Children and young people’s mental health: policy and services (England)

Successive Governments have pledged to improve mental health support for children and young people. This briefing covers the structure of Children and young people’s mental health services, recent policy from the Department of Health and Social Care, Department for Education and NHS England, and evaluations of Government policy.

How many children and young people have mental health conditions?

In November 2018, NHS Digital published the results of the first national Children and Young People’s Mental Health Survey since 2004. The survey was undertaken in 2017 and followed up in 2020, 2021, 2022 and 2023. The 2023 survey found that:

• In 2023, 20% of children aged 8 to 16 had a probable mental disorder.
• Among young people aged 17 to 19, the rates of probable mental disorder increased from 10% in 2017 to 18% in 2020 (a statistically significant increase). Between 2020 and 2021 the rates remained similar before increasing again between 2021 and 2022, from 17% to 26%. In 2023, rates remained fairly stable at 23%.

445,000 people were in contact with children and young people’s mental health services in November 2023, up from 362,000 two years year earlier in November 2021. This number has increased steadily in recent years: there were 231,000 people in contact with children and young people’s services pre-pandemic in November 2019.

Children and young people’s mental health services

Children and young people’s mental health services (CYPMHS) is an umbrella term for all mental health and wellbeing services supporting this group.

CYPMHS are provided by a range of organisations including NHS mental health and community trusts, local authorities, the private sector and the voluntary sector. Most NHS services are commissioned by Integrated Care Boards but some specialist services, such as children’s inpatient services, are commissioned by NHS England through NHS-Led provider collaboratives.

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, ICBs are responsible for deciding how much to budget for these services from their overall funding allocation.

In 2023/24, ICBs planned to spend £1.1 billion on CYPMHS (excluding eating disorders), and a further £96 million on eating disorders. This represents 8% of planned total local mental health spending. This is up from confirmed spending of £1.0 billion on children and young people’s mental health services and £83 million on eating disorders the previous year.

Government policy on children and young people’s mental health

This briefing paper covers Government policy on CYPMHS from 2011 to present.

In September 2023, the Government published a five-year cross-sector strategy for suicide prevention in England alongside an action plan with intended timelines for delivery. The strategy 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, ten-year plan for mental health and wellbeing in England. However, it was later announced mental health would be covered alongside physical health conditions in an upcoming Major Conditions Strategy. The Government published a strategic framework for the strategy in August 2023.

The NHS Long Term Plan (January 2019) said that by 2023/24, at least 345,000 additional children and young people (up to age 25) would be able to access mental health support through NHS services or school or college-based Mental Health Support Teams.

In December 2017 a green paper on children and young people’s mental health was published for consultation, setting out measures to improve mental health support through schools and colleges. The green paper set out three key proposals:

• To incentivise and support all schools and colleges to identify and train a Designated Senior Lead for mental health.
• To fund new Mental Health Support Teams supervised by NHS children and young people’s mental health staff.
• To pilot a four-week waiting time for access to specialist NHS children and young people’s mental health services.

The Government’s response to the consultation, published in July 2018, committed to taking forward all proposals in the Green Paper. In January 2024, the Government said the roll-out of Mental Health Support Teams is aimed to extend to an estimated 44% of pupils and learners by the end of financial year 2023/24, and at least 50% by the end of March 2025. It also said that over 14,400 settings have claimed a grant to train a senior mental health support lead.

There Government has said it is 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; in September to November 2023, 66% of urgent referrals were seen within one week and 77% of routine referrals were seen within four weeks.

Children and young people in mental health hospitals

There are no age limits in the Mental Health Act 1983, meaning children can be detained under the legislation if they are suffering from a mental disorder and pose a risk to themselves or others.

NHS Digital recorded 997 detentions under the Mental Health Act of people aged 17 and under in 2022/23, though the true figure will be higher as not all providers submitted data. A report by the Children’s Commissioner in 2020 found that Black children were less likely than White children to be admitted informally to mental health wards, and more likely than White children to be held in secure wards or psychiatric intensive care units (PICUs).

Concerns have been raised about the placement of children in adult mental health beds and out of area beds. There are also concerns about use of restrictive practice in mental health services, including segregation, seclusion and restraint.

In June 2023, the Government announced that a national investigation of mental health inpatient services would commence in October 2023.

Evaluation and commentary on children and young people’s mental health services

In February 2023, the National Audit Office published a report on Progress in improving mental health services in England. It said that, even if the NHS achieves its 2023/24 access target for CYPMHS (as set out in the Long Term Plan), this would equate to only around two-fifths of 0 to 17 year olds with a diagnosable mental health need accessing services. The Government is due to provide the Public Accounts Committee with an update against recommendations based on the report in January 2024.

A report by the Education Committee in 2023 said the current capacity of CYMHS is “grossly inadequate”. In its response, the Government said it “extensive cross-government working” is taking place on several children’s mental health projects.

This briefing applies to England only.