The mental health of children and young people in England is worsening, and record numbers of children are presenting with mental health difficulties. Mental health support services both in the NHS and schools are not sufficiently resourced to meet the growing demand, and children and young people are struggling to get the help they need.  

Since early 2020, the number of children and young people in contact with secondary NHS mental health, learning disabilities and autism services at the end of each month has doubled, and in 2024-25, there were over 1 million people under the age of 18 in contact with services. This sharp rise in need has not been matched by investment or capacity in mental health services, leaving too many children falling through the gaps in an overstretched system.  

The importance of intervening early in someone’s life to prevent or manage mental illness cannot be overstated. Over half of all mental health disorders start before the age of 14, with 75 per cent starting by 24 years of age. Prevention and early intervention are therefore key.

Through a series of interviews with frontline healthcare and education staff, the BMA has explored the impact of rising demand within mental healthcare services, and further actions that could be taken to stop children falling through the gaps in care.

Our recommendations

1. Prioritise early interventions in mental health services to prevent children and young people reaching crisis point

Too many children and young people are receiving help far too late. The UK Government must continue to roll out mental health support which enables earlier interventions for children and young people before they need help from NHS mental health services, i.e. mental health support teams in schools and Young Futures hubs.

2. Strengthen communication and collaboration between siloed services

To close gaps in care, there must be more integrated working across services. This includes clearer referral pathways into CAMHS (Child and Adolescent Mental Health Services), improved signposting to community, voluntary and school-based support, and robust information sharing systems between mental health services, primary care, and mental health support teams in schools.

3. The UK Government and DHSC (Department of Health and Social Care) should determine the level of funding for mental health services based on a full assessment of unmet need

The data and assumptions used to determine this should be published so it is clear and transparent how funding is determined, alongside the overall proportion that will be spent on children and young people’s mental health services. Regular data collection on the prevalence of mental illness among children and young people, including for populations experiencing inequality, deprivation, and the long-term impact of the pandemic, is essential. The UK Government should ensure that the minimum pledge set by the NHS Long Term health plan of at least £2.3 billion for mental health services per year in real terms is met.

4. DHSC must plan for, incentivise and fund the expansion of the professionally trained mental healthcare workforce across health and education

Without the right numbers of staff, and without the right skill mix of staff, doctors will continue to struggle to provide the best care for their patients. The 2023 NHS Long Term Workforce Plan goes some way towards this, by identifying clear targets for medical and nursing staff, and psychologists. The 10 Year Health Plan for England re-commits to hiring an additional 8,500 mental health staff, however it is not clear how many of these staff will work in children and young people’s mental health services.

Demand is exceeding mental health service capacity

The sharp rise in need for mental health services has not been matched by resources, and urgent action is needed. 

Healthcare and education staff have told us that demand is outpacing service capacity and that the severity of the cases they see has drastically increased in recent years, particularly since the pandemic. Children and young people are now rarely seeking help for a single mental health difficulty; instead, they are presenting with multiple, complex needs which require specialist help.

Very commonly, our young people will have psychosis, neurodiversity, substance use problems, learning disabilities… so there is an increase in complexity of young people who end up in inpatient services, which almost inevitably extends their inpatient stay significantly.

Specialty doctor in psychiatry, West Yorkshire

Waiting times for mental health services are so long that by the time some children and young people access help, their symptoms have compounded. Over half a million children and young people are currently on a waiting list for mental health support, and they are still being sent far from home in out of area placements.

Our data analysis below shows the number of referral spells waiting more than 52 and 78 weeks for a first contact with mental health services:

The waiting list is horrendously long, so it's very difficult if you want to get a diagnosis… I think that young people don't always get the support that they may need because of lack of resources, or they don’t fit the criteria.

Paediatric Mental Health Liaison Nurse, North East and Yorkshire

High demand is leading to higher thresholds for CAMHS. Staff making referrals to CAMHS and other NHS mental health services for young people often find that referral thresholds are so high, in part due to lack of service capacity, that their patients are turned away.

Quite a lot of the time we get feedback that they don't reach threshold or they're not quite bad enough to be working with CAMHS… we’ve done everything we can internally, and we need that kind of specialist support, but we’re told they don’t quite reach thresholds.

