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Children’s mental health services are a postcode lottery

Nearly a third of young people are not receiving treatment when referred – the government must take action.

By Rachel de Souza

Listening to children and acting on their views is the guiding principle of my work as children’s commissioner for England. When I took office, one of the first things I did was carry out The Big Ask survey. I wanted to understand, as we were emerging from the pandemic, what children wanted for their futures, and what worries were holding them back. From the more than half a million responses to that survey, and the frequent conversations I have with children, it was clear that good mental health is of paramount importance to young people. They are able to talk about their feelings and struggles with a level of eloquence and confidence that escapes many adults.

And while I was encouraged to find that most children were happy with their lives, despite the obvious and growing pressures facing their generation, there were far too many who were unhappy. The survey found that one in five children were unhappy with their mental health – rising to nearly two in five among older teenage girls.

The NHS estimates that 31 per cent of girls and young women aged 17-24 have a probable mental health disorder. Analysis published by my office shows that despite a fall in the overall number of children being detained, or sectioned, under the Mental Health Act, in 2021-22 71 per cent of the children who were detained were girls.

Undoubtedly, there are lots of reasons why young people are struggling with their mental health. But what I am overwhelmingly hearing from the children I speak to, is that the pandemic – and its impact on face-to-face learning – as well as young people’s exposure to harmful content online, has had a significant impact on their mental wellbeing.

We are seeing the results of this in numbers: the prevalence of children with a probable mental disorder increased substantially during the pandemic (from one in nine to one in six among children aged 6-16). For young people aged 17-19, it is estimated that one in four had a probable mental health disorder in 2022 – up from one in six in 2021.

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And, worryingly, the research published by my office today shows that the average waiting time between a child being referred to Children and Young People’s Mental Health Services (CYPMHS) and starting treatment is once again increasing. While there were several years of good progress by the NHS in reducing waiting times, they have increased again from 32 days in 2020-21, to 40 days in 2021-22.

What’s more, the percentage of children who had their referrals closed before treatment has also increased for the first time in years. In 2021-22, 32 per cent of children who were referred did not receive treatment, in comparison with 24 per cent the year before. Again, there is wide variation across England – 5 per cent in East Sussex compared with 50 per cent in north Cumbria.

It is vital that we can provide children and young people with timely and effective support. They need to be able to receive treatment to recover and go on to achieve all that they want to. Without support we know things, sadly, can quickly end up in crisis.

That’s why I want to see mental health support teams delivered in every school as soon as possible. We must be as ambitious as possible for children – we need to reach 50 per cent coverage by 2023-24 and they must be in every school by 2026-27 at the latest. We need a clear-eyed focus on the specific needs of children in government mental health investment.

Alongside this, schools need to be made the fourth statutory safeguarding partner alongside police, local authorities and health. Given the role that schools play in shaping, identifying and addressing children’s mental health, it is paramount that we provide them with the appropriate tools and methods to support pupils. 

I am also urging the government to put children’s mental health at the core of its upcoming major conditions strategy. It is essential that this strategy covers the whole spectrum of mental health support, from prevention to inpatient provision, and be delivered across government – young people’s needs cannot be overshadowed.

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