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Foreword from the Children’s Commissioner for England, Dame Rachel de Souza

My first priority as Children’s Commissioner was to hear from England’s children how they feel about life today, particularly as we emerge from the Covid pandemic. I wanted to hear about their hopes and aspirations for the future as well as their worries and priorities right now.

That’s why I launched The Big Ask, which I’m happy to say is the biggest ever survey of children in England. Over half a million children responded and it is clear that the vast majority are happy with their lives and optimistic about the future.

Nevertheless, the one area that stood out for me as something we really need to get to grips with was children’s mental health and wellbeing. This generation of children are clearly very conscious that it is impossible to separate mental and physical health. They recognise the importance of good mental health now and for their future success. The majority of children were happy with their mental health. But, 1 in 5 children were not happy with their mental health, and this rose to 2 in 5 for some groups.

What they are asking for is not rocket science: they want someone to talk to when they are worried or upset. They want easier access to support when problems are emerging so that they don’t start to build up.

I believe that as adults we need to listen to what children say and respond. It is clear from The Big Ask that children’s mental health will be a top priority for me in my role as Children’s Commissioner.

Children’s mental health has for decades been a low priority service within the NHS – with no improvement targets and low levels of funding. However, in recent years there has been good progress to reduce the gap between the number of children with an emerging mental health need and the support available. Our annual briefing has tracked this performance improvement.

This year, we again see increased investment. Spending by the NHS on children’s mental health has increased by 4.4% since 2019/2020 in real terms, and has increased in each of the last four years (when national data on expenditure was first collected).

And this investment is making a difference. More children have been accepted into treatment and for some children waiting times have reduced.

However, there is still more to do. Some children are still waiting a long time for their treatment to begin, and many are still not accepted onto waiting lists.

There is still wide variation between local areas on what is being achieved. For example, the percentage of children waiting for treatment at the end of the year varied greatly between local areas: from as low as 14% in NHS Castle Point & Rochford and NHS Mid Essex, to 78% in NHS East Sussex.

Because of the pandemic, the challenge is also greater. Over the last two years, there has been a sharp increase in the number of children experiencing mental health problems. NHS surveys show that before the pandemic, in 2017, 1 in 9 children had a probable mental health disorder. That has now jumped to 1 in 6.

At the same time, we saw the number of children being referred to mental health services drop in the year 2020/21 (against a backdrop of increasing numbers pre-pandemic). It is likely that even though more children have mental health problems, fewer were being referred to services during lockdowns because of disruptions caused by the pandemic.

Numbers referred into services are likely to increase again in the coming years. The Health Secretary will be publishing a review later this year to explore how we can address this increased level of need and adopt a more preventive approach. This is extremely welcome. As a society we need to raise our level of ambition to support children’s mental health. This means schools and early years settings providing good support for all of their children. It means early support like Mental Health Support Teams in schools being extended across the country. It also means a continued push to increase access to NHS services.

I look forward to working across Government and with schools and other key partners to ensure that we, as adults, come together to help our children stay mentally healthy and get the right help, in the right place, at the right time.