- Demand for children’s mental health services continues to increase, outstripping investment
- More children with referrals began treatment in 2023-24 than the previous year – but numbers still waiting for treatment by the end of the year jumped by 50,000
- Black children, older teenagers and girls among groups most likely to be referred for mental health crises – and data exposes deep regional inequalities to treatment for all children
- New analysis reveals higher waiting times for treatment when looking at children’s direct contact with professionals only
- Children’s Commissioner calls for renewed focus and investment in children’s mental health services, through the NHS 10 Year Plan
The Children’s Commissioner’s annual report on the state of children’s mental health services highlights huge inequalities when it comes to accessing support, with some young people waiting up to 17 times longer than others depending on where they live.
In her fourth annual report, Dame Rachel de Souza sets out children’s experiences with mental health services in England as data from 2023-24 shows nearly 60,000 children in England were referred for being ‘in crisis’ – more than 6% of all those referred to children’s mental health services that year – and 50,000 more children with active referrals were still waiting for treatment to begin at the end of March 2024.
Releasing the analysis to mark the end of Mental Health Awareness Week, Dame Rachel has urged health professionals and politicians to put children at the heart of the forthcoming NHS 10 Year Plan – because previous research[1] by the office shows children with additional vulnerabilities are often the ones most at risk of missing out on education.
This must be backed by a drive to end regional health inequalities, improve data on children’s health and review routes to diagnosis to reduce waiting times and introduce a shared definition of health conditions accepted by professionals across England.
Today’s report finds children in England awaiting treatment for mental health conditions face a mixed picture, despite real terms increases in investment in Children and Young People’s Mental Health Services (CYPMHS) and fewer referrals being closed before children receive treatment.
Dame Rachel de Souza, the Children’s Commissioner for England, said:
“The numbers in this report are staggering – but these are not numbers, these are real children who not only missing precious moments of their childhood while stuck waiting for vital treatment for months, sometimes years, but also the scaffolding that makes their lives happy and fulfilled with their friends.
“All too often, it is these children with unmet additional needs who go missing from education, falling off the radars of services and denied opportunities their peers take for granted. Children tell me they want to be in school – we must match this ambition they have for themselves and take preventative steps so that fewer children miss school for mental health-related reasons.
“There are some encouraging signs of progress: increased investment in real terms, some localised improvements in accessing services and shorter waiting times for children experiencing mental health crises. But even five days is a long time for a child in crisis to wait – so we must grasp this moment of transformation in the NHS with both hands to build a system that meets the needs of every child – early, fairly, and locally.”
Findings in today’s report include:
- Total numbers: More than 958,200 children in England have an active referral to CYPMHS as of the end of March 2024, an increase of 10,000 from the previous year and equivalent to 8% of England’s population of 12 million children.
- Age: More than three quarters (76%) of children entering treatment were over the age of 10. Children aged 13 to 15 were the largest group accessing treatment (nearly 300,000 children were referred), making up 35% of all those entering treatment despite making up only 18% of all children in England.
- Referral reason: Anxiety was the most common primary referral reason (16% – up slightly from 15% in 2022-23), followed by neurodevelopmental conditions excluding autism (11% – up from 9.2%), suspected autism (6.8% – up from 5.3%) and ‘in crisis’ (6.2% – up from 5.8%).
- Waiting times: More children began treatment in 2023-24 – 92% entered treatment within the year and 45% within four weeks. 50,000 more children with active referrals were still waiting for treatment to begin at the end of the year – up to 320,000 in 2023-24 from 270,300 in 2022-23.
- Direct contact with professionals: New analysis of previously unpublished data reveals waiting times are higher when only counting direct activity with children and discounting other types of contact usually counted in official published data, such as a professional attending a multi-disciplinary meeting to discuss a child’s case.
- Neurodevelopmental conditions: The number of children referred for neurodevelopmental conditions like autism and ADHD has increased by almost 30% – despite not being mental health conditions – with these children facing some of the longest waits. 64% of children still waiting for treatment at the end of the year in March 2024 were referred for suspected autism, which was the reason for a referral with the longest average waiting time of 223 days.
