Record High Refusals in Child Mental Health Referrals
New data reveals a record number of referrals have been declined by NHS specialist child mental health services in Scotland.
According to Public Health Scotland (PHS), 1,274 referrals to Child and Adolescent Mental Health Services (CAMHS) were not accepted in March, marking the highest monthly figure ever recorded.
This upward trend in rejected referrals also culminated in an all-time yearly peak in 2025.
The Scottish government's Mental Wellbeing Minister, Maree Todd, stated that CAMHS is intended for a small subset of young people experiencing serious mental health challenges. Since 2020, over £80 million has been invested in community-based mental health support services.
However, medical professionals and charities caution that the rising number of rejected referrals highlights deficiencies in alternative mental health provisions for young people, potentially leaving some at risk of crisis without adequate assistance.
Personal Experience of Referral Rejection
Élise Graham's referral to NHS specialist child mental health services was declined when she was 14 years old.
Following her parents' divorce, Élise struggled with her mental health but eventually confided in a teacher who referred her to CAMHS.
"I had knots in my stomach all the time, I felt sick getting out of bed, going to school," she recalled. "I was just like, what do I do now?"
"It feels really humiliating because I opened up to all these people and it was really hard to look at it all and think 'this is what I'm going through and you still don't think it's enough'."
Her referral was rejected in 2019 due to insufficient evidence, leaving her "absolutely distraught."
While she did receive some support from her general practitioner and four counselling sessions at school, Élise described the assistance as fragmented.
She advocates for expanded mental health support for young people to ensure that "everyone can get the support they deserve" and hopes to assist others by sharing her experiences.
"I don't want anyone else to feel the way that I did," she added.
Now aged 20, Élise has gained confidence through her role as an ambassador for Scottish Action for Mental Health (SAMH) and by participating in beauty pageants.
She was a Miss Great Britain Glasgow finalist in 2026.
Progress and Challenges in CAMHS Waiting Times
In March of the previous year, the NHS met a government target for the first time, with 90% of children receiving a first assessment by CAMHS within 18 weeks.
Professionals working in this sector welcome this progress but caution that it does not fully represent the situation.
Dr Laura Sutherland, vice-chair of the CAMHS Faculty for the Royal College of Psychiatrists in Scotland, noted increased pressures on the service, with patients presenting more complex conditions and higher levels of distress.
She explained that children treated often have multiple mental or developmental disorders, including eating disorders, psychosis, or depression.
Dr Sutherland emphasized the importance of other support services, such as counselling for bullying, to help prevent the development of mental illness and reduce future CAMHS demand.
She suggested that investigating the reasons behind the rising number of rejected referrals would be beneficial.
In 2018, when approximately 20% of referrals were declined, the Scottish government commissioned an audit.
One recommendation from the report stated: "In a well-functioning system, there should be no need for rejected referrals. However, if they do occur, the Scottish government should require personalised and meaningful signposting to be mandatory."
Between January and March of this year, 37% of referrals were rejected.
Concern Over Unmet Mental Health Needs
Over the past four years, the number of referrals accepted by CAMHS has decreased annually.
Conversely, the number of rejected referrals has either increased or remained steady during the same period, reaching a record high of 11,067 in 2025.
Dr Katie Cathrow, vice chair of the Royal College of GPs Scotland (RCGP), described the "unmet need" in youth mental health as "very evident" and called for increased funding.
She advocated for a broader range of options, including consistent community services, for those whose referrals to CAMHS are declined.
"Rejected referrals can add to a patient's feelings of being unworthy of help, however unintended," Dr Cathrow said.
"Everyone should feel comfortable seeking support if they are at all concerned about their mental health and we need to ensure there are enough onward services to refer people on to if required."
Mental Wellbeing Minister Maree Todd reported that nearly 80,000 children, young people, and family members accessed community-based mental health support in 2024-25.
She also commended the "sustained and significant improvements in waiting times," noting that the longest waits had fallen to their lowest level since 2015, but acknowledged that "there is still more to do."
Scottish Labour mental health spokesperson Joe Long expressed concern over the high number of children and young people being turned away from services when in need.
"It is deeply concerning that so many children and young people are being turned away from services in their hour of need," he said.
"The Scottish government need to investigate why the number of rejected referrals is so high and ensure young people are not allowed to fall through the cracks when they need support."
