Reports and surveys reflect what practitioners are seeing: young people are struggling with their mental health. Journalist Anna Scott explores why and asks what can be done.
‘Too many young people are unhappy with their lives,’ The Children’s Society’s latest annual Good childhood report revealed. One child in 10 aged from 10 to 17 who completed a household survey in May and June 2023 had low wellbeing and almost a third were unhappy with at least one specific area of their lives (The Children’s Society, 2023). The charity called this out as ‘unacceptable’ stating the government must act now to protect every childhood.
This major report is not alone in suggesting that young people are unhappy, and that more are struggling (see tables at article end for the picture around the UK). For example, the NHS Digital Mental Health of Children and Young People Surveys have been examining the mental health of more than 2000 people aged from eight to 25 in England – as well as their household circumstances, experiences of education and services and of life in their families and communities – since 2017. The most recent report saw a rise in the number of young people struggling since 2017. In 2023, about one young person in five (aged from eight to 25 years) had a probable mental disorder (NHS Digital, 2023a). Commenting on this report, the YoungMinds charity said the number of ‘young people aged 8 to 16 with a probable mental health condition is the highest on record’ (Young Minds, 2023).
Meanwhile 414,550 people in England were in contact with children and young people’s mental health services at the end of August 2023 (NHS Digital, 2023b) representing an increase of nearly 4% on the previous year.
Anxiety and mood disorders, eating disorders, self-harm and suicidal thoughts –are among the problems being experienced by children. What’s going on exactly and what can be done?
THE PROFESSIONAL PICTURE
The Text-a-Nurse service in Northern Ireland is very busy, according to Janet Taylor, CPHVA Executive chair and public nurse manager with a multidisciplinary team in South Eastern Health and Social Care NHS Trust. ‘Our nurses have a wide range of subjects that young people are contacting them with – from sexual health to mental health issues, self-harm – or they may be concerned about a parent who has a drug or alcohol issue, for example,’ she says.
‘Issues with school attendance have become increasingly prominent since the Covid-19 pandemic,’ adds Charlotte Rainer, coalition manager at the Children and Young People’s Mental Health Coalition (CYPMHC).
‘It is perhaps no coincidence that school absence rates have increased alongside mental health problems. Data from NHS Digital shows that children with a mental health problem are seven times more likely than those without a mental health problem to have missed more than 15 days of school in a single term,’ she says.
Barnardo’s practitioners are supporting more children and young people with their mental health needs, which, according to Becky Rice, the charity’s senior policy adviser on mental health and wellbeing, are ‘becoming more complex and progressively serious too’.
‘Existing services, such as child and adolescent mental health services (CAMHS), are significantly overstretched so children and young people are facing long waiting times of months – or even years – as well as a requirement to meet strict criteria before getting support,’ Becky adds. ‘The knock-on effect of this is that children and young people’s mental health is deteriorating, and – all too often – reaching crisis point before they qualify for help.’
Dr Gavin Morgan is an educational psychologist, a tutor at University College London and chair-elect of the British Psychological Society’s division of educational and child psychology. He says that children and young people appear to be more unhappy today than in the past. ‘This has been shown in stark relief following the pandemic,’ he says, adding that many of these problems emerged following the change of government in 2010.
‘What we’re living with now is the consequence of 13 years of austerity. Up until 2010 there was lots of investment in, and acknowledgement, of early years education and the importance of things like children’s centres, pointing families in the direction of where they could find help and support. Then the schools were closed during the pandemic and, now we have the cost of living crisis. Children don’t exist in a vacuum and they pick up on family tensions and unhappiness,’ Gavin adds.
Dr Danny Goldberger, a consultant child and adolescent psychotherapist, says that the loss of Sure Start centres ‘really deprived families of a proper resource of being able to be out, be seen, mix, [have] difficulties thought about in a community context’.
In addition to the pandemic, austerity, the cost of living, and any family tensions, it seems modern life is taking its toll and its impact needs to be addressed.
Professor Peter Fonagy, chief executive of the London-based charity Anna Freud, says there is a pressing need to address the increase in emotional disorders girls experience as they grow older. ‘Pressure to look a certain way, achieve academically and comparison on social media all contribute to setting the bar much higher for girls and young women within society,’ he says.
