Mental health support for children and young people

On 23 November 2023, the House of Lords is due to debate the following motion:

Earl Russell (Liberal Democrat) to move that this House takes note of the current state of mental health support for children and young people in England.

1. What are the recent trends in the mental health of children and young people?

According to a survey of children and young people conducted by NHS Digital in 2022, 18% of children aged 7 to 16 years in England had a probable mental disorder.^[1] This figure was higher for young people aged 17 to 24 years at 22%. As shown in graph 1, the proportion of young people with a probable mental disorder has grown since 2017. (This survey was not conducted in 2018 or 2019 and figures for young people aged 20 to 24 have only been collected in the last two surveys.)

Graph 1: Proportion of children and young people in England with a probable mental disorder, ages 7 to 19

The next wave of this survey, covering 2023, was published on 21 November 2023.^[2] As the cohort used for the survey had aged by a year, the survey only provides data for children and young people aged 8 to 25 years. It found that about 1 in 5 children and young people aged 8 to 25 years had a probable mental disorder. However, it also reported rates of probable mental disorders had remained stable in all age groups between 2022 and 2023.

There has also been a reported decline in the subjective wellbeing of children and young people over the same period. In February 2023, the Department for Education published the results of a survey asking young people to report how they felt about their lives. The survey found that levels of anxiousness among both primary and secondary-age pupils appeared to have increased during 2021/22 compared to the previous academic year.^[3] The same report found the proportion of children and young people reporting low happiness with school had also increased.^[4]

One of the factors identified as contributing to this decline in mental health has been the isolation resulting from the Covid-19 pandemic. In June 2023, research from the Institute for Fiscal Studies and University College London’s Institute of Education showed that nearly half of parents (47%) reported that their child’s social and emotional skills had worsened during the first year of the pandemic.^[5]

2. What support is provided to children and young people?

In England, children and young people’s mental health services (CYPMHS) are provided by the NHS, local authorities, schools and other organisations, including those from the private and the voluntary sector.^[6] The types of services available to children and young people will vary locally but may include local NHS services, such as inpatient care, and support teams in schools and colleges.^[7]

Most NHS services are commissioned by integrated care boards (ICBs).^[8] However, some specialist services, including specialised mental health, learning disability and autism services, are commissioned by NHS England through NHS-led provider collaboratives.^[9] Services provided or funded by the NHS for children and young people are usually available to anyone under the age of 18.^[10] However, some services are available to young people up to the age of 25.

Most funding for CYPMHS is not ringfenced. However, NHS England requires local spending by ICBs to meet the mental health investment standard. This was first introduced in 2018 and applied originally to clinical commissioning groups, the bodies previously responsible for local NHS spending until they were dissolved in July 2022.^[11] The mental health investment standard requires any increase in planned spending on mental health services by ICBs to be larger than their overall increase in budget allocation each year.^[12]

3. How many children and young people currently receive mental health support and how long are they waiting for treatment?

At the end of August 2023, 414,550 children and young people in England were in contact with NHS funded CYPMHS.^[13] In March 2023, the Children’s Commissioner for England published her annual review of children’s mental health services.^[14] The review found that, in 2021–22, 32% of children who were referred for mental health treatment did not receive treatment. The Children’s Commissioner noted that this number had increased since 2020–21 when the figure was 24%. She also highlighted the average waiting time between a child receiving a referral and starting CYPMHS treatment had increased from 32 days in 2020–21 to 40 days in 2021–22.

This increase in demand has also led to an increase in the proportion of local health care funding going towards services for children and young people.^[15] In 2023, the National Audit Office reported that spending by clinical commissioning groups, the predecessors to ICBs, on mental health services across all age groups increased from 10.9% in 2018–19 to 11.4% in 2020–21. It also found spending on CYPMHS as a proportion of overall mental health spending had increased from 9.4% in 2018–19 to 10.1% in 2020–21.

Although most forms of support had faced increased levels of demand, the Children’s Commissioner for England also noted the proportion of children in inpatient care and the number detained under the Mental Health Act 1983 had fallen compared to the previous year.^[16] It said 869 children were detained under the act over the course of 2021–22, of whom the majority (71%) were girls.

4. How have the government and NHS England proposed to improve the support available?

The government and NHS England have made a series of policy announcements on the provision of mental health support for children and young people. In December 2017, the government published ‘Transforming children and young people’s mental health provision: A green paper’.^[17] The green paper included proposals to establish designated senior leads for mental health and new NHS-funded mental health support teams in schools and colleges. It also included proposals to pilot a new four week waiting time target for children accessing specialist NHS mental health services. In July 2018, following a consultation, the government confirmed it would implement these proposals.^[18]

The NHS long term plan, published by NHS England in January 2017, included a commitment that funding for children and young people’s mental health services would grow faster than both overall NHS funding and total mental health spending.^[19] NHS England also said that, by 2023–24, at least an additional 345,000 children and young people would be able to access mental health support through NHS funded mental health services and mental health support teams. In November 2023, the government stated there were around 400 mental health support teams operating in schools and colleges, covering an estimated 3.4 million children, approximately 35% of pupils.^[20] The government has said it is aiming to increase this coverage to 50% of pupils in England by April 2025.^[21]

In April 2022, the government launched a call for evidence ahead of a proposed new ten-year strategy for improving mental health.^[22] In the discussion paper published as part of this call for evidence, the government noted the recent increase in the rate of young people with probable mental health disorders.^[23] In May 2023, the government published its response to this call for evidence.^[24] This stated proposals for improving mental health would be incorporated into its planned major conditions strategy rather than as part of a separate mental health strategy. In September 2023, the government said the new major conditions strategy would be published in early 2024.^[25]

