On taking up my post as children’s commissioner for England last year, the first thing I had to do was listen to England’s children about their lives today – their aspirations, and how the pandemic had affected them. That’s why I launched The Big Ask – and I was overwhelmed by the response: over half a million children replied, making this the largest-ever consultation of children in England.
Reassuringly, despite the Covid pandemic, the majority of children are happy with their lives. Eight out of ten children told me they were happy or OK. They are an ambitious and passionate generation, optimistic about the future. The majority felt they would have a better life than their parents, and their top priority is to get a good job. They also want to change the world and make a difference on issues like climate change and building a fairer society.
To help them achieve these dreams, it is our responsibility to provide them with the support they need to have a good childhood and a successful future.
Children were very aware of the importance of good mental and physical health. But one in five said they worried about their mental health, and for older, teenage girls, this rose to two in five.
I have made it my mission as children’s commissioner to make sure I am advocating for these children. I have used my unique data-gathering abilities to ask the NHS how much it is spending on children’s mental health and about children’s access to care.
In recent years, good progress has been made to increase access to mental health care for young people. Spending has increased, tens of thousands more children are accessing treatment, and new waiting time targets and services have been introduced. Mental Health Support Teams are being rolled out in schools and more areas are providing access to support online. NHS England has an ambition to ensure that all children who need specialist care can get it by 2028/29.
But the pandemic has taken its toll on children’s mental health, and that makes this ambitious goal even more challenging. The pandemic saw demand rising – the NHS statistics show that the number of children with a probable mental health disorder has jumped from one in nine before the pandemic to one in six.
Alongside this, the pressures of the pandemic have impacted children accessing care, with a sharp drop in referrals. Only around a third of children with a probable mental disorder are accessing treatment. Across the country there is also far too much variation in how easy it is for children to access the care they need.
In their responses to The Big Ask, children spoke of their frustration at not being able to access this support. They often simply need someone to talk to as problems emerge – someone they trust and who has the capacity to listen. Time and again, we have heard from children who say that if they had support early enough, they would not have reached a crisis point later.
Children tell us that they really want support in school, and research shows that children are more likely to talk to a teacher than any other professional when they are concerned about their mental health. We need to support schools to know how to promote good well-being, to adopt a “whole-school approach” to mental health – covering it effectively in the curriculum and all policies and procedures. Mental Health Support Teams should also be expanded to every school, with joint training for school leaders and NHS professionals so that those with more severe clinical needs can get help within school and referred on to the right specialist treatment.
We need to change the system to invest in the right support, in the right place, at the right time. It is great to see more local NHS services spending their budgets on mental health, but we need to see more of them going further to help more children access care and support.
For children who are absent or not in education, support through school is not the right approach. It is also important that there are other ways for children to access early support, either online or through a drop-in centre in the community, rather than simply joining a waiting list for an NHS clinic.
For children with problems that are just starting to emerge and for those with clinically diagnosable conditions we need to reimagine children’s mental health services to make them much more accessible to young people – and that means a clearer national offer for online and community support. There are some excellent examples of best practice, such as community hubs in Manchester as well as in Lambeth in London. What is needed now is a higher level of ambition so that every area in the country can learn from the best.
It is also important that children who hit crisis point have quick access to high-quality care. NHS England has started the process of introducing new access and waiting time standards for crisis care and for improving the quality of inpatient care. There is a long way to go to improve this care and this work must continue.
Now is the time to refresh the plans to reform children’s mental health care and set a new level of ambition. Children have sacrificed so much during the pandemic to keep us all safe. That’s why I have prioritised making it my mission to shine a light on this important topic and to ensure that every child gets the care they need when they need it, no matter where they live in the country.
Rachel de Souza is the children’s commissioner for England