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State of Child Health 2026: Emotional health and wellbeing

Children & Young People Engagement team
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This is a child and young person-led indicator, selected through a UK-wide engagement and ballot process and further developed with children and young people across the UK to reflect what emotional health and wellbeing support should look like and how it should be measured.
Last updated
Post date
14 July 2026
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Contents

This is one of 12 indicators in our State of Child Health resource.

Download a child and youth-friendly poster of this indicator (PDF)

Methodology

The RCPCH Children and Young People’s Engagement Team uses a mixed-methods, rights-based approach grounded in the United Nations Convention on the Rights of the Child1 to ensure children and young people could meaningfully participate in shaping decisions about their health and wellbeing. This rights-based approach recognises children and young people as active, rights-holding participants2 whose experiences and views should inform policy, service design and delivery.

Our methodology was supported by the RCPCH Engagement Standards3 to ensure it was inclusive, accessible and meaningful. These standards are:

  1. Trust and rights
  2. Inclusive engagement
  3. Practical arrangements
  4. Community reach
  5. Take action

Activities took place across a wide range of settings such as schools, clinics, and community spaces to reach a diverse group of participants. Demographics included a wide age range: primary school, secondary school, 18 – 25-year-olds, and parents/carers. We had above average engagement with children with long-term conditions and disabilities, a diverse range of ethnic backgrounds, and from urban, rural and coastal areas across all four nations.

A range of engagement methods were used to gather and develop insights:

  1. Roadshows and outreach: UK-wide engagement with 3,350 children and young people of different ages and backgrounds to gather their views on the NHS4
  2. Challenge days: Collaborative sessions where young people reviewed roadshow and outreach findings to develop ideas and solutions5
  3. Projects: Longer-term involvement where young people co-developed outputs, shaped recommendations and influenced change.6
More about our methodology for this indicator

Emotional health and wellbeing emerged as a key concern through this process. Initial findings from the Voice of the Nation programme were tested through the State of Child Health Ballot, where 350 children and young people across the UK were asked to identify the issue where policy action was most needed. Emotional health and wellbeing were consistently identified as a top priority both within the general cohort and among children and young people with health conditions.

Following the ballot results, groups of children and young people from diverse backgrounds – different lived experiences, different ethnic backgrounds, young carers, amongst other demographics – participated in focus groups and ongoing engagement to explore what a child and youth-led indicator for emotional health and wellbeing should include, demonstrate and explore.

The findings presented in this chapter are based on:

  • Input and review by RCPCH &Us children and young people of both quantitative and qualitative data over a two-year period
  • The consistent themes, experiences and requests for change identified across multiple engagement settings
  • Highlighting direct quotes and lived experience to retain children and young people’s voice.

These insights highlight real-time experiences that may not be fully captured in existing data sets, ensuring that the findings and future policy making reflect the everyday realities of children and young people across the UK.

What is the problem?

Across England, Wales, Scotland, and Northern Ireland, young people consistently say that a lack of access to emotional health support is a major concern. Emotional health and wellbeing are highlighted as a daily challenge for all young people, not just those in crisis, and young people experience stress, anxiety, and emotional pressure without access to adequate support.

Young people emphasise that emotional health difficulties do not require a diagnosis; however, they report that the absence of a diagnosis is often used to deny support. Consequently, many feel their emotional health struggles are normalised or minimised.

Young people with a long-term health condition

Young people with long-term health conditions describe emotional wellbeing as affecting them as much as their physical health, including ongoing anxiety about symptoms, treatment, appointments, and the future. Transitions, particularly into adult services, are a key point of stress, with many young people feeling uninvolved in decisions about their care. Despite frequent contact with services, emotional support is often inconsistent and overshadowed by clinical priorities, making it harder to ask for help when illness already takes up space: “Doctors ask how you are, but don’t always mean it.”

Young people without a long-term health condition

Young people without long-term health conditions also experience significant emotional health difficulties, which they say are common but not always taken seriously and are often dismissed as "normal stress". They report difficulty accessing support because they do not meet thresholds or have a diagnosis, leaving their needs overlooked. As a result, emotional health difficulties can feel “not serious enough” to address until they worsen.

Support rarely comes before a crisis point

Young people across the UK describe a system where support is difficult to access, inconsistent, and often only available at crisis point, meaning that emotional health needs build up while they are left waiting, coping alone, or falling through gaps in care.

Access depends on where you live

 Across the UK, young people describe unequal access to services, including differences in what is available locally, long waits for overstretched support, and the need to travel significant distances to receive care.

Schools as a barrier to access

School and education systems are often described as not adequately supporting, or providing access to support, students' emotional health needs, leading to stress and disengagement

Why does it matter?

Children and young people describe not being able to access support for widespread emotional health needs that affect their relationships, routines, confidence and participation in daily life.

Emotional health support must therefore work for all children and young people, not just those with a diagnosis.

Impact on learning and education

Limited access to emotional health support has a direct impact on learning and education. Across the UK, children and young people report difficulties concentrating, attending school, exams and coursework, and transitions when emotional health needs are not supported. This results in increased stress, falling behind academically, and disengagement from education.

