The youth mental health crisis

The rise in mental health needs

The state of children and young people’s mental health in the UK makes for difficult reading. One in five (20%) children and young people in England aged between 8 and 25 years had a probable mental health disorder in 2023. This describes a whole range of conditions affecting children and young people, from anxiety disorders to depression, self-harm, eating disorders, and personality disorders. In Scotland, a 2022 survey found that a third of young people aged 11-15 reported anxiety and 35% were classified as having either low mood or risk of depression.

This generation of children and young people—Generation Alpha—have experienced uniquely challenging circumstances. As a result of the Covid-19 pandemic, many spent long periods isolated and indoors, whilst the cost-of-living crisis has intensified the pressure on young people. Suicide is now the main cause of death in young people under the age of 35 in the UK, with 654 young people under 25 dying from suicide in 2022. Hospital admissions for self-harm for children aged 8-17 in the UK increased to over 25,000 in 2022, up 22% on the previous year.

‘There was a huge jump in suicidal thinking after the pandemic, it was so shocking. When young people weren’t interacting with friends, or at school, it has definitely seemed to have an impact.’  

Bohdana Dock, The Mix

The climate and nature crises are also having a negative impact on the mental health of children and young people, with over half of young people (54.8%) aged 17-25 years old reporting being worried about the impact of climate change. Not only is environmental change causing rising levels of eco-anxiety, but it is also exacerbating the existing mental health conditions that young people may be experiencing. Air pollution, for example, is linked to schizophrenia and other psychotic disorders, and exposure to poor quality air in adolescence is a risk factor for depression.

How are charities responding to rising need?

Piloting new referral mechanisms and services 

To meet the needs of children and young people, some charities are piloting new approaches to mental health support.

For example, in 2021 a huge surge in demand for support from the Gloucestershire mental health charity TIC+ during the Covid-19 pandemic increased the average wait for its counselling service from 3.8 weeks to 12-14 weeks. In response, the charity started varying its standard seven sessions, depending on the needs of each individual. The introduction of a new One At A Time Counselling Model (1@T), which provides a single, solution-focused intervention within two to three weeks of self-referral, has freed up additional capacity and led to a significant reduction in waiting times across the service. Both measures enhanced the charity’s ability to serve a greater number of young people in need.

Charities are also tailoring their services to better meet the increasingly complex needs that young people are now presenting with. In Bristol, Empire Fighting Chance has developed the innovative Box Therapy programme to enhance its highly successful Box Champions offer which combines non-contact boxing with psychologically informed mentoring. Many of the young people Empire supports do not feel comfortable in a traditional therapeutic environment. However, they willingly engage with and respond well to Box Therapy which fuses non-contact boxing with Acceptance and Commitment Therapy (ACT).

Developing and expanding digital services

The continued development of digital technology has presented a growing opportunity for long-term integration of digital and blended approaches into mental health treatment. Digital technology is boosting capacity across the care pathway. For many charities, the use of digital technology allows mental health support to be scaled quickly, increasing rapid access to treatment. Offering earlier digital intervention can also reduce demand on other treatment options and prevent progression to more severe symptoms which can be more costly to treat.

However, the advantages of digital technology also extend beyond this ability to scale services. From our conversations with charities, we know that digital tools, if designed and implemented correctly, can lead to more person-centred and holistic treatment. For example, the use of smart technology in stem4’s Worth Warrior app (which aims to reduce symptoms of early-stage eating disorders) tailors the content of what young people see to meet the needs of each individual. Digital support can reach young people where they are, in an environment that is comfortable for them; accessing support in this way can feel less daunting and more immediate than speaking to an adult face-to-face. The use of text or online chat services can also afford young people a greater sense of autonomy, as they are able to determine the pace at which they respond to tasks or answer questions. Off the Record Croydon, for example, offers a text-based counselling service so young people can communicate their feelings to a professional ‘in their own time and on their own terms’, without having to book an appointment.   

