COMPLEX, fragmented and “under significant pressure” – Audit Scotland today reveals the strain on child and adolescent mental health services (CAMHS).

Auditor General Caroline Gardner has called for a “step change” in response to figures which show referrals to specialists have risen by more than 20% since 2013-14.

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And vulnerable young Scots had to wait an average of 11 weeks for their first treatment appointment in 2017-18.

In worst placed NHS Grampian, the delay rose to a massive 21 weeks – more than five months.

Mental Health Minister Clare Haughey – who worked as a nurse in this area of healthcare – said youngsters are being let down and vowed to improve services.

The Rutherglen MSP said: “Mental health is a priority for this government and I am determined that we will address the issues affecting the care of young people.”

But the Scottish Children’s Services Coalition said: “The dismal state of mental health services is Scotland, as outlined in this report, means that many children and young people are simply not getting the care and support they need, when they need it.”

Toni Giugliano of the Mental Health Foundation Scotland commented: “Referral pathways to CAMHS are still patchy and inconsistent across the country, referrals are increasingly rejected with few alternatives provided by professionals, data gathering is limited and waiting lists are getting longer.

“The status quo is not sustainable.”

Labour’s Anas Sarwar also attacked the First Minister, calling the report “a mark of shame” for her Government and adding: “Mental health services for children and young people have gone backwards under Nicola Sturgeon. It is a national scandal that standards for waiting times have never been met for these services.

“These figures are disgraceful and are a result of years of SNP inaction.”

According to the report, carried out with the Accounts Commission, an additional 6000 referrals have been made to specialist services over the last five years.

Rejected referrals are also up by around one quarter, with access varying around the country.

And while around £56.6 million was spent by the NHS on this area of care in 2016-17 – a £6m boost – the report says poor financial and performance data means it is difficult to identify how much is being spent on services or the difference they are making.

Meanwhile, approaches to referrals and even the age of those treated differs between health board areas. While patients aged up to 18 are treated under CAMHS in most of the country, this is limited to 16-year-olds in other parts, with older teenagers only included if they are in full-time education.

Other exceptions can be made for patients with learning difficulties.

And though urgent referrals can trigger a response within two hours in NHS Orkney, this rises to four weeks in NHS Forth Valley.

Gardner said: “The mental health system is complex and fragmented, making it difficult for children, young people and their families to get the support they need.

“Improving mental health and wellbeing is a public health priority for the Scottish Government.

“A step change is required in the way services respond to the needs of children and young people.”

The Scottish Government’s recent programme for government included £100m for young people’s mental health, as well as measures to help prevent children reaching “crisis point”. This includes secondary school counsellors and extra mental health help for women during pregnancy and after giving birth.

Welcoming the report, Haughey said: “Dedicated mental health professionals provide high quality care to our young people across Scotland every day. But despite this, too many children and adolescents are being let down by the current system.

“I have been clear that this is unacceptable and that we must look at making the changes necessary to ensure young people get the care they need and deserve.”