The New Childhood:
Mental Health in a Connected Age

Foreword from Professor Peter Fonagy

Children aged 13 and under are often overlooked in discussions of mental health support, despite this being a formative period in which emotional difficulties first emerge, and patterns of seeking help begin to take shape. This report brings together multiple sources of evidence (including children’s own perspectives, Shout conversation data, practitioner experience, and expert interviews) to examine the mental health needs of younger children and the extent to which current systems are meeting them. Taken together, the findings suggest that this group is both developmentally distinct and insufficiently served by existing models of support. 

The report shows that children aged 13 and under represent a stable and important group within Shout’s user base and, among those users who provide their age, are more likely than older users to return repeatedly and to seek support late at night. A significant proportion of these conversations involve serious distress, including self-harm and suicidality. Many children describe feeling that they have no trusted adult to turn to, while others appear to use anonymous, text-based support even when adults are present in their lives, suggesting that accessibility, privacy, and emotional safety matter as much as simple availability of support. These patterns point to important gaps in current provision. They also challenge any assumption that younger children do not actively seek help or that their needs can be absorbed within systems designed primarily for older adolescents. 

A central theme running through the evidence is that younger children require support that is developmentally attuned, relationally safe, and easy to access before difficulties escalate. Current arrangements are often poorly aligned with these needs. Thresholds for specialist services remain high, support in schools is uneven, and many available services are designed with older adolescents in mind. Children 13 and under are therefore at risk of falling between universal provision, which may be too light-touch, and specialist provision, which may be too inaccessible.  

The evidence also suggests that digital support has become part of the real help-seeking ecology of childhood. For some children, anonymous and text-based support appears easier to use than face-to-face routes, especially where shame, fear of burdening adults, or worries about confidentiality are present. The report does not argue that digital provision can replace relationships with trusted adults or formal services. Rather, it suggests that digital support should be understood as one component of a broader system of care: useful where it is easy to access, private, developmentally appropriate, and connected to wider support when risk or complexity increases. 

Three broad implications follow. First, younger children need to be recognised explicitly in service design and policy, rather than treated as a residual subgroup within broader children and young people’s mental health provision. Second, support needs to be available earlier and in forms that children can and will use, particularly in schools, community settings, and carefully governed digital spaces. Third, provision needs to help the adults around children as well as the children themselves, because effective support depends not only on direct intervention but on the emotional and relational environments in which children live. 

The report therefore recommends a more coherent approach to 13 and under mental health support built around early access, developmental fit, and integration across school, community, family, and digital settings. It calls for lower-threshold support, stronger links between schools and specialist services, and greater investment in approaches that combine privacy, safety, and human connection. The central message is that children aged 13 and under are already telling us, in multiple ways, that they need support that better reflects their developmental stage and lived reality. Government, providers and developers of digital support should heed this message and respond to the report’s recommendations.   

Executive summary

This report, produced by the Institute of Global Health Innovation (IGHI) and Mental Health Innovations (MHI), aims to better understand the mental health of children aged 13 and under and the opportunities to improve the support they receive.  

This report features key insights from children themselves, captured through the Middle Years Projectand an analysis of how this age group uses Shout, MHI’s 24/7 texting service to support those struggling to cope. It leverages insights from the literature, mental health professionals and Shout volunteers with experience of supporting children aged 13 and under. This report benefited from the knowledge and experience of our Children's Advisory Group, all 13 and under, who supported the researchers throughout this project. 

Childhood is a crucial developmental stage for individuals’ mental health and wellbeing. Their experiences and the support they receive during this time can have an impact on the rest of their lives. Crucially, today’s children are exposed from an early age to digital technologies, social media and artificial intelligence, the effects of which are not yet fully understood. 

In this report, we provide an overview of what we know about children’s mental health in England (Part 2) we describe the unmet mental health needs of children aged 13 and under (Part 3), and we recommend how to better meet these needs through traditional and digital support (Part 4).  

In our survey we found that most children aged 13 and under prefer to receive mental health support from friends and family, but NHS England estimates that up to a third of children with mental health needs use online or telephone support. This is consistent with what we see in the use of Shout: although only 32 per cent of Shout texters share their age, we see that texters aged 13 and under have become a significant and stable share of users over the past five years, with the vast majority returning more than once to the service for support. While these findings do not represent all texters 13 and under who contact Shout, this group represents a disproportionate share of overall Shout conversations. They are also increasingly contacting Shout about higher-severity topics such as suicide and self-harm. 

