Child mental health: recognising and responding to concerns

Who is at risk?

Any baby, child or young person can develop mental health issues. But research has shown there are some factors that are associated with children's long-term mental health.

Abuse and neglect

The traumatic impact of abuse and neglect increases the likelihood of children developing a range of mental health issues – both during childhood and in later life. These include anxiety, depression, eating disorders and post-traumatic stress disorder (PTSD).^1,2

Specific types of abuse may be connected to certain mental health issues. Children who have experienced emotional abuse may be more likely to develop anxiety and depression compared with children who have experienced other types of abuse.^3,4 One study found that almost three quarters (74%) of young people who had experienced sexual assault developed PTSD.⁵

Abuse and neglect can also make children more vulnerable to developing more than one mental health condition at one time (known as composite mental health issues).⁶

Children who have experienced abuse may be reluctant to talk about how they are feeling, particularly if they haven't yet told anyone about the abuse. They may feel that something is wrong with them or that things may get worse if they talk about it.

An open environment will help them communicate the challenges they are facing and may help them feel able to tell you what’s been happening to them.

Identifying and responding to mental health concerns may be one way of helping children who are experiencing abuse to get the support and protection that they need.

> Use our resources to find out how you can let children know you’re listening if they tell you they have experienced abuse

> Find out how to recognise and respond to abuse 

Providing effective mental health support for children who have experienced abuse and neglect can help them recover from its effects.⁷

d/Deaf children and children who have disabilities

d/Deaf children and children who have complex or additional needs may face a range of challenges including:

• reduced mobility
• prejudice, discrimination and bullying.

These challenges may lead to lower self-confidence, difficulty forming peer networks and social exclusion, putting them at higher risk of developing mental health issues.⁸

Adults may confuse the signs of learning disabilities with the symptoms of mental health issues. This can mean concerns aren't recognised and responded to quickly or appropriately.

> Find out more about safeguarding d/Deaf and disabled children and young people

Children from Black, Asian and minoritised ethnic communities

Children from Black, Asian and minoritised ethnic groups may experience:

• racism, discrimination and prejudice – this can be direct, indirect or institutional
• an increased stigma around mental health issues in the community.

This can lead to inequalities and issues in accessing appropriate care and support for mental health needs.⁹

> Find out more about safeguarding children who come from Black, Asian and minoritised ethnic communities

LGBTQ+ children and young people

LGBTQ+ children and young people may experience:

• prejudice, discrimination and bullying
• a fear of or an actual rejection from family and/or friends
• feeling excluded or like an outsider.

They may also experience gender dysphoria: the unease felt when someone's sex registered at birth does not match their identity.

These factors and experiences mean they are more likely than their heterosexual and cisgender peers to experience a range of mental health problems.^10,11

> Find out more about safeguarding children LGBTQ+ children and young people

Living in care

Statistics suggest that children in care are more likely than their peers to have a mental health difficulty. This can be due to isolation and loneliness. Children in care may also have experienced abuse or neglect, which increases the likelihood of developing mental health issues.¹²

> Find out what statistics can tell us about the experiences of children in care

> Find out more about children in care

Young carers

Young carers are more likely to experience mental health problems than peers who don’t have caring responsibilities.¹³

Young carers may:

• feel worry or stress about the health and wellbeing of the person/s they care for
• feel that they must manage or hide their emotions due to fear or guilt of upsetting the person/s they care for
• feel that they don’t have time for themselves and are missing out on opportunities or activities.

Excessive or inappropriate caring roles and a lack of support from services can be risk factors in a young carer experiencing poor mental health.¹⁴

Life events

Stressful or traumatic situations and experiences, such as bereavement or sudden changes in environment, can trigger mental health issues.

Social isolation and loneliness

Anyone can experience loneliness, but risk factors include:

• having a long-term health condition or disability
• having caring responsibilities
• living in care
• being from an ethnic minority community
• being LGBTQ+.¹⁵

Studies show that there is a strong association between social isolation and anxiety and depression in children.¹⁶

Recognising mental health issues in children

Talking about mental health

Children may come to you directly with worries about their mental health and wellbeing. It’s important you feel confident having these conversations with children. You could try some of the techniques and strategies used by our Childline counsellors to help you talk to children about their mental health.

> Find out more about Childline’s model for understanding child mental health wellbeing

There are lots of factors that might make it difficult for a child or young person to ask for help.

