Trust, access, and referral to CAMHS after a national look-back review: a mixed-methods study of GPs

Abstract Background Highly publicised reviews of child and adolescent mental health services (CAMHS) aim to improve safety and governance but may also shape professional and public perceptions of service quality and trust. General practitioners (GPs) are the main gateway to CAMHS, yet little is known about how reviews influence GP perceptions or referral and prescribing practices. Aim To examine Irish GPs’ perceptions of a highly publicised CAMHS look-back review and its reported impact on access, interprofessional communication, prescribing, and trust in CAMHS. Methods National cross-sectional mixed-methods online survey of GPs in Ireland, including qualified GPs, locums, and trainees. Survey domains, informed by Donabedian’s structure-process-outcome framework, captured communication, referral access, shared prescribing, and perceived changes before and after the review. Quantitative data were analysed using descriptive statistics, Wilcoxon signed-rank tests, and chi-square tests. Qualitative responses underwent inductive content analysis. Results A total of 208 GPs responded; most were based in Leinster and had over 10 years’ experience. Although 63.9% would bring their own child to CAMHS if needed, 93.8% rated access and 70.7% rated communication as poor. Following the review, GPs reported reduced caregiver willingness to accept referrals, reduced willingness to bring their own child, and greater concern about underprescribing, with little change in communication. CAMHS was viewed as difficult to access but high quality once accepted. Conclusions Highly publicised CAMHS reviews may influence trust, referral behaviour, and perceptions of prescribing safety in primary care. Improved communication, referral pathways, and GP–CAMHS collaboration are needed to rebuild confidence and support timely access.