Building on the findings from this work we developed key recommendations across three levels: system-level recommendations for government, the Department of Health and Social Care (DHSC) and NHS England (NHSE); service design recommendations for providers; and specific design principles for digital tools.  

At the system level, DHSC and NHSE should reframe the narrative towards a positive focus on children’s mental health and resilience. DHSC and NHSE should also encourage the integration and better coordination of existing services to improve access and impact.  

At the provider level, mental health services should be consistently delivered across communities and schools. Service providers should also incorporate educating adults on children’s mental health.  

Children are already using digital support services, so the question is not whether digital should be involved, but how it can best meet their needs. Digital tools should carefully balance safeguarding needs with accessibility, ensuring the burden of safeguarding rests with the service providers rather than the children. Finally, digital tools should incorporate human support as well to avoid isolation, develop the children’s social skills, and ensure the children receive the appropriate support.  

1.1 Introduction 

This report is the third in a series that builds on the long-standing partnership between Mental Health Innovations (MHI) and the Institute of Global Health Innovation (IGHI) at Imperial College London.

MHI is a charity that builds and delivers digital products and insights to transform the mental health of the UK. Youth charity The Mix merged with MHI in 2024, strengthening their digital early intervention offer for young people. IGHI brings together a multi-disciplinary team of academics, public involvement specialists, policy experts and data scientists to tackle some of the most pressing challenges in healthcare today.

Through this series of reports, MHI and IGHI have partnered to conduct research on key groups and make policy recommendations around how to better support their mental health. Our first report looked at the accessibility and availability of MHI’s text service, Shout. Shout is the UK's first and only free, confidential, 24/7 text messaging service for anyone who is struggling to cope. Our report found that digital solutions are essential and should be scaled to meet the increasing demand.

Our second report focused on the relationship between mental health and work. It explored the nuanced relationship between the two, where mental health can have an impact on work, and work can in turn, impact people’s mental wellbeing. The report included a guide for employers (co-developed with experts by experience) on how to foster a work environment that is supportive of mental health.

This third report focuses on children aged 13 and under, their mental health needs and how these can be addressed. Both MHI and The Mix have experienced a growing demand for mental health support from this age group in the past seven years. This increasing demand is reflected in the rise in the number of conversations with texters from this age group on the Shout service since its establishment in 2018. Existing children and young people’s mental health services have historically been designed for older teens, leaving a gap in services tailored specifically for children aged 13 and under. This report has been developed to provide insights into the rising mental health needs of children aged 13 and under, and recommendations on designing services to meet them.

It draws on findings from:

• The Middle Years Project (Box 1), a mixed methods research project to better understand the mental health challenges faced by children in primary and secondary school (years 6 through 8).
• Meetings with our Children’s Advisory Group (Box 2), a group of children aged 9-13 who advised on this report’s research questions, data interpretation and recommendations.
• Focus group discussions with Shout volunteers (Box 3) with experience of supporting texters aged 13 and under.
• An analysis of aggregated and anonymised data from Shout conversations (Box 4) where the texters were 13 and under.
• Interviews with experts from healthcare, education and charities involved in children’s mental health (Box 5).

This report aims to guide system leaders, policymakers and service providers in how to better support the mental health of children aged 13 and under by:

• Providing a nuanced description of the mental health needs of children aged 13 and under and the services currently available to them – see Part 2
• Mapping out the unmet mental health needs of children aged 13 and under, drawing on findings from their use of Shout – see Part 3
• Making recommendations on tailored support for children aged 13 and under that can help bridge the existing gap - see Part 4 

1.2 What we did

This report builds on the findings from the Middle Years Project (Box 1). We carried out desk research on the mental health and wellbeing of children aged 13 and under, their age-specific needs and the services that are currently available to them in the UK. MHI conducted focus groups with Shout volunteers with experience of supporting texters aged 13 and under. We also conducted expert interviews with stakeholders from healthcare, education and charities working in children’s mental health.

We are acutely aware of the importance of ensuring that people with lived experience shape our work. Each of our reports has benefited from the guidance of advisory groups of people with lived experience of the issues in our reports.

We worked with a Children’s Advisory Group (Box 2) who helped us interpret the data and shape our recommendations. While the Children’s Advisory Group has been instrumental to this work, their experience covers only part of the issues faced by this age group. Access to MHI’s Shout dataset offers the opportunity to hear first-hand from a larger group of children in this age group who are struggling. Quantitative analyses conducted on these data (Box 4), as well as pre-existing analyses conducted by MHI’s data insights team, are included in this report.

A note on language

This report refers to mental health, mental ill-health and mental health needs throughout.