Children and young people may not have the language or ability to communicate how they feel. Or they may be unsure who to talk to and how to talk about their problems. 

Babies and young children aren’t able to verbally communicate their feelings. Older children and young people may not want, or feel able, to discuss their mental health.¹ This might be because they:

• worry they won't be taken seriously
• believe others won't understand
• have had a negative experience talking about their thoughts and feelings in the past
• feel that no one can help them
• fear being dismissed or labelled an attention seeker or 'crazy'. ²

Creating an environment where mental health and wellbeing are both promoted and openly discussed can help children feel able to speak about their worries.

> Find out about promoting child mental health and wellbeing

If you’re concerned that a child may be struggling, don’t wait for them to come to you. 

Make sure you are familiar with the potential signs a child is experiencing mental health concerns. Encourage them to share their worries with yourself or another trusted adult and take action to help them get the support they need. 

> Take our mental health and wellbeing safeguarding children training

Signs of mental health issues

Different children may show different signs of poor mental health at different ages and stages of development. Indicators of poor mental health can be influenced by many factors, including children’s personalities, identities, needs and experiences.³

Some signs of mental health issues may look like normal child behaviour. For example, ‘tantrums’ in younger children or teenagers keeping feelings to themselves. Other mental health issues may not have visible signs.

It’s helpful to think about the context and patterns of the emotions and behaviours children display. For example, is there a known cause, such as a stressful event at home? Are the intensity of emotions or frequency of behaviours unusual for the individual child?⁴

There could be a number of different explanations for potential signs of mental health issues.

Don't attempt to diagnose mental health issues yourself or make assumptions about what’s happening in a child's life.

Do look out for signs, talk to the child about how they’re feeling and share any safeguarding concerns in line with your organisation’s child protection policies and procedures.

Babies and young children

In the first years of a child’s life they are developing the ability to understand and manage their emotions and build meaningful relationships. How parents and carers bond with and emotionally support their children can significantly shape babies and young children’s mental health. When working with babies and young children it’s important to observe the parent-child relationship and note any concerns.

> Find out more about attachment and child development

Babies and young children sometimes display behaviours that could indicate potential mental health concerns. This can include characteristics of anxiety disorders, depression and post-traumatic stress disorder.⁵

Behaviours that babies might display include:

• persistent crying which cannot be soothed
• changes in behaviour around, or struggles with, settling, feeding or playing
• becoming rigid, arching their back, squirming to physically escape feelings of distress
• finding it difficult to respond to their caregiver’s cues
• after a change in routine or separation from a caregiver they struggle to self soothe (if they have already started being able to self soothe).⁶

Behaviours that young children might display include:

• frequently being unable to manage their emotions or behaviours, these are sometimes called ‘temper tantrums’
• an increase in signs of fearfulness when being separated from their caregivers
• an increase in angry or aggressive behaviours, for example towards caregivers and peers
• being withdrawn or showing little interest in social interaction
• being very overactive, restless or not being able to concentrate.⁶

Many of these signs and behaviours can happen when there are no concerns regarding mental health. However, these signs combined with other information about a family’s situation could point towards concerns and the need for further assessment.

Older children and young people

By being attentive to a child or young person's mood and behaviour, you can recognise patterns that may suggest they need support.

Common warning signs of mental health issues in older children include:

> Find out more about understanding children’s mental health and wellbeing

Responding to mental health issues

Mental health issues indicate that a child or young person needs support. If possible, discuss with them what help could be put in place. If you are supporting a baby or young child, this conversation could be had with their parent or carer.

If a child isn't able, or doesn’t want, to talk about their mental health needs you should still consider what support can be put in place for them.

Follow your organisation's procedures to share any concerns you have about a child's wellbeing. For example, you could talk to the person who is responsible for pastoral care in your school or organisation.

Safeguarding and child protection issues

You must always consider whether you need to take any action to protect a child or those around them from harm.

If you identify a safeguarding or child protection issue, you must follow your organisation's policies and procedures.

Safeguarding issues include:

• a child being in immediate and/or significant danger
• someone else being in immediate and/or significant danger
• a child being at risk of or experiencing abuse.

> Find out more about responding to safeguarding and child protection concerns

Confidentiality

If a child is confiding in you about their mental health they may ask you not to tell anyone what they've expressed.

You should never promise to keep what a child tells you a secret. Explain from the outset that you might have to talk to someone else who can help.

