Transforming access to children and young people’s mental health support

The importance of prevention

The number of CYP with a probable mental health condition is increasing, and there is currently thought to be one-in-five, eight-to-18-year-olds with significant mental health needs that would benefit from specialist support. There is discussion elsewhere about what is potentially causing this increase, but it is having a significant impact on the numbers wanting to access mental health support, with a 152 per cent increase in the number of referrals to CYP mental health services between June 2019 (33,440) and June 2025 (84,412). 

Despite the increase in demand, NHS organisations are making radical improvements to tackle and reduce waiting times to specialist community children and young people’s mental health services. For instance, improving flow through services; ensuring young people are on the right pathway as soon as possible; improving data quality; more efficient use of workforce; adopting approaches that include effective partnership working with social care services and primary care; increasing capacity in the form of mental health support teams working in schools; and community eating disorder services.

Despite this work, the increase in demand for services is still having an impact, as according to the Children’s Commissioner, at the end of March 2024, 320,000 CYP were still waiting for CYP mental health services. The Mental Health Services Dataset shows that the 10 per cent longest waits for CYP mental health services were about two and a half years for first contact with services.

Serious mental illnesses such as psychotic conditions often start in the late teens with a peak onset of 15 years of age, but the root causes are often from earlier childhood experiences such as psychological trauma. There is longitudinal evidence indicating that between 50 and 70 per cent of adults with a mental health condition had indications of mental health issues in childhood. Effective early intervention when symptoms first emerge can help prevent the continuation or the development of other mental health conditions in adulthood.

Mental health conditions impact on the individual and their family, but also on the wider society. The Lancet Psychiatry Commission on youth mental health highlighted how mental health issues can result in poorer educational outcomes, unemployment, lower income and being more reliant on welfare benefits. 

Children and young people with mental health conditions are more likely to be absent from school and are ‘seven times more likely to miss more than 15 days of school over the course of a school term.  Research has shown that persistent absenteeism due to mental health conditions reduces educational attainment, which is very likely to impact on exam outcomes. A recent report from the Department for Work and Pensions found that young adults aged 16-25 years with mental health conditions are nearly five times more likely to be economically inactive compared to their peers without them. 

While the focus is often on the impact an ageing population has on the NHS, there is currently a cohort of young people with mental ill health, needing support. Unless they can access effective interventions and are helped onto a more positive trajectory, they may become a cohort of mentally unwell adults who are economically inactive. This will put more strain on the NHS and other public services, as well as negatively impacting on their lives and that of their families. 

The importance of evidence-based approaches

To address this, is it imperative that approaches to support the mental health and wellbeing of children and young people are evidence-based and produce good outcomes. In the past two decades there has been a proliferation of initiatives promoted to schools to address poor mental health and improve mental wellbeing. There is evidence that some of these initiatives are not necessarily effective when rolled out across the whole school population. 

The Department for Education (DfE) recently published the results of the Education for Wellbeing research programme, which was one of the largest randomised controlled trials to look at mental health within schools in England. This research had mixed findings regarding universal interventions that were provided to all CYP within schools, with some elements of the programme resulting in no improvements or only short-term benefits for some pupils. 

The research found that mindfulness-based interventions were not effective for all CYP with emotional difficulties, but potentially useful in reducing emotional difficulties in secondary age young people if delivered regularly and consistently. Researchers also found that some groups of young people, such as those who had already experienced mental health issues, experienced higher levels of emotional difficulty after the intervention. 

This highlights the challenges in providing universal interventions in schools, which is why government has opted to roll out a more systematic approach through mental health support teams (MHSTs), who can help steer what is being delivered in schools. 

There are risks that mental health clinicians are well aware of, including pathologising normal emotional responses, which are heightened by discussions about mental illness on social media and people self-identifying with mental health or neurodiverse conditions. This does not refute the real increase in the number of CYP who are experiencing mental health conditions but does create a challenge in the way the language of mental health is used. It can blur the boundaries of normal emotional experiences and the pastoral support, advice and peer support that many young people can benefit from, and those CYP experiencing more severe mental distress that will benefit from clinical interventions. 

The economic case for early intervention 

There is a strong economic case for improving access to early intervention services based in the community. In 2019, 40 per cent of the total CYP mental health budget in England was spent on about 4,000 CYP admissions to inpatient units. In 2021/22, the budget for CYP mental health services (excluding eating disorders) was £922 million, which was about 8 per cent of the mental health budget. The average cost of one admission would pay for approximately 100 CYP to be supported in the community for one year. The GIRFT report on children and young people’s mental health services highlights that intensive community support is more clinically effective than an admission for many young people, but there is a need to invest in these services. NHS England carried out a review of children and young people’s inpatient provision and produced a draft service specification which proposed the development of an acute and intensive mental health centre in every local system. Unfortunately, to date these documents have not been published and there is no additional funding for them currently.  

