It has been 10 years since the coalition government introduced Future in Mind, a bold policy aimed at transforming mental health support for children and young people.
The vision was ambitious: prioritising early intervention, integrating care across sectors, and ensuring no child or young person slips through the cracks. But a decade later, how much of that promise has been fulfilled?
Despite a growing recognition of the importance of children's mental health, political will has fluctuated over the decade. While successive initiatives – such as the NHS Five Year Forward View for Mental Health, the Transforming Children and Young People's Mental Health green paper, and the NHS Long Term Plan – have built on Future in Mind, systemic issues remain. Now, as the government drafts a new 10-year health plan, will this finally be the moment real change happens, or will it be another false dawn?
Better access and investment
One of the most notable achievements has been expanding access to NHS mental health services. NHS England has steadily increased treatment availability, with more than 420,000 children and young people receiving support in 2020/21 – exceeding initial targets. The NHS Long Term Plan set an even more ambitious goal, aiming to support an additional 345,000 young people by 2023/24 – a target that remains a priority in this year's guidance for local NHS systems.
There have also been promising developments in targeting support for groups of children and young people at greater risk of poor mental health. Pilots for mental health assessments for children entering care, improved local partnerships across disciplines, and a shift toward 0-25 services have all helped create a more integrated system. Recognising the dangers of a “cliff-edge” drop in support at age 18, this move towards seamless pathways is a step in the right direction.
The NHS workforce has expanded significantly too, rising from 12,683 in 2016 to 21,643 in 2022, bolstered by new roles such as children's wellbeing practitioners and educational mental health practitioners.
Too many being failed
Despite progress, the scale of need continues to outstrip capacity within support services. The number of children experiencing mental health conditions has soared since Future in Mind was published – from one in eight in 2015 to one in five in 2023. Demand is at crisis levels, and services are overwhelmed. The Covid-19 pandemic only made things worse, stretching an already fragile system to breaking point and entrenching inequalities. Long waiting lists also persist, leaving children in distress for months, sometimes years, before receiving care.
While some areas boast well-developed pathways to support, others are struggling to meet even basic demand. It is expected that mental health support teams will only be available to 50% of England this year.
For those requiring inpatient care, the average stay in a mental health hospital for a child in England lasts around 70 days – seven times longer than in Sweden. Inpatient care is not only significantly more expensive than community-based alternatives, but it is also often an unsuitable and distressing environment for young people in crisis. Meanwhile, certain groups – such as young people with eating disorders, autism and learning disabilities – continue to face severe inequities in accessing the care they need.
System barriers to change
- A lack of early intervention: While there has been investment in NHS mental health services, earlier help services have been undermined by years of austerity policies, especially in local government.
- The transition cliff-edge: Despite moves towards a 0-25 model, many young people still face abrupt and damaging transitions to adult services at 18. The system is not built for continuity.
- A workforce under pressure: While staffing levels have improved, they remain insufficient to meet soaring demand. NHS staff vacancy rates within children and young people's mental health services rose from 9% in 2021 to 17% in 2022, and retaining mental health professionals remains a major challenge.
- Inequities in access: Marginalised groups such as LGBTQ+ young people, those from racialised communities, autistic conditions and those with speech and communication needs continue to struggle to get the holistic support they need.
Possible solutions
While Future in Mind could have been a strong foundation, it's clear that far more is needed. That's why our Future Minds campaign – run in partnership with the Children and Young People's Mental Health Coalition, Centre for Young Lives, YoungMinds, and the Prudence Trust – has set out a clear, costed roadmap to deliver real change.
We are calling for increased investment in children and young people's mental health services, with scaled funding increases year-on-year until 2029, starting with an additional £167mn in 2025/26. This will help to expand mental health support teams to all schools and colleges, and to make early support hubs available in every community, providing accessible, drop-in mental health support for children and young people up to the age of 25.
To achieve these ambitions, we need a comprehensive workforce strategy that strengthens the entire mental health support ecosystem – including voluntary and community organisations.