In October 2023, the Bishop of Derby tabled a written question asking the government what measures would be included in the major conditions strategy to prevent poor mental health and promote wellbeing in children and young people.^[26] Parliamentary Under Secretary of State at the Department of Health and Social Care Lord Markham said in his response the government was considering “the most effective ways to prevent and treat poor mental health and promote wellbeing for people of all ages” as part of the development of the strategy.^[27]

In June 2023, NHS England published the ‘NHS long term workforce plan’. This set out NHS England’s ambitions for increasing the number of NHS staff working in mental health. The plan included a commitment to increasing the number of training places available for children’s wellbeing practitioners. These practitioners provide assessments and support for children and young people with common mental health difficulties, such as mild to moderate symptoms of anxiety, depression and behavioural difficulties. It also said it would provide more training places to educational mental health practitioners working in mental health support teams in schools and colleges.

In addition to these measures, the government has said it intends to introduce a bill to reform the Mental Health Act 1983. The government published a draft mental health bill in June 2022.^[28] The Joint Committee on the Draft Mental Health Bill published its report on the draft bill in January 2023.^[29] It argued reform of the 1983 Act presented the government with “a crucial opportunity” to strengthen the rights and protections for children and young people receiving mental health treatment.^[30] A bill was not included in the 2023 King’s Speech. However, the government has said it still intends to publish this legislation when parliamentary time allows.^[31] Further information on proposals to reform the Mental Health Act 1983 is provided in the House of Lords Library briefing ‘King’s Speech 2023: Health and social care’ (1 November 2023).

The Labour Party has criticised the government’s handling of mental health services for children and young people. Shadow Home Secretary Yvette Cooper described the government as “floundering” in the face of increased demand for mental health support by young people.^[32] The Labour Party has also criticised the government for not including proposals for reforming the Mental Health Act 1983 in the King’s Speech, saying it would implement the government’s proposed reforms to the act if elected.^[33]

5. What assessment has there been of the adequacy of provision?

In 2021, the House of Commons Health and Social Care Committee held an inquiry into children and young people’s mental health. In the committee’s final report, it argued children in England were facing a mental health crisis, exacerbated by “heightened academic expectations and the ubiquity of social media”.^[34] The committee also argued this situation had been made worse by the three lockdowns and social distancing requirements introduced during the Covid-19 pandemic. It said this increased need for mental health support in the population was putting a strain on NHS staff who—the committee argued—faced permanent staff shortfalls.

The committee noted the progress the government had achieved in the roll-out of new mental health support teams in schools. It also said progress had been made in the number of children with diagnosable conditions receiving NHS treatment, which had risen to around 40%. However, the committee argued it was “not acceptable that more than half of young people do not receive the mental health support they need”.^[35] The committee recommended the government should focus more on early intervention and prevention.

The committee also said too many children and young people were in inpatient care units receiving inappropriate care. It argued, in the majority of cases, these children should be receiving social care near their families. The committee recommended the government should do more to establish new integrated care systems jointly with the social care system.

The government published its response to the committee’s report in March 2022.^[36] The government acknowledged the increased risk to children and young people’s mental health during the pandemic. It said the Department for Education had announced £17mn to improve mental health and wellbeing support in schools and colleges following the pandemic. The government also said it was planning to increase the number of mental health support teams in schools during the 2022–23 financial year. More recently, in February 2023, the government published proposals for greater integration of local NHS and social care services in its children’s social care strategy, ‘Stable homes, built on love’.^[37] Further information on proposals for the reform of children’s social care is provided in the House of Lords Library in focus article ‘Reforming children’s social care: Public Services Committee inquiry’ (14 September 2023).

The mental health of children and young people in England was also considered by the House of Lords Children and Families Act 2014 Committee in its report published in December 2022.^[38] The committee argued CYPMHS were in crisis, with children and young people facing long waiting lists for referrals and treatment. It argued the government had “not grasped the importance and severity of this problem” and argued one of the policy areas which needed the most attention was early intervention.^[39] The government published its response to this report in February 2023.^[40] This response addressed the specific recommendations concerning the provisions in the 2014 Act but not the committee’s points concerning mental health provision more broadly.

In June 2023, the Local Government Association and the Children and Young People’s Mental Health Coalition published a review of government support for mental health services for children and young people over the previous decade.^[41] This review shared the Health and Social Care Committee and the Children and Families Act 2014 Committee’s conclusion that early intervention in an individual’s childhood and teenage years was crucial for avoiding future mental health difficulties. The review argued that, while there had been some “tangible progress” in the expansion of support provided to families, children and young people, it was concerned these attempts were at risk of being undermined by “a lack of coordinated vision and action both locally and nationally”.^[42] The review recommended the government should develop a new cross-government strategy on mental health and wellbeing. It also made several recommendations concerning the way different types of support were currently provided. This included that the government should increase provision of early intervention support through community based early support hubs. It argued the government should ensure there is a full, national roll out of mental health support teams in schools and colleges. The review also concluded too many children and young people in inpatient care were receiving inappropriate support and it recommended the government should bring forward its plans to reform the Mental Health Act 1983.

6. Read more

• House of Lords Library, ‘Commission on Young Lives: National plan for vulnerable young people’, 19 January 2023
• House of Lords Library, ‘NHS in England: Current performance and innovation’, 8 June 2023
• House of Commons Library, ‘Support for children and young people’s mental health (England)’, 15 August 2023

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This briefing has been updated to include statistics from wave 4 of NHS Digital’s follow up to its 2017 survey of the mental health of children and young people in England. These figures were published on 21 November 2023.

Image by BBC Creative on Unsplash.