For children and young people with long-term health conditions, barriers to accessing support are compounded by rigid education systems that do not adapt to their healthcare needs. Missing school due to illness or appointments, combined with limited educational flexibility and emotional support, leads many feeling pressured to cope quietly to avoid being seen as difficult.

The impact of these access barriers varies across the UK. In England, young people describe exam clustering, heavy workloads, and limited emotional support within school systems. In Scotland and Northern Ireland, young people emphasise feeling unsupported through key educational transitions and, in some cases, being pushed out of education due to unmet emotional and health needs.

Impact on everyday life, relationships, and confidence

Barriers to accessing emotional health support also affect young people’s everyday lives, as limited access to support affects independence, social connection and everyday participation. Across the UK, young people describe difficulties maintaining routines, friendships, family relationships, and feeling unable to access healthcare.

These impacts are experienced differently across the nations. In England, young people often describe emotional health as “the biggest struggle,” including among those without a formal diagnosis. In Wales and rural Scotland, young people highlight dependence on adults for transport and access to services, alongside concerns about confidentiality and increased isolation due to limited activities and safe spaces. In Northern Ireland, young people identified inconsistent emotional support for those with long-term conditions, especially during transitions to adult services - which created additional stress and anxiety.

Drivers of poor outcomes

These impacts highlight the consequences of barriers to accessing emotional health support and point to the system level factors that define when, where, and whether young people receive help. They are shaped by how systems are designed, operated, and accessed across the UK, with shared challenges and important differences between nations.

Access, availability, and design

Young people describe complex systems with long waiting lists and high barriers to access, meaning support is often only available once needs become severe and urgent.

Quotes from children and young people:

  • "GP appointments are only by phone – booking systems are not fit for purpose"
  • "Accessing healthcare in rural areas is near impossible without an adult"
  • "Young people cannot always access confidential appointments"
  • "Mental health support and community-based care taking a long time to develop"
  • "Hospital or specialist services being far away (3+ hours travel) for basic healthcare"
  • "GP practices taking on specialist mental health issues due to lack of services"
  • "Access to services is more of an issue in Northern Ireland"
  • "In Northern Ireland there are many different trusts and funding, so waiting lists are very different which leads to missed access"
  • "Waiting times and access to services are a problem for children and young people with and without health conditions"
Health system experience, relationships, and voice

Young people often feel unheard within the systems they navigate, with limited involvement in decisions and little reflections of their experiences in research or service design.  These experiences reduce trust in services and affect how young people access them.

Quotes from children and young people:

  • "Low levels participation in services"
  • "There is a difference in emotional health. If you have a long-term condition, you can have lots of anxiety about it compared to someone who doesn’t"
  • "For children and young people with a health condition, it was harder to decide what was most important, because when someone is ill, everything matters to them"
Education systems and pressure

The school system itself is identified as lacking support and basic emotional health check-ins, and many students feel unsupported that schools prioritise academic attainment over student wellbeing.

Quotes from children and young people:

  • “Pressure from parents”
  • “Lack of support in school systems”
  • “Skills for life not having enough access”
Community, environment, and inequalities in access

Young people note that a lack of community structures outside of schools, such as youth groups, and long travel distances to the nearest community support, increases reliance on crisis services. They also highlight that support depends heavily on where they live, with differences in funding and provision, and long travel distances creating transport barriers, especially for those in rural communities – entrenching inequalities.

Quotes from children and young people:

  • “Lack of opportunities out of school”
  • “Reduced opportunities for children and young people in Scotland”
  • “Going back to sport after lockdown felt awkward and challenging”
  • “Wellbeing policies exist, but funding is lacking”

Why we need to act now

Young people across all four nations are clear that without action, emotional health difficulties will persist. They identify pressures in education, a lack of safe community spaces and barriers to early support as key contributors, reinforced by systems that misinterpret need, delay support, and fail to reflect their lived experiences.

How current systems delay support and increase harm

Young people emphasise that the issue lies in how systems are designed, particularly where support is gatekept by high access thresholds. They emphasise that these categories and assumptions increase the risk of harm by delaying support until crisis point.

Adults may assume that young people with health conditions are already supported, that those without conditions are coping, or that emotional health support should be based on diagnosis or crisis. Young people are clear that being within the system does not mean emotional needs are met, and being seen regularly does not mean being listened to.

These approaches leave many young people without support at the point they need it most.

Why listening to children and young people is essential

Young people are clear that addressing these issues requires their meaningful participation in decision-making. Without young people’s input, services will continue to not meet young people’s needs as data alone can be misunderstood without lived experience.

Adults have a responsibility to ensure early access and to recognise that community support plays a vital role in prevention.

Young people explain why action is needed now, in their own words

Across the UK, young people describe systems that create pressure, limit early support, and fail to respond to emotional health needs before they escalate.

