in any given year. Researchers suggest that child and adolescent mental health services (CAMHS) may be reluctant to accept referrals for children involved with child welfare services, leaving the responsibility on child welfare agencies and families. Some cases show that referrals were rejected because the children’s needs were seen as too complex or tied to their social circumstances. For example, a 12-year-old girl in residential care who had attempted suicide was considered too complex for specialist support, and a 12-year-old boy who ran away from his foster home was denied access to CAMHS, as his issues were seen as the responsibility of child welfare services. Professor Robbie Duschinsky from the University of Cambridge noted that many children with mental health challenges are not offered treatment because their living situations are considered too complex or are viewed as the domain of child welfare services. The study also found that contact with mental health services tended to plateau or decrease between the ages of 17 and 18, a period of high risk for mental illness. Possible reasons include a lack of advocacy for young people at this age and the tendency to respect their wishes if they are not interested in engaging with services. Additionally, children and young people who identified as Asian or Black were less likely to be in contact with mental health services than expected based on population estimates. Dr. Barry Coughlan, the study’s first author, emphasized that while the demand for mental health services is rising, many children—especially those at higher risk—are not receiving the referrals or support they need. He stressed the importance of early intervention during the teenage years to prevent long-term mental health problems. The study also found some evidence—though not fully conclusive—that children on child protection plans or in care were more likely to have contact with mental health services in 2020–21 compared to 2019–20, suggesting that the impact of the pandemic and public health measures was more pronounced for these vulnerable individuals. The researchers highlighted the potential of routinely collected data to identify and address health inequalities.