Our previous reports on digital mental health services found that many charities are successfully using digital services, alongside their pre-existing face-to-face support, to enhance the package of care available for children and young people. However, there are a number of barriers which prevent charities from fully embracing digital technology. These include a lack of workforce capacity and confidence, concerns about ethical and safeguarding issues relating to digital platforms, and the high cost of developing and maintaining effective digital services. More research into the types of digital support that work best for different groups of young people and for different mental health conditions is still needed.

Developing the professional mental health workforce 

Workforce retention and staffing shortages remain ‘one of the greatest challenges for the mental health sector, affecting the quality of care and the safety of both patients and staff.’ Demand for mental health care is increasing faster than the mental health care workforce, which remains the same size as it was 10 years ago. Although NHS England plans to increase the number of NHS staff working in mental health, primary care, and community care by 73% by 2036-37, this may still not address the current shortfall. Currently, there is NHS funding available for trainee Clinical Psychologists but no public funding for trainee therapists, beyond student loans and a handful of higher education scholarships. This lack of funding acts as a major barrier to many who would otherwise be interested in qualifying as a therapist.

As well as numbers, the workforce also has a diversity problem. Eighty five percent of all CYPMHS staff are female. Asian/Asian British staff are particularly under-represented in the mental health workforce. There is a real need, therefore, not just to expand the CYPMH workforce but also to diversify the workforce to better support all children and young people who require support.

Many young people turn to support from charities when they cannot access NHS services or are on long waiting lists. But there are not enough qualified mental health practitioners in the charity sector either. In response, many charities are investing in workforce development activity and designing their own training pathways for those interested in qualifying as a child mental health practitioner. Place2Be has training bursaries available and TIC+ offers subsidised placements to people from backgrounds under-represented in the counselling workforce.

Collaborating with others 

In response to the growing demand for youth mental health support, some charities are developing innovative partnerships—including with corporates, NHS Trusts, research institutions and other charities—to deliver mental health interventions.

Expanding the volunteer workforce 

Many charities within the youth mental health sector depend heavily on volunteers to run their services. Childline, Beat, and Shout are three well-known mental health initiatives that rely heavily on volunteers to run their helpline services, particularly since demand for support has increased significantly in the past few years. Shout, for example, had over 4,000 active volunteers over the course of 2023, many of whom are based in New Zealand and support night-time conversations with UK service users.

Volunteers undoubtedly play a central role in many charities that support children and young people with their mental health. Yet the ongoing cost-of-living crisis and the impacts of the pandemic have contributed towards a drop in volunteering. The proportion of the UK population who volunteered at least once a month in 2021-22 was 16%, down from 23% in 2019-20. Smaller charities are particularly concerned about volunteer recruitment, with six out of ten small charities rating this as their main concern. For many mental health charities that rely on volunteer support to staff helplines, online support services, and in-person support sessions, this is a worrying trend.

How are funders responding to rising need?

Statutory services for CYPMH are chronically under-funded and funding is not ring-fenced. Funding comes from a mix of local authority and NHS funding. In 2022/23 NHS funding was just under one billion pounds, which was an increase on the previous year, but still only 8% of the total local mental health spending that year. Local statutory services, particularly those that focus on early interventions, were hit by a real terms spending cut of 50% in 2010/2011 and 2020/21.

Statutory funding is primarily given to mental health charities through commissioning contracts. These contracts tend to limit how far charities can use them to invest in organisational capabilities and capacity and are often short-term. Many public contracts are also chronically underfunded, with 62% of charities across the sector believing that they do not receive the full value it costs to deliver a contract. The insufficient and insecure nature of commissioning contracts heightens the financial risk for charities and undermines long-term sustainability and investment—particularly now when there is a need to invest in adapting services.

There is an urgent need for greater philanthropic investment in the youth mental health sector and several major funders are responding.

