Seen but not heard: A qualitative interview study exploring the views and experiences of children and young people referred to Child and Adolescent Mental Health Services for support with suicidality

Suicide is a leading cause of death amongst children and young people (CYP), and numbers of CYP presenting with suicidality continue to rise. CYP seeking help for suicidal thoughts and behaviours are generally referred to Child and Adolescent Mental Health Services (CAMHS) for assessment and treatment. However, CAMHS across the UK are unable to meet the demand for their services. Little is known about what happens to these children after they have been referred to CAMHS. Grounded in critical realism, and informed by a children's rights approach and feminist perspectives, this qualitative study sought to explore how children and young people presenting with suicidality experience the CAMHS referral process and care journey thereafter. In-depth interviews of between 60-90 minutes duration, were conducted with ten CYP aged between 13-17yrs, living in two different health board areas in Scotland, and having been referred to two different CAMHS (sites A and B). Using Charmaz constructing grounded theory approach, analysis revealed three main themes which are presented: Nothing got resolved: the care experience; "If you had more choice…" about how, when and where they worked with you; The person not the profession who helped, each built upon layers of overlapping subthemes. Further interrogation of the data, and synthesis supported the development of a substantive theory, that conceptualises children and young people presenting with suicidality as "Seen but not Heard". It is argued that CAMHS do not meet these CYP needs even when they are seen. This finding has implications for policy makers and service providers as the CYP in this study express that the support they need and find most helpful is not congruent with CAMHS. Further research is urgently required to develop and design a new service model that better meets the needs of children and young people and prioritises their views.