We use the term mental health to refer to the full spectrum of psychological and emotional wellbeing, which can include positive and negative feelings and behaviours.

We use the term mental ill-health to refer to specific conditions or episodes that children may experience, such as anxiety or depression.

We use the term mental health needs to refer to the various factors including physical and environmental conditions, relationships, services, support and skills needed for good mental health or recovery from mental-ill health. In the context of this report, it is helpful to see mental health in its broadest sense and to consider the factors that support children’s wellbeing, not just the factors that can cause periods of mental ill-health.

This report refers to children aged 13 and under throughout.

We use this age group to describe children who are old enough to articulate feelings, emotions and mental health needs and fall within the age range of those who typically reach out to the Shout service (often between the ages of 9 and 13, but in some instances may be younger).

1.3 Limitations of this report

As with our first and second reports, our aim is to be guided by people with lived experience of the issues the report covers.

While the views of the Children’s Advisory Group have been instrumental in shaping our understanding of the findings and recommendations, their experience will not cover the range of mental health difficulties faced by children in this age group.

They had not accessed Shout for support and may have limited experience of more severe mental health issues such as self-harm and suicidality. They likely also have more positive relationships with friends and family than Shout users. Participants in focus groups for the Middle Years Project were also left to the schools to decide.

This presents a potential source of selection bias and may not fully reflect the range of perspectives for this age group. Access to fully anonymised Shout conversation data and discussions with Shout volunteers who have supported children with these needs have helped us begin to understand this group in the absence of being able to speak to them directly.

Only 32 per cent of Shout texters responded to the post-conversation survey with their age information. This survey is the only opportunity MHI have of attributing demographic characteristics to texters.

All analyses have been based on varying subsets of this 32 per cent. Additionally, trends in frequency of topics discussed are impacted by service demand. In the queue to chat with a Shout volunteer, texters who use certain words indicative of higher severity can access a Shout volunteer sooner.

Therefore, at times of peak demand, higher severity topics will appear as more prevalent because these are the ones prioritised by the system. They are not necessarily representative of the broader pool of topics that texters in the queue are hoping to discuss.

Additionally, only a subset (64 per cent) of conversations was analysed to understand the topics and issues that texters discuss. This is due to limitations in data completeness for how conversations are assigned a topic (Data analysis appendix Section 6.6).

Finally, while we believe that the recommendations laid out in this report can support children’s mental health today, they are not necessarily future proof. Changes in technology and social media mean that governments, healthcare workers, schools and parents should remain vigilant and willing to support children in the most appropriate way for the contexts they are in, with the understanding that this will evolve over time.

Summary

Children develop in the context of their relational and social environments. Their mental health is significantly impacted by the presence or absence of appropriate support during this time.

While children who experience adversity or are from vulnerable groups have a higher likelihood of developing mental ill-health, children without any obvious mental health risks still face mental health stressors that are unique to this time of their lives. Some of these, such as schoolwork and life transitions, can be underestimated or exacerbated by the adults around them.

One in five children are estimated to have a mental health disorder, with over half of mental health issues starting before the age of 14, making the focus on this age group crucial.

While most of the children we surveyed prefer receiving support from family, friends and their schools, NHS England estimates one in three children with mental health needs uses online or telephone mental health support services. This is consistent with the pattern of use of Shout by texters who stated their age as being 13 and under: they are a significant and stable group of approximately 9 per cent of texters who account for up to 15 per cent of all Shout conversations.

2.1 The development and mental health of children 13 and under

The UK government defines a child as anyone under the age of 18, young persons as those between the ages of 14 and 18 and young adults as those between the ages of 18 and 25. This report focuses on children 13 and under as a service-relevant category, but the evidence necessarily comes from partially overlapping age bands and is interpreted with caution.

Children develop in the context of the relational and social environment around them. Children’s mental health is significantly impacted by developmental changes, and the presence or absence of appropriate support. In pre-teens (9-12) children commonly begin showing greater cognitive ability compared to other years, ask deeper questions, make connections in patterns of human behaviour, solidify their values and question beliefs.

They also begin to question their self identity and cultural identity. In early adolescence (10-13), children commonly begin experiencing the physical and physiological changes that come with puberty, abstract thinking and mood changes associated with new hormones. Understanding the emotional, social and cognitive behaviours of children aged 13 and under provide a foundation for understanding their mental health needs.

Certain groups are more likely to experience mental ill-health compared to their peers, such as children who experience adversity, children who identify as LGBTQ+, and children with learning disabilities.