- Investment in services: Investment in CYPMHS represents just over 1% of Integrated Care Boards’ (ICB) total annual spend – £1.1 billion in 2023-24, an increase of £87 million in 2022-23.
- Regional variation: Children in the ICB area of Leicester, Leicestershire and Rutland wait just six days for treatment on average, while children in Hampshire and Isle of Wight wait up to 17 times longer: 103 days on average.
- Waiting times almost always increase when looking at direct contact with professionals only: in NHS South-East London, children waited an average of 52 days more, the largest difference of any ICB.
- Spend per child referred varied widely by ICB, from as much as £2,513 in North-West London, to £548 in Coventry and Warwickshire.
- Referral routes: Fewer children had their referral closed before treatment, but there is significant variation in treatment depending on a child’s referral route. 72% of children referred by the justice system had their referrals closed before treatment – fewer than one in five of these children (19%) began treatment.
- Crisis care: Nearly 60,000 children – 7.7% more than the previous year – were referred for being in crisis in 2023-24.Black children, older teenagers and girls are among the groups of children most likely to be referred for crisis mental health treatment. ‘In crisis’ was the referral reason with the shortest average waiting time of five days.
With NHS England being brought into the Department of Health and Social Care (DHSC), and major reforms to practice proposed, the Commissioner’s report sets out a vision that puts children at the heart of a once-in-a-generation opportunity to shift the system towards prevention, early intervention, and community-based support.
Dame Rachel said:
“Part of this transformation must include rethinking how the health profession communicates with children. Too often, the conversation focuses on what a child with a particular condition – or even a suspected condition – cannotdo, instead of what they can do. I want to see a consensus across every service working with children that they should never be labelled or diagnosed by professionals who are not clinicians – to do so without the appropriate support in place will only limit their ambition and ability.
“The future of our NHS must start with children. If we get this right, we don’t just reduce pressure on services – we give every child the best start in life.”
To support this reform, particularly through the NHS 10 Year Plan, the Children’s Commissioner has made the following recommendations:
- Early access to support: All children should be able to get mental health help in their schools and communities without needing a diagnosis or medical label. Mental Health Support Teams must continue being rolled out to all schools ahead of 2030 in line with the government’s manifesto commitment and the new Young Futures Hubs must offer open-access support in every Integrated Care Board area.
- Support in school: Alongside the roll-out of Mental Health Support Teams, any child on a CYPMHS waiting list or receiving treatment and beginning to disengage from school should automatically be referred to a multi-agency attendance forum and assigned a key worker to address underlying issues.
- Shorter waiting times: Children should wait no longer than four weeks for assessment and four weeks for treatment. This will require additional, annual, ring-fenced funding for children’s mental health services in every local area.
- Better data and transparency: The government must introduce a single, meaningful national measure of waiting times from referral to treatment – not just ‘activity’ that may not involve direct contact with children.
- Support for marginalised children: Targeted investment in community-led therapeutic services is needed to reach children less likely to access NHS services – particularly those from minority ethnic backgrounds, disabled children, and children in care.
- Improved diagnostic pathways: Children with autism, ADHD and other neurodevelopmental conditions face some of the longest waits. The government must commission urgently an independent review of diagnostic and post-diagnostic support for children, so that whether they are referred for diagnostic assessment or not is not subject to a postcode lottery.
- Stronger accountability: The Care Quality Commission’s new Chief Inspector of Mental Health should lead a thematic review of children’s services, examining gaps in thresholds and access.
- Mental Health Act reform: The new legislation must include better protections for under-16s, a duty to provide appropriate inpatient care, and safeguards against inappropriate placements.
Today’s report draws on powerful testimony from the Children’s Commissioner’s The Big Ambition survey of over 250,000 children and young people across England:
“There should be more staff and funding because at the moment people are struggling more than ever with their mental health … The waiting lists are too long.” – Girl, 16.
“Better mental health support in schools, shorter waiting lists, equal opportunities for people with additional needs.” – Girl, 17.
“I think you should improve mental health hospitals, especially ones for young people.” – Girl, 13.
[1] https://www.childrenscommissioner.gov.uk/resource/children-missing-education-the-unrolled-story/
