Mental health crisis: The children and young people waiting years for support
Research by the children's commissioner for England reveals extent to which the children and young people referred to mental health services are waiting to receive the support they need
Of almost one million children and young people referred to mental health services in 2022/23, more than 270 000 were still waiting for support at the end of the year.
NHS data obtained by the Children's Commissioner for England shows that the average wait for a second contact (which is usually when support begins) for these children and young people was 142 days—including 32 000 who had been waiting for more than two years.
Of those whose reasons for referral were known, the most common issues were anxiety, ‘reaching crisis’, neurodevelopmental conditions (excluding autism), depression, and self-harm.
However, concerningly a third of cases were recorded as reason ‘unknown’.
The disturbing picture is painted in a report from the Children's Commissioner. It finds that 949 200 children and young people–roughly 8%–had active referrals to Child and Adolescent Mental Health Services (CAMHS) in the 2022/23 financial year.
Of this number, 305 000 entered treatment, with an average waiting time of 35 days. Meanwhile, 372 800 had their referrals closed before accessing CAMHS, leaving 270 300 who were still waiting by the end of the year (March 2023).
The report reveals geographical differences when it comes to waiting times—with young people waiting for an average of 147 days for treatment in Sunderland and 133 days in Portsmouth. This compares to just 4 days in Southend.
And the data also reveals that boys and younger children are among those waiting the longest.
Of the 305 000 children and young people accessing treatment in 2022/23, the most common age groups were 13 to 15 (113 000), 10 to 12 (73 000), 16 and 17 (53 000) and 7 to 9 (44 000).
The report warns that while £997m of NHS money was spent across England on CAMHS in 2022/23 – an increase from £922m the year before – this is just a 1% rise year-on-year in real-terms once inflation is taken into account.
The fundamental truth outlined in the report is that demand for children's mental health services ‘continues to outstrip the availability of support’.
It comes at a time when NHS research estimates that 1.4 million children and young people aged 8 to 17 have a probable mental health condition. This compares to separate NHS data showing that only 678 400 children and young people had at least one contact with CAMHS in 2022/23.
Children's commissioner Dame Rachel de Souza is calling for a national target of no more than 4 weeks' waiting time for an initial assessment and no more than another 4 weeks for support to begin.
She also wants increased support for children who do not reach the threshold for CAMHS, including through Early Support Hubs, Mental Health Support Teams (MHSTs), and via school counsellors. And she wants a new 10-year plan for children and young people's mental health as well as reforms to the Mental Health Act.
She said: ‘This generation of children have faced uncertain and challenging times like no other generation before them – they are bombarded with negative world news, and many are exposed to the harmful impact of the online world. Against this backdrop, it's unsurprising that so many children and young people are continuing to experience issues with their mental health.
‘Children are still waiting far too long to access the support they need, and for too many children the speed at which they can access support is still down to the luck of where they live. With the right early support, many children would not need access to mental health services.
‘It is shocking to see so many children being referred to mental health services because they have reached crisis point. Many problems we see in children's mental health services stem from local and national leaders failing to prioritise children's mental health. We need fresh, long-term thinking when it comes to children's mental and emotional health and wellbeing.’
- Children's Commissioner: Children's mental health services 2022-23, 2024: www.childrenscommissioner.gov.uk/resource/childrens-mental-health-services-2022-23
Mental health support teams: Schools lament ‘glacial progress’ as only 44% of pupils reached
The latest figures show that 8 years after the idea was first proposed, only 44% of pupils are covered by Mental Health Support Teams—with huge regional variations in provision
Mental Health Support Teams (MHSTs) are on track to reach half of all children and young people by next year, 8 years after the initiative was first proposed.
Figures published by the Department for Education (DfE, 2024) show that around 4.2 million students are now covered by support from MHSTs – about 44%.
This is up from 35% coverage last year and the initiative is forecast to reach 54% coverage in March 2025.
However, while the initiative is well-supported there has long been frustration at the long timescales and slow roll-out.
Margaret Mulholland, SEND and inclusion specialist at the Association of School and College Leaders, is frustrated by the lack of progress: ‘It's just not acceptable that in 2025, 8 years after the initiative was first proposed, half of all pupils will still be without access to MHSTs’
MHSTs support the mental health needs of children and young people in primary, secondary and further education (ages 5 to 18), providing early intervention on issues such as mild to moderate anxiety. Delivery is led by the NHS with support from the DfE.
The latest figures show that 498 MHSTs are now operational with an additional 109 due to be online by March 2025. Each MHST covers an average of 8 400 learners in 17 schools or colleges and are also intended to support education settings in promoting good mental health and wellbeing.