There is a significant prevalence of these exacerbating conditions in children aged 13 and under who text Shout. Of the texters who provide age information (32 per cent), the proportion of texters aged 13 and under with vulnerable characteristics has been on the rise since 2020. Texters in this age group are more likely than older texters to identify as autistic (30 per cent) or receive free school meals (29 per cent). They are also more likely to identify as LGBTQ+ (56 per cent).

Children without any obvious mental health risks or exacerbating factors still face mental health stressors as they navigate schoolwork and societal pressures. Respondents from our surveys (children aged 10-13 and in years six to eight) and participants in our school focus group discussions (children in year seven) highlighted the mental health impact of navigating school changes and academic pressures (Box 6).

These insights indicate that in addition to the significant support provided by school-based services and family and friends, children in this age group are increasingly turning to digital services for support, including helplines (Box 7).

Summary

Traditional mental health services are struggling with the growing demand. Up to 40,000 children are experiencing wait times of two years and nearly one in five consultant positions in CAMHS are unfilled.

The fragmented care across community, mental health and population-level initiatives makes it difficult for children and families to get the support they need.

Charities are seeing an increased demand for their services among children 13 and under. This is driven both by the limited availability of traditional services and a preference from this age group for alternative support. Not having any friend or trusted adult to talk to, wanting to talk to someone who did not know them, and feeling more comfortable texting than speaking about how they felt were all reasons raised by children 13 and under for texting Shout.

The prevalence of higher-urgency topics among Shout conversations for texters who stated their age was 13 and under is worrying. Texters who state their age is 13 and under and contact Shout more than once are more likely than other age groups to text about suicide-related topics, and to present at a higher level of risk. The proportion of conversations related to suicidality in this age group has risen since 2023 despite an overall decline across the broader texter population.

3.1 Challenges with traditional services

Children and young people’s mental health services (CYPMHS) are struggling to meet the growing demand for support. The Children’s Commissioner reports that of the one million children and young people in England with active referrals to CYPMHS in 2022-2023, 28 per cent (270,300) were still waiting for support in 2024 while 40 per cent (372,800) had their referral closed before accessing the service. While the average wait time was 35 days, up to 40,000 children experience wait times of at least two years. Although children in crises had the shortest waiting times, they faced a median wait time of five days.

While most children from our survey preferred speaking with family and friends, the leading reasons for not using mental health services was connected to stigma or taking up resources from others in need. The absence of suitable services was a factor highlighted by Shout volunteers. Experts highlight insufficient available services, limited resources in schools and limited support for vulnerable groups as key gaps in current services.

The challenge is further compounded by a limited number of consultant child and adolescent psychiatrists available. The Royal College of Psychiatrists (RCPsych) report that as of 2023, 19 per cent of consultant positions in CAMHS were unfilled. RCPsych also reports that CAMHS faces the highest rate of consultancy vacancies of any psychiatric specialty and is working to attract more doctors to the field. RCPsych stated in June 2025 that financial investments in the NHS are insufficient to meet the increased demand for mental health services and requested that mental health services be given their ‘fair share’ of NHS funding.

3.2 The increasing role of non-traditional support

Given the challenges faced by traditional mental health services for children, it is no surprise that charities are seeing an increase in the use of their services by those aged 13 and under.

Shout, a 24/7 mental health support texting service provided by MHI, is one of those services supporting children and young people. Our previous report showed that 43 per cent of Shout texters do not access public mental health services or the NHS, with those under 25 being the least likely to explore these. Less than 10 per cent of Shout users strongly agreed that public mental health services and the NHS were easy to use.

Of the 32 per cent of texters who provide their age, texters 13 or under account for a significant and sustained share of Shout texters (9 per cent) and conversations (11 to 15 per cent) (Figures 4 and 5). They are also more likely than other age groups to use the service repeatedly: since 2023, approximately 90 per cent of conversations with children who stated their aged was 13 or under have been initiated by returning texters.

Furthermore, across all conversations with this age group, over half (55 per cent) of texters aged 13 and under returned to Shout for support within four hours of a previous conversation at least once, with 36 per cent of returning conversations occurring within 24 hours of previous conversations. In contrast, only 29 per cent of conversations with returning texters aged 14-17 occurred on the same day. This suggests that engagement with Shout is seen not as a ‘one-off’, but a continued source of support for this group (Figure 6). While these findings only apply to those who provided their age (and not all Shout texters who are 13 or under), they describe a unique pattern of use for a subset of this age group.

