Children’s and Young People’s Mental Health Services: 2024-25

As I enter my final year as Children’s Commissioner, one thing is clear: before we make decisions that affect young people, we need to listen to young people. Children’s mental health is no exception. I am in no doubt that we are facing a crisis in young people’s mental health. The number of children with a referral to mental health services reached over a million – about 1 in 10 children – almost double the 564,000 in 2018-19.   

The Independent review into mental health conditions, ADHD and autism’s interim report, led by Professor Peter Fonagy, has found an increased rate of mental health conditions and rising distress particularly among young people. In my census of schools and colleges the most cited concern about the local area was mental health services. The government’s reforms of the special educational needs and disabilities system recognise the current system isn’t working. 

But look beyond the data and the policy debates. These are real children in distress, reaching a point where the only option available to them is a referral to mental health services. These are young people whose lives are on hold waiting for vital treatment for months, sometimes years.   

This is a crisis not confined to the NHS or our schools. The government has recently announced a ban on children’s use of social media, citing the potential impact on children’s mental health. The Milburn Review has argued that mental health needs are a crucial factor driving the rising number of young people who are not in education, employment or training.  

But I am optimistic. We have a once-in-a-generation opportunity to transform mental health services and improve the mental health and wellbeing of our children – and we must seize it.  

The government recently announced a new mental health strategy. It is essential that there is a specific focus on children, jointly owned by the Department of Health and Social Care and the Department for Education, to ensure children with additional needs, neurodevelopmental and mental health conditions are receiving help at the earliest point possible.  

We must also be able to confidently say in ten years’ time whether children’s needs have decreased, whether their access to treatment has improved, and crucially whether that treatment has worked. Because as things stand, there is far too little accountability on any of those measures.   

Also key to preventing the escalation of children’s needs are the government’s reforms of the special educational needs and disabilities system. Evidence-based interventions in schools and support for children at the point of need will require joint working.  

Undertaking cross government reforms in step is key to turning the tide against rising distress among children – whether that be educational reforms, support for those not in education, employment or training, and strategies to prevent the development of mental health needs.  But this is only one part of the solution.  

We cannot continue to accept that ever more children will reach a point where the only option available to them is a referral to mental health services. We must find a way through – one which acknowledges that children are suffering, and does not dismiss the reality of it, but also retains a hope that we can prevent that suffering, rather than just referring ever more children for treatment.  

Diagnosis is necessary and life changing for some children. It enables health, social care and education professionals to provide better support, and can help children and their families with an understanding of how they experience the world and what they need.  However, relying on diagnosis as the only key to access support often risks inequitable outcomes for children: including children whose needs do not fit into any diagnostic category (for example, those with serious social, emotional and behavioural issues); or for children with syndromes so rare they never receive a diagnosis.  It is not helping the children with suspected neurodevelopmental conditions who I highlight in this report are being referred in large numbers to CYPMHS but effectively being stuck in the system. No child should have to wait for a diagnosis before they get support. 

We need a new vision for childhood, one that doesn’t silo mental health away from education, care, or physical wellbeing. Young people need a whole state effort from government and local services for children and families. We need a system that works together to nurture, support, and empower every child from the start.   

Most of all, we need to listen to young people. I am currently visiting towns and cities and speaking to young people as part of my Big Future survey. I am struck by how articulate young people are when it comes to their mental health.  They know what makes them happy – they know what is affecting their wellbeing. The shocking figures in this report should also push us to improve the conditions of childhood, from the long tail of COVID, the harms of social media to the impact of the cost-of-living crisis.   

Even the most skilled mental health and wellbeing practitioners cannot provide the antidote to these challenges alone: they are collective problems that require collective solutions with all the people in a child’s life working together.   

Throughout my tenure I have challenged Government to ensure that every child gets the support and help they need to thrive at the earliest opportunity, and each year I request NHS data on waiting times and investment in children’s mental health services.   

This fifth and final report into children’s mental health services is perhaps the most important, as it comes at a moment of both crisis and opportunity. It is time to stop asking children to prove they are unwell enough to deserve help.  We need to bring back joy, address barriers to wellbeing and worry less about diagnosis and more about support.