A review of children and young people’s mental health insight in south west London

Executive summary

This report explores key insights gathered through engagement in south west London, with a focus on the emotional wellbeing of children and young people, including those with special educational needs and disabilities (SEND).

The report has been compiled to inform a future engagement project in Sutton focused on children with neurodiversity – to support with understanding key factors or events that contribute to escalating behaviours; and exploring the barriers and challenges faced by children and young people and their families in accessing appropriate support. 

The following findings highlight key issues affecting children and young people and their families:

Feelings of anxiety, stress and mental health concerns among young people – reflected across all reports is emotional wellbeing concerns from children and young people. Young people say that triggers for poor emotional wellbeing are often linked to personal life events or circumstances in their life. They discuss a range of coping mechanisms outside of mental health services including talking to friends and family and playing computer games. Work with asylum seekers and refugees noted that they felt more comfortable talking openly to those who “genuinely care for them”, such as friends, foster families, and youth workers.

Stigma and school-related stressors – children were worried about the stigma of mental health and the effect it could have on their social status, embarrassment and being treated differently by peers. High prevalence of anxiety was noted with one study showing that 46% of secondary school students felt anxious every day. Coping mechanisms included hurting themselves in some way when they are struggling/feel bad or feel stressed/worried – with levels increasing for LGBTQ+ pupils and transgender pupils. Suicidal thoughts were also found in primary school students.

Waiting list for mental health services – concerns raised by children and staff around long waiting lists and lack of capacity leading to needs not being met. Findings indicated that there is a need to improve the ways young people are communicated with and supported while on the CAMHS waiting list. The transition between children’s and adult’s services was also noted as a difficult area causing disruption to the treatment they were receiving.

Barriers to accessing support services – some families have not been able to access activities that support mental wellbeing, such as sports and creative programmes as they can’t afford to. Other factors such as language barriers, housing and the local environment were found to impact young people’s wellbeing.

Lack of support for parents and carers – Many parents and carers feel isolated and uncertain about where to seek support for their children’s mental health needs. A lack of post-diagnosis support for parents and carers was noted with parents feeling there was a lack of support from practitioners as well as access to peer support groups.

Findings for Children and young people with special educational needs and disability

Delays in assessment and diagnosis – across boroughs it was found that long waiting times for assessment led people to seek private assessments and left people feeling that they had to cope alone. Examples given of people receiving a diagnosis and then feeling abandoned to cope with no follow up support.

Impact on mental health – difficulties in accessing specialist support was noted as contributing to increased emotional distress and poorer mental health among children with SEND. Pupils with SEND were also more likely to hurt themselves when worried or stressed.

Lack of inclusive support – There were concerns regarding the lack of inclusive activities for children and young people with SEND – often leaving people feeling quite isolated and under pressure to organise activities themselves.

School-based support and Education Health and Care plans – there was a mixed picture around people’s experiences of EHC plans – some feeling that schools resisted applications, or once they were in place, not receiving the support that it specified. Whereas some parents had more positive experiences with the plans being effectively implemented. Insight from Black communities with neurodevelopmental needs showed that children are falling behind in school with some neurodiverse behaviours being attributed to poor behaviour leading to inappropriate sanctions and discipline

Challenges in navigating SEND support pathways – many parents described the struggle of ‘fighting for support’ within a complex system with little assistance. Parents commented that they struggled to navigate the system without professional help. Those with neurodiverse children felt it was often difficult to locate community support and respite services making it difficult for parents to manage their own wellbeing. There were challenges accessing the right services due to a lack of clear guidance following diagnosis.

Introduction

Discussions at the Sutton Health and Care Executive meeting in January 2025, highlighted a clear focus on the emotional wellbeing of children and young people with neurodiversity, particularly where there are behavioural challenges – and in some cases related to special educational needs. Ahead of beginning a new phase of engagement with children, young people and their families we have undertaken a literature review of insights from previous engagement work across south west London.

This report details findings from insight conducted in Richmond, Wandsworth, Sutton, Merton and Croydon between 2020 and 2024 – identifying the key issues and challenges experienced by children and young people and their families in relation to emotional wellbeing and SEND.

Background

Mental health and wellbeing among children and young people in south west London has become a growing concern, with increasing rates of mental health issues, self-harm, and suicide reflecting the need for enhanced support services.

Children and young people in south west London, as well as nationally, are facing increasing challenges with their mental health and wellbeing. Approximately 16,000 under 18s receive NHS funded community mental health treatment each year, representing 4.5% of the population of children and young people in the region which is higher than the London average of 4.1% 15.

Around 16% have special educational needs (SEN) with this number growing. Many of these pupils require support for social, emotional, and mental health needs, with rates higher than the London and national averages.