Compared to older age groups, texters who shared their age as being 13 or under have a higher proportion of conversations in the evenings and before school, times when traditional services are not available. The Children’s Advisory Group suggested that these may also be the times of the day when children feel most alone, distressed and away from peers or parents.  

The reasons why children reach out to Shout are varied.

Higher-urgency topics, such as suicidal ideation (38 per cent) and self-harm (30 per cent), are most concentrated in conversations late in the evening and overnight. Bullying (8 per cent), which is mentioned more frequently by this age group than others, is a more prevalent topic in hours before school and during the start of the school day.  

Only 32 per cent of Shout texters share their age. Of these, those 13 or under who have contacted Shout more than once are more likely to contact to Shout about suicide-related topics than other age groups. They are also more likely to present at the highest level of risk. Furthermore, the proportion of conversations related to suicidality has continued to rise since 2023 for this group despite an overall decline in the share of conversation on this topic. These findings were echoed by Shout volunteers’ experiences (Box 10).  

Shout data reveal a subset of children 13 and under whose level of need, timing of distress, and preference for anonymous or text-based support expose gaps in current provision. This challenges the assumption that younger children either do not need or will not use such support. While Shout is supporting this group, this reveals an opportunity for more dedicated services for this age group in these areas. Further analysis into these trends and insights from texters aged 13 and under using Shout can be seen in the appendix. 

Summary

Findings from this report inform seven recommendations to improve the mental health support that children aged 13 and under receive today.  

DHSC and NHSE should: 
1. Give the narrative on children’s mental health a positive focus on wellbeing and resilience. 
2. Integrate and better coordinate existing mental health services for children 13 and under. 

Mental health service providers should:  
3. Expand and standardise mental health services in schools and communities, particularly in primary schools. 
4. Educate adults who care for children about children’s mental health and the impact they can have. 

Developers of digital mental health services for children should:  
5. Design tools that are tailored to the needs of children 13 and under.  
6. Balance safeguarding and the accessibility of these tools. 
7. Complement the digital support element with human support where possible. 

Building on the findings from this work we developed key recommendations across three levels: system-level recommendations for DHSC and NHSE, service design recommendations for providers, and specific design principles for digital tools. 

At the system level, DHSC and NHSE should give the narrative on children’s mental health and resilience a positive focus. Mental health services for children should look fundamentally different from adult services, emphasising prevention, building resilience, and prioritising overall wellbeing rather than only treating diagnosed conditions. DHSC and NHSE should also encourage the integration and better coordination of existing services to improve access and impact. Current plans to expand school-based mental health services are moving in the right direction. However, given fiscal constraints and competing priorities, increased collaboration among existing services can expand reach and impact while expansion efforts are being established. 

At the provider level, mental health services should be more consistently delivered across primary schools, not just in secondary ones. Community mental health should also be more consistently available, with models such as peer and near-peer support being particularly effective. Service providers should also incorporate educating adults on children’s mental health. The effectiveness of these services can be significantly increased when the adults who care for this child (for example, parents, guardians, teachers) are fully aware of the impact their words and actions can have, and how to best support the children in their care. 

Regarding the design of digital tools, these must be tailored to meet the specific needs of children 13 and under. A child-first approach that meets children where they are and that is co-developed with children from this age group will have a higher likelihood of success. Digital tools should also carefully balance safeguarding needs with accessibility, ensuring the burden of safeguarding rests with the service providers rather than the children. Finally, digital tools should incorporate human support as well, where voice support and participations in in-person groups are encouraged to avoid isolation, to develop the children’s social skills, and to ensure that the children receive appropriate support.  

4.1 System-level recommendations for DHSC and NHSE 

4.1.1 The narrative around children’s mental health must be re-framed towards a positive focus on wellbeing and resilience  

There is a growing misunderstanding of mental health among children aged 13 and under, largely driven by peer influence and social media narratives. Addressing their mental health needs will require re-education that frames mental health and wellbeing through a positive lens.  

Mental health education should begin early and be delivered in ways that are positive and skills-based rather than problem-focused, which can be overwhelming. Self-paced learning programmes like The Mix’s ‘LifeSkills’ equip young people with helpful tools and resources focused on real-life issues such as depression, anxiety, and growth mindset in constructive ways that emphasise the positive aspects of mental health. These are delivered through self-paced modules based on co-design sessions of how young people would respond best. 

A proactive, skills-based approach is critical for this age group and should be embedded in schools and community settings. Education should focus on what positive mental health looks like and how children can achieve this naturally. 

Negative narratives about mental health also often start early without proper education, with “mental health” often used as a label by children and young people without any assessment. Mental health services for this age group should focus on a better understanding of the concept, healthy relationships and emotional wellbeing.  