If you're concerned about someone's safety and welfare you must share this information with relevant professionals.

Sources of support

There are lots of different types of support available for children’s mental wellbeing and to help with mental health issues.

Midwives and health visitors

During the perinatal period, from pregnancy up to a year after birth, mothers can be affected by a number of mental health problems. These can range from antenatal and postnatal depression to anxiety and postpartum psychosis.¹ Fathers can also experience mental health concerns, such as depression and anxiety.²

If perinatal mental illnesses go untreated they can have long-term implications for the wellbeing of parents and their children.³

Midwives and health visitors play a key role in identifying and responding to parents and families affected by perinatal mental illness.

> Find out more about parental mental health problems

GPs

GPs may be able to diagnose children’s mental health conditions, suggest next steps and provide medication, if appropriate. There is information for children and young people about visiting GPs on the Childline website.

Child and adolescent mental health services (CAMHS)

Across the UK, CAMHS is a free NHS service for children that aims to help with mental health problems such as depression, anxiety, self-harm and eating disorders.

Teachers, social workers, GPs and parents can refer a young person to CAMHS. Services differ from area to area.

In England, you can find CAMHS services in your area through the NHS CAMHS webpage.

Counselling and therapeutic services

Counselling services are available to help children and young people with their mental health. Services can include helplines, one-to-one counselling sessions in person, online or by phone, and online chats and forums.

These services are available through a range of fee-paying and free services including schools and the NHS.

Childline

Children and young people can get free, confidential support from a Childline counsellor via online chat, email or phone.

Childline will listen and provide advice to any concerns about topics ranging from exam stress to depression and suicidal thoughts.

Childline offers a range of resources for children and young people, including:

• Art box to write or draw about their feelings
• Mental health first aid kit to help when things get challenging
• Calm zone with breathing exercises
• Games to help relax and de-stress.

> Download Childline posters, encouraging children to contact Childline if they need to talk

NSPCC services and resources

Pregnancy in Mind is a preventative mental-health service designed to support parents-to-be who are experiencing or at risk of mild to moderate anxiety and depression.

Look, Say, Sing, Play is a set of resources which encourage interaction between parents and their babies to help positively shape brain development.

Letting the Future In is a play-therapy service that helps children who have been sexually abused.

Consent for treatment

It's best practice to get parental consent for children's therapeutic and medical treatments. You should have an organisational policy about seeking and obtaining consent from the child or young person and their parents. But there may be times when a child or young person does not want their parents to know. In this case, your policy should set out how you would assess whether the young person has the capacity to make the decision for themselves to consent to treatment.

The Gillick competency and Fraser guidelines help professionals assess whether a child is mature enough to make decisions.

> Read our information about Gillick competency and Fraser guidelines

Legislation and guidance

Key legislation

In England and Wales, the Mental Health Act (MHA) 1983 covers the assessment, treatment and rights of people with a mental health condition. It applies to all children and young people under the age of 18. The Act allows for people to be detained in hospital if they need treatment for a mental health condition. It gives children the right to appeal against detention.

The Mental Health Act 1983 was amended by the Mental Health Act 2007. This strengthened safeguards for children, for example adding a duty to ensure an age-appropriate environment for children and young people.

In Northern Ireland, the Mental Health (Northern Ireland) Order 1986 is the main mental health legislation which applies to children and young people under 18. It covers the assessment, treatment and rights of people with mental health conditions. The Guidelines and Audit Implementation Network (GAIN) provides guidelines on the use of the Mental Health (Northern Ireland) Order 1986 (PDF).¹

In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 applies to all those with a 'mental disorder', including children and young people. It contains specific safeguards for under 18s regarding mental health treatment, including on named persons, promoting wellbeing and the welfare of children.

The Mental Health (Scotland) Act 2015 amended the provisions relating to children and young people in the Mental Health (Care and Treatment) (Scotland) Act 2003, including providing services and accommodation for mothers.

Strategy

In England, the Department of Health and Social Care is developing a Major Conditions Strategy that will focus on whole-person care and ensure mental health conditions are considered alongside physical health conditions.^2,3 An interim strategic framework setting out the key elements of this new approach was published in 2023.⁴

In Northern Ireland, the Department of Health has published a mental health strategy for 2021-2031.⁵ This sets out actions under three overarching themes:

• promoting mental wellbeing, resilience and good mental health across society
• providing the right support at the right time
• new ways of working.

It also includes actions to improve child and adolescent mental health services (CAMHS).

The Department of Health has also published a Mental Health Action Plan, which is comprised of 38 actions.⁶

In Scotland, Getting It Right For Every Child (GIRFEC) includes eight wellbeing indicators and lists resources professionals can use or adapt for conversations with children, young people and families.⁷

The Scottish Government has also produced a framework for community mental health and wellbeing supports and services, which sets out an approach for the mental health and wellbeing support children and young people should be able to access in their community.⁸

In Wales, the government last published a strategy for mental health and wellbeing (PDF) in 2012. This covers children and young people as well as adults.⁹

Guidance

Early years

In England, the Department for Education’s (DfE’s) Early years foundation stage (EYFS) statutory framework covers the standards that school and childcare providers must meet while caring for children in their early years. It includes guidance on children’s personal, social and emotional development.¹⁰

> Read our CASPAR briefing on the EYFS statutory framework

In Northern Ireland, the Public Health Agency has an Infant Mental Health Framework (PDF) that gives guidance on prioritising and supporting the development of positive social and emotional wellbeing in children 0-3 years.¹¹

In Scotland, the Care Inspectorate has a quality framework for daycare of children, childminding and school-aged childcare (PDF) that includes guidance on supporting young children’s emotional wellbeing.¹²

In Wales, the Welsh Government’s guidance on embedding a whole-school approach to emotional and mental wellbeing, covers early years settings alongside schools. ¹³

Schools

In England, the Department for Education (DfE)’s statutory guidance for schools highlights that child mental health problems may be an indicator that a child has experienced abuse, neglect or exploitation. It also notes that staff should be aware that mental health problems can develop into safeguarding concerns. The guidance includes information on how schools and colleges should support children and young people’s mental health.¹⁴

> Read our CASPAR briefing on the Keeping children safe in education statutory guidance

The DfE has published guidance for school staff on supporting children and young people whose mental health problems manifest in their behaviour. It emphasises the importance of a whole-school approach to mental health and gives guidance on risk and protective factors, identifying children that might need support and working with other agencies.¹⁵

The DfE has also published guidance for schools and colleges on the help available for developing a whole school approach to mental health and wellbeing.¹⁶

The statutory guidance for schools in England on relationships, sex and health education includes guidance on how primary and secondary schools should teach children and young people about mental health and wellbeing.¹⁷

The PSHE Association has published guidance for teachers on teaching mental health and emotional wellbeing. The guidance covers creating a safe environment to talk about mental health and wellbeing, safeguarding children and young people, signposting sources of support and building teaching about mental health and wellbeing into the curriculum.¹⁸

Public Health England (PHE) has published guidance for headteachers and college principals on promoting children and young people’s emotional health and wellbeing in schools and colleges. This sets out eight principles for protecting and promoting young people’s emotional health and wellbeing.¹⁹

In Northern Ireland, the Department of Education has published an emotional health and wellbeing in education framework, which provides guidance for education settings on supporting children and young people’s mental health and wellbeing. It highlights that children in care and those who have experienced abuse or other adverse childhood experiences might be more vulnerable to mental health problems.²⁰

In Scotland, the government has published guidance on Access to counselling in secondary schools. This provides a framework on developing access to counsellors within schools for education authorities.²¹

In Wales, the government has published a Framework on embedding a whole-school approach to mental health and wellbeing for schools, pupil referral units and educational settings. The framework sets out how to develop plans to identify and address weaknesses and build on strengths. It also looks at how to evaluate whether the measures put in place meet the emotional and mental health needs of children and young people.²²

Children with additional needs and disabilities

The National Autistic Society and Mind have produced a free good practice guide to help professionals in the UK adapt talking therapies for autistic adults and children.²³

In Northern Ireland, the Department of Health has published guidance on risk assessment and management in mental health and learning disability services. This includes information about assessing whether a person might be a risk to themselves or others.²⁴

The Department of Education’s resource to support children who have or may have special educational needs includes a chapter on Social behaviour and emotional wellbeing.²⁵ This highlights that social behaviour and emotional wellbeing (SBEW) ias an identified need for every single member of the school community. It provides guidance on developing a supportive and nurturing whole school ethos.

In Scotland, the government has produced guidance on the mental health and wellbeing of disabled children, young people and their families.²⁶