Reports of child sexual abuse are at an all-time high in the United Kingdom. There were 115,000 reported sexual offences against children under 16 made to police in 2024. In 2025, the Children’s Commissioner has gone as far to state that peer to peer sexual abuse has become “normalised” in schools.
Despite growing public visibility of the problem, our recent work has identified startling inequalities in access to statutory mental health provision for young survivor-victims seeking support. Our analysis was based on information of 26,160 young people who received a brief risk assessment from one large, urban Child and Adolescent Mental Health Service (CAMHS). We found that of the 1,836 young people who were identified as having experienced sexual violence 80% (n=1,465) did not receive subsequent care.
These counter-initiative findings are disconcerting given what we know about the prevalence and devasting impact sexual violence can have on young people. While prevalence rates vary and reflect under-reporting, the Centre of Expertise on Child Sexual Abuse predicts that 5-20% of girls and 7-8% of boys will experience some form of sexual violence before their 16th birthday. While it impacts young people differently, it is a key predictor of suicidal distress, depression, PTSD, metabolic and respiratory diseases, as well as risk of further abuse. Socially marginalised young people face a double disadvantage of being at greater risk for both sexual assault and psychiatric disorders.
Rejecting young people’s request for support following a disclosure of sexual violence may have serious consequences. We know that service rejection can leave young survivor-victims feeling that they are “the problem”, contributing further to feelings of shame, self-blame, and isolation, responses commonly associated with the experience of sexual violence itself. We also know that where disclosures of sexual violence result in negative responses, young people are far less likely to trust formal services and to pursue future help.
Working alongside survivors and informed by the current evidence base we’ve tried to make sense of these inequalities in service provision.
Under resourcing of children’s mental health care
The decision to not offer provision to young people with experiences of maltreatment may stem from a variety of factors. One is likely the high and narrow service thresholds that result from sustained underfunding of children’s mental health services. While children make up 20% of the population, they account for only 9% of overall mental health spending. This is in a context of a dramatic 353% rise between 2016 and 2024 of referrals to CAMHS. Coupled with increasing austerity measures shaping public services in the UK, mental health care has become increasingly rationed to young people with a distinct diagnosable mental health concern, who are viewed as being at risk to themselves or others and as having mental challenges that are resolvable in a relatively short number of sessions.
A byproduct of such an approach is that young people with more complex challenges, including experiences of sexual violence, may face systemic barriers to having their mental health needs addressed. Our recent qualitative analysis of 70 sets of clinical notes of young people with safeguarding needs, found that sexual violence, and other forms of maltreatment, contributed to needs being framed as “social” rather than “psychological”. This distinction was in turn used to justify the decision to not provide mental health care. Rape Crisis England & Wales have similarly identified CAMHS’s stringent eligibility criteria, lengthy waiting lists, relatively short intervention duration as impacting their ability to provide suitable care.
Assumptions around therapy readiness
Our research also indicates that a problem lies with attitudes held by organisations and professionals. We found that professionals frequently queried whether young people who had experience sexual violence were in a sufficiently stable place to benefit from therapy due to their high levels of distress and/or concerns around whether their caregivers could support the psychological intervention. Assumptions about these young people’s “complexity” and anticipation about their complicated recovery journeys were also cited as reasons for their referral to not be accepted. These assumptions may be true. But they also might not be. Our research has found that children with experiences of maltreatment benefit from CAMHS provision no less than children without experiences of maltreatment. There is a need for critical questioning of the assumption that children and young people with experiences of sexual violence would not benefit from support from CAMHS.
Someone else can help better
The third assumption that we’ve heard time and again from our practitioner consultations around our findings is that CAMHS services tend to refer young people who have experienced maltreatment to other services who they feel will be better placed to respond to their needs. This is amplified in the case of sexual violence where both organisational and professional anxieties are rife, and reinforced by limited training on the subject, which potentially results in professionals feeling ill equipped to support young people who disclose sexual violence.
The issue with this outsourcing tendency is that CAMHS is not the only service that has been affected by austerity. The Centre for Expertise on Child and Sexual Abuse have found that the the specialist sexual violence sector identified the lack of stable funding as the most important factor inhibiting their ability to support more children and young people affected by sexual violence. As such, we have found that signposting a young person onto another service, while intended as a gesture of care, often results in them falling through service gaps.
How can we improve access and service delivery?
- Fund services sustainably There is a clear need for increased funding to increase mental health provision for young people who have experienced sexual violence. This year the government has announced new initiatives to improve care provision including the new Violence Against Women and Girls strategy which has committed £50 million in the next three years to extend the integrated Child House Model across every NHS region. We think existing structures, including CAMHS and grass-roots sexual violence charities also need to benefit from funding injections of sustained and unrestricted core funding that enables long-term care provision for young people who have experienced sexual violence. This is key because young people and their carers/advocates deserve a choice of diverse, flexible and long-term provision that meets their range of needs and circumstances.
- Embed trauma competency and shame sensitivity training There is an urgent need for improved trauma competency and shame sensitive training that provides professionals with the skills, understanding and confidence to holistically support young people with experiences of sexual violence in their services. Part of this might also be about moving away from a diagnosis model and scaffolding service rejection in a more sensitive way, given we recognise that some referrals will always be turned away. Commissioners of service also need this training to ensure that services are not designed in a way that retraumatise those seeking care.
