“It probably took about three or four years until the point that he stabbed somebody and ended up in custody… I almost feel like we didn’t even give him that opportunity.” 

That was how one professional described a boy who waited years for Child and Adolescent Mental Health Services (CAMHS). His story is not unusual. Across the country, youth justice and health professionals warn that children are being failed by a system that too often waits until after a crime has been committed — or someone has been harmed — before offering mental health support. 

NHS data shows the scale of the crisis. The number of children referred to mental health services has more than doubled since 2016/17 (up 105%). Yet, in 2023/24, fewer than half (46%) of those referred actually received help, leaving thousands without the support they need. 

A new report commissioned by the Youth Endowment Fund explores these challenges in depth. Based on interviews and focus groups with more than 100 professionals, parents, carers and young people, it highlights concerns among practitioners that children vulnerable to violence may be left without timely mental health support — with their needs sometimes seen as overlooked, mislabelled or considered too complex to address. 

Systemic failings put young lives at risk 

Practitioners highlight a mental health system that reacts to crises rather than preventing them. Many youth justice practitioners said young people often only receive help or a diagnosis once a situation has escalated or they’ve entered statutory services. As one professional explained, Youth Justice Services can paradoxically open doors to care that was previously out of reach: 

“There’ll be kids that might have been sitting on waiting lists for assessment for sometimes over a year or two years, and they commit an offence, come into contact with the youth justice service, and suddenly, a couple of weeks later, get an assessment.” 

Young people shared similar experiences — describing how support arrived only after they were seen as “troubled”: 

“It’s easier if you’re a troubled kid than, like, if you’re not. I was a bit naughty and then I got all… the youth workers and support workers and that. But my sister [was well-] behaved, and wanted [support], but didn’t get it.” 

In some areas, youth justice teams have embedded mental health practitioners or established direct referral pathways to CAMHS that facilitate quicker assessments and support, giving young people access to care before situations escalate. Reflecting on the broader challenge, one professional (Youth Justice Board, London) said: 

“It’s a source of frustration for pretty much everyone involved in youth justice that it takes something bad happening for them to come into contact with the system to get that kind of accelerated service… If that had happened earlier, they may never have committed an offence.” 

Children’s needs go unrecognised until crisis point 

Professionals said opportunities to provide early mental health support are routinely missed. A lack of understanding of neurodiversity was highlighted as a key factor. 

Children with autism, ADHD or communication difficulties are often misread — labelled “disruptive”, “shy” or “challenging” — rather than given the help they need. As a result, they are denied support and, in some cases, pushed further toward exclusion, isolation, and even criminalisation. One professional (NHS Vanguard, West Midlands) explained: 

“Neurodiversity and trauma often present in a very similar way… It’s often assumed that it’s the trauma presentation that we’re seeing, rather than something else.” 

Bias leaves Black children unsupported 

Practitioners stressed that Black, Asian and Minority Ethnic children are particularly vulnerable to mislabelling and neglect. Bias — both overt and subtle — means they can be seen as threatening rather than vulnerable, leading to punitive rather than supportive responses. As one interviewee (CYP Health and Justice, West Midlands) put it: 

“We see that with a lot of our young Black males, in particular… they’re very much experiencing adultification in the criminal justice system. Often the identification of the need is overlooked, because we see them as adults and not vulnerable children.” 

The “hot potato” effect 

Even when children meet thresholds for support, many are still left without help. Mental health services were often described as being organised around “straightforward” presentations such as anxiety, low mood or self-harm. By contrast, young people facing exploitation, neurodiversity or multiple-agency involvement are frequently excluded as “too complex” or “too risky.”  This can lead to what professionals described as a “hot potato effect,” where responsibility is repeatedly passed on without anyone taking ownership: 

“We do get a lot of cases where young people present in crisis… unfortunately, they then become perceived as a bit of a nuisance by the police and then other services, and they get bounced around… And then it becomes a bit like that hot potato that nobody then wants to work with.” (Professional, Forensic CAMHS, East Midlands) 

Building a system that works for young people 

Professionals and parents alike stressed that if mental health services are to prevent, rather than react to, violence, they must be designed around the realities of young people’s lives. 

Children who have experienced trauma are less likely to stay engaged unless they feel safe, respected and understood. That means slow, relational approaches — often outside clinical settings — where trust can be built over time. Flexibility was seen as key: support in familiar places, accommodating missed appointments and avoiding rigid cut-off dates. 

Many highlighted the value of professionals who “show up” consistently, even when young people test boundaries. As one practitioner explained: 

“You’ve almost got to get past that stage where they’re testing how far they can push it… and still be there to support.” 

Dr Abigail Bentley, author of the report, said: “This research makