The mental health and emotional wellbeing of babies, children, and young people – a report on the findings of our engagement exercise.
We know from our own large-scale nationwide survey in autumn 2022, and the work of others, that mental health and wellbeing is one of the biggest issues children and young people are concerned about. This is also true of parents and carers; and professionals supporting babies, children, and young people. The Commissioner has stated that one of her four strategic priorities in her 2023-26 three-year strategy is mental health and emotional wellbeing.
In December 2024 and January 2025, we held 4 focus group sessions with young people; and 3 roundtable events with professionals working with and for babies, children, and young people, from across the statutory and third sector.
The sessions were structured around 5 key themes:
- Definition and language around mental health, and emotional wellbeing
- Community-based support for mental health and emotional wellbeing
- School-based support for mental health and emotional wellbeing
- Specialist services and support for children with complex needs
- Priorities and key messages for the Commissioner to take to Welsh Government
We were keen to discuss good practice examples, and positive experiences of what works, as well as the challenges and examples of poor experiences. We have included within this report some selected good practice examples.
If you would like to find out more about our views and work on mental health and wellbeing policy in Wales, you can read our position paper here.
Thank you to all those who took part in this exercise.
Recent policy context
In February 2024, the Welsh Government consulted on a new draft all-age Mental Health and Wellbeing Strategy. The final strategy, and an accompanying delivery plan, was published in April 2025.
In our 2022-23 Annual Report, we recommended that:
The Welsh Government should ensure that the needs of children and young people are clearly reflected and addressed in their new Mental Health Strategy, and that the recommendations from the Senedd Ieuenctid’s Young Minds matter report are reflected in this strategy.
The Welsh Government’s response was:
As we develop the strategy we will and have been engaging with young people to ensure it reflects their needs. The Deputy Minister for Mental Health and Well-being has met with the Senedd Ieuenctid to discuss the Young Minds Matter report and there are further sessions planned. This report together with engagement with other groups will inform the final strategy.
In our 2023-24 Annual Report, we recommended that:
The Welsh Government should within the 2024/25 financial year publish a delivery plan for children and young people’s mental health and wellbeing.
The Welsh Government’s response was:
We recognise that children and young people can have specific needs and are committed to improving mental health provision for them. However, we consider these improvements would be best delivered by incorporating provision into a delivery plan that considers the mental health and wellbeing of the whole population. This will help ensure that support is person centred and needs led, rather than determined by age thresholds. The Strategy will continue our focus on young people through prioritising the early years, implementing our NEST/NYTH framework and our work in schools.
What do we mean by mental health and wellbeing?
We asked young people and professionals what they felt is meant by the terms ‘mental health’ and ‘wellbeing,’ whether they are different, or how they inter-relate:
“Good wellbeing is preventing mental health problems from developing” – Young Person
“Good mental health and wellbeing is feeling safe, secure, supported; with a sense of belonging and purpose” – Professional
“Resilience is important, mental health is seen as negative and should be seen as positive; how we feel in ourselves and impacts how we interact and how we deal with things” – Young Person
“There is a distinction between mental health and wellbeing. Too often they’re conflated as one. Mental health is about the brain’s health and emotional stability whereas wellbeing is about a broader overall positive functioning. One can have poor mental health but positive wellbeing, and vice versa” – Professional
“I don’t think we have an agreement about how good mental health has to be to be good” – Professional
“We should feel okay about using the term mental health – we all have it, good and bad. It’s about recognising the tools for when the bad days are prolonged” – Professional
Young people told us that:
- Emotional wellbeing is about thriving, not just surviving; happiness; and being able to have a positive attitude to life
- There continues to be lots of stigma and judgement associated with mental health and emotional wellbeing
- They would like the relationship between emotional, physical, and social wellbeing to be properly understood, appreciated and supported
- Language and taboo around mental health and wellbeing differ by culture, and it is therefore vital to consider individual circumstances
Professionals told us that:
- Good mental health is about trusted relationships; feeling safe and secure; how a person feels about themselves and managing/ coping
- It is important to use the language young people use themselves. An example from one participant was that children and young people might talk about feeling sad, upset, or lonely. Mental health is often not the first term they use.
- There is a need to develop a shared language across services as there is variation on definitions and understanding between services. Terminology and language are often confused and differ between professionals
- Collectively, we need to consider and address the wider determinants of poor mental health – poverty or housing for example. We need a holistic response based on the social model rather than the medical model of healthcare.
- We need to state more clearly what good mental health actually means and looks like for babies, children, and young people.
The most popular themes from the data were:
- The feeling that there is a problem with the language used, and the conflation of the concepts of mental health and wellbeing.
- A need to use the language young people use to describe their feelings – ask them!
- The importance of feeling safe and having trusting relationships; and the impact of those relationships on their ability to manage thoughts and feeling
- The impact of external factors on children and young people’s mental health and emotional wellbeing, including poverty and other lived experiences.
Community-based support
We asked young people and professionals what good community-based support does or should look like.
“Have well-funded youth services, safe spaces for youth to access and meet peers and youth workers” – Young person
“Community support should be easily accessible, non-judgemental, inclusive, safe and supportive, holistic, and focus on prevention, early intervention and whole family involvement” – Professional
“I had a support worker come to the house which was great as I was in a comfortable place” – Young person
“We need a multi-agency approach, recognising the expertise of the child, family or others working with them” – Professional
“A place that’s calm with trained professionals, such as counsellors or mental health workers, who are empathetic, patient, and skilled at de-escalating crises. Staff would approach with respect and non-judgment, offering options without force” – Young person
“We need better extended, integrated pathways between and across services and sectors. Less compartmentalisation of problems, more holistic systemic approaches” – Professional
“Have wellbeing support from places where young people go like places of worship, sports clubs, hobby clubs, libraries, hubs” – Young person
“It would be lovely to see community hubs develop across all areas for families to access advice and support on ‘their front door’ and having these hubs manned by appropriate trained staff to identify need and provide that support or signpost appropriately” – Professional
Young People told us they would like:
- Crisis safe spaces in the community that young people can go to where they can speak to someone or just chill but know you are safe.
- A place that’s calm with trained professionals, such as counsellors or mental health workers, who are empathetic, patient, and skilled at de-escalating crises. Staff would approach with respect and non-judgment, offering options without force.
- Better accessibility to community provision which supports wellbeing, including those with disabilities – this includes youth clubs / services, LGBTQ+ support groups, libraries, swimming, and others.
Professionals told us that there needs to be:
- Multidisciplinary and multi-agency team approaches – no wrong door, single point of access and single pathway approaches. Linking up pathways is key – need to share pathway plans across services and across geography, and for these to be clear and accessible
- Early intervention in terms of both the onset of poor mental health, and in terms of supporting children earlier, including parent-infant mental health support
- Improved accessibility: meeting young people where they are at – including an understanding of their circumstances, which may include whether they are care-experienced, living in poverty, or are in the youth justice system or have experienced it
- Better use of, and partnership with, the Third sector, who are too often not fully connected in with statutory services, leading to duplications of projects and roles. Savings could be made by Welsh Government and the NHS by supporting third sector projects that already exist
- There was a feeling expressed that we have examples of good practice, but that services lack the tools or resource for scaling these up successfully
The most popular themes from the data were:
- Single point of access / multi-agency and multidisciplinary services are most supportive for children
- ‘Whole family’ or ‘whole child’ approaches should be more widely practiced and available to babies, children, young people, and their families
- The importance of the First 1,000 days, with support for babies and infants being considered as well as the needs of older children and young people
Many examples were mentioned under this topic, which were described as good practice. These include:
- The Hangout, Cardiff and Barry. These are spaces designed to allow young people to meet others and join groups, access mental health support, and find volunteering opportunities. It is run by Platfform and funded by Cardiff and Vale University Health Board
- Gwent SPACE-Wellbeing panels – multiagency panels meeting weekly to discuss and agree plans for children with mental health and emotional wellbeing needs
- AP Cymru. This neurodiversity charity run family sessions and events for neurodivergent CYP and families – young people described this as a friendly and safe space to meet peers
- YEPS – Rhondda Cynon Taf based youth work provision
- Barnardo’s family wellbeing service, Cardiff. Early intervention and support to families, with an identified need for support in relation to emotional wellbeing and mental health but below the level where they would be entitled to specialist health service and/or statutory care and support
- Mind Our Future Gwent, is delivered by ProMo Cymru in collaboration with Newport Mind. This is a five-year project funded by the National Lottery, aimed at designing innovative solutions to prevent mental health challenges from arising or worsening across Gwent. The project works collaboratively with 11 young people, employed as Peer Service Designers
- Parent-Infant mental health teams. More information about the work of the existing teams within Wales can be found here
- NSPCC Pregnancy in Mind preventative service – supporting parents’ mental health during pregnancy
- Meic Cymru – offers 16 hours per day single pathway to information, advice, advocacy support, referral, signposting, and solution focused intervention
- The NEST / NYTH framework. NEST/ NYTH is a planning tool for improving mental health and wellbeing services for babies, children, young people, and their families
- 111 press 2 telephone service. The Royal College of Psychiatry Wales undertook a year 1 review of this service which shows that 99.7% of under 18 callers had their distress reduced by calling 111 press 2, on average by 25%
School-based support
We asked young people and professionals what good support within their school does or should look like.
“Lots of my friends seek support from wellbeing staff in college and it is felt that there is not enough training for staff; it is important that staff have training as people feel dismissed and some things haven’t been addressed” – Young person
“Lots of schools have great wellbeing support. It becomes difficult for some young people who are not attending school regularly or who are struggling in school for variety of reasons” – Professional
“Something positive in sixth form school that pushes the No wrong door is that pupils are coming to sixth formers as peers support in clubs we run and will talk about their MH” – Young person
“Teachers and school staff need to feel confident to pick up on signs and symptoms of abuse and neglect, and on how to respond to potential disclosures” – Professional
“There should be better options for when you get excluded for school- home schooling through the school, access to pupil referral units and more specialist mental health schools” – Young person
“Lots of CAMHS appointments are during the school day this shouldn’t be the case – academia is important, and it is stressful to leave” – Young person
“There are punitive punishments in some schools – being 5 minutes late is seen as very serious” – Young person
“It’s good to see some schools also looking at relational approaches and behavioural support approaches rather than punitive approaches – there is a shift in mindset” – Professional
Young people told us:
- There is a need for more training and resource for teachers who can lack knowledge or understanding of mental health and wellbeing needs, and they feel can lack compassion
- Bullying, exam pressure and peer pressure impact on mental health and wellbeing
- There can be a lack of privacy when accessing support within school
- Some young people told us there isn’t enough support for physical disability which then impacts their emotional and social wellbeing
- There is a need for better support for children not in school, or not regularly in school
- There is a need for better links between services to support children and young people in schools – particularly between health, social care, and education
- Intervention and support in school is welcome (workshops / assemblies)
- Young people value support from peers, teachers, and support staff
- Neurodiversity: There is a lack of support if undiagnosed, and schools demand proof of a diagnosis. There is a reliance on teachers to identify ADHD / autism, but feel they aren’t resourced / trained well enough
Professionals told us:
- School-based support has numerous challenges, particularly around capacity and resource. Schools feel overwhelmed with the level of need, and staff do not feel trained or confident to handle the issues faced.
- Some felt there is a need for further capacity in CAMHS to support schools
- ‘On the ground’ school staff most valued – “Teaching Assistants, Youth workers and Health Care Support workers are the key link points for children not the expensive staff”
- Professionals noted that some schools have a designated officer, although some noted this can be challenging if the child or young person is not comfortable speaking to that adult.
- Process challenges include lack of co-production with parents, the referral process not being clear within schools, and the need for transitional support between key milestones.
- School counselling is too limited a provision and not equitable across Wales. It is also not always the appropriate provision for the child or young person, but they are referred there anyway as other options limited
- What does the accountability for the whole school approach look like from a child or young person’s perspective – how are we monitoring and reporting on progress? How is this accountable to children and young people’s experiences?
The most popular themes from the data were:
- Schools are overwhelmed and under-resourced
- There can be unnecessarily punitive approaches in schools which impact emotional wellbeing and are not trauma informed
- Counselling is a limited resource and not always appropriate
- Lack of access to any support for those not regularly in school, being educated somewhere other than in a school, or who are home schooled
- Not enough coproduction with children and families
- The importance of investing in Teaching Assistants, ELSAs (Emotional Literacy Support Assistants), and pastoral / support staff.
Many examples were mentioned under this topic, which were described as good practice. These include:
- The CAMHS In-Reach Programme, in place across Wales. More information is available here on one example, in Swansea Bay.
- Health and wellbeing promoting schools
- Joined up approaches between school and youth clubs
- Occupational Therapists embedded within schools in Swansea Bay
- Having a designated wellbeing officer and wellbeing room / space
- Schools taking relational and behavioural support approaches, which are non-punitive including embedding the Positive Behaviour Support (PBS) framework in schools
- ELSAs (Emotional Literacy Support Assistants) – an evaluation of the value of ELSAs has been undertaken in Pembrokeshire and published in the Educational Psychology in Practice journal (May 2024).
- Community-focussed schools – “…mean there is more information accessible for parents – this brings them into conversations around wellbeing and mental health. Will mean they can spark up conversations where they know who the person to speak to is if they have a concern”
- Multi-agency forums which include education and health representatives, to support problem solving for individual children, young people, and their families
- Gwent whole school approach (Cynefin)
- Carmarthenshire Council – spoke to all pastoral care leads in the county about how to write and implement a safer schools policy to deal with self-harm and suicide.
Specialist support / complex needs
We asked young people and professionals what good support does or could look like for those children and young people who need specialist mental health support, or who have complex needs which include mental health needs.
“Services to have more crisis support options besides being admitted to hospital or sent home with nothing. Reopen the crisis day centres!” – Young person
“People go undiagnosed because of the waits” – Young person
“Specialist provision is overwhelmed. The waiting lists are really long. Often the use of the medical model prevents people from accessing specialist provision” – Professional
“Someone needs to address the transition from child to adult services there is a lack of support – at the end of CAMHS I got discharged from child services and had to go on a waiting list for adult services and start all over again” – Young Person
Young people told us:
- There is a lot of stigma / judgement around mental health conditions
- CAMHS services should value the voice of the young person first and show this in their actions
- There is a need for a smoother transition from child to adult services as this is not the experience of many young people and the process can itself be traumatising
- Person-centred approaches should be embedded across mental health care, including when discussing diagnoses; providing therapies; bereavement services; support for families and carers.
- Disparities between areas in terms of accessibility to specialist services
- There is a ‘missing middle’ of young people deemed ‘not bad enough’ for a service, but ‘too bad’ for another so the right support just isn’t there for them
Professionals told us:
- Young people in crisis are still often not eligible for support from specialist services, and professionals expressed concern for the message this sends to young people about what needs to happen before someone will help them.
- The preventative work in the community and in schools needs to improve in order to support specialist services
- The quality of crisis care is not consistent across Wales
- Inaccessibility of CAMHS services and the ‘postcode lottery,’ particularly for children and young people living in rural areas
- We should be co-designing services with children and young people, including experiences of wards and spaces used by children and young people
- There needs to be trauma informed, professional support in an environment a child feels safe and comfortable in
- Support for minority groups more at risk of self-harm and suicide. There should be specialised and universally accessible support services for care-experienced and unaccompanied asylum-seeking children
- The offer of independent mental health advocacy should be extended to all children and young people who are accessing mental health services
The most popular themes from the data were:
- Need more focus on early intervention to protect resource of specialists; but specialists then need to support those early interventions
- The need for improved crisis care
- Financial barriers of accessing help / spaces
- Trauma informed / non-judgemental
- Co-design of services including experience of wards and spaces
- Need for specialist parent-infant MH support
- Accessibility for all; additional support for minority groups
- There should be more information about specialist services for children, young people, families, and professionals. “Why is specialist CAMHS so hidden?”
Many examples were mentioned under this topic, which were described as good practice. These include:
- The Mental Health Sanctuary services being modelled across Wales. One example is in the Hywel Dda University Health Board area.
- Tonnau team – this is an educational psychologist-led drop-in model in Neath Port Talbot
- The Mental Health Foundation leads a partnership project in Dundee called ‘Together to Thrive‘. Schools, CAMHS and third sector partners train and work together to respond to referrals, providing community-based support to children and their families. The project has demonstrated reduced pressure on CAMHS, and the provision of improved support more quickly to children, young people, and families.
- The Positive Attachment Therapeutic Service in Powys. This service supports young people and families who are experiencing difficulties with adverse childhood experiences and trauma, and who are not getting enough support for Neurodiversity and attachment challenges.
Messages to the Welsh Government
“We need to keep digging to the root causes – we naturally focus on waiting list, redesigning services – but we need to be asking why are there so many children and young people in high levels of distress?” – Professional
“Recognising the children’s rights framework is a solution – if we have a system that works with rights in mind, we can tackle this” – Professional
“Covid really impacted sense of community, and availability of trusted adults outside the home…There is the negative, but also the positive learning that this has brought – community does bring solutions. Rather than just a focus on the negative consequences of covid – more positive that we now have learning that evidence there” – Professional
Young people told us:
- They need to have a safe, non-judgemental, accessible space. This is a youth club model, but with access to support for those needing it. The Hangouts in Cardiff and Barry would be examples of that model.
- Neurodiversity and lack of support / waiting times for assessment was raised a lot
- Need to have one website for resources related to mental health and wellbeing – “Shopping, for services”
Professionals told us:
- There is a need to focus on outcomes not waiting lists
- There is a need for psychologically informed service development and delivery
- We should prioritise child-led design of services and spaces
- Need to tackle the root causes; wider determinants of poor mental health and wellbeing
- Recognise the importance of and invest in support in the early years;
- Health professionals being embedded in schools as good practice
- The need to improve data available around the mental health and wellbeing offer for babies, children, and young people. What data are we missing that is preventing us from putting resource in the right place to tackle these longstanding issues? There is currently no published data on assessment and treatment times for specialist CAMHS. This is because of the introduction across Wales of Single Point of Access models – however, this means we have less data to meaningfully use relating to children’s mental health services
- The need to utilise third sector and private sector involvement, which can be more agile and innovative than statutory sector
The most popular themes from the data were:
- Concerns over the all age approach for the Mental Health strategy – there is a need for a focus on babies, children, and young people
- Co-production – young people supported to produce solutions
- Prevention – tackling root causes / social determinants
- The need to embed a Children’s Rights Approach
- Third sector often has more agility to be innovative – should be utilised and supported more
- Need for trauma informed practice across all services supporting babies, children, and young people
Our Conclusions
The following is a summary of key points under each theme explored in the engagement sessions.
Definition and language around mental health and emotional wellbeing: Too often, there is a lack of clarity over language between agencies. Professionals should use language young people use themselves when talking about their mental health and emotional wellbeing. Children and young people should be actively involved as co-producers in policy making, and in the implementation of policy. They should be co-designers of the spaces and places they use.
Community-based support for mental health and emotional wellbeing: Young people value accessible safe spaces in their community which support them socially, and which can provide a service for young people with lower levels of need and those experiencing a mental health crisis. There is a need for clear and accessible single point of access pathways which include input and support services from multiple agencies, including both statutory and third sector partners. These should include whole family approaches.