Ms Mulholland also expressed her frustration that access to MHSTs continues to vary ‘widely’.
The DfE's figures show that regional MHST coverage is highest in London (50% of pupils), the North West (49%), and the South West (48%), while the areas with the least coverage are the Midlands (37%), South East (39%), and East of England (41%).
Ms Mulholland said: ‘Access varies widely across the country, meaning the level of support available is still something of a postcode lottery, while waiting times for children and young people's mental health services remain worryingly long.
‘There needs to be significant investment in tackling the mental health crisis among children and young people, including the roll-out of MHSTs to all schools and colleges as soon as possible. This glacial progress, when set against the increasing demand for support and growing unmet needs, should be no cause for celebration.’
The MHST initiative was first floated in 2017 and was announced in July 2018 as part of the government's mental health Green Paper. The plans also included funded training for senior mental health leads in schools (DfE, 2021).
MHSTs are intended to work closely with the mental health leads and give advice to schools and colleges, including supporting with referrals.
The latest figures show that take-up of the senior mental health lead training has increased to 70% of schools–around 16 700–as of March 2024, up from 58% last year. This includes 80% of secondary schools. The DfE aims to offer this grant funding to all schools by next year.
Despite the eight-year roll-out, Claire Murdoch, NHS national mental health director, said that the MHSTs had been ‘fast-tracked’ – a comment certain to raise eyebrows in some quarters.
She said: ‘NHS mental health teams are currently in contact with record numbers of children and young people, and since fast-tracking the introduction of these MHSTs, it's brilliant that we can confirm that well over two-fifths of pupils in schools and in further education are now covered by expert support.
‘This achievement shows the joint commitment to mental health and wellbeing across the NHS and education is crucial, and we know that these world leading services are helping children and young people with many anxieties or issues they may have.
‘NHS staff and our partners in education continue to push implementation, and we are on course to reach more than 50% this time next year, so I would urge everyone, whether you're a teacher, parent or child, to access this early support.’
- DfE: Guidance: Senior mental health lead training, 2021: www.gov.uk/guidance/senior-mental-health-lead-training
- DfE: Transparency data: Transforming children and young people's mental health provision, 2024: www.gov.uk/government/publications/transforming-children-and-young-peoples-mental-health-provision
‘By the time we teach them about sexual image-sharing it is too late’
Research finds that one in seven teenagers are experiencing abuse relating to online ‘nude-sharing’ with many incidents taking place long before schools have begun to teach young people about the issue
One in seven teenagers aged 16 and under have experienced abuse relating to online ‘nude-sharing’, sparking calls for the introduction of dedicated single-sex lessons earlier in secondary schools.
Research from Internet Matters (Hilton et al, 2024) has put forward a range of proposals to stop children from sharing sexual images of themselves.
The report highlights a specific risk for students aged 11 to 13, who it says appear most frequently in self-generated child sexual abuse material (CSAM).
Self-generated CSAM ranges from material that is voluntarily shared between peers (where material is re-shared without their knowledge or consent) to coerced ‘self-generated’ imagery where grooming, pressure or manipulation has been used.
The report warns that with all forms of self-generated imagery there is a ‘significant risk’ that it passes into the hands of adult offenders and is shared within offender networks. The report says there has been a 14% increase between 2022 and 2023 alone in the amount of self-generated CSAM featuring 11 to 13-year-olds—from 199 363 reported images in 2022 to 254 071 in 2023.
Survey findings in the report show that 14% of teenagers under the age of 16 say that they have experienced a form of image-based sexual abuse. This would equate to more than 400 000 children in the UK.
Furthermore, a quarter of the teenagers in the same survey said they were aware of image-based abuse being perpetrated against another young person.
It comes after the National Crime Agency in April sent a warning to schools about a recent rise in reports of financially motivated sexual extortion targeting children and young people (NCA, 2024).
This practice involves an adult offender threatening to release nude or semi-nude images and/or videos of a child or young person unless they meet a financial demand. A large proportion of cases have involved male victims aged 14 to 18.
The report says that while most efforts to tackle the issue until now have focused on removing the content, this ‘must be supported with greater efforts to prevent sexual content from being created and shared in the first place’.
The authors worked with focus groups involving 111 young people to try and discover what approaches are effective. They found that many of them had not received any specific education in relation to image-sharing – or only brief references during RSHE lessons, and often too late to make a real difference. The report states: ‘When the issue was discussed, it was not perceived to be detailed enough or to offer enough information and was usually delivered by teachers that were non-subject specialists who (the young people) felt often sped through the topic because they found it awkward.’