A recent report from Pro Bono Economics (PBE) found that improving CYP mental health could result in economic benefits of £51 billion, which is about £5,300 per child over the course of their lifetime. This is through higher earnings (£50 billion), lower exclusion costs (worth £17 million) and redistributed special educational needs (SEN) support (worth £606 million). While many of these savings are very relevant to government policy generally as well as for individuals, most will not directly benefit the NHS. This is why a system approach is important where different agencies share risks and savings. 

Frayman and colleagues at the London School of Economics have estimated that every £1 invested in MHSTs provides a return of £22 in wellbeing benefits and predict that MHSTs will pay for themselves within two years. Important to note that this study is based on estimates, rather than an evaluation of the model itself in practice. 

The government’s priorities

Best start for children and families

The government has committed to ensuring that 75 per cent of five-year-olds reach a good level of development in the early years foundation stage assessment, which includes social and emotional development, alongside other key developmental markers. Best Start Family Hubs are a key element of the plan to improve childhood development and should be in every local authority by April 2026.

There is a commitment in the NHS 10 Year Health Plan to ensure that neighbourhood health services work with family hubs, schools and colleges to ensure that all CYP including those with special educational needs and disabilities (SEND) can access timely support, such as helping parents who have children with emotional needs and ensuring that all children reach a good level of development and are school ready.  

Childhood is a key developmental stage. Intervening at the earliest opportunity, such as in the perinatal period and first two years of life, can make a significant impact as it creates the building blocks for good mental health. This includes support for perinatal mental health, parenting and addressing attachment or relationship issues between the child and parents/carers. Parenting programmes have a strong evidence base. They can help to improve child and parent/carer relationships, give parents the skills to manage problem behaviours and can be effective for conditions such as ADHD. According to McDaid and Park, every £1 spent on parenting programmes can generate up to £15.80 in the longer term. 

There are NHS services, such as the Building Attachment and Bonds Services (BABS) provided by Mersey Care and partners, that support parent/care givers’ relationships with their child. The service is aimed at parents who might be struggling to bond with their baby, but is also important where there are safeguarding issues, parents have mental health issues or where previous children were taken into care. 

Mental health support teams

The NHS and partners have been rolling out mental health support teams (MHSTs) since the publication of the green paper on transforming CYP mental health provision in 2017. There are three main components that should be included in these new teams: 

• Delivering evidence-based approaches such as low-intensity interventions based on cognitive behavioural and social learning theory informed techniques for CYP with mild to moderate mental health issues, and their parent/carers.
• Senior mental health leads in each school or college to introduce or develop a whole school or college approach.
• Providing timely advice to school and college staff and liaise with external specialist services to help CYP get the right support and stay in education.

The government committed to providing access to a mental health specialist in every school in its 2024 election manifesto. Currently about 52 per cent of children can access MHSTs, with plans to roll them out to nearly 1 million more, or about 60 per cent of CYP in schools or further education, by the end of 2025/26. The NHS 10 Year Health Plan commits to reaching national coverage by the end of the decade, which is reiterated in the Medium-Term Planning Framework’s measures of success for 2026/27 and 2028/29. 

A large proportion (85 per cent) of schools and colleges reported that working with the MHSTs ensured better mental health and wellbeing support than would have been available otherwise. According to the Children and Young People’s Mental Health Coalition, most educational organisations have implemented whole-school approaches to mental health and wellbeing. Any specialist mental health and learning disability service that is funded by the NHS should be submitting data to the Mental Health Services Dataset, which gives a national picture on use of mental health services in England, and so access to MHSTs will count towards improving access to CYP mental health services. 

A new role was developed to support the MHSTs in the form of education mental health practitioners (EMHPs), who undertake a graduate/postgraduate diploma at participating higher education institutions (HEIs). According to the British Psychological Society, these practitioners will receive training to deliver low intensity interventions for CYP and their parents/carers with common mental health problems such as anxiety and depression, be able to work in educational settings and support whole-school approaches to mental health. The MHSTs also require experienced mental health professionals, who provide supervision for the EMHPs.

