Time for concerted action: the mental health of children and young people in England
4 November 2021
By Huong Le
The mental health of children and young people has been a source of considerable concern over recent years, and never more so than in the aftermath of Covid-19. A recent NHS Digital survey of 6–23 year olds in England has shed some light on the question by updating figures it collected in 2017 and 2020.
Compared to 2017, rates of probable mental health problems in 2021 increased from one in nine to one in six in 6 to 16 year olds, and from one in ten to one in six in 17 to 19 year olds. Even though there were no significant changes between 2020 and 2021, this high prevalence continues to highlight the need for the development and implementation of effective mental health support for young people, including prevention and early intervention programmes.
There is a concerning rise in possible eating problems from 7% to 13% of 11-16 year olds, and from 45% to 58% in 17-19 year olds. This number is also particular worrying in the 20–23-year-old group as 62% screened positive for a possible eating problem. Rates were higher in girls than boys across all age groups, with women aged 17-23 at highest risk. Even though not all eating problems will be diagnosed as an eating disorder, there is a strong link between eating problems and later eating disorders. Given that eating disorders have the highest mortality rates of all mental health problems, this rapidly increasing rate in young people urgently calls for further research and support to address this issue.
Similar to the 2020 survey, this report looked at sleep problems, loneliness, and substance use. Results again showed that a large proportion of children and young people experienced sleeping problems, and its prevalence increased with age. The frequency of feeling lonely also became more common with age, suggesting that there might be some links between loneliness and factors that are specifically associated with adolescence such as peer pressure, development of romantic relationships, and increasing use of social media. Most children and young people reported no use of alcohol, cigarettes, or cannabis or other drugs in the previous seven days, which is encouraging. However, the rates of substance use, sleeping problems and loneliness were much higher in young people with possible and probable mental health problems compared to those without. Therefore, it is still important to recognise these problems as potential risk factors for mental health problems in children and young people. If prevention and early intervention programmes can target these problems effectively, it is possible that they can help to reduce the levels of mental health difficulties.
Mental health in children with special educational needs and disabilities
The findings highlight an urgent need to address mental ill-health in children and young people with special educational needs and disabilities (SEND). More than half (57%) of 6-16 year olds with SEND had a probable mental health problem. This number is much higher compared to those without SEND (13%). Parents of children with SEND in this survey also reported a reduction in the support that their child received due to the pandemic. There is no doubt that we need to direct more attention and resources to support children and young people in this group as well as their caregivers, so that they can seek and receive appropriate and effective care in time.
Half of 11-16 year old social media users reported that they spent more time than they should on social media, with 17% of them saying that social media interaction (likes, comments, shares) had a significant impact on their mood. This figure was also higher in young people with a probable mental health problem, and especially in girls compared to boys. Although it is worrying that many children and young people are spending a large proportion of their time on social media which might negatively influence their mental health, the findings also suggest that social media can be a platform to reach those who are most at risk. For example, in light of the data above on eating problems, prevention and intervention programmes specifically operating on social media using positive body image or healthy eating messages have the potential to be effective. Alternatively, social media apps that help to connect and forge friendships can potentially be useful in combatting youth loneliness. The report did not give a direct comparison in the use of social media before and after the pandemic, which would have been helpful to shed light on how this has changed in the last two years.
The role of family and household circumstances
The current follow-up survey continues to reinforce the role of family and household circumstances in children and young people’s mental health. Specifically, young people with a probable mental health problem not only had lower levels of family connectedness but also were more likely to live in a family that reported problems with family functioning (i.e., family tension, communications), or one that had fallen behind with bills, rent or mortgage during the pandemic. This once again highlights the links between social and economic inequalities and mental health difficulties in young people. Together with the recent UNICEF report on global children’s mental health, which highlights family connectedness as one of the biggest protective factors in young people’s mental health, this highlights the need for future programmes to focus on support families holistically, addressing their social needs, in order to improve children and young people’s mental health. Nevertheless, these findings also imply the absence of family support as a potential risk factor for children and young people’s mental health.
The low tendency of help-seeking behaviour among young people is not a surprising result, but it is an important one. Results also showed that 26% of parents of 6-16 year olds with a probable mental health problem and 42% of young people with mental health concerns did not seek help between summer 2020 and spring 2021. Understanding and addressing the reasons behind the low levels of help-seeking behaviours are a vital part of ensuring that children, young people, and their careers can access appropriate mental health support when they need it.
The interplay between age and gender
A common theme emerging from this report is the interplay between age and gender in mental health. For example, we see that boys aged 6-10 were much more likely to have a probable mental health problem than girls, while the opposite pattern applied to the 17–23 year old group. Compared to 2017, rates of probable mental health problems significantly increased for young women but not young men (17-19 years old), even though significant increases were shown in both boys and girls under 16 years old. This difference was not only related to the prevalence of mental health problems but also how long they lasted. Since 2017, girls and young women have been more likely to experience mental health deterioration than boys and young men. Although it is important to consider the general impact of Covid-19 on young people’s mental health, this interaction between age and gender should not be underestimated. This should be a reminder for researchers and services that our approaches to children and young people’ mental health needs to be appropriate to both their gender and developmental period.
Results regarding ethnicity again show a rather complex picture. In line with the 2020 report, children and young people from white and mixed-race communities were more likely to present with probable mental health problems compared to those from Black/Black British and Asian/Asian British communities. On one hand, this data is in line with other evidence which suggests that young people from racialised communities may have better mental health than their white counterparts. On the other hand, these findings contrast dramatically with other data about the mental health of people from racialised communities. For example, by adulthood, there is an overrepresentation of Black people experiencing severe mental health difficulties such as schizophrenia or psychosis. Similarly, data from the UK Millennium Cohort Study found greater risks of a wide range of different mental health difficulties among children from racialised communities up to the age of 14. The inconsistency between NHS Digital’s data and that from other sources needs urgent investigation to explore the factors affecting mental health among children and young people from racialised communities, as well as those explaining the disproportionality of mental health diagnoses in adults from racialised communities. Further research must consider the impact of external factors such as systemic, structural racism and experiences of discrimination; these factors have been overwhelmingly cited as consistent barriers to mental wellbeing in adults from racialised communities yet remain overlooked in children and young people.
Another important note emerging from the UK Millennium Cohort Study is that, of all the subgroups, ‘Black Caribbean’ young people showed the highest levels of mental health problems at age 14. This shows that the frequent use of the general category of “Black” within research and official reports (including in NHS Digital’s reports) is a major cause for concern, as this practice undoubtedly contributes to the scant and inconsistent picture of the mental health of young people from diverse racialised communities. Even though the inclusion of ethnicity subgroups can be challenging given their smaller proportion in the UK population, it is necessary that we act now to reach and understand the needs of these communities.
There is now no room for doubt that the mental health of children and young people in England is deteriorating. And there are stark inequalities between different groups. Data only tells us a part of the story, but it helps us to identify priorities and points to the need for concerted action to turn the tide and enable all children to have a better chance of good mental health.
To learn more about children and young people's mental health, check out our handy fact sheet.
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