Self-harm is a major concern across the region. Kingston, Richmond, and Sutton have some of the highest self-harm admission rates for both children and adults in London. Wandsworth and Merton also rank among the top ten London boroughs for self-harm-related hospital admissions in children and young people. In Kingston, self-harm admissions for both young people and adults are twice as high as the London average 1

Methodological approach

This report is a synthesis of findings from insight reports published between 2020 and 2024 by local Healthwatch organisations, local authorities, voluntary and community sector organisations and NHS Place-based community engagement teams. It pulled out common themes from across all sources. The primary reports used a variety of methods to collect data including surveys, face to face discussions and interviews.

The report sought to identify key challenges, barriers, and support gaps across the mental health and SEND services – and included findings on stigma, school-related stressors, social isolation, and transition between services.

Key themes – mental health and wellbeing

Children and young people’s mental health

Mental health and wellbeing are a key concern for children and young people with recent years showing a rise in mental health issues and longer waiting times for treatment. Engagement from Richmond and Wandsworth highlighted an increase in the prevalence and severity of mental health conditions among children and young people, with Black, Asian and Minority Ethnic communities, and LGBTQ+ youth identified as particularly vulnerable groups ⁶. Healthwatch Croydon found that a quarter to a third of Croydon’s young people still needed support ⁸. Most children and young people preferred help by speaking to their friends, family, or trusted adults over mental health professionals and emphasised the need of having someone to talk to when feeling down ^{1, 5, 8}. Wandsworth young people’s survey reported that young people from Black communities were more likely to cope with stress by playing computer games ¹⁶. Engagement across schools in south west London highlighted that children and young people defined emotional wellbeing as feeling happy and free from stress, with triggers often linked to personal life events or external circumstances. Many children also lack the knowledge to support themselves or others with mental health concerns ⁵.

Children and young people’s mental health

Mental health and wellbeing are a key concern for children and young people with recent years showing a rise in mental health issues and longer waiting times for treatment. Engagement from Richmond and Wandsworth highlighted an increase in the prevalence and severity of mental health conditions among children and young people, with Black, Asian and Minority Ethnic communities, and LGBTQ+ youth identified as particularly vulnerable groups 6. Healthwatch Croydon found that a quarter to a third of Croydon’s young people still needed support 8. Most children and young people preferred help by speaking to their friends, family, or trusted adults over mental health professionals and emphasised the need of having someone to talk to when feeling down 1, 5, 8. Wandsworth young people’s survey reported that young people from Black communities were more likely to cope with stress by playing computer games 16. Engagement across schools in south west London highlighted that children and young people defined emotional wellbeing as feeling happy and free from stress, with triggers often linked to personal life events or external circumstances. Many children also lack the knowledge to support themselves or others with mental health concerns 5.

Stigma and school-related stressors

In south west London, negative stigmas surrounding mental health were identified particularly among older students ⁵. This is due to concerns about social status, embarrassment, or being treated differently by peers. Other significant stressors include feelings of exclusion, misunderstanding, academic pressure and bullying ⁵. In Richmond and Wandsworth, the Schools and Students Health Education Unit (SHEU) surveys showed 46% of secondary school pupils felt anxiety ‘often’ or ‘every day’^{6, 7}. The surveys reported 34% of primary school students in Richmond and 31% in Wandsworth at least ‘sometimes’ deal with things by hurting themselves in some way when they are struggling/feel bad or feel stressed/worried. Around 10% of pupils said they experienced suicidal thoughts ‘often’ or ‘every day’. In Wandsworth, LGBTQ+ pupils are more likely to have self-harmed when stressed (44% vs 20%) and are less likely to be happy with life (32% vs 55%). Transgender pupils are more likely to have negative emotions/experiences every day (67% vs 36%) ¹⁶. Healthwatch Croydon’s recent engagement on young people and mental health found that a quarter to a third of their respondents still needed support ⁸.

Mental health services

Long waiting lists for mental health and wellbeing treatment were highlighted as a significant issue. Concerns have been raised about a lack of resources in CAMHS. The South London Listens partnership found there was a need to improve the ways young people were communicated with and supported while on the CAMHS waiting list across south west London⁹. The transition from CAMHS to adult mental health services was also mentioned as an issue.

Outreach by NHS SWL with children and young people across Kingston and Richmond and with St Geroge’s Patient Involvement Forum, reflected the lack of mental health service capacity in general, with some feeling CAMHS as inaccessible. Feedback suggested the CAMHS referral system was not working between different agencies, with young people from specific backgrounds being failed by the system. They also raised concerns about low morale among staff working with children and young people, as they felt young people’s needs were not being met. Other issues included a lack of a joined-up approach to transition, switching to adult waiting lists and the disruption to treatment by having to change therapists ¹⁰. Better transitions were noted to ensure continuity of care ¹.