Evaluation of the mental health support teams

The first 25 trailblazer sites were evaluated and researchers provided number of findings:

• Good progress had been made in rolling out the MHSTs in the pilot areas.
• Young people appreciated having someone in the school who they could talk to about their mental health problems.
• MHSTs focused more on supporting CYP mental health difficulties than working with the schools to promote mental wellbeing across the whole school or college.
• MHSTs worked hard to engage with a diverse range of young people, but some populations were underserved by these teams, including CYP with SEND or neurodiversity, those from some BME groups, and those from challenging families or social circumstances. This is concerning as these groups potentially are at a higher risk of developing mental health problems and have complex needs.
• Retaining EMHPs was challenging. Some people saw these posts as a stepping stone to other posts. There was a lack of career development and progression once in the role, as well as frustrations about just using the CBT approach and high workloads.
• Engaging with the school or college is essential for embedding and developing a whole-school approach, but this was quite challenging for some schools, both in terms of level of support needed and them not having the time to engage. These services are generally commissioned by the NHS, but it is essential that there is an integrated and true partnership approach between health, schools and other partners.
• The MHSTs are aimed at CYP with mild to moderate mental health needs. But, the needs of some CYP will be more severe and complex and may not meet criteria for either the MHST or for statutory CYP mental health services, because the threshold for access is increasing due to high levels of demand. This has been referred to as the ‘missing middle’ and CYP may potentially fall through the gaps in service provision. 

The roll out of the MHSTs must take these findings into consideration. Each school will have different needs, depending on their population. The commissioner for the MHSTs should assess the needs for any given school or college and whether a standard MHST approach will work. For instance, whether the standard model with potentially newly qualified and inexperienced staff will work if the case load is CYP with complex needs, and where there are very high waiting times for statutory CYP mental health services. 

In these instances, there may be a need for an enhanced MHST model, which might need a multi-disciplinary team to provide support for families, and higher intensity support for CYP with more severe and complex mental health problems. 

A recent report on CYP mental health has estimated that a 100 per cent roll-out of MHSTs will cost about £455 million a year. Funding to develop MHSTs is ring-fenced through Service Development Funding (SDF) in order to reflect that it is a key government commitment. However, there are concerns from the system that funding MHSTs could be to the detriment of other core mental health services due to tight financial settlements and challenging cost- saving targets.

Plurality of providers of MHSTs

Great Manchester ICB established a consortium of organisations providing the service. For instance, mental health charity Place2Be provides support for primary school children, and 42nd Street provides support for secondary school children. The pilot for this approach produced good outcomes, including schools having more confidence in supporting pupils with mental health problems, and pupils having a greater understanding of mental health. 

South London and Maudsley NHS Foundation Trust (SLAM) developed the Discover Programme, which is a brief, self-referral workshop programme for 16-to-18-year-olds in schools and colleges. It can be delivered by MHSTs and helps young people to manage their worry and stress. This approach was tested in a randomised control trial (RCT) called the Brief Educational Workshops in Secondary Schools Trial (BESST). 

The RCT compared the Discover Programme to treatment as usual (TAU) and found that the former intervention reduced depression and anxiety symptoms and increased levels of wellbeing and resilience in young people. This intervention is important as it focuses on older teenagers, who are often not included in MHSTs. These young people are at a key developmental stage where they are transitioning to adulthood and adult services, and it is a time when more serious mental illnesses first present. 

myHappymind is commissioned by some NHS and local authorities to work with schools to provide a fun and easy way to promote and build children’s mental health and wellbeing. All the lessons are digital, which makes it easier for school staff to put them into practice. The organisation also supports parents and school staff as part of a whole-school approach, and their work plays an important part in rolling out of the MHSTs. 

Implementing myHappymind in primary schools in Bury saw a reduction in referrals to CYP mental health services by 43 per cent, and 80 per cent of teachers saw an increase in children’s self-esteem. A review by Health Innovation Manchester found that every £1 invested in myHappymind saw a return on investment for the NHS of £1.97 over five years, as a result of reducing referrals to CYP mental health services.  Similarly, providing this service in Kirklees, West Yorkshire, saw a significant reduction in referrals to CAMHS, mental health support teams and special educational needs coordinators (SENCOs).

Young Futures hubs

Not all CYP attend school or colleges, or want to access mental health support there, so having an easily accessible service in their local community is important. 

The Labour Party’s 2024 election manifesto committed to an open access hub for CYP with drop-in mental health support, and the NHS 10 Year Health Plan has committed to providing additional support for CYP mental health through the proposed Young Futures (YF) hubs. The current government committed £2 million to develop eight YF hubs in the following local authority areas in 2025/26: 

• Nottingham.
• Tower Hamlets.
• County Durham.
• Manchester.
• Birmingham.
• Brighton and Hove.
• Bristol.
• Leeds.

These locations were selected as they have high levels of anti-social behaviour and knife crime, and they will act as pilots for the YF hubs.  

Further guidance has now been published by the Department for Culture, Media and Sport, and states that YF hubs will be aimed at ten-to-18-year-olds and be designed locally to meet three priority areas: 

• Increasing opportunities.
• Improving mental health and wellbeing.
• Reducing crime.

The government has announced that 50 YF hubs will be in place over the coming four years and form part of a £70 million transformation programme for local authorities to improve their local youth services offer

The YF hubs are potentially an important service development, but it is important that mental health and wellbeing should be prioritised alongside addressing knife crime. There will be an overlap between young people involved in knife crime or antisocial behaviour and those with mental health issues, but it will not cover all young people in need of support. 