Becky from Barnardo’s points out that young people’s mental health was declining even before the Covid-19 pandemic struck. This, she says, is due to social media pressures, among other factors. ‘Online bullying – which we know through our own work is prevalent – can be incredibly damaging,’ she adds. ‘We hope that the Online Safety Act and the introduction of age verification will reduce the risk of children and young people being exposed to harmful content and pornography which can dramatically distort a young person’s perceptions of healthy sex, relationships, and consent.’
The Online Safety Act received royal assent in October 2023, and Ofcom will be introducing guidance on different aspects of it over the coming few years.
Resource in schools is an issue too. ‘Many schools promote positive and safe learning environments both in the classroom through the curriculum, by supporting teachers with safeguarding, and providing early intervention help through mental health support teams (MHSTs) for students with mild to moderate needs,’ Becky adds. But MHSTs are currently only available in about 35% of schools and colleges in England. ‘Research shows that three quarters of children and young people want more support in schools (76%) and 73% of parents would like to see more funding available for mental health in schools,’ she says (Barnardo’s, 2023).
The closure of schools during the pandemic affected attachment for some children. ‘Mental health and social skill development are all linked to a lack of opportunity to play, engage with other kids, make friends, fall out and make friends again – this may be why kids are perhaps lacking coping skills, or the skills to be resilient,’ Gavin says.
When it comes to modern life pressures, Dr Goldberger adds: ‘I think climate change creates a lot of anxiety for young people.’
|WHAT CAMPAIGNERS WANT FROM GOVERNMENT
|Children and Young People’s Mental Health Coalition (England)
|> Commit at least an additional £1.7bn a year for Integrated Care Systems to deliver a comprehensive mental health service for all those aged 0 to 25 to ensure that all children and young people get the support they need, when they need it.
> Embed whole education approaches to mental health and wellbeing across all settings to create cultures that promote positive mental health and wellbeing for learners and staff alike.
> Invest in a national network of early support hubs in every local area in order to increase the provision of early intervention support in the community.
|> Invest in prevention and early intervention and provide consistency for all children and young people in their communities, schools and health services.
> Expand the MHST model, which would provide school counsellors and increase flexibility within teams to respond to local need.
> Create a national strategy (England) for social prescribing for children and young people with mild but complex needs which do not require clinical support.
A JOINT EFFORT
‘We need to consider what we are doing to help children and in the earliest part of life,’ says Dr Goldberger. The government’s Start for Life programme, which was introduced in 2021, has led to more ‘wraparound’ services developing for children and families in many parts of the country. ‘Looking at the [child’s] first 1001 days is crucial: it should form the blueprint for how we look at everything, and improve resilience,’ he adds.
|Even in the absence of
the resource and policy
campaigners are calling
for, there are, of course,
excellent examples of good
practice to help young
people. This is just one
example, in Northern Ireland:
South Eastern Health and
Social Care Trust successfully
piloted a programme in
which a SN employed by the
trust is based in a secondary
school on a full-time basis.
‘It’s been really successful
and we’re getting really great
feedback,’ says Janet Taylor.
‘Because she’s there, she’s in
the school and that’s where
she is best. She’s not just
there to give [the children]
an injection and walk
right out again.’ The nurse
organises simple things for
the children, including walks
and talks at lunchtime. ‘This
is what we used to have 30
years ago,’ Janet adds.
‘The young people love the
fact that if they need her,
they can go to her or make
an appointment with her,’
Janet adds. ‘She can have
a more holistic approach
with them. Would we love it
in every school? Absolutely
we would. We need
investment and resources
to expand that service.’
Building healthy bonds and relationship with family, the community, and the neighbourhood, are essential. ‘And community practitioners are absolutely central to being a part of building that firm base,’ Dr Goldberger adds. ‘Building proper multi-agency, multidisciplinary teams must be the most effective way of working.’
Peter from Anna Freud agrees that integrated working is an opportunity for professional collaboration which centre the experience on the child and family. ‘Co-location of professionals, such as having mental health workers in schools or health visitors in family hubs, is an opportunity for key parts of the healthcare system to come together. ‘The benefits of co-location can be enhanced with integration at a strategic, governance and leadership level,’ he adds. The government announced funding for 75 councils to open new or expand existing hubs in England in 2023 (Department for Education).