Waiting months for a CAMHS appointment is totally unacceptable and the transfer from child to adult services is very disorganised

It would be useful to address the issue of young people ‘aging out’ of the system. They may have developed a good relationship with a professional and find they have hit the age where they have to go onto adult services and have to pretty much start over. A better transition should be instituted.

Barriers to accessing services

Financial barriers often prevent engagement in activities that support mental wellbeing, such as sports and creative activities 1, 3. In Merton and Wandsworth, affordability was identified as a barrier to mental wellbeing, with free or low-cost activities being beneficial to help promote mental wellbeing 1. Other factors such as language barriers and the local environment were found to impact young people’s wellbeing. Having access to green spaces and recreational areas was found to promote positive mental health by enabling social interactions and physical activity 1. Other wider determinants of health, including better housing and safer neighbourhoods where also identified as contributing factors 1.

Key themes – children and young people with special educational needs and disability

Diagnosis and navigating services

Children and young people with Special Educational Needs and Disabilities (SEND) were identified to face challenges, including delays in assessments and diagnosis 2, 4. In Kingston and Richmond, inadequate support and long wait times for autism and ADHD evaluations, led some to seek private assessments and left people feeling there were left to cope alone 4. Some parents with children with autism and ADHD referred to CAMHS, reported not receiving support despite being referred 4. Parents commented on the struggle they encountered as they felt the system is not easy to navigate without professional help, struggling to access the right services due to a lack of clear guidance following diagnosis 2, 4.

Only support received has been through my son’s primary and secondary school SEN department post diagnosis. There has been no other support offered. He got his ASD diagnosis in 2016. It felt like we were given a diagnosis then abandoned. No follow up or support coming to terms with what ASD means to him or us as a family. He is now nearly 16 and has not come to terms with his ASD. Even CAMHS didn’t help. We were just signposted to information. websites despite his mental health being affected during his teenage years

In Croydon, insight from Black communities with neurodevelopmental needs showed there is a lack of awareness and education within the community including a lack of understanding from professionals working with families. Findings reported that children are falling behind in school with some neurodiverse behaviours being attributed to poor behaviour leading to inappropriate sanctions and discipline 18.

Difficulties in accessing specialist support was identified to contribute to increased emotional distress among children with SEND 1. In Richmond, Achieving for Children reported children and young people and parents and carers that felt they were involved in planning their care and staff in Early Years settings, worked proactively to identify and support their needs 11. Mencap Merton suggested mental health information needed to highlight support services which have specialist expertise and easy access routes for people of all ages with a learning disability or autism spectrum diagnosis 13.

There were concerns regarding the lack of inclusive activities for children and young people with SEND. Healthwatch Croydon reported difficulties in finding suitable community activities with some activities labelled as “inclusive” being found to be inaccessible. Parents also described the challenge of limited opportunities for family-inclusive events and accessible after-school or weekend activities. There were concerns about limited programmes for individuals with complex needs and sensory sensitivities particularly as children reach adulthood. Many parents reported having to take on the responsibility of identifying and organising suitable activities themselves, which added stress 2.

There are not enough resources for after school and weekends. It can be very isolating for the child and carer. Playgrounds are always a challenge. Maybe having ‘set times’ that SEN children can access playgrounds. This would enable them to enjoy the space without judgement.” 2

“Students with autism/disabilities are often not included nor celebrated, they’re mostly in the background and hardly get noticed, they’re forced to fit in rather than be themselves

Social isolation and school-based support

Social isolation has been highlighted as an issue, with some children experiencing bullying and difficulties in forming friendships 2. Pupils with SEND were also more likely to hurt themselves when worried or stressed (46% vs 30% in Richmond and 33% vs 26% in Wandsworth) 6, 16. In Wandsworth, pupils with SEND were reported more likely to have negative emotions/experiences every day (51% vs 36%). Pupils with SEND were also more likely to have low resilience scores (28% vs 18%) 16.

In terms of school-based support, some parents reported that schools provide the most effective support while others have found positive experiences through programmes such as the EarlyBird’s course and ADHD Embrace 4. There is insufficient support for children transitioning between educational stages, making it challenging for families to navigate the academic system 3, 4. Concerns were raised that some schools resist Education Health and Care (EHC) plan applications due to internal pressures, although others have had positive experiences where EHC plans were effectively implemented 2. Healthwatch Croydon reported there were sometimes delays in EHC plan assessments, support and coordination resulting in issues in transition, particularly from primary to secondary schools 2. Some parents and carers whose children had an EHC plan, felt their children were not getting the support specified in their plan, such as speech and language, due to lack of funding or availability 12. Improved communication between schools, healthcare providers, and social services was highlighted to support families with additional needs 1.