The research trialled a prototype, single-sex RSHE lesson designed by Internet Matters. The students in the focus groups responded well to the lesson, which was interactive and discussion-based, with revised, specific messaging for boys and girls. The report states: ‘Girls in particular want smaller, gender-based groups. They said they found it hard to share or discuss issues in front of the boys in their class for fear of being teased or bullied.
‘Girls say they want educational resources to acknowledge the much greater likelihood that boys will behave as perpetrators, pressuring girls for images, while girls are more likely to experience harassment for those images. Girls said boys should receive perpetrator-targeted messaging that would help them to understand the harmful impact of demanding nude images from others.’
It adds: ‘Strikingly, boys saw huge value in messages which tackle ‘perpetrator’ behaviour with unequivocal and un-sensationalised information about the consequences and legality of this behaviour.’
The students also wanted information much earlier in secondary school, with many criticising that if lessons on image-sharing happened at all they came too late. The report adds: ‘Children are clear that this teaching must occur early on in secondary school – by the time that most are receiving lessons about sexual image-sharing (year 9 and above), it's simply too late.’
One girl in the report, now aged 16, described how she had fallen victim to image-sharing in year 8 and only received a lesson on the topic once she was in year 10.
The research considered two further interventions: an interactive educational game and a nudge technique based on detection technology and designed for deployment in the moment a child attempts to send an image – both of which proved effective. Internet Matters will be developing these further to make them available to a wider number of children.
The not-for-profit body, which is funded by industry to offer child internet safety advice to parents and professionals, is recommending teaching on this topic to be delivered by gender-based groups in the classroom, from an earlier age, and to be accompanied by digital prevention methods (such as nudges).
- Hilton et al: Shifting the dial: Methods to prevent ‘self-generated’ child sexual abuse among 11-13-year-olds, Internet Matters, 2024: www.internetmatters.org/hub/research/methods-prevent-self-generated-child-sexual-abuse-11-13s/
- NCA: Financially motivated sexual extortion: Alert for education settings, 2024: www.ceopeducation.co.uk/globalassets/professional/guidance/nca_financially_motivated_sexual_extortion_
Relationships and sex education: Young people turning to social media
The quality of relationships and sex education is improving but inconsistent delivery of key topics is driving many young people onto social media in their search for information.
The annual Young People's RSE Poll finds that the quality of provision in schools has improved but many young people are still not learning about key issues.
Published by the Sex Education Forum, the report is based on survey responses from more than 1 000 students in England aged 16 and 17 and asks them about their experience of RSE during their schooling.
The results show that 50% of the respondents said that their RSE at school was ‘good’ or ‘very good’—the highest proportion yet in this research.
Broken down by issue, a majority of the respondents reported good coverage of topics including puberty (79%), sexual consent (71%), sexual harassment (64%), STIs (62%), and sexual orientation (57%).
However, many report not being taught enough about key issues including pornography (49%), power imbalances in relationships (49%), how to access local sexual health services (46%), healthy and unhealthy/abusive relationships (40%), STIs (35%), sexual harassment (33%), sexual orientation (38%).
Within this, 23% of the students said they were taught nothing at all about pornography at school. The report raises concerns that this inconsistent provision is driving young people online in their search for information.
While ‘school’ still ranks as the main source of information across all topics, 16% of young people said they learnt about pornography while watching it, while 22% said their main source of information about pornography was social media and other websites. When it comes to consent, 14% said they turned to social media or other websites for information.
Indeed, social media and websites were the main source of information on a number of topics for a significant minority of the respondents, including for healthy and unhealthy relationships (18% and 21%), sexual health (18%), and LGBT+ issues (34%).
The government published statutory guidance on the teaching of relationships and sex education (RSE) almost five years ago and had floated plans to update this guidance before the General Election was called.
When asked during the research about what changes they would like to see, young people said the priority must be training to ensure teachers can deliver RSE with confidence (57%) as well as more flexibility for schools to cover topics at the age their students need the information (52%).
Nearly four out of 10 of the respondents (39%) said that it would have been better if RSE had started earlier in their life with the introduction of key topics at primary school including consent (81%), the harms of pornography (73%), questioning and challenging stereotypical ideas about how girls and boys should behave (69%), and examples of same-sex relationships (56%).
Lucy Emmerson, chief executive of the Sex Education Forum, said: ‘Government has failed to address the gaps even as young people cry out for support with significant issues like harms linked to pornography, rising rates of STIs, lack of LGBTQ+ representation, and power imbalances in relationships.’
