Children's Mental Health: Recognising the Signs and Getting Support

Children’s mental health has become one of the most prominent public health concerns in England. NHS survey data, published in 2023, found that one in six children aged 5–16 had a probable mental health disorder – a figure that has risen significantly since 2004, when the equivalent rate was one in ten. Anxiety disorders and depression have seen some of the steepest increases, alongside significant growth in autism diagnoses and eating disorder referrals. The consequences of unaddressed mental health difficulties in childhood extend into adult life: most adult mental health conditions have their origins in childhood, and two-thirds of adults with mental illness have their first episode before the age of 24.

Understanding children’s mental health is not simply a clinical matter. It requires understanding the social, economic and environmental determinants of mental health (poverty, adverse experiences, relationship quality, community belonging) alongside the individual biological and psychological factors that shape risk and resilience. Mental health is not simply the absence of disorder; it is the presence of wellbeing, belonging and the capacity to thrive.

Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are a category of childhood experiences associated with significantly increased risk of physical and mental health problems across the life course. The original ACE study, conducted by Kaiser Permanente and the CDC in the late 1990s with over 17,000 participants, identified ten categories: physical, emotional and sexual abuse; physical and emotional neglect; and five types of household dysfunction including domestic violence, substance misuse, mental illness, parental separation and incarceration of a household member.

The dose-response relationship between ACEs and poor outcomes is robust: the more ACEs a child experiences, the greater their risk of mental illness, substance misuse, cardiovascular disease, early death and many other poor outcomes. However, it is crucial to understand that ACEs are risk factors, not determinants: many children who experience multiple ACEs develop into healthy, flourishing adults. Protective factors (particularly the presence of at least one stable, caring adult relationship) significantly buffer the impact of adversity. This is one reason why relationships with trusted practitioners in early years settings and schools can have lasting protective effects.

Five Ways to Wellbeing

The Five Ways to Wellbeing, developed by the New Economics Foundation on behalf of the Foresight Mental Capital and Wellbeing Project, provide a practical, accessible framework for promoting mental health and wellbeing, based on a review of the evidence. They are:

• Connect (building and maintaining relationships)
• Be Active (regular physical activity)
• Take Notice (mindfulness and attention to the present moment)
• Keep Learning (continued curiosity and intellectual engagement)
• Give (volunteering, helping others, generosity)

These five actions are relevant to children as well as adults and can be incorporated into both home and educational environments. Settings that focus on building genuine social connections, providing plentiful opportunities for physical activity, fostering curiosity and learning, encouraging children to help and contribute, and developing mindful attention to their surroundings are actively promoting mental health – not by treating problems but by building the foundations of resilience and flourishing.

Common Mental Health Difficulties in Children

Anxiety disorders are the most common mental health conditions in childhood. Generalised anxiety, social anxiety, specific phobias and separation anxiety all present frequently in school-age children. School refusal (persistent, severe difficulty attending school) is often anxiety-related and requires collaborative, compassionate management rather than punitive responses. Depression in children often presents differently from adult depression: irritability, social withdrawal, physical complaints without medical cause and loss of interest in previously enjoyable activities are common presentations. OCD involves intrusive thoughts and compulsive behaviours that the child finds distressing and difficult to control.

Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, often begin in adolescence but have precursors in childhood, including disordered eating patterns, intense focus on weight or shape and exercise behaviour. The incidence of eating disorders in England has risen sharply since 2020. Self-harm: typically cutting, but also burning, hitting or other forms of deliberate self-injury – is often a maladaptive coping mechanism for emotional distress in adolescents; the motivation is usually to manage overwhelming emotions rather than to end life, though all self-harm should be taken seriously and assessed by a clinician.

CAMHS: Assessment and Treatment

Child and Adolescent Mental Health Services (CAMHS) is the specialist NHS service for children and young people with significant mental health needs, typically referred by a GP or school. CAMHS operates at multiple tiers:

• Tier 1 (universal services, including school counsellors and health visitors)
• Tier 2 (targeted support from primary mental health workers)
• Tier 3 (specialist outpatient CAMHS for children with more complex or severe needs)
• Tier 4 (inpatient CAMHS for children who need intensive or residential treatment)

Waiting times for CAMHS in many parts of England are a significant problem. NHS England data shows that many children wait many months for assessment following referral, and the 2023 NHS Mental Health Implementation Plan acknowledged significant capacity gaps. Families who are concerned about their child’s mental health should not wait for CAMHS alone: school-based counsellors, educational psychologists, voluntary sector organisations (Kooth, Young Minds, Childline) and, where available, Early Help provision can provide support while waiting for specialist services.

Supporting Children’s Mental Health: What Parents Can Do

The most powerful determinant of children’s mental health is the quality of their relationships with their primary caregivers. Warm, consistent, responsive parenting builds the secure attachment that is the single most protective factor against mental health difficulties across the life course. Beyond this, the evidence points to several practical actions parents can take: establishing predictable daily routines (which reduce anxiety by increasing a child’s sense of control); ensuring adequate sleep (which is causally linked to emotional regulation and mental health); limiting excessive screen time; maintaining regular physical activity; fostering social connections; talking openly about feelings using accurate emotional vocabulary; and modelling healthy emotional regulation.

Parents’ own mental health matters enormously for children’s mental health. Parental depression, anxiety and stress (even at sub-clinical levels) affect parent-child interaction and child outcomes. Supporting parents to access their own mental health support is, therefore, also an investment in children’s mental health. GPs, Health Visitors, IAPT (Improving Access to Psychological Therapies) services and parenting programmes such as the Incredible Years are all available to parents who are struggling.

For related guidance, see also our articles on health requirements under the EYFS, SEND and children with additional health needs, play-based learning and quality childcare provision.