Re-framing the narrative also involves building children's mental health and emotional resilience to deal with the challenges of life and know when to seek care. Children need to understand what healthy responses to life's challenges or stressful situations look like and when additional help is needed. Children should be supported to understand and manage difficult emotions such as anxiety, anger, and stress as a normal and healthy part of life, and to avoid over “over-pathologising” emotional states as mental health conditions. Mental health services for children in this age group should equip them to better respond to life and avoid self-diagnosed labels. 

4.1.2 Existing mental health services for children must be integrated and better coordinated 

The growing number of mental health services targeted at children must be coordinated to improve access and impact. Traditional mental health services like CAMHS often require parents, carers, and children to navigate multiple independent care pathways and specialist referrals, which can lead to high dropout rates and fragmented care.  

The readiness for cooperation is evident in children and young people's mental health, where organisations and stakeholders are open to collaborative opportunities and partnerships. Given children's vulnerability and developmental needs, there is a need to integrate mental health services to improve engagement and care outcomes. 

Multi-agency hubs provide a model for collaborative care. These hubs bring together mental health services and professionals from multiple sectors to work collaboratively through a single point of referral, streamlining access and reducing fragmentation. The Children and Young People's Multi-Agency Navigation Hub in Gloucestershire brings together professionals from mental health services, the voluntary sector, local authorities, and education to provide coordinated advice, assessment, and intervention through a streamlined care pathway. It now serves as the single point of contact for all mental health and education referrals from Gloucester City Schools, streamlining the process of navigating multiple referral pathways for mental health and related social care needs. 

The UK government's recent approval of additional funding to expand multi-agency hubs for early intervention signals a growing recognition that collaborative, coordinated services are essential to meeting children's mental health needs effectively. The government is expected to launch 50 Young Future Hubs to improve opportunities, to cater to mental health and well-being, and to reduce crime among 10-18-year-olds in England by March 2029. 

Collaboration should also extend beyond statutory services to include partnerships with the private sector, civil society organisations, community networks, and other stakeholders interested in children's mental health. Cross-sector collaboration can expand available resources, provide valuable insights, and build capacity to meet the growing mental health needs of children.  

4.2 Service design recommendations for providers

4.2.1 Mental health services for children in schools and communities should be expanded and standardised

While there has been a historical focus on mental health provision in secondary schools, primary schools require equal attention. The Labour Party has promised to place a mental health professional in every school by 2030 and roll out based on NHS identification of local need. An evaluation of New Zealand’s Counselling in Schools initiative including primary schools has shown mental health improvement in 80 per cent of students who received counselling, improved attendance and better school achievements. Early support also addresses mental health needs before they escalate, reducing the need for further services.  

School-based mental health support should be designed and delivered by dedicated professionals. School curriculums should be designed to teach about the wider determinants of health that impact mental health, wellbeing and resilience. This should include topics like nutrition, physical exercise and even finances as they grow from primary to secondary school.  

Some children from the Children’s Advisory Group highlighted having dedicated spaces in their schools to speak with a mental health advisor or mentor teachers, however this was absent for others. Even where support existed, they highlighted significant barriers such as: 

• Going to mental health support spaces could signal to peers that you're struggling. Some schools require a pass to access mental health services, making it obvious to their peers that they are in need. 
• Being taken out of lessons for support sessions draws attention and leads to peers asking questions, creating rumours and assumptions.  
• Many children will only go to support spaces if they have a scheduled session, avoiding drop-in visits to prevent being noticed.

These insights highlight the importance of privacy and confidentiality in services for this age group. Privacy and confidentiality for children is important not just for how care is delivered but also in how accessing it is perceived by their peers. 

Equally important is establishing informal support systems, including trusted adults and safe spaces within schools, alongside formal counselling. Programmes such as game clubs, sports interventions, or mentoring activities can help provide emotional support through relationship-based mentoring and informal engagement. These activities can create safe spaces for children to connect with each other, or a trusted adult, and to receive support without needing formal counselling. 

Experts also highlight the importance of informal spaces within schools that encourage play, build skills, and support mental wellbeing. Referral criteria to traditional mental health services are often strict and complex, which can result in high dropout rates among children.  

In addition, schools should encourage self-agency in seeking mental health support. Place2Be’s self-referral service Place2Talk, enables children in schools to self-refer. Children write a concern on a piece of paper and place it in a post box. Trained personnel review these notes, triage them and make an appointment with the child. This process empowers the children and teaches them self-advocacy and emotional management. 