Dr Morgan agrees that multi-agency working is necessary. ‘Unhappy kids won’t learn,’ he adds. ‘A goal for schools should be to teach children – with the help of other professionals – to learn social skills, coping, skills, how to look after their mental health and be supportive of their own needs.’
Community practitioners play a vital role in helping to identify areas of need for any family member and signposting to where the right type of support is available. ‘For example, health visitors take a “whole family” approach so, if there are older siblings in a household who are showing signs of poor mental health, they can speak to a school nurse (SN) or GP to highlight where help is available,’ Becky says.
‘Each of these professionals also plays a safeguarding role for every member of the family and helps to provide a network of support at every stage of a child’s life from conception, early years and once the child has started school. They are well-placed to identify those at risk of poor mental health and to intervene early or refer to specialist support when needed, such as local services, helplines, information and advice or direct interventions.’
The Department of Health and Social Care (DHSC) announced in October 2023 that it was making nearly £5 million available to provide earlier, open-access mental health interventions at 10 hubs in community locations across England (DHSC, 2023). This comes on top of an additional £2.3 billion already helping an extra 345,000 children and young people to access NHS-funded mental health support by 2024.
Meanwhile in November 2023, the Scottish Government announced it was investing more than £50 million in its Mental Health Outcomes Framework. This, it said, would support the delivery of clinical services in priority areas, including CAMHS (Scottish Government, 2023).
The Welsh Government and Plaid Cymru have a Co-operation Agreement to fund crisis hub facilities for children and young people that offer bespoke mental health provision (Welsh Government, 2023). Funding investment in the projects reached £3.18 million in 2023 (Welsh Government, 2023).
And in November 2022, the Northern Ireland health minister announced a new Regional Mental Health Service, as part of the country’s 10-year Mental Health Strategy, designed to drive and support locally delivered integrated care (Department of Health, 2022).
MORE TO COME
According to the DHSC, spending on mental health services for children and young people has increased, with a spend of around £1.1 billion planned in this financial year.
|My Story and Me, an Anna
Freud project, is looking for
girls and young women aged
12- to 24-years to help them
create videos by recording
their answers to key questions
|Barnardo’s policy and research
document The Missing Link:
social prescribing for children
and young people
|The Children’s Society:
Good Childhood Report
|Wellbeing and mental health
support for young people
going through hard times from
charity Step by Step
|Guides and advice for young
people struggling with their
mental health, from charity
It includes the roll-out of mental health support teams in schools and colleges in England, and investment in family hubs. ‘We’re determined to do everything we can to support children and young people with their mental health, no matter their background or location,’ a DHSC spokesperson adds.
Campaigners say that, thus far, government action has not been enough to tackle a nationwide problem of this size. For instance, the CYPMHC voiced ‘deep disappointment’ at the ‘lack of legislation’ to improve the care and treatment of children and young people with mental health problems, announced in the King’s Speech last November (CYPMHC, 2023).
‘This was a missed opportunity to transform the care provided to children and young people in mental health hospitals and to strengthen rights and safeguards,’ says Charlotte at CYPMHC.
‘It has long been recognised that the Mental Health Act 1983 is no longer fit for purpose, and numbers of people detained under the Act remains high. Experiences of care within mental health hospitals are also often poor.’ The CYPMHC is calling for a new Mental Health Bill to reform the Mental Health Act, by explicitly protecting and promoting children and young people’s rights.
For now, as CPHVA Executive chair Janet says, ‘It’s about wisdom and using what resources we have wisely and trying to make sure that we target and help where we can.’
CHILDREN AND YOUNG PEOPLE’S MENTAL HEALTH ACROSS NORTHERN IRELAND, SCOTLAND AND WALES
11 to 19-year-olds
|reported self-injurious behaviour
|reported thinking about or attempting suicide
|met criteria for any mood or anxiety disorder
10,556 children and young people were referred to CAMHS in Scotland from January to March 2023
|The increase compared to the same quarter in 2022
|Average time it takes for one in two children and young
people to start their CAMHS treatment, an increase from
an average of eight weeks in the same quarter
Young people in years seven to 11 at school
|of young people experienced very high levels of mental
health symptoms in the years following the pandemic
|of girls and 16% of boys reported these very high levels
|reported feeling a lot of pressure from schoolwork
The fourth ‘wave’ of the NHS Digital Mental Health of Children and Young People Surveys found that:
8- to 16-year-olds
|had a probable mental disorder – rates
were similar for boys and girls
|of those with a probable mental disorder
had a parent who could not afford
activities outside school or college,
compared with 10.3% of those unlikely to
have a mental disorder
11- to 16-year-olds
|of those with a probable mental disorder
have been bullied in person, compared
to 7.6% without a mental disorder
|were identified with eating disorders
(4.3% girls, 1% boys)
17- to 19-year-olds
|had a probable mental disorder – rates
were twice as high for young women than
17- to 25-year-olds
|reported being worried about the impact
of climate change
The report also found that after a rise in prevalence from 2017 to 2020, rates of probable mental disorder remained stable in all age groups from 2022 to 2023.
NHS Digital, 2023a
WHAT ARE YOU SEEING?
What’s happening in your practice? What do you think is the answer?
Get in touch with editor Aviva Attias:
Barnardo’s. (2023) It’s hard to talk: Expanding Mental Health Support Teams in education. See: barnardos.org.uk/research/its-hard-talk-expanding-mental-health-support-teams-education (accessed 6 December 2023).
Cardiff University – School Health Research Network. (2023) Nearly a quarter of young people in Wales are reporting very high levels of mental health symptoms following the pandemic. See: cardiff.ac.uk/news/view/2713528-nearly-a-quarter-of-young-people-in-wales-are-reporting-very-high-levels-of-mental-health-symptoms-following-the-pandemic (accessed 6 December 2023).
Children and Young People’s Mental Health Coalition. (2023) CYPMHC Response to the King’s Speech. See: cypmhc.org.uk/cypmhc-response-to-the-kings-speech/ (accessed 6 December 2023).
Department for Education. (2023) Thousands of families to benefit from local support in rollout of Family Hubs. See: gov.uk/government/news/thousands-of-families-to-benefit-from-local-support-in-rollout-of-family-hubs (accessed 6 December 2023).
Department of Health. (2022) Swann announces new Regional Mental Health Service for Northern Ireland. See: health-ni.gov.uk/news/swann-announces-new-regional-mental-health-service-northern-ireland (accessed 6 December 2023).
Department of Health and Social Care. (2023) Earlier mental health support announced for thousands nationwide. See: gov.uk/government/news/earlier-mental-health-support-announced-for-thousands-nationwide (accessed 6 December 2023).
Health and Social Care Northern Ireland. (2020) Youth wellbeing prevalence survey. See: online.hscni.net/our-work/social-care-and-children/youth-wellbeing-prevalence-survey-2020/ (accessed 6 December 2023).
NHS Digital. (2023a) Mental Health of Children and Young People in England 2023 – wave 4 follow up to the 2017 survey. See: https://bit.ly/3NWKEew (accessed 6 December 2023).
NHS Digital. (2023b) Mental Health Services Monthly Statistics, performance August, provisional September 2023. See: https://bit.ly/41UFWDD (accessed 6 December 2023).
NHS Digital. (2023c) Mental Health Services Monthly Statistics, performance April, provisional May 2023. See: https://bit.ly/3ScpifF (accessed 6 December 2023).
Public Health Scotland. (2023) Child and Adolescent Mental Health Services (CAMHS) waiting times. See: https://bit.ly/3vvqRfU (accessed 6 December 2023).
Scottish Government. (2023) Mental health and wellbeing strategy: delivery plan 2023-2025. See: gov.scot/publications/mental-health-wellbeing-delivery-plan-2023-2025/pages/19/ (accessed 6 December 2023).
The Children’s Society. (2023) The Good Childhood Report. See: childrenssociety.org.uk/good-childhood (accessed 6 December 2023).
Welsh Government. (2023) First-in-Wales mental health hub offers new way of helping young people in crisis. See: https://www.gov.wales/first-wales-mental-health-hub-offers-new-way-helping-young-people-crisis (accessed 6 December 2023).
Young Minds. (2023) Young Minds responds to new NHS prevalence data. See: youngminds.org.uk/about-us/media-centre/press-releases/youngminds-responds-to-nhs-data/ (accessed 6 December 2023).
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