It is unclear what the mental health and wellbeing offer will consist of and how mental health services will be involved in their development. Historically, CYP mental health support has been somewhat fragmented, so it is important that there is a joined-up approach to planning and commissioning mental health support for CYP and the YF hubs need to be part of this. The guidance on YF hubs refers to bringing services together, so hopefully this will consider how YF hubs fit into wider pathways of care and support. 

The pilot YP hubs are all in urban areas, which will help in developing this service model, but it is unclear what a similar model would look like in more rural areas. This approach may be more challenging due to problems with transport links and other issues such as anonymity and privacy for the young person living in a smaller community. 

While the YF hubs will provide an opportunity for early intervention, ten-to-18 is a very broad age group in terms of potential needs and providing a safe, CYP-centred service. So, the YF hubs will need to consider how they will provide age-appropriate services that encourage young people of different ages and developmental stages to access them. 

There already exists a one-stop-shop approach for young people, led by voluntary, community and social enterprise (VCSE) organisations, in many areas of the country. These services are co-produced with young people and families and are easily accessible within the community and are in keeping with the existing evidence-informed Youth Access model. Youth Access has recently published a quality framework that sets out what good looks like for these hubs. 

 There are many examples of existing early access hubs: 

Support for children and young people’s mental health in primary care 

Primary care is an important gateway to mental health support and has also seen an increase in demand from CYP seeking help for mental health issues. Research from the Youth Futures Foundation, estimated that there were one-in-11 (9 per cent) young people in contact with primary care for mental health issues in 2019, compared to one-in-44 (2 per cent) in 2000, and most referrals to specialist community CYP mental health services are from primary care. 

There are examples of good practice, where primary care is innovating and working in partnership to provide early intervention services for CYP. 

Support for children and young people with complex needs

The government committed in the NHS 10 Year Health Plan to work with local authorities to ensure that children with the most complex mental health needs in residential care get the treatment and support they need to avoid expensive hospital admissions and repeated emergency department visits.

Children and young people in the care system have a increased risk of developing a mental health condition, which is estimated to be about four times higher than the general population, often due to adverse events prior to being placed in care such as violence or family breakdown, as well as placement breakdown when in care. The number of CYP entering local authority care was 81,770 in March 2025, compared to 60,920 in 2009, which is about a 35 per cent increase. 

Children and young people in the care system are known to be more likely to have a special educational need, which increases the complexity of their needs. There has been nearly a 500 per cent increase in the number of CYP given a deprivation of liberty (DOL) order between 2018/19 -2020/21. These are high court orders that deprive young people of their liberty. They are put in place if the young person is considered a risk to themselves or others and they can be placed in unregulated settings, often out of area, in expensive provision to ‘contain them’, but which does not necessarily improve their outcomes.  

Ensuring that all young people in the care of local authorities have enhanced access to mental health support is welcome and should be available for children at as young an age as possible. We have yet to see the detail of the government’s proposals, but alongside this it is important to build on evidence for the support required for those young people who have already developed severe and complex mental health needs, typically as a consequence of experiencing early life trauma. 

People with complex emotional needs are often high intensity users of NHS services such as urgent and emergency care services and primary care. The cost of people of any age with complex emotional needs accessing NHS services is estimated at between £480 million and £785 million each year nationally. 

There are existing examples of good practice to draw on: 

Conclusion

The direction of policy is positive with the combination of Best Start Family Hubs, Young Futures hubs, MHSTs and dedicated mental health support for CYP within the care system. This creates an ambitious programme that could make a significant contribution to the left shift towards preventing illness or responding early when symptoms first arise.

The examples in this briefing demonstrate that there are a number of existing well developed approaches; the Mental Health Network will continue to help disseminate good practice by sharing examples of relevant services that have shown a positive impact.

The challenge now is to maintain pace and sustain the roll out of programmes committed to in the NHS 10 Year Health Plan, which can be achieved through continuing to evaluate programmes so evidence and learning is built in as they are developing.

It is also about supporting mental health providers in the NHS and beyond to develop and scale these approaches of care to meet the needs of the ‘missing middle’, who are currently too often sitting on excessively long waiting lists in CAHMS, and to better meet the needs of the relatively small cohort of young people with complex needs. This is in part about commissioning appropriate levels and models of care but goes beyond this, to ensuring the workforce pipeline exists to deliver the roles and skills across statutory and non-statutory services to meet need early and effectively. A possible Modern Service Framework for CYP, developing neighbourhood models and the 10 Year Workforce Plan are key opportunities to ensuring this happens.

The government is rightly concerned about the high number of young people not in education, employment and training, and has also laid out its ambition to achieve a left shift in the health sector. Improving early access to mental health support for children and young people is key to addressing both these challenges.