There is a significant need to invest in community-based mental health services for children through spaces that provide opportunities for children to come together in social environments, meet peers, and talk about their experiences. These spaces should be designed intentionally and in ways that communicate respect for children's needs and personalities. Community spaces offer low-barrier, non-clinical environments where children and young people can connect with peers through shared activities and informal support. 

Community-based services can be particularly valuable when targeted for different at-risk groups, such as dedicated spaces for LGBTQ+ children or those with special educational needs (SEN). Community-based mental health services can help meet children where they are in their preferred social spaces, providing structured connection and reducing isolation.  

Community based services can provide an alternative form of informal support outside school hours. Community-based mental health services for children provide an alternative that is close to home, and independent from teachers or carers. In addition, these services can help support school efforts to balance academic demands and mental health needs. Services like Off the Record provide accessible evening and weekend mental health counselling for children and young people across Croydon, Merton, and Sutton.  

Within communities, peer and near-peer models appear to be particularly effective.  The Children’s Advisory Group highlighted that connecting with a near peer over shared interests like football or skincare could be helpful in building rapport more easily. They also value personal experience from someone who “has gone through similar things”. They raised caution over speaking with peers who may know them too well or have preconceptions. 

4.2.2 Adults who care for children should be educated regarding children's mental health

Mental health service providers who support children must also include training adults, including parents, guardians, and other caregivers, on how their words, actions, and behaviours impact children's mental health to support children’s wellbeing. Meeting the mental health needs of children aged 13 and under requires taking a whole-child approach, addressing the child's entire ecosystem, including their environment and relationships.

A significant portion of this ecosystem is shaped by parents, carers, and other adults, whose own mental health and wellbeing directly influence the children in their care (Part 2). Parents and adult carers can unintentionally transfer their stress and unmet needs onto children, creating feelings of guilt and worsening outcomes. This dynamic is especially critical for at-risk children, including those with long-term illnesses, special educational needs, or from low-income backgrounds (Part 2).  

Adults understanding the impact of their words on children's mental health is a key step in meeting children’s mental health needs. Words Matter’s newly launched course, ‘How to Communicate with Children so they Thrive’, provides guidance on transformational communication, pattern recognition and techniques that enable adults to use words to support children’s mental health. 

Place2Be’s parent and child coaching model builds parents’ capacity to manage difficult situations at home while providing tailored support that adapts as children grow and their needs evolve. The model recognises that parents, carers, and other adults in children's lives often need guidance and practical strategies to effectively support their children's mental health and wellbeing. 

4.3 Specific design principles for design tools

4.3.1 Designing digital tools that are tailored to meet the needs of children 13 and under

The design process of digital support for children 13 and under should actively involve them to respond to their needs. Organisations like MHI do this through their Youth Board and Youth Voice groups, which provide valuable insights that make services more impactful for young people.  

There is an opportunity for health organisations to learn from the expertise of companies whose target audiences are children and young people. The Charity of Chelsea and Westminster Hospital NHS Foundation Trust’s (CW+) collaboration with marketing companies to gather insights for children and young people has strengthened their ability to understand what children need and support them effectively.  

Digital mental health services for children should be designed to integrate with platforms children already use. Services should leverage insights from how children use large digital platforms, including social media, to provide targeted messaging and support. Understanding children's behaviour on different platforms enables services to be contextualised to their current habits, increasing retention and engagement.  

Digital mental health services should look trusted, professional, and relevant to children. Services should use messaging, imagery, and design choices that communicate trust, understanding, and invitation. Children should feel a sense of belonging when using these services. Experts highlight this is difficult to achieve without involving children or near peers in the design process. 

4.3.2 Balancing safeguarding and accessibility

Digital mental health services for children should be delivered with robust safeguarding measures but also be readily accessible to children. Platforms should be monitored by skilled staff who can observe and address trends, behaviours, or patterns that may be harmful to children. Age-verification systems could also be deployed to ensure users are the intended group. Children should receive clear guidance on how to navigate the platform safely and what constitutes harmful or unsafe behaviour by themselves or their peers. Guidance should be provided with reassurance and care, emphasising the benefits and importance to the child to assuage fears. 

Safeguarding measures should be balanced with accessibility. Barriers to access, such as requirements for passwords, login details, or email addresses, can exclude children who lack these and discourage engagement with the platform. Experts also note that children are often uncomfortable with being monitored or having their data continuously collected, which can lead to increased dropout rates. Digital mental health services for children should be designed with low barriers to entry, while placing the responsibility for protection and safety standards on service providers. 