- Centre young survivors expertise Fundamentally, young survivor-victims must be included in policy and academic discussions about ways to improve access and service delivery. This is something survivors themselves have requested and will help to counter the “persistent marginalisation” of young survivors’ voices in research and policy. We also endorse the development and funding of lived experience youth survivor advisory groups in NHS Trusts to ensure their expertise is fed into every step of the re-design process.
About the authors: Tessa Morgan is an Early Career Wellcome Fellow in the Child Health and Development Group, University of Cambridge. Her research focuses on improving mental health care for young people who have experienced sexual violence.
Julia Mannes is an NIHR Doctoral Research Fellow in the Child Health and Development Group, University of Cambridge. Her research focuses on access to Child and Adolescent Mental Health Services.
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Why are children who have experienced sexual violence being denied access to mental health support?
by Tessa Morgan and Julia Mannes Jul 29, 2026Reports of child sexual abuse are at an all-time high in the United Kingdom. There were 115,000 reported sexual offences against children under 16 made to police in 2024. In 2025, the Children’s Commissioner has gone as far to state that peer to peer sexual abuse has become “normalised” in schools.
Despite growing public visibility of the problem, our recent work has identified startling inequalities in access to statutory mental health provision for young survivor-victims seeking support. Our analysis was based on information of 26,160 young people who received a brief risk assessment from one large, urban Child and Adolescent Mental Health Service (CAMHS). We found that of the 1,836 young people who were identified as having experienced sexual violence 80% (n=1,465) did not receive subsequent care.
These counter-initiative findings are disconcerting given what we know about the prevalence and devasting impact sexual violence can have on young people. While prevalence rates vary and reflect under-reporting, the Centre of Expertise on Child Sexual Abuse predicts that 5-20% of girls and 7-8% of boys will experience some form of sexual violence before their 16th birthday. While it impacts young people differently, it is a key predictor of suicidal distress, depression, PTSD, metabolic and respiratory diseases, as well as risk of further abuse. Socially marginalised young people face a double disadvantage of being at greater risk for both sexual assault and psychiatric disorders.
Rejecting young people’s request for support following a disclosure of sexual violence may have serious consequences. We know that service rejection can leave young survivor-victims feeling that they are “the problem”, contributing further to feelings of shame, self-blame, and isolation, responses commonly associated with the experience of sexual violence itself. We also know that where disclosures of sexual violence result in negative responses, young people are far less likely to trust formal services and to pursue future help.
Working alongside survivors and informed by the current evidence base we’ve tried to make sense of these inequalities in service provision.
Under resourcing of children’s mental health care
The decision to not offer provision to young people with experiences of maltreatment may stem from a variety of factors. One is likely the high and narrow service thresholds that result from sustained underfunding of children’s mental health services. While children make up 20% of the population, they account for only 9% of overall mental health spending. This is in a context of a dramatic 353% rise between 2016 and 2024 of referrals to CAMHS. Coupled with increasing austerity measures shaping public services in the UK, mental health care has become increasingly rationed to young people with a distinct diagnosable mental health concern, who are viewed as being at risk to themselves or others and as having mental challenges that are resolvable in a relatively short number of sessions.
A byproduct of such an approach is that young people with more complex challenges, including experiences of sexual violence, may face systemic barriers to having their mental health needs addressed. Our recent qualitative analysis of 70 sets of clinical notes of young people with safeguarding needs, found that sexual violence, and other forms of maltreatment, contributed to needs being framed as “social” rather than “psychological”. This distinction was in turn used to justify the decision to not provide mental health care. Rape Crisis England & Wales have similarly identified CAMHS’s stringent eligibility criteria, lengthy waiting lists, relatively short intervention duration as impacting their ability to provide suitable care.
Assumptions around therapy readiness
Our research also indicates that a problem lies with attitudes held by organisations and professionals. We found that professionals frequently queried whether young people who had experience sexual violence were in a sufficiently stable place to benefit from therapy due to their high levels of distress and/or concerns around whether their caregivers could support the psychological intervention. Assumptions about these young people’s “complexity” and anticipation about their complicated recovery journeys were also cited as reasons for their referral to not be accepted. These assumptions may be true. But they also might not be. Our research has found that children with experiences of maltreatment benefit from CAMHS provision no less than children without experiences of maltreatment. There is a need for critical questioning of the assumption that children and young people with experiences of sexual violence would not benefit from support from CAMHS.
Someone else can help better
The third assumption that we’ve heard time and again from our practitioner consultations around our findings is that CAMHS services tend to refer young people who have experienced maltreatment to other services who they feel will be better placed to respond to their needs. This is amplified in the case of sexual violence where both organisational and professional anxieties are rife, and reinforced by limited training on the subject, which potentially results in professionals feeling ill equipped to support young people who disclose sexual violence.
The issue with this outsourcing tendency is that CAMHS is not the only service that has been affected by austerity. The Centre for Expertise on Child and Sexual Abuse have found that the the specialist sexual violence sector identified the lack of stable funding as the most important factor inhibiting their ability to support more children and young people affected by sexual violence. As such, we have found that signposting a young person onto another service, while intended as a gesture of care, often results in them falling through service gaps.
How can we improve access and service delivery?
About the authors: Tessa Morgan is an Early Career Wellcome Fellow in the Child Health and Development Group, University of Cambridge. Her research focuses on improving mental health care for young people who have experienced sexual violence.
Julia Mannes is an NIHR Doctoral Research Fellow in the Child Health and Development Group, University of Cambridge. Her research focuses on access to Child and Adolescent Mental Health Services.