More than one million children in England are currently receiving support from mental health services, a figure the Children’s Commissioner has said lays bare the “sheer scale of distress young people are facing today”. Dame Rachel de Souza’s annual report, published on Monday, records 1,048,965 active referrals to children and young people’s mental health services (CYPMHS) in the 12 months to March 2025 – covering those referred, awaiting treatment, or in treatment, though excluding children already receiving care at the start of the year.
The number has nearly doubled from 563,639 in 2018-19, with a 9.5 per cent increase in just the last year. That growth means roughly one in ten children in England now has an active referral to mental health services, according to the Commissioner’s analysis of NHS England data.
Anxiety and neurodevelopmental conditions drive referrals
Anxiety remains the single most common reason for referral, accounting for 16 per cent of all cases in the year to March 2025. Referrals for anxiety climbed by 12 per cent over that period, from 151,479 to 169,389. But demand is “growing especially” for children referred with suspected autism and other neurodevelopmental conditions. Referrals for suspected autism soared by 47 per cent, from 65,530 to 96,393, while referrals for other neurodevelopmental conditions rose by almost a quarter, from 107,479 to 133,435. Together, suspected autism (9.2 per cent of all referrals), other neurodevelopmental conditions (13 per cent) and depression (3.9 per cent) make up the other major categories.
Age plays a clear role in these patterns. Children under ten are far more likely to be referred for neurodevelopmental conditions, particularly suspected autism among those aged six and younger. For children over ten, anxiety is the predominant reason for referral. A government review published in March noted there is no “single narrative” to explain the rising numbers of autism and attention deficit hyperactivity disorder (ADHD) diagnoses in children’s mental health services. It suggested that “rising distress” among young people, alongside a “medicalisation of distress” – where diagnosis becomes the primary route to support – could be contributing factors. The review also cautioned that increased diagnoses do not necessarily mean a rise in prevalence; they could reflect improved recognition, changes in help-seeking behaviour and evolving social patterns. Charities such as Ambitious about Autism have expressed concern that public debate around “overdiagnosis” risks undermining the real needs of neurodivergent children, stressing that rising demand is a sign of progress in identifying those who need help.
Waits of more than a year are now common
The scale of demand is set against deeply concerning waiting times. The weighted average wait for all children in the year ending March 2025 stood at 128 days. More than 60,000 children – 16 per cent of those still awaiting treatment – had been waiting for over two years, up from 14 per cent the previous year. That represents an increase of more than 15,000 children compared with the year before. Waits exceeding a year are described as “common”, and in the worst cases young people are waiting more than two and a half years – 976 days – between referral and treatment.
Analysis by the charity YoungMinds shows average waits reached 304 days between September and November 2025, an increase of 28 days from the previous year and marking the fourth consecutive reporting period in which waits have remained above 300 days. By March 2025, 35 per cent of children were still waiting for treatment, up from 33 per cent in 2023-24 and 29 per cent in 2022-23. Children with suspected autism and neurodevelopmental conditions are among those most likely to experience the longest delays. Fewer than one in five children referred for these conditions received treatment in 2024-25.
The mental health charity Mind described the figures as “deeply concerning”, warning that longer waits increase the likelihood of children and young people ending up in crisis and requiring A&E services. The pandemic, social media and systemic underfunding have all been identified as contributing to the surge. Even before Covid-19, the rate of probable mental health problems among six- to 16-year-olds rose from one in nine in 2017 to one in six by 2021. School closures, social isolation and disruption to family life during the pandemic are widely acknowledged to have exacerbated existing issues and created new ones. Extended social media use – more than three hours a day – has been linked to increased depression and anxiety, primarily through disruption to sleep, with girls showing a stronger association between social media use and depressive symptoms. Concerns persist that online platforms promote anxiety and lower self-esteem by replacing direct communication and encouraging constant comparison.
Funding and capacity constraints remain a critical issue. Historically, a significant portion of child and adolescent mental health services (CAMHS) funding has gone to specialist care rather than early intervention, and there have been long-standing worries about the lack of ring-fencing for CAMHS budgets. Access also varies significantly by area, creating what campaigners describe as a “postcode lottery” in children’s mental health support.
Commissioner calls for joined-up services
Dame Rachel de Souza acknowledged “encouraging signs” that more children received support last year, but warned that the system is facing a “colossal challenge” as demand outpaces capacity and funding. She argued that a fundamental shift is needed: “The way we look to support young people’s mental health must change – we cannot address mental health alone in isolation, improving children’s wellbeing requires action across government.”
Her prescription centres on “greater focus on joined-up services across health, education and social care to ensure children are getting the help they need in schools and the community. Only then will we stop asking what is wrong, but rather ‘how can we help?’” She regards the government’s forthcoming mental health strategy and reforms to the special educational needs and disabilities (SEND) system as a “once in a generation opportunity to transform children’s mental health and improve outcomes for children”.
Several policy initiatives are already under way or in development. The NHS is expanding Mental Health Support Teams (MHSTs) in schools and colleges, with a target of 100 per cent coverage by 2029-30; more than 600 teams are now operational, reaching 52 per cent of the pupil population. Funding has been extended for 24 early support hubs offering drop-in community-based mental health support for young people aged 11 to 25, with campaigners calling for a national rollout. The government’s 10 Year Health Plan aims to shift focus towards prevention, early care and community support, including more support in schools, easier access to specialist services via Young Futures Hubs, and the recruitment of 8,500 additional mental health staff to reduce waiting times. A major independent review into mental health conditions, ADHD and autism – led by Professor Peter Fonagy and expected to report in summer 2026 – is seeking practical, evidence-based ways to improve prevention, early support and intervention across all ages, and is intended to inform the 10 Year Plan.
Despite these efforts, Dame Rachel’s figures show the scale of the challenge is still growing. “Roughly one in 10 children have an active referral to mental health services in England, which clearly demonstrates the sheer scale of distress young people are facing today,” she said. “These are not just numbers, but children whose lives have been put on hold for months and, in some cases, years waiting for support they urgently need.”
