Are adolescent boys from African and Caribbean heritage underrepresented in CAMHS referrals, and what are clinicians' experiences working with this group?

Research on Black boys and young men in the UK has been limited. At 11, Black and White boys have the same chance of being diagnosed with a mental health disorder, but when they reach adulthood, Black men are many times more likely to have severe mental health disorders. Therefore, this study was interested in what happens during adolescence, whether they are referred to mental health services, and, if so, what it is like working with them. This study completed an audit to understand the representation of Black adolescent boys (BABs) aged 11-15 in referrals to an inner-city Child and Adolescent Mental Health Service (CAMHS) in 2019. Semi-structured interviews were conducted thereafter with four CAMHS clinicians to understand their experience working with this patient group. Using local population data, the audit found that BABs were underrepresented in referrals to CAMHS. CAMHS received more than expected referrals for adolescent boys who identified as ‘White’, Mixed’, and ‘Other’. These results are limited due to the lack of specific data on ethnicity for adolescents 11-15. However, these results indicated discrepancies in referrals to CAMHS based on ethnicity. Interviews analysed using a Reflective Thematic Analysis method highlighted the need for professionals to be curious about the behaviours of BABs to understand their needs and for intersectionality to be part of clinical thinking and practice. The findings highlight the importance of supervision for clinicians to reflect on their unconscious biases and the significance of working flexibly within one’s therapeutic frame when working with differences. Building trust was found necessary when working with BABs and their families to increase engagement and accessibility. The study recommends areas for further research and highlights the responsibility of services to BABs and their families and the community.