One million referrals. One clear message: the system needs the workforce to hold the line.
This week, the Children’s Commissioner Dame Rachel de Souza, published her fifth annual report into children’s and young people’s mental health services in England. The headline figure will stop most people in this sector in their tracks: referrals to Children and Young People’s Mental Health Services (CYPMHS) have doubled since 2018-19, from 563,639 to 1,048,965, and they’re still climbing, up 9.5% in the last year alone.
For those of us working in and around children’s mental health services, this isn’t a surprise. It’s confirmation of what frontline teams have been telling us for years. But it’s also a moment worth pausing on, because a report like this doesn’t just describe a system under strain, it tells us where that strain is concentrated, and where the workforce response needs to go next.
Here’s what the report actually found, and what it means for anyone delivering, commissioning, or staffing these services.
The headline numbers
The scale of demand growth is the story. Referrals have nearly doubled in six years and crossed one million for the first time. But the report is more useful than a single top line figure, it shows us where that demand is coming from.
Referrals for suspected autism rose 47% in a single year, from 65,530 to 96,393. Suspected neurodevelopmental conditions rose 24%, from 107,479 to 133,435. Anxiety referrals rose 12%, from 151,479 to 169,389. Alongside these, referrals for children in crisis and for depression also increased.
This is not simply “more children are struggling.” It’s a shift in the composition of demand, services built primarily around clinical mental health pathways are now absorbing a much larger volume of neurodevelopmental and autism assessment work, often without the specialist capacity to match.
The report also surfaces inequalities that should concern anyone thinking about equitable service design: Black and Asian children remain underrepresented in referrals relative to need, children from more deprived areas are more likely to be referred, and boys are marginally less likely to be referred than girls. And on outcomes, over a third of referred children are still waiting for treatment, with more than 60,000 waiting over two years, up from over 44,000 the year before.
Children’s Commissioner Dame Rachel de Souza was direct in her assessment: the system is “struggling” to keep pace, and she’s calling for a shift toward prevention; earlier intervention in schools, expansion of mental health hubs, and a joint national strategy that stops treating mental health as separate from education, care, and physical wellbeing.
What this means if you work in children’s mental health
Neurodevelopmental and autism expertise is no longer a specialism, it’s core capacity. With autism referrals up nearly 50% in a year, services and staffing plans built around a narrower clinical model are already behind demand. Teams need clinicians, assessors, and support workers who are confident across neurodevelopmental pathways, not just traditional CAMHS presentations. This has direct implications for how services structure caseloads, and for the skills mix organisations need to recruit and retain.
Waiting list pressure is a workforce problem as much as a funding problem. Sixty thousand children waiting over two years isn’t just a resourcing gap, it reflects the reality that services can’t flex capacity quickly enough when demand shifts. Flexible, skilled staffing; whether that’s locum clinicians bridging capacity gaps, or permanent hires who can move across referral types, is part of how that gap gets closed.
Prevention and early intervention roles will grow. The report’s recommendations point firmly toward schools, early support hubs, and joint DHSC/DfE funded initiatives. That signals real growth in roles that sit outside traditional clinical CAMHS settings, school-based mental health leads, allied health professionals working in education, and early intervention practitioners. Anyone building a career in this space should be watching this shift closely.
Equity of access has to be a workforce conversation, not just a policy one. Underrepresentation of Black and Asian children in referral data isn’t resolved by strategy documents alone, it requires a workforce that reflects and understands the communities it serves, and services actively designed with equitable access in mind.
This is a sector under sustained, structural pressure, not a temporary spike. Six years of consistent, compounding referral growth tells us this is the operating environment now, not a peak to wait out. Organisations that plan their workforce around that reality, rather than treating current demand as exceptional, will be the ones best placed to deliver consistent care.
Our take
Reports like this matter because they give language and evidence to what practitioners already know from experience. The system is stretched, but it isn’t standing still, the direction of travel is toward prevention, toward neurodevelopmental competence as standard, and toward joined-up delivery across health, education, and care.
At CAMHS Professionals, this is exactly the shift we’re built around: connecting skilled, specialist professionals with the services that need them, across the full breadth of children’s and young people’s mental health, clinical and neurodevelopmental, crisis and preventative, NHS and independent sector.
If you’re a service leader thinking through how your workforce needs to evolve to meet this demand, or a clinician considering where your specialism is most needed, we’d welcome the conversation.
Read the full Children’s Commissioner report, Children’s and Young People’s Mental Health Services: 2024-25, for the complete findings and recommendations.
