Children’s mental health services 2023-24

As Children’s Commissioner, it is my job to make sure we never lose sight of the biggest challenges affecting children – mental health is one of the most significant. Each year, I publish this report to shine a spotlight on the state of children’s mental health services in England.  

This is the fourth report of its kind. I will continue to request NHS data on waiting times, investment in children’s mental health services and ask the tough questions until there is a comprehensive plan to ensure that every child gets the support and help they need to thrive at the earliest opportunity.   

There have been some welcome improvements in investment and access to services, but too often it remains a case of too little and too late, leaving children waiting far too long for help. 

Black children and ethnic minority children are less likely overall to be accessing mental health services, and when they do come to the attention of services, they are often in crisis – well past the point of prevention, only treatment. We are talking about children who are in acute distress, and are at serious risk of harm, and even death.

I remain deeply concerned about the clear health inequalities that exist for children across the country highlighted in this report.   

Every child has a right to a safe, healthy childhood – but this means not sitting on a list waiting for treatment. This report shows children who were yet to get support by the end of 2023-24 waited on average nearly six months for treatment to begin, with almost a third of these children waiting over a year. That’s years of brief and precious childhoods wasted. Months of lost learning, of social development, of wellbeing that can come with a heavy cost in every aspect of a child’s life.  

Children are crying out for our help so they can get on with their lives, and we must listen.   

When I ask children what is making them unhappy, their answers are clear and consistent: families struggling to afford food; feeling unsafe in their neighbourhoods or at home; being misunderstood at school; feeling isolated, unseen, disconnected.  

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 agencies in a child’s life working together, across education, health and social care.  

These issues need to be understood in the round, not just as personal challenges—they are societal ones. If we look at children’s mental health in isolation, we risk placing the burden of change on children themselves.  

We need a new vision for childhood—one that doesn’t silo mental health away from education, care, or physical wellbeing. We need a system that works together to nurture, support, and empower every child from the start. 

We need a cross-government approach to children and young people’s mental health and wellbeing which addresses these wider determinants of happiness and health. If we are to break down barriers to opportunity, we must start here – because for hundreds of thousands of children, the barrier to opportunity is their mental health.

We need a world where children can access help without having to have a label, one where support is not dependent on a diagnosis.   

And we need to provide needs-led support in schools so that mental health professionals can spend less of their time on lengthy diagnostic assessments, and more of their time actually supporting children.   

So where do we go from here?   

I believe we have a significant chance for change with the NHS 10 Year Plan.  

It needs to set a clear, ambitious direction for a fairer share of investment in children and young people’s mental health and wellbeing services – right across the spectrum of need.   

I want to see national coverage of early support hubs and mental health support in school, so that the majority of children never need to come close to their thoughts, feelings and behaviours being diagnosable before they get help.

I want to see health working in partnership with the community-based services that are able to reach the children who currently seem to only be visible to statutory services once they reach crisis – and a  national, cross-government strategy for children and young people’s mental health and wellbeing that addresses the root causes of distress, not just its symptoms.   

Above all, we need to stop asking children to prove they are unwell enough to deserve help. We must build a system that is not reliant on diagnosis for care, only responding to children who meet a threshold – but one which listens earlier, acts faster, and supports every child.  

For the first time, I believe we have a genuine opportunity to rethink how we approach public health in this country, with prevention and early intervention at its heart.   

I can think of no better public health approach than treasuring childhood, and giving young people the building blocks for long, happy, fulfilling adult lives. 

I hope our leaders are ready to seize the moment, because our children can’t wait.