Accessibility also requires digital mental health services to cater to different levels of digital access. While apps may offer more personalised functions, delivering digital mental health services through websites may be more accessible. Not all children have access to smartphones, but most use websites as part of their daily learning and activities.  

4.3.3 Complementing digital mental health services with human support

Digital services should enable children to engage with human interaction and in-person support, which helps build resilience and social skills while creating opportunities for more tailored care. Connecting to human support can be achieved through integration with school-based mental health services or community mental health provision where children spend most of their time. Digital mental health services for children should create pathways that enable children to develop skills, receive support, or access counselling through face-to-face interactions. 

Voice-based support has also been identified as a valuable way to build human connection in children's mental health services. Speaking to someone via a phone or an online meeting provides a sense of connection and trust for the child. It also enables practitioners to assess additional mental health cues such as tone, breathing, or phrasing that are helpful in providing appropriate support. 

The need to better support the mental health of children is clear and is being prioritised by the government.

In December 2025, the government appointed Professor Peter Fonagy to chair an independent review into mental health conditions, attention deficit hyperactivity disorder (ADHD) and autism. In the terms of reference, the government states that “the NHS mental health, ADHD and autism services have never fully met the needs of the population in a tailored, personalised or timely way.”  

The first 13 years of life of a person see them develop cognitively, socially and emotionally. Skills such as self-regulation, developed during this time, are key to being mentally healthy throughout a person’s life.  

While children who experience adversity, living in care, or have learning disabilities are more likely to suffer from mental health issues, children without any obvious exacerbating factors still face mental health stressors (Part 2). As they navigate schoolwork and societal pressures, responses by adults to negative situations (e.g. exam results) can “feel catastrophic”. There is a sense that adults do not fully understand the impact these reactions can have on children’s mental health.  

While there has been a welcome reduction in stigma and increased awareness of mental health, there is also a risk that informal support channels, primarily through social media, pathologise normal emotions and encourage self-diagnosis, blurring the lines between mental health disorders and the ‘normal struggles’ of growing up (Part 4).  

Children must know that no problem is ‘too small’ to ask for help, and the first line of support should come from trusted adults. Learning how to deal with the ‘normal struggles’ of growing up can equip children with the tools they need to self-regulate and manage their mental health into adulthood.  

That being said, not all children have access to a trusted adult. Only 32 per cent of Shout texters share their age, but of these, we see children aged 13 and under are a significant, stable proportion of users (Part 3). The overwhelming majority (over 90 per cent in 2025) of texters who shared their age as 13 or under texted Shout more than once, indicating this goes beyond a ‘trend’ or a ‘desire to fit in’. Of those who chose to respond to a post-conversation survey, 40 per cent indicated they had no one else to talk to. While these findings are not representative of all children 13 and under who text Shout, they represent a subgroup that has a clear need for evidence-based, age-appropriate support and information.  

Children aged 13 and under are not simply younger versions of teenagers, their life experiences, needs and preferences are unique. Many are already using digital support in active and repeated ways, but these services have not been designed explicitly for them. This limits their effectiveness. Distress in this age group often emerges in contexts and times poorly matched to current services. Service redesign should therefore privilege developmental fit, privacy, low-threshold access, adult support, and integration across school, community and digital settings. 

Acknowledgements

This report was jointly produced by Imperial College London’s Institute of Global Health Innovation and Mental Health Innovations. It was funded by Mental Health Innovations.  

The authors would like to thank several people who provided valuable input during the production of this report: Emma Baker, Inaaya Kaul, Dara O’Hare, Rosie Palmer, and Stella Rendall.  

We would like to thank our Children’s Advisory Group, whose guidance and insight have proved invaluable in shaping the findings of our report and our recommendations as well as the parents and carers who supported them to get involved in this work.

We would like to thank our Young People's Advisory Group, who were instrumental in shaping the design and delivery of the Middle Years Project.

We would also like to sincerely appreciate all Shout volunteers who provided valuable insights that have shaped this report through focus groups and surveys. 

We would like to thank Peter Fonagy for his valuable feedback as an external reviewer of the original draft.

We would also like to thank all experts who kindly agreed to be interviewed for this project: Jessica Bondy, Sarah Golden, Kane Hazard, Tricia Nearn, Marianna Nicolaou, Fiona Pienaar, James Porter and Catherine Roche. 

Suggested citation

Ajah C, Batchelor S, Walker E, Jarvis J, Chan J, Leis M, Howitt P, Cowley A, Ungless M, Darzi A. The New Childhood: Mental Health in a Connected Age (2026).