The expansion of children’s mental health services over the past four years is welcome but, such was the poor starting point, services are still nowhere near meeting the needs of many hundreds of thousands of children.

This is the stark warning from the children’s commissioner for England in her fourth annual report on the state of children’s mental health services in England. Anne Longfield argues this is because of a lack of ambition in improving children’s mental health services, despite numerous government announcements on children’s mental health.

Anne Longfield, Children’s Commissioner for England, said: “Even before the Covid pandemic, we faced an epidemic of children’s mental health problems in England and a children’s mental health service that, though improving significantly, was still unable to provide the help hundreds of thousands of children required.

“It is widely accepted that lockdown and school closures have had a detrimental effect on the mental health of many children. Since the NHS study in July 2020 estimating one in six children in England have a probable mental health condition, we have had another long lockdown. Sadly, this will be causing even more damage to many children’s mental wellbeing and putting even greater strains on mental health services, potentially for years to come.

“That is why in the short term it is so important the government sets out a roadmap that helps schools to reopen over the coming weeks,” she added.

The analysis examines the progress that has been made over the past five years as well as looking at the impact the Covid crisis has had on children’s mental health.
The main positive emerging from the report is that some individual local areas are improving above and beyond what central government has expected of them and delivering vastly improved services for children.

However, the data in the report mainly covers the period up to end of March 2020, showing a system without the necessary capacity or flexibility to respond to the COVID-19 pandemic, which has been such a “seismic event in the lives of children”.
The major disruption to education, limited opportunities to see friends and wider families, few options to play and enjoy activities and the worries about the impact of Covid on their families, will have taken a heavy toll on some children.

Even before this crisis, children’s mental health services were far from meeting the existing level of need. In the year before the pandemic, referrals to children’s mental health services increased by 35% while the number of children accessing treatment increased by just 4%.

Alarmingly, one in six children now have a probable mental health condition. However, it is impossible to ascertain how far this spike will have long term consequences on children’s mental health, nor do we know the impact of further lockdowns. It is highly likely that the level of underlying mental health problems will remain significantly higher as a result of the pandemic. There has already been a spike in referrals to NHS services during Autumn 2020.

Ms Longfield who steps down later this year urges the government to raise its ambition significantly to deliver a wholesale change in the way children’s mental health services are provided. The work that has been undertaken over the past five years paves the way, in particular the creation of Mental Health Support Teams which provide a model of integrated mental health care across schools and the NHS. As a result of COVID-19, some of these services can be provided digitally.

But the government’s current plan to roll out NHS-led counselling in schools to 20-25% of areas by 2023 is not ambitious enough, the children’s commissioner argues, particularly following the Covid pandemic, and she repeats her call for an NHS-funded counsellor for every school as quickly as possible.

The main findings of the report are:

- Access to children’s mental health services is still not adequate. 4% of children accessed mental health services last year in 2019/20. This is equivalent to about 1 in 3 children who needed mental health services. In 2020 this was one in four. Those that do access services often have to wait weeks or months for treatment. Last year only 20% of children referred to services started treatment within four weeks.

- Access is improving, but not as quickly as hoped. NHS England will need to increase the pace at which services expand to meet the commitments in the NHS Long-Term Plan. The number and rate of children referred to NHS mental health services has continued to increase. In 2019/20, 538,564 children were referred for help, an increase of 35% on 2018/19, and nearly 60% on 2017/18.

- The numbers getting treatment are also increasing but at a much slower rate. In 2019/20, 391,940 children received treatment. This number is up only 4% on the previous year.

- Spending on children’s mental health is slowly increasing but highly variable and still inadequate. The biggest constraint on improvements appears to be spending decisions made locally and nationally. On average, local CCG areas spend less than 1% of their overall budget on children’s mental health and 14 times more on adult mental health services than on services for children. The local areas which are spending considerably more have much better mental health services as a result.

- There is a postcode lottery around what local areas spend, waiting times for treatment, access to treatment and how many children are referred to services and go on to receive support. 70 local areas in England close 30% or more of their cases before children access support.

“In the longer term, the government’s ‘building back better’ plans must include a rocket boost in funding for children’s mental health, to expand services and eliminate the postcode lottery. As an absolute minimum, all schools should be provided with an NHS-funded counsellor, either in school or online,” said Ms Longfield.

“We have seen how the NHS has risen to the scale of the Covid crisis for adults. We owe children, who are suffering the secondary consequences of the pandemic, a mental health service that provides the help and support they need,” she concluded.

The state of children’s mental health services 2020/21