Head Teacher, North East

Elsewhere, doctors have noticed the increase in children and young people presenting with autism and ADHD (attention deficit hyperactivity disorder). Waiting lists for autism and ADHD services are growing, and doctors are not adequately resourced to accommodate the rising demand. Though autism and ADHD are not considered by some to be mental health conditions, they are largely diagnosed and treated within mental health services.

Understanding the scale of the problem is difficult, as there is no official national data on waiting times for autism and ADHD services. There is, however, experimental data published by NHS England on autism. 

What the data shows

• In June 2025, only 1 in 20 of under 18s with a suspected diagnosis had had a first appointment within the recommended 13 weeks.
• For ADHD, statistics (also not given official status) suggest 6 in 10 children had been on a waiting list for over a year.

Waiting lists for assessments, particularly assessments around neurodiversity… some young people are waiting years for even a first appointment.

Specialty Doctor in Psychiatry, West Yorkshire

Eating disorders are also a group of conditions which doctors have reported seeing more of since the outbreak of the pandemic. For some young people, no matter how much they might be struggling, they might not meet the criteria for specialist eating disorder services and are falling through the gaps. These are commonly children and young people with disordered eating patterns, who don’t meet the diagnostic criteria for the specific eating disorders that the services are commissioned for. 

Funding for children and young people’s mental health services continuously fails to address the scale of demand, and commitments to deliver on funding for mental health services have not been met.

• The 2019 NHS Long Term health plan committed to providing mental health with at least an additional £2.3 billion per year in real terms. However, in 2023/24, real terms spending was only up by £1.4 billion compared with 2018/19.
• The additional £688 million investment in mental health services this year is welcomed, however it is not clear what proportion of this will be spent on children and young people’s mental health services. 
• The Labour party committed in its 2024 manifesto to recruiting an additional 8,500 mental health staff but has not specified the proportion of staff between adult mental health services and CAMHS. Despite the reported additional 7,000 mental health staff employed between July 2024 and November 2025, it is not clear how many of these staff will be employed to fill the gaps where the need is greatest in children and young people’s mental health services.

Our analysis of the most recent data shows that since 2016, the number of children and young people in contact with CAMHS has expanded at almost four times the pace of the psychiatry workforce.

Children and young people need to be met earlier with support for their mental health, before reaching crisis point. Early support hubs which offer drop in, holistic and local mental health services are proven to deliver positive outcomes for young people but face similar barriers to access as specialist mental health services due to high demand. There were 385,540 children and young people still waiting for a first contact from community mental health services in the three months to March 2025, up by 14.4% since last year.

For some, being able to use resources that they have within their community can often produce the best results for a young person.

Consultant Child and Adolescent Psychiatrist, West Yorkshire

Services need to be joined up to address gaps in children’s mental health support

There is a lack of coordination between services that support children and young people’s mental health. 

Health and education staff have told us that there needs to be improved communication and collaboration between mental health services in different settings, allowing for escalation and de-escalation between different services. Ingrained boundaries and a lack of information flow between mental health services, education-based support, and the voluntary sector is exacerbating the gaps in mental health care. The use of different record-keeping systems and information sharing practices is frustrating for staff and slows down processes. 

We are just hundreds of different organisations operating under the umbrella of the NHS… and it is as much of a fight for me to talk to my colleagues and the trusts down the road as it is for patients to be referred and for parents to receive information.

Specialty doctor in psychiatry, West Yorkshire

Information for staff helping them to signpost to local voluntary sector mental health support services, which are beneficial whilst children and young people are experiencing long waiting times to access NHS mental health services, is unclear and not easily accessible.

Federal criteria change, projects lose funding and then they close down, another one pops up and it’s really hard to keep on top of what’s available and what their criteria are and how you refer to them, whether it’s self-referral, professional referral and they also have websites. But if you don't know they exist, it's hard to then go around looking for them… it’s trying to keep up with what’s out there...

Consultant child and adolescent psychiatrist, South Yorkshire

Healthcare staff have said that more funding and staff are needed, but this is not the sole solution to the problem. Early intervention in the community and schools, and better support for families to help their children through mental health struggles are crucial for creating a societal environment that fosters good mental health. 

One of the challenges in mental health support based in schools is the variability of training and resourcing for mental health support between local authorities, and differing levels of experience among teachers. There is not enough mental health training for teachers who are struggling to engage students with complex needs and are already overloaded. Some healthcare staff were not fully aware of the support offered by MHSTs in schools, or how to refer children and young people who might be better suited to MHSTs back to their school. 