Schools are named as sites of emotional stress:

  • "Schools – emotional health issues caused by stress"
  • "23 exams of GCSEs in a short period – no support"

They also highlight the impact of limited local community support:

  • "No youth services, no clubs, no entertainment in rural Wales"
  • "Youth work and community support being defunded or unavailable in many areas"

Emotional health needs are closely tied to how services listen and respond:

  • "If you have a long-term condition, you can have lots of anxiety about it compared to someone who doesn’t"
  • "Staff don’t really ask how young people are in clinics – they just say it to break the ice"

These experiences show that without action, young people will continue to face systems that do not reflect their realities.

What does good look like for children and young people?

Early intervention, prevention, and support in everyday settings

Young people across all nations emphasise that support should be early, universal, and non-stigmatising, with good emotional health recognised as part of everyday life and help readily available before crisis point. Schools, parents, and families all have an important role in supporting emotional wellbeing, and young people want access to clear information and support.

They also highlight the importance of community services and youth work, including local youth spaces, activities and opportunities that make support easier to access, alongside time to rest and socialise and practical tools for coping, self-care, and resilience.

Access availability, quality and equity

Young people consistently describe the need for simpler and more equitable access to emotional health support. Waiting times should be shortened, systems should be easier to navigate, and services should be available locally and consistently across all regions with stable funding and provision, particularly for community organisations, to ensure equitable access regardless of where young people live.

They also highlight that access is closely linked to workforce capacity, service quality, and long-term investment. They identify the need for professionals to be trained to support emotional wellbeing, and for staff to have the time to listen and understand. Sustained investment in long-term programmes, with greater consistency in professional training, is seen as essential to improving access for all young people, especially those who face additional barriers.

Holistic, person-centred, and inclusive care

Across all four nations, young people highlight the importance of being seen as a whole person. Support should include mental, physical, and social wellbeing as well as recognising individual needs, identity, and context.

Approaches to care should be rights-based and inclusive, reflecting the intersectionality and diversity of the young people they care for. Young people want to be recognised as experts in their own experiences.

Relationships, trust, and participation

A consistent priority identified by young people is the need for trusted, safe, and supportive relationships with adults outside of school settings, such as youth workers and community practitioners. Young people want adults who listen and understand in inclusive, judgement-free services. Active involvement is highly valued by young people. Participation improves services for young people, who want to be involved in shaping guidelines and solutions.

One young person said:

If young people were given more opportunities to shape services, then our emotional health and wellbeing, physical health, support with transitions, fair access, and skills for adulthood would all be met.

Recommendations

Key messages from children and young people

  • Children and young people want investment in workforce, not just services, ensuring quality, consistency, and continuity.
  • Children and young people want early holistic support that reflects real life and prioritises prevention, not just diagnoses.
  • Children and young people want a system that is easy to enter, responsive and fair.
  • Support should be local, visible, and part of daily life, not only delivered in clinical settings.
  • Support works best when it is relational, respectful, and built on trust, with young people’s voices central to design and decision-making.
A single combined policy ask

Governments across the UK should invest in universal, early, and inclusive emotional health and wellbeing support. This support should span education, health, community, and youth work systems, moving beyond threshold-based models so that support is available before crisis and without requiring a diagnosis or identification of risk.

Recommendations for education systems

Education departments, local authorities, and school governing bodies should embed consistent, universal emotional wellbeing support in schools, reduce unnecessary pressure from exams, and ensure support does not depend on individual staff. Support should not rely on identifying visible need.

Youth workers play an important role in schools and should be embedded in or linked to schools to provide early support. This should include:

  • Emotional health check-ins for all students
  • Support that adapts for young people who miss school due to illness or appointments
  • Opportunities for young people to shape how schools respond to emotional wellbeing.

One young person explained:

It should be for all young people, not just those who are struggling. Otherwise, it misses people who are masking, and in schools that can mean some groups, including boys, are less likely to access support.

Recommendations for health services

Health services and commissioners should treat emotional health as equal to physical health, routinely explore emotional wellbeing during appointments, and involve young people in decisions about their care.

Youth workers play an important role in helping young people navigate health services and should be embedded throughout these systems to ensure that:

  • Young people with long-term health conditions receive holistic emotional support
  • Emotional wellbeing is routinely explored as part of physical healthcare
  • Transitions into adult services do not increase anxiety or leave young people unprepared, providing continuity and emotional support.
Recommendations for community services and local investment

Local authorities and governments should fund accessible, non-clinical community spaces for young people, such as youth clubs outside school hours to give young people places to go before difficulties escalate. This is particularly important for addressing inequalities in access, which especially impact young people in Scotland, Wales, and rural areas.

Recommendations for participation and use of lived experience

Governments, policymakers, and service leaders should require meaningful participation of children and young people in the design, delivery, and evaluation of emotional health support.

This participation should ensure:

  • Lived experience is considered alongside data to interpret need
  • Different experiences of young people with and without health conditions are recognised
  • Youth work is shaped by young people’s priorities and experiences
  • Young people can see how their input makes a difference.

This is one of 12 indicators in our State of Child Health resource.