The Children's Commissioner for England, Dame Rachel de Souza, has recently published her fifth annual report into children's mental health services. It sits alongside a growing body of work - including Professor Peter Fonagy's independent review into mental health conditions, ADHD and autism, the Government's proposed mental health strategy, SEND reform, and the Commissioner's own Big Future survey - asking how we should respond to the growing number of children experiencing emotional distress.
The latest figures are striking. More than one million children now have an active referral to NHS Children's and Young People's Mental Health Services (CYPMHS), almost double the number seen in 2018-19. The greatest increases are in anxiety, suspected autism and other neurodevelopmental conditions. Many children wait months for support, while some wait years. Two important conclusions are that we need earlier intervention and better conditions of childhood; rather than simply expanding access to diagnosis and treatment.
As a child psychotherapist, I found myself agreeing with much of what the report says. Children deserve earlier support, families should not be left waiting and mental health cannot be separated from education, social care or wider society.
I also found myself reading the report through a different lens.
If statistics tell us what is happening, psychotherapy asks why. Rather than asking only why so many children are being referred, I wondered what these referrals might be telling us about childhood itself. Statistics tell one story depending on who is interpreting them. Children tell other stories.
One statistic particularly caught my attention. Over a third of referrals are recorded as having an unknown primary reason. At the same time, some of the fastest-growing referrals relate to suspected autism and neurodevelopmental differences rather than confirmed diagnoses. I think children are reminding us that emotional distress rarely arrives in neat diagnostic categories. Children don't usually walk into a room saying, "I'm anxious because..." or "I meet these diagnostic criteria".
Anxiety may first appear as stomach aches. Grief may become exhaustion. Stress can affect
sleep, learning and physical wellbeing just as much as emotions. As a transpersonal integrative psychotherapist, I find it more helpful to think in terms of wellbeing as a whole. Mind, body and soul are continually influencing one another. Certain services need specialist knowledge, but our understanding of children should be integrated.
Children’s distress rarely belongs only to the child
Statistics can help us understand the scale of a problem, but they cannot tell us what a particular child's distress means. That meaning is discovered through relationship, curiosity and context. Children rarely struggle in isolation. Every child arrives carrying an invisible network of relationships: parents, siblings, teachers, friends, grandparents, neighbourhoods and the wider culture in which they are growing. Their distress often makes sense when viewed within that wider system.
A child's anxiety may partly belong to them, but it may also reflect bereavement, bullying, poverty, family conflict or the uncertainty of growing up in a generation shaped by Covid, smartphones and constant comparison. These are not simply background factors - they form part of the emotional landscape children are trying to navigate.
Sometimes children are also carrying emotional burdens that have travelled through families for generations. Experiences of trauma, shame, loss or emotional absence can quietly shape family life long before a child is born. In psychotherapy we speak about intergenerational patterns; Jung described something similar through the collective
unconscious. Whatever language we use, children are often the first people to express what families - and sometimes wider society - have not yet found words for.
Support should begin long before diagnosis.
One of the report's strongest messages is that children should not have to wait for a diagnosis before receiving support. I wholeheartedly agree. Diagnosis can provide understanding and access to services, but it is not the same as understanding a child. Two children with the same diagnosis may need entirely different things because their stories are different.
What do we mean by support, though? The report focuses on NHS mental health services, yet children's lives extend far beyond the NHS. Support may come through parents, schools, family therapy, youth organisations, charities, independent practitioners or simply one trusted adult who remains consistently present. The more broadly we understand support, the more opportunities we create for children to experience healing before difficulties reach crisis point.
I also found myself wondering about outcomes. We measure referrals, waiting times and access to services in considerable detail, yet hear much less about which interventions genuinely help children recover, which families feel more resilient afterwards and what prevents future referrals. Understanding demand is essential. Understanding healing feels equally important.
Improving childhood, not just services
The sentence that stayed with me longest from the report was its call to improve the conditions of childhood. I wonder if this is where the conversation now needs to deepen. When I think about children flourishing, I often find myself using the metaphor of a garden. A struggling plant is rarely understood by looking only at its leaves. We naturally look at the soil, the water, the light and the changing seasons around it. Children deserve the same curiosity.
In my own therapeutic practice, I often think about four essential conditions that help children grow. They need the stability and boundaries that help them feel safe. They need emotionally nourishing relationships. They need opportunities to play, explore and develop confidence. They need space to imagine, learn and make sense of their experiences.
In other words, children need more than treatment. They need environments in which they can flourish. That includes schools, but it also includes homes, communities and the everyday relationships that shape childhood. Earlier intervention is not only about reducing waiting lists but strengthening the environments around children long before specialist services become necessary.
While families are waiting
If your child is currently waiting for specialist support, it can be tempting to feel that everything is on hold. It isn't. Children continue developing every day. Stay curious before becoming certain. Spend time together without needing to fix everything. Hold boundaries consistently and kindly. Allow space for boredom, creativity and play rather than filling every moment. Encourage expression of feelings rather than rushing to explain the story. Look after your own wellbeing too, because children often borrow their sense of safety from the adults around them.
Above all, remember that your child is far more than a referral, a diagnosis or a waiting list. You know your child better than anyone else. Stay curious about what they may be communicating, empower yourself through trusted psychoeducation, and don't feel you have to wait for a diagnosis before seeking support. Whether that support comes from family, school, community organisations, charities or independent professionals, children continue developing every day, and relationships remain one of the greatest sources of healing.
The Children's Commissioner's report is an important contribution to a conversation our society urgently needs to keep having. My hope is that we continue widening that conversation - beyond referrals and diagnoses, beyond thinking about mental health as something separate from physical health, relationships or development. Children do not grow in silos. Their wellbeing emerges through the continual relationship between mind, body and soul; between home, school and community; between the past they inherit and the future they are still becoming. If we strengthen those relationships and create the conditions in which children and families can flourish together, we may discover that we are doing more than improving children's mental health. We may begin creating the conditions in which childhood itself can flourish.
