Post-COVID children's mental health services “buckling under pressure"

There is a profound crisis in children and young people's mental health services in England and a system of support that is “buckling under pressure”, a new report warns.

The report from the Commission on Young Lives, headed up by former Children’s Commissioner, Anne Longfield, says that support is frequently over-medicalised and bureaucratic, unresponsive, outdated, and siloed.

Co-authored with the thinktank Centre for Mental Health and the Children and Young People's Mental Health Coalition, researchers spoke to professionals who work with children, and to children and families themselves, hearing about young people who have barely returned to school since the start of the pandemic. Researchers also heard that the increase in the regularity and extreme nature of many young people's mental health problems, and how self-harm and suicide attempts are a much more regular feature of school and college life.

It warns that failing to support some young people with mental health problems could lead to more behavioural incidents at school, a rise in exclusions, and more children becoming at risk of grooming and exploitation. The report says a rising tide of poor mental health has the potential to expose even more children to exploitation, crime, and offending. A failure to detect problems early in many young offenders can increase the likelihood that they will persist with criminal activity into adulthood.

The report does, however, recognise how some children's mental health services have widened the support they provide following increased investment. It also highlights the positive work being done by many organisations, charities, and community groups to provide support to children with mental health problems, including programmes that divert children with mental health problems away from crime. However, it argues that Children and Young People's Mental Health Services is still losing the battle against rocketing demand for help and failing to meet the needs of thousands of children in crisis.

Researchers estimate that one in six children aged 6-16 were identified as having a probable mental health problem in July 2021, up from one in nine in 2017. There was a 47% increase in the number of new emergency referrals to crisis care teams in under-18-year-olds between December 2019 and April 2021.

The Commission on Young Lives said it was “shocked” to hear from those working with young people about how often those suffering from serious mental health conditions are unable to receive treatment in some areas until they have had multiple suicide attempts 'with serious intent'. At the end of April 2022, 388,887 people were in contact with children and young people's mental health services, and 352,866 new referrals were received. Yet in 2020/2021, just 23% of children referred to services started treatment within the 4-week waiting target.

“Children and young people's mental health services just aren't working for many of those who desperately need help. I regularly meet children and their families who are struggling with serious mental health problems but are on long waiting lists for treatment, can't even get a referral or don't trust that they will get the kind of help they need,” Steve Chalke, Founder of Oasis, which hosts the Commission on Young Lives, said.

He added that the Government needs to put in the right resources and have an “urgent rethink” about the kind of support provided in communities and through schools. “Until we tackle the drivers of youth crime, including underlying psychological and mental health issues, we will continue to fail children and young people at risk of being excluded, exploited and criminalised.”

The report also argues mental health services for young people are still not set up to support all those with multiple and complex needs, with clinical thresholds too rigid, some children ricocheting around services, and too many children only receiving help at crisis point. Early prevention services are underfunded and to not reaching most children, particularly the most vulnerable or marginalised.

Many children from marginalised groups have negative perceptions of mental health services because they have had previously bad experiences of other statutory services. Researchers found that clinical models devised to help young people often feel outdated, uncomfortable, and overly medicalised to children themselves.

Young Black men were less likely to seek formal mental health support through doctors, counsellors, or psychologists and racialised communities are also more likely to report more dissatisfaction with mainstream mental health care. Many families, particularly those living in racialised communities, have a deep distrust of statutory services.

Centre for Mental Health chief executive, Dr Sarah Hughes, said action is needed now to protect the mental health of those at greatest risk, including the poorest and the most marginalised children in society.

“Children and young people's mental health is at risk from the after-effects of the pandemic, the cost of living crisis and the ongoing effects of endemic racism and inequality.

“Expanding mental health support for children and young people is essential. But alongside it we need to reduce child poverty, support young families, make schools mentally healthier and rebuild youth services.”

The report recommends that the next Prime Minister commits to funding an immediate £1bn children and young people's mental health wellbeing recovery programme to improve the quality and effectiveness of mental health care and support, with guaranteed appointment and treatment times.

“The overall response from the Government to this children's mental health crisis has so far been too slow and inadequate, and we are failing to support hundreds of thousands of children with mental health problems,” Anne Longfield, Chair of the Commission on Young Lives said.

“The next Prime Minister will have an opportunity to show they care about tackling this children's mental health emergency.

“The children's mental health emergency in England is so profound that we face a generational threat to our country's future national prosperity and success. The scale of the problem is growing, rocket-boosted by the pandemic and the system is buckling under pressure and unable to cope with the explosion in demand for help.”

“Thousands of vulnerable children are falling through gaps in the mental health support system, boosting the chances of those resourceful, manipulative, and ruthless criminals and abusers who are so good at grooming them.”