School-based support for mental health and emotional wellbeing: School staff need further resource and training to realise a whole-school approach to emotional and mental wellbeing. Key to this is investment in ‘on the ground’ staff with whom trusted relationships can be built. Children and young people should be co-producers of their school’s whole school approach action plan
Specialist services and support for children with complex needs: Crisis care should be more accessible, and information about how to access specialist provision should be more readily accessible for those who need it. There is a need for more focus on early intervention and preventative approaches, this includes throughout pregnancy and in the early years of a child’s life. Is we get this right; we can take some pressure off specialist mental health interventions further down the line.
Priorities and key messages for the Commissioner to take to Welsh Government: There are concerns over the all-age approach of the new Mental Health and Wellbeing Strategy for Wales. There must be a focus on babies, children, and young people to ensure their needs are actively addressed.
Young People’s Conclusions
School-based support
- There is not enough training for staff; it is important that staff have training as young people can feel dismissed and some things haven’t been addressed
- School needs to be more sensitive and discreet about mental health appointments, for example recognising the impact of a child or young person being called out of class to attend an appointment.
Community-based support
- Youth services/workers are great as there is relationships and space to talk. Barriers to support include inaccessible locations; services need to think about timing, travel, and location. This is particularly difficult in rural areas or where transport options are limited and / or expensive
Top tips
- Have one website for resources, as one young person put it, so you can go “shopping for services”
- Social media campaigns to raise awareness what support is available and how to access it
- Someone needs to address the transition from child to adult services as there is a lack of support and it can feel like starting all over again
Recommendations
- There is no specific delivery plan for children and young people sitting under the Mental Health and Wellbeing Strategy, and actions related to children and families only sit within one of the four Vision Statements in the published plan. The Welsh Government should develop a detailed narrative and child and young person–specific actions across all four areas of the Mental Health and Wellbeing Strategy delivery plan, including the themes outlined in this report.
- Every part of Wales now operates a form of a Single Point of Access service for children’s mental health and wellbeing, which is welcome. This has meant that there are now far fewer direct referrals into specialist CAMHS. Welsh Government no longer publish assessment and treatment data for specialist CAMHS due to the difference in the way referrals are made. We agree with recommendation 26 of the November 2024 HIW, Estyn and CIW joint report into support for children’s mental health needs which calls for consideration to be given to publishing data on core / secondary CAMHS interventions. Welsh Government must set out how it will make meaningful data on those accessing secondary CAMHS services publicly available.
- Neurodevelopmental conditions and experiences of poor wellbeing as well as co-occurrence of poor mental health was mentioned regularly throughout these roundtables. The renewed Neurodiversity Improvement Programme must develop a needs-led approach which provides support pre-assessment to meet the child or young person’s needs in the moment they need support, not just following a diagnosis. The Programme must also establish a mechanism for meaningful and regular engagement with children and young people themselves as plans are developed for the future of services.
- Through Regional Partnership Boards, there must be continued targeted investment in multi-disciplinary and multi-agency models of delivery, which demonstrate NEST / NYTH principles. The role and value of the third sector in supporting statutory services and demonstrating good practice came through strongly in these roundtables.
- The whole-school approach is still not felt as a reality in many schools. While there has been good progress in schools signing up to creating an Action Plan for delivering the Whole School Approach framework, it is unclear to what extent children and young people themselves have ownership and have co-designed those plans. The ongoing evaluations of the embedding of a whole school approach across Welsh schools must ensure there is a specific evaluation of the level to which children and young people are co-designers of their schools’ approach.
Next steps
Thank you to everyone who take part in this engagement exercise. The next step in this process will be to present these findings to the Minister for Mental Health and Wellbeing in the Welsh Government. The Commissioner will be closely monitoring the publication of the new Mental Health and Wellbeing Strategy for Wales, and the accompanying delivery plan.