Roll call: Why the child and adolescent mental health sector must be present for severe school refusal

Abstract

School refusal can be a complex and intractable transdiagnostic syndrome that derails psychosocial development and jeopardises the successful transition to adulthood. Amid a global youth mental health crisis and in the aftermath of the COVID-19 pandemic, school refusal rates appear to have surged, prompting calls for urgent action. With a focus on severe forms of school refusal, we present an agenda for how the child and adolescent mental health sector can support the education sector in answering this call. We first identify three core challenges that must be tackled: (1) the need for clearer distinctions between mild and severe forms of school refusal to support classification, research, and intervention planning; (2) the treatment gap, which leaves many young people without timely or appropriate care; and (3) the absence of an evidence base to guide interventions for treatment non-responders. Then, for each challenge, we identify potential solutions, namely: (1) developing clinical staging frameworks to enhance conceptual clarity and support targeted research; (2) exploring outreach models of care to improve treatment access and engagement; and (3) devising robust methodologies for evaluating intensive Tier-4 interventions to strengthen the evidence base for treatment non-responders. Just as a roll call ensures that every individual is accounted for, this paper calls on the child and adolescent mental health sector to be fully present in addressing severe school refusal. By strengthening collaboration between clinical practice, education systems, and researchers, the field can move towards more effective, integrated, and scalable solutions that better meet the needs of these students and their families.