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13 September 2018, 06:22 | Updated: 13 September 2018, 06:26
Mental health services for children and young people are "complex and fragmented", with the system under "significant pressure" due to a big increase in demand, a new report has found.
The Auditor General and the Accounts Commission called for a "step change" after their joint report uncovered patchy provision of services such as school counselling, and increased waiting times for specialist treatment.
The Scottish Government has pledged to take action, including £100 million of new funding targeted at improving support for children and young people.
The report found the current system of support is geared towards specialist care and responding to crisis, with "limited" action around early intervention and prevention.
It found demand for specialist services has risen by 22% since 2013/14, while children and young people are waiting longer to begin treatment.
Just over a quarter of those who started treatment in 2017/18 waited over 18 weeks - the Scottish Government's referral to treatment waiting time target for child and adolescent mental health services (CAMHS).
Meanwhile, average waiting times for a first treatment appointment increased from seven to 11 weeks between 2013/14 and 2017/18.
The report also noted that while children and young people are waiting, they may receive "little or no support or advice".
The number of rejected referrals has also risen, up 24% since 2013/14.
"It is difficult for children and young people, their parents and carers, and professionals to understand how the referrals process works," the report stated.
It found children can "drop out" of the system during the process.
"For example, if their referral is rejected, or if it is accepted but they do not opt in to services, there is no routine monitoring of what then happens to them."
Services to prevent and intervene early in mental health problems, such as school counselling, are patchy across Scotland, the report found.
"While it is important that local areas have the flexibility to respond to local need, the level of variation raises questions about equity of access to services in different parts of Scotland," it stated.
Auditors also found it was not possible to identify total spending on CAMHS, and assess the effectiveness of services.
Caroline Gardner, the Auditor General, 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.
"For this to happen, a step change is required in the way services respond to the needs of children and young people."
Ministers have been under pressure to address issues around access to services and rejected referrals in recent months.
Data published earlier this month showed waiting times were the worst on record between April and
Meanwhile, a government-appointed taskforce this week made a series of recommendations including immediate action to address issues with rejected referrals, a stronger focus on prevention and early intervention, and better data quality.
Additional funding will help provide counsellors in every secondary school, 250 more school nurses and training for teachers among other measures.
Mental Health Minister Clare Haughey welcomed the report, adding "too many children and adolescents are being let down".
"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," she added.
Scottish Conservative mental health spokeswoman Annie Wells said: "We've had plenty of warm words from the SNP government on this, but it's now time to see these changes actually happen."
Scottish Labour health spokesman Anas Sarwar said: "The additional funding and counsellors announced in the programme for government is a start, but it is clear we are still some way off seeing mental health services treated with parity of esteem with acute services."
Alison Evison, president of local government body Cosla said: "Cosla welcomes the report and will work with partners to consider the recommendations made."