Ms Emmerson said any updates to the RSE curriculum by the next government must prioritise ‘flexible age and stage relevant content and providing teachers more training to confidently deliver lessons’.
She added: ‘Neglecting young people's views does the next generation a disservice by leaving them dependent on potentially untrustworthy online sources for information and ill-equipped for healthy relationships.’
- SEF: Young people's RSE poll, 2024: www.sexeducationforum.org.uk/resources/evidence/young-peoples-rse-poll-2024
Record number of suspensions as schools report rising problems with challenging behaviour
Myriad factors ranging from mental health issues and unmet SEN to disengagement with the curriculum and wider problems within families are driving up persistent disruptive behaviour in schools
Record numbers of suspensions are being handed out as schools across England report increasing problems with challenging student behaviour.
Figures from the Department for Education (DfE, 2024) reveal a sharp rise in the number of exclusions and suspensions.
They show a total of 263 904 suspensions handed out during the spring term 2022/23 – the highest number ever recorded and an average of 3.13 per 100 pupils.
It is a notable rise on the previous spring term (2021/22) when 201 090 suspensions were recorded (2.4/100), although this rise can be explained by the sharp drop in suspensions seen during Covid.
Nonetheless, the current rate of suspensions is notably higher than pre-Covid figures, which tended to stay around the 120 000 to 150 000 mark for the spring term.
The DfE analysis notes that suspensions are ‘typically higher’ in autumn term than in spring and summer, but the latest figures have bucked that trend as the autumn term 2021/22 saw 247 366 suspensions.
The rise in suspensions is being driven at secondary level. Between the autumn and spring terms, secondary school suspensions increased by 9% from 214 100 to 232 600, while primary school suspensions decreased by 3% to 25 900. Special school suspensions also fell by 18% to 5 300.
School leaders this week reported ‘a really difficult situation’ with challenging student behaviour due to myriad factors including mental health issues, unmet SEN, disengagement with the curriculum, and wider problems within families.
The DfE analysis reflects this situation. The most common reason for suspensions (and permanent exclusions) was persistent disruptive behaviour. Meanwhile, the second most common cause of suspensions was verbal abuse or threatening behaviour against an adult in the school.
A suspension can involve a part of the school day and it does not have to be for a continuous period. A pupil may be suspended for one or more periods up to a maximum of 45 school days in a single academic year. The figures show that the most common suspensions are for a single day (47%) while 99% of suspensions were for five days or fewer.
The most common year group for suspensions is year 9, closely followed by year 10. Meanwhile boys and students eligible for free school meals were more likely to be suspended than girls and non-FSM students.
When it comes to exclusions, 3 039 were recorded in the spring term 2022/23 (0.04 per 100 students), up from 2 179 the previous spring term, but down from 3 100 in the autumn term (2021/22). Secondary schools account for 85% of these exclusions.
Again the number of exclusions is higher than pre-pandemic levels when spring term exclusions tended to hit between 2 100 and 2 800.
A permanent exclusion refers to a pupil who is excluded and who will not come back to that school (unless the exclusion is overturned).
The DfE's figures only include permanent exclusions which have been upheld by the governing body or Independent Review Panel.
Pepe Di'Iasio, general secretary of the Association of School and College Leaders, said: ‘This data unfortunately reflects what we are hearing from school leaders across the country—that there is a really difficult situation with challenging behaviour among some pupils. There are a number of reasons for this – mental health issues, unmet SEN, disengagement with the curriculum, and, in some cases, wider problems within families.
‘It hasn't happened out of the blue. The whole tapestry of social and mental health support services around families and children has receded over the past 14 years because of budget pressures and increasing demand, and schools are left to pick up the pieces without sufficient funding.
‘This means that behavioural issues often escalate to a point at which a suspension – or exclusion – is the only option that is left. It is a terrible legacy of government underinvestment.’
Paul Whiteman, general secretary of the National Association of Head Teachers, said that too often the problems that lead to suspensions and exclusion ‘go way beyond the school gate’.
He continued: ‘Too often schools are left to tackle the problems that lead to exclusions and suspensions alone, and with scarce resources. Inadequate government funding of schools is leading to a reduction in pastoral care and teaching assistants in schools.
‘Early intervention is often crucial – government funding cuts to services that support schools have made it harder for children and families to access help from mental health services and social care amid long waiting lists and higher thresholds.
‘We've seen local authorities forced to stop providing key services, such as behaviour support teams.
- DfE: Spring term 2022/23: Suspensions and permanent exclusions in England, 2024: https://explore-education-statistics.service.gov.uk/find-statistics/suspensions-and-permanent-exclusions-in-england