SCALE OF THE PROBLEM
A key indicator of the level of mental health needs in the child population is the annual survey of children and young people carried out by NHS England.
Figures published last November (the 2024 survey findings are due out imminently) show that 20% of eight to 25-year-olds had a probable mental disorder in 2023.
The NHS England data found that 20.3% of eight to 16-year-olds had a probable disorder, rising to 21.7% for 20- to 25-year-olds and 23.3% for 17- to 19-year-olds.
After a rise in rates of probable mental disorders between 2017 and 2020, prevalence continued at similar levels in all age groups between 2022 and 2023.
Survey participants were also questioned about eating disorders for the first time since 2017. In 2023, 12.5% of 17- to 19-year-olds had an eating disorder, an increase from 0.8% in 2017. Over the six years, rates rose both in young women (from 1.6% to 20.8%) and young men (from 0% to 5.1%) in this age group.
When looking at how young people’s needs translate to demand for support from services, NHS England data shows there were 463,069 people in contact with child and adolescent mental health services (CAMHS) in 2023. In addition, 963 children and young people were detained under the Mental Health Act in the year to March 2024, down from 997 in the previous year.
Analysis of the 2023 NHS England figures by Mind found that more than half of all youth referrals for mental health problems came from households with at least one parent who is struggling financially, which the charity says highlights how the cost-of-living crisis is driving demand.
Young people dealing with such issues report sacrificing their social life, not joining extra-curricular activities or going out, prompting seclusion and loneliness, the charity adds (see debate). Analysis by the Children & Young People’s Mental Health Coalition found that children in the least well-off 20% of households are four times more likely to experience serious mental health difficulties by age 11 compared to those from the wealthiest 20%.
FUNDING AND SERVICE RESPONSE
Most recent NHS figures show that more than one in five of the roughly five million patients in contact with mental health services in 2023/24 were children and young people.
Overall, the number of under-18s in contact with NHS mental health services was 788,108, an increase of around 79,000 compared to the previous year.
The number of 18- to 24-year-olds having at least one contact with NHS funded mental health services – excluding NHS Talking Therapies – in 2023/24 was 234,255, an increase of 18,000. NHS figures also show that one in five 16-year-old girls are in contact with services (70,963).
As part of its work to transform mental health services, the NHS is rolling out hundreds of mental health support teams (MHSTs) in schools (see practice example).. As of spring 2024, 44% of pupils and learners in further education were covered by an MHST. A further 200 teams are currently in training and due to become operational by spring 2025, covering five million pupils and learners (more than 50% of the total).
A report published last March by the Children’s Commissioner for England based on analysis of the previous year’s NHS figures states that more than a quarter of a million children and young people were waiting for mental health support after being referred to Children and Young People’s Mental Health Services (CYPMHS) in 2022/23
The annual report on children’s mental health found that almost 305,000 (32%) children and young people referred to mental health services received support. But 28% (270,300) were still waiting for support from mental health services, while 39% (372,800) had their referral closed before accessing support (see key data).
The NHS is seeing 55% more children and young people with eating disorders compared to pre-Covid levels, with 79% of routine referrals seen within four weeks and 73% of urgent referrals within one week, well below the 95% target.
The NHS spent £13.9 billion on mental health services in 2023/24, up from £12.6bn the previous year. Most funding for CYPMHS is not ring-fenced. This means that the government and NHS England don’t determine how much is spent on services at a local level. Instead, integrated care boards (ICBs) are responsible for deciding how much to budget for these services from their overall funding allocation.
In 2023/24, ICBs planned to spend £1.1bn on CYPMHS and a further £96mn on eating disorders. This represents 8% of planned total local mental health spending. This is up from confirmed spending of £1bn on children and young people’s mental health services and £83 million on eating disorders the previous year.
EXISTING POLICY INITIATIVES
In September 2023, the then Conservative government published a five-year cross-sector strategy for suicide prevention in England alongside an action plan with intended timelines for delivery. It includes targeted actions for children and young people.
In 2022, the government launched a discussion paper and call for evidence to inform a new cross-government, 10-year plan for mental health and wellbeing in England. However, it was later announced mental health would be covered alongside physical health conditions in a Major Conditions Strategy, a framework for which was published in August 2023.
In 2019, the NHS Long Term Plan set out arrangements for rolling out MHSTs to a third of children by 2023/24, a target that was exceeded. MHSTs were a measure first included in the 2017 green paper on children and young people’s mental health which also set out measures to require schools to identify and train a designated senior lead for mental health and pilot a four-week waiting time for access to specialist NHS CYPMHS.
Last year, the then government said it was working with NHS England to implement new access and waiting time standards for mental health services, including CYPMHS. There is an existing waiting time standard for children and young people’s eating disorder services. The target is for 95% of young people in need of an eating disorders service to be seen within four weeks, and within one week in urgent cases. This standard is not being met – 66% of urgent referrals were seen within one week and 77% of routine referrals within four weeks at the end of last year.
In October 2023, the Department for Health and Social Care unveiled plans to set up 10 new children’s mental health hubs with nearly £5mn. The hubs offer services including psychological therapies, specialist advice on sexual health, exam worries, jobs, drugs, alcohol and financial concerns and are open to those aged 11 to 25 and anyone who may not meet the threshold to receive NHS support. The department announced an extra £3mn to expand the network to 14 last February. A network of around 70 early support hubs currently exist in England, run by a range of local services including volunteer organisations, NHS trusts andcouncils.
REFORMS IN THE PIPELINE
The new Labour government has pledged to continue many of the policy measures they’ve inherited and at the Kings Speech in July unveiled plans to publish a Children’s Wellbeing Bill aimed at tackling several issues negatively affecting children’s mental health, including children’s access to social media, school pressures and food poverty.
According to briefing notes published to accompany the speech, the bill “will make changes so they [children and young people] are safe, healthy, happy and treated fairly”.
The government says the bill, which is yet to be published, will help families with the cost-of-living crisis and see every school offer a free breakfast club. The move has been backed by children’s charities. The Children’s Society’s latest Good Childhood report found one in 10 children aged 10 to 17 had low wellbeing due to cost-of-living worries. Analysis by the Centre for Mental Health suggests that mental ill health costs England £300bn a year; meanwhile, child poverty costs £39bn a year.
The centre alongside the CYPMHC and Save the Children produced a report, Dual Crisis, that highlights the need to tackle child poverty and children’s mental health together. Measures put forward include: committing to a cross-government strategy for mental health in England that addresses the underlying causes of mental ill health such as poverty; introduce a ‘child lock’ by locking children’s social security entitlements to increase either by earnings or inflation; provide £1.7bn in increased investment to deliver a comprehensive pathway of mental health support; and roll out MHSTs across all schools and colleges in England.
The government has also committed to publishing a new Mental Health Bill designed to modernise the Mental Health Act. The bill proposes to “ensure that detention and treatment under the Mental Health Act takes place only when necessary” and end the use of police stations and prisons as places where people, including young people, can be detained for welfare reasons. The draft Bill gives little details on plans to reduce waiting times and increase access to services for children.
FURTHER READING
Mind report, September 2024
Dual crisis briefing, CYPMHC, July 2024
NHS England performance data 2023, February 2024
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