Damage to children’s mental health caused by Covid crisis could last for years without a large-scale increase for children’s mental health services, Children’s Commissioner warns

Anne Longfield, Children’s Commissioner (@ChildrensComm) for England, is today (Thursday) publishing her fourth annual report on the state of children’s mental health services in England.

• Children’s Commissioner’s annual report into the state of children’s mental health services in England shows improvements but a system still not helping hundreds of thousands of children.
• With 1 in 6 children estimated to have a probable mental health condition, the Children’s Commissioner calls for a major recovery programme for including an NHS-funded counsellor is every school in England and online wellbeing support.

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 report finds that while there has been an expansion of children’s mental health services over the past four years, such was the poor starting point that services are still nowhere near meeting the needs of many hundreds of thousands of children. The Children’s Commissioner 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.

However, the main positive from the analysis 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.

The data in the report largely covers the period up to end of March 2020, showing a system without the necessary capacity or flexibility to respond to the pandemic, which has been such a seismic event in the lives of children. The major disruption to two years of education, alongside the limited opportunities to see friends and wider families, to play and enjoy activities and the worry 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%.

A large study, undertaken by the NHS in July 2020, found that clinically significant mental health conditions amongst children had risen by 50% compared to three years earlier. A staggering 1 in 6 children now have a probable mental health condition. We do not know how far this spike will have long term consequences on children’s mental health, nor do we know the impact of further lockdowns, but 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.

In the report, the Children’s Commissioner calls for the Government to raise its ambition significantly to deliver a wholesale change in the way we provide children’s mental health services. She argues 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. One positive development from the Covid-19 crisis is that it has shown that some of these services can be provided digitally.

The Children’s Commissioner also warns that the Government’s current plan to roll out NHS-led counselling in schools to 20-25% of areas by 2023 is not ambitious enough, particularly following the Covid pandemic, and repeats her call for an NHS-funded counsellor for every school as quickly as possible.

The substantive findings for this report are based on detailed examination of the data on children’s mental health for 2019/2020. 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 (based on 2017 estimates of need); or 1 in 4, based on 2020 estimates of need mention above. 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 4 weeks.
• Access is improving, but not as quickly as we would expect. 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. However, some local areas are spending considerably more, and have, accordingly much better mental health services.
• 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 Herefordshire, this rises to 48% of cases.

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.

“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.

“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.”

Mental health remains the biggest issue raised by children with the Children’s Commissioner, here are just a few of the experiences that children have shared with us:

“Lockdown has not helped with my mental health, it’s emotionally draining, like I’m always tired and I’ve got a constant headache. I don’t talk to anyone about my mental health and I struggle to open up about it.” Boy, 17 years old 

“Over lockdown, I feel like I’ve changed, I feel like a different person. Everything has changed.” Girl, 11 years old

“Young people and children are suffering a lot more than people think they are. In my opinion, people underestimate how much young people and children are affected by these current circumstances.” Boy, 16 years old

“I’ve been on a counselling waiting list for ages. I know it’s hard times for everyone but if there was more counselling I think people would be happier. [I was] referred to CAMHS like 10 months ago by the Doctor.” Boy, 15 years old

“Mental health support in schools needs to improve quite a lot. We don’t have a counsellor at all, just a nurse every two weeks […] Everyone is on edge and I think people would benefit a lot more from talking about it.” Girl, 16 years old