For example:

• BBC Children in Need recently opened applications for a new £1m award to support the implementation of the learnings that came out of its £10m ‘A Million & Me’ fund. The original £10m fund was set up to support children and young people’s emotional wellbeing and mental health. One single award will be made to an organisation or partnership of organisations that can offer targeted and innovative early intervention support (probably involving a large digital element) to children aged 8-13 from marginalised communities.
• Maudsley Charity is launching a new grants programme, Building Brighter Futures, designed with children and young people, at the end of June 2024. The programme is for organisations supporting children and young people most at risk of mental illness. The charity has also contributed £10.3m to date towards the development of a groundbreaking new care and research centre—the Pears Maudsley Centre for Children and Young People.
• The Prudence Trust, established in 2020, invests specifically in the advancement of young people’s mental health services and research in the UK. The Trust has awarded funding in a range of different areas, including academic research, digital technology, and projects that use creative and nature-based approaches to support wellbeing.
• The Stone Family Foundation, which works with NPC, has recently shifted its mental health funding strategy to focus on young people, which will naturally include a number of early intervention initiatives.
• Nominet is funding NPC’s Signpost+ programme—a collaborative initiative working with communities, data experts, the social sector, and beyond to ensure that young people can navigate the many sources of mental health support available and find the option that works best for them.

As the demand for young people’s mental health services continues to grow, philanthropic funding has a key role to play. However, as well as giving more, funders also need to change how they are giving because of the rapidly changing environment.

Philanthropic funding is not keeping pace with rising need 

Although funders increased their giving during the pandemic that figure has since dropped off, while the number of referrals to CYPMHS continues to rise (see figure 1 below). While it can be difficult to compare funding by year using 360Giving as new funders share their data every year, this picture does reflect many of the conversations that we have had with mental health charities over the past two years. As demand has increased, funding has not. Charities in this position now face what NCVO refers to as a ‘triple threat’ of falling income, increasing costs due to inflation, and ever-increasing demand for services.

Philanthropic investment varies across the country

Investment in voluntary sector mental health services can help to support people that statutory services cannot accommodate. However, like statutory services, charity sector support across the country is not equal. Research has highlighted how individuals in ‘left behind’ neighbourhoods (LBNs) receive less than half the amount of funding per capita in comparison to the national average in England and the average across other deprived areas. Whilst charities in deprived areas are less likely to survive, in comparison to those in more affluent areas, and tend to be harder hit by funding reductions. For example, between 2008 and 2014 there was a 9% fall in charities’ real income in the least deprived local authorities in England and Wales, compared to a 14% reduction in the most deprived, with key local infrastructure bodies doing especially badly.

How can funders improve mental health outcomes for children and young people?

Drawing on our research into youth mental health over the past 15 years, we have identified six key areas where funders have the potential to create long-term positive change for children and young people:

1. Preventative work and early intervention: Research shows that early intervention is more effective than addressing mental health problems after they present. The return on investment is three times higher for preventive care than specialist treatment. Many charities have highlighted to us the lack of preventative work, noting that statutory services are extremely stretched and can only address acute needs. Increasing preventative work could have a big impact and fill a gap in current provision. Interventions that support children’s social-emotional functioning or work to prevent Adverse Childhood Experiences (ACEs) are backed by the strongest evidence base.
2. Supporting children from minoritised groups: Our research shows that some groups, including young women, children from ethnic minority communities, LGBTQ+ groups, and disabled children and young people, are more likely to experience mental health challenges. Providing tailored and appropriate support for these groups would help to reduce inequalities in access and care across the country. On the digital side, in particular, there is little to no focus on how these tools can be designed for and used by under-represented groups. Targeted funding to support the development of new technologies (or adaptation of existing tools) designed specifically for particular groups of young people could have a significant impact. NPC has a strong track record in convening people with lived experience, charities, funders, and policymakers to discuss key topics. We could use our convening power to mobilise key stakeholders around the question of how to provide better support to marginalised children and young people.
3. Building and diversifying the mental health workforce: The mental healthcare workforce is chronically underfunded and lacking in diversity. Without more targeted funding to train and retain mental health professionals, none of our other recommendations will have a long-term impact. Funding training placements in existing mental health organisations is one approach here. Supporting the training of professionals in rural areas could also help to reduce patchy provision and have a lasting impact on young people’s access to mental health support in these areas. Given the greater role that digital and blended interventions could play in tackling the mental health crisis, it is critical to invest in building the digital skills and confidence of mental health practitioners, so that they feel comfortable using and recommending digital services to young people. Given that many smaller organisations struggle to fund and resource digital capacity building projects, there could be value in funders offering wraparound or ‘funder plus’ support to charities.
4. Funding research on what works: Several of those interviewed by NPC highlighted the lack of funding for innovative research, yet at the same time, the importance of evidence-based approaches was stressed throughout our research. This is particularly relevant for digital mental health interventions, where evidence of effectiveness is relatively scarce. For example, reviewing and increasing evidence-based practice in Artificial Intelligence technology and convening the sector to respond and safeguard the quality of digital interventions could create high impact. If used well and in certain circumstances, AI has the potential to provide extensive, accessible, and scalable support at low-cost. However, in a bid to develop more innovative and effective solutions to support young people’s wellbeing, research institutions, charities, and funders alike often spread their energy too thinly and do not focus on rigorous testing, implementing, evaluating, and scaling ideas which have potential. Helping to scale an intervention that already has some evidence of effectiveness would be a fruitful avenue for funders to pursue. However, funding also has a key role to play in strengthening the infrastructure around an intervention, by training up healthcare and teaching staff to use new digital tools, for example, or by equipping parents to support their children to engage with a particular mental health intervention.
5. Enabling collaboration across the mental health sector: The current landscape of mental health provision for young people is undoubtedly complex. There are many different actors involved (including healthcare providers, researchers, commercial businesses, and charities) and a huge range of services available. Enabling effective communication between actors in the mental health ecosystem—including connecting larger and smaller organisations—and encouraging the sharing of good practice across the sector is important to avoid duplication of effort. Many of the people we spoke to for this research recognised that better partnership working was sorely needed, however, they often faced financial or capacity barriers to implementing this in their own organisations. Enabling effective collaboration across the charity sector is a core part of NPC’s work. Through Everyone’s Environment, we are convening over 60 social and environmental charities to accelerate action on the social impacts of the environmental crises. Our youth strand of the programme works with youth charities and others to help them identify and implement effective solutions to some of the problems that young people are facing. Through our Signpost+ project, we are also working with communities, data practitioners, the social sector, and beyond to explore how online signposting to support services for young people can be improved. In the youth mental health space, the scale of the challenge means that simply funding more delivery work is not enough—real transformation in this space is dependent on better collaboration and this needs more investment.
6. Exploring a systems-based approach to funding: Targeted funding in areas such as early intervention; support for marginalised young people or workforce development could certainly help to address gaps in the current provision of mental health support. But could transformative funders go further? We need funders who seek to understand and influence the systems which combine to create the mental health issues that children and young people experience. The youth mental health crisis stems from a bewildering array of interconnected factors—personal, relational, social, political, cultural, environmental—that are virtually impossible to untangle. Mental health connects with all areas of government policy; improving mental health and preventing mental ill-health requires a holistic approach. Most charities respond by developing simple linear interventions, and receive funding based on the promise of these solutions. There is undoubtedly a very real need for this work on a micro scale. Yet there is also a need to zoom out and gain a better understanding of the multiple and dynamic causal factors that influence youth mental health. A pooled fund which supports service delivery work alongside policy, campaigning, and systems change work has the potential to drive real change, both in the short and long-term, in this space.

After 15 years of research, we want to play an active role in seeking a solution. We are currently exploring ways in which we could help make change happen in each of the five areas above, but we need support to do this. We are seeking partners that are interested in exploring working together with us to deliver transformative change for this and future generations of young people.