Providing funding and resources for schools to deliver early interventions is crucial to stem the tide of children and young people requiring help from healthcare services. The government has committed to the expansion of MHSTs (Mental Health Support Teams) to 100% of schools in England by 2029/30 and currently covers 41% of schools and colleges. MHSTs in schools provide support for mild to moderate mental ill-health and pupils’ emotional wellbeing needs, such as anxiety. 

An early evaluation of the MHST ‘trailblazer’ programme found that pupils were not always aware their school had an MHST, or what it did, but those that had direct contact universally reported their experience as positive. The evaluation also identified concerns that there are children and young people whose mental health concerns exceed the mild to moderate threshold for MHST support, but are not severe enough to meet the referral criteria for specialist support. A 2023 survey of MHSTs conducted by the Department for Education found that 85% of senior mental health leads in schools agreed that working with their MHST had provided better mental health support for pupils.

In addition to MHSTs in schools, the government has recently committed to £95 million in funding for Young Futures hubs, intended to provide open access mental health support to stop vulnerable young people from falling through the gaps in education and social services. These services, while promising, should report regularly on implementation progress and must be joined up with each other and healthcare services to be truly effective. 

Education staff said that there are differences in achievable goals for children’s mental health services between education and healthcare, or felt that the recommendations and guidance provided by CAMHS could not realistically be delivered by educators. Guidance for mental health support does not always consider the number of other pupils in a class, or the lack of time and training teachers have to provide this support. This is why the implementation of dedicated, fully funded mental health support in schools, which are effectively joined up with healthcare services, is crucial.

Mainstream schools are still being very, very reactive instead of proactive in their approach to manage and support young people with complex mental health needs.

Head Teacher, North East

There are inequalities in the experiences of children and young people in mental healthcare

Children and young people are still dealing with the effects of the pandemic on their wellbeing, and those who live in areas of higher deprivation face higher rates of mental ill-health.

Children and young people’s experiences of mental healthcare can vary considerably. Depleting resources in NHS services are exacerbating the negative impact of deprivation on mental health. Those who live in more deprived areas are more likely to have poor mental health due to a range of factors, such as inadequate living standards and unsafe (i.e. crowded and damp) housing, a lack of access to green space and fresh air, and job stability. They are also in contact with mental health services twice as often as those who live in the least deprived areas.

A child whose mental ill-health is influenced and exacerbated by these inequalities, who is also unable to get help from mental health services, is inarguably at a disadvantage when it comes to navigating their adult life. Without addressing the building blocks of health, mental health outcomes will not improve for anyone, let alone among the most disadvantaged in our society.

Meanwhile, the Covid-19 pandemic has had a significant negative impact on children and young people’s mental health. Teenage years are a time of vulnerability to mental ill-health, and school closures disrupted young people’s lives considerably. It is generally agreed that it was a greater exposure to risk factors such as unstable home environments, domestic violence, and financial instability, as well as disruption to protective factors, that resulted in a negative impact of the pandemic on children and young people’s mental health.   

The pandemic exposed inequalities in children’s experiences of such factors. For example, children and young people living in areas of deprivation and disadvantage experienced poorer mental health and wellbeing throughout the pandemic.  

The impact of COVID and the pandemic has further escalated mental health issues.

Paediatric Anaesthetist, North West

The below heatmap demonstrates that children and young people in areas of higher deprivation are more likely to be in contact with mental health services (hover over different areas of the map to see how many CYP are in contact with MH services in each local authority by deprivation score):

Disadvantaged children who were most impacted by the pandemic are a group who have fallen through the gaps in mental health services. Children who are vulnerable, who have poor mental health or a neurodevelopmental condition are finding it increasingly difficult to attend school and remain persistently absent in the aftermath of the pandemic  and those from socio-economically disadvantaged backgrounds are more likely to be persistently absent than their classmates . One consultant psychiatrist told us that children with a neurodevelopmental condition find it especially difficult to attend mainstream schools, which often aren’t set up well for their needs. 

If you are interested in finding out more about doctors’ experiences working in mental healthcare, you can read the BMA’s 2024 report ‘It’s Broken: Doctors’ experiences on the frontline of a failing mental healthcare system’.