Challenges in navigating SEND support pathways

There were mixed feelings among parents regarding their involvement in decision-making for children with SEND. Some felt that the process was unclear and inconsistent 2. Many parents described the struggle of ‘fighting for support’ within a complex system with little assistance 2. Those with neurodiverse children felt it was often difficult to locate community support and respite services. A lack of respite care was identified to add to family stress, making it difficult for parents to manage their own wellbeing 1.

There is an assumption that parents know where to look to find information – we do not have a crystal ball! We are expected to know to check webpages to know when deadlines are, when we have no idea that there are deadlines, as we have no experience of the SEND processes and are learning as we go

Post-pandemic impact on wellbeing

In 2023, Healthwatch Sutton’s wellbeing survey highlighted a decline in overall happiness since 2020, with boys much less likely to feel ‘very happy.’ While fewer reported dissatisfaction with secondary school and SATs, their wellbeing declined across multiple areas 3. Issues like falling out with friends, trouble sleeping, and loneliness increased, especially among girls. The pandemic had a lasting impact on family relationships, with fewer children seeking parental support when facing problems (dropping from 63% to 54%) and fewer feeling listened to at home (declining from 63% to 48%) 3. Girls reported higher rates of loneliness, and children with neurodiversity or learning disabilities in Richmond experienced greater adverse effects.

Asylum seekers and refugees

NHS South West London’s insight from the children and young people’s grant funding programme highlighted feedback from young asylum seekers and refugees. They felt more comfortable talking openly to those who “genuinely care for them”, such as friends, foster families, and youth workers. Major stressors identified included a lack of social connections, poor housing conditions, and limited support from social services. A key concern was feeling unheard by social care networks and authorities, which added to their stress. Experiences with CAMHS were mixed, with some describing the support as neutral and others noting a lack of practical support. They reported feeling better supported in London boroughs compared to those placed outside the city, where they experienced more delays in accessing education, leisure, and housing 1.

Support for parents and carers

Many parents and carers feel isolated and uncertain about where to seek support for their children’s mental health needs. Findings from multiple sources indicate that the main channels of support include teachers, family, friends, general practitioners (GPs), community centres, playgroups, online resources (such as the NHS website), and social networking groups including WhatsApp communities 1, 2, 4. Parents seeking support for their own mental health often turn to employers, GPs, therapy, or peer support from other parents 1. Achieving for Children in Kingston identified a lack of post-diagnosis support for parents and carers, with parents feeling there was a lack of support from practitioners as well as access to peer support groups 12. Parents experiences with GPs also vary, while some found their GPs knowledgeable and helpful, others reported that time constraints and long waiting periods added to their anxiety 1.

Next steps

This report will be considered by the Sutton Health and Care Executive and Sutton Place Partnership Board.

References

NHS SWL (2024) Children and young people’s grants programme.
Healthwatch Richmond (2023) SEND Future Experiences.
Healthwatch Sutton (2023) The impact of the Covid pandemic on the mental wellbeing of 9-11 year olds in Sutton.
NHS SWL (2023) Experiences of post diagnostic services for Autistic people and people with ADHD – Kingston & Richmond.
South West London Health & Care Partnership (2020) SWL children and young people’s mental health communications insight report.
Richmond Public Health (2022) Mental Health Needs Assessment.
Wandsworth Public Health (2022) Mental Health Need Assessment.
Healthwatch Croydon (2023) Croydon young people’s mental health insight – Final report
South London Listens (2022) Impact report: year 2021/22
 SWLNHS (2023) Joint Forward Plan Our engagement with people and communities April to May 2023
Achieving for Children (2023) Summary of feedback from the SEND Futures engagement with parents and carers and children and young people in Richmond (June to September 2023).
Achieving for Children (2023) Summary of feedback from the SEND Futures engagement with parents and carers and children and young people in Kingston (June to September 2023) 
Public Health LBM and Mencap Merton (2021) Impacts of Covid 19 on people with a learning disability or autism and their carers 
Achieving for Children, LBR, SWLCCG (2021) Richmond upon Thames SEND Futures Plan 2021/22 to 2025/26 
NHS SWL (2023) Joint Forward Plan 2023 – 2028.
Wandsworth Public Health (2022) Young People’s Survey.
NHS SWL (2023) Our Mental Health Strategy.
NHS SWL & Croydon BME Forum (2024) Neurodiversity – report pending