Social Prescribing as a CAMHS Waiting List Intervention

Up to three quarters of young people on CAMHS waiting lists experience deterioration in their mental health while waiting. For many young people, waiting is the period during which their condition worsens to the point where the original referral no longer reflects their needs, or where crisis intervention becomes the first contact with services.

In a 2022 YoungMinds survey, over a quarter of respondents shared that they had attempted suicide while waiting for support. Beyond immediate mental health consequences, long-term delays make recovery harder. Without early intervention, mental health issues can become more difficult to treat.

The system is, in effect, creating a more expensive problem by deferring a cheaper one. A young person who deteriorates on a waiting list is more likely to present in crisis, require inpatient admission, or carry their difficulties into adulthood. The cost of waiting is not zero. It is paid later, by a different part of the system.

Thankfully, the UK Government is keen to push for more preventative care, which may open them up to the benefits of social prescribing and community-led support.

Prolonged waiting times for CAMHS leaves many young people without structured support while awaiting specialist treatment. Social prescribing has been proposed as a community-based adjunct within CAMHS pathways to help engage with patients as soon as possible, though evidence regarding its safety and clinical impact has remained limited.

Social prescribing in this context means connecting young people on waiting lists to non-clinical community support: skills development, peer support, befriending, creative and cultural activities, sport, and volunteering. A link worker (rather than a clinician) holds the relationship and helps the young person identify what matters to them, connecting them to activities that address social and emotional needs without requiring a clinical threshold.

The model is not a substitute for specialist treatment. It does not diagnose, prescribe, or replace the CAMHS appointment that is eventually coming. What it does is fill the gap between referral and first contact with something structured, relational, and responsive, rather than leaving a young person to manage alone.

The challenge has been evidence. Social prescribing for adults is well-established in primary care. For children and young people, the evidence base has been thinner — and the logistics of embedding it within CAMHS pathways are genuinely complex. Referral routes, consent frameworks, the role of the link worker relative to the clinical team, and the question of what “good” looks like for a 13-year-old with anxiety are all harder to standardise than they are for an adult with loneliness.

University College London and the Anna Freud Centre's INSPYRE programme - formally titled Wellbeing While Waiting - set out to build and test a rigorous answer to these questions.

The study was a multi-site non-randomised controlled trial embedded within a hybrid implementation–effectiveness evaluation conducted across 11 CAMHS in England. Between May 2023 and March 2025, 558 young people aged 11–18 years referred to CAMHS were enrolled: 225 receiving usual care and 333 receiving social prescribing. Primary outcomes measured were anxiety and depression symptoms, total emotional and behavioural difficulties, and perceived stress.

The trial's published results, released in July 2026 in European Child & Adolescent Psychiatry, represent the first rigorous controlled evidence of social prescribing's impact for children and young people on CAMHS waiting lists. The study protocol, published in BMC Psychiatry, was designed to inform the prioritisation, commissioning, and running of social prescribing in other CAMHS - with the three-year goal of producing a fully developed and tested model that can be scaled nationally.

University College London is working in collaboration with the NHS and the NIHR Biomedical Research Centre (BRC) to perform additional research, with studies beginning in June 2025.

The INSPYRE trial matters beyond its own findings because it represents a shift in how the CAMHS waiting list problem is being framed.

The primary framing has been supply-side: there are not enough clinicians, not enough funding, not enough capacity. That framing is accurate, but it’s also slow to fix. Building clinical workforce takes years, and demand is rising faster than supply can follow. Prior to COVID-19, it was estimated that 1 in 9 young people had a diagnosable mental health condition. Since COVID-19, that figure has increased to 1 in 6.

Social prescribing offers a different lever; one that operates at the community level, uses existing infrastructure, and can be deployed without waiting for clinical workforce expansion. Link workers are not scarce in the way that CAMHS clinicians are. Community activities are not rationed in the way that therapy slots are.

The question for commissioners is not whether social prescribing can replace CAMHS. It cannot, and no credible advocate suggests it should. The question is whether the waiting list period can be made less harmful, and whether a structured, evidence-based community offer can reduce deterioration, prevent crisis escalation, and improve the condition of young people when they finally reach the front of the queue. The logistics of embedding social prescribing within CAMHS pathways are complex, and uptake among children and young people has historically been low. The INSPYRE trial was designed to address both problems - building the pathway and generating the evidence simultaneously.

For social prescribing to function as a genuine CAMHS waiting list intervention at scale, several things need to be true.

• Referral needs to be automatic, not optional. If social prescribing is offered only to young people whose families know to ask, or whose GP happens to be aware of the pathway, it will reach the most resourced families, not the most vulnerable. The INSPYRE model embedded referral within the CAMHS pathway itself, so that a waiting list placement triggered a social prescribing offer as a matter of course.
• Link workers need CAMHS-specific training. Working with young people aged 11–18 who are waiting for specialist mental health support is not the same as working with adults in primary care. Safeguarding thresholds, consent frameworks, and the boundaries of the link worker role all require specific guidance. The INSPYRE programme developed training and protocols for this - a resource that any scaling effort would need to adopt or adapt.
• Data needs to flow between systems. A young person on a CAMHS waiting list who is also engaged with a social prescribing link worker has two active relationships with the health system. For that to be safe and coordinated, information needs to move between them. In practice, this means CAMHS and social prescribing systems need to be connected; not just in principle, but in the data infrastructure that clinical and community teams actually use.
• The offer needs to be sustained, not one-off. A single referral to a community activity is not social prescribing. The evidence base for social prescribing - in adults and, increasingly, in young people - points to the importance of an ongoing relationship with a link worker who can adjust the offer as the young person's needs change. That requires funded link worker capacity, not just a list of local activities.

Social prescribing is not a solution to the CAMHS capacity crisis. A young person with severe depression, an eating disorder, or psychosis needs clinical treatment - no amount of community activity changes that. The risk of a poorly implemented social prescribing offer is that it becomes a way of managing waiting lists rather than supporting the young people on them: a mechanism for closing referrals without providing care.

The INSPYRE trial was designed with this risk in mind. Its primary outcomes were clinical - anxiety, depression, emotional and behavioural difficulties - not process measures like referral rates or activity uptake. That matters. It means the question being asked was whether young people got better, not whether the pathway looked tidy. We can only assume that UCL’s follow-up research will continue this investigation in more detail, given that social prescribing has grown in uptake in the years since INSPYRE, though we must wait for information on what the trial’s specifically examining and when it intends to conclude.

For now, we must turn to the INSPYRE findings. The task for system leaders is to read that literature, commission accordingly, and build the infrastructure that allows a tested model to reach the young people who need it, not just the ones lucky enough to be in a trial site.

Access HSC supports NHS and local authority organisations to manage and improve children's mental health pathways, including waiting list management, referral tracking, and community service integration. If you are working on CAMHS pathway transformation or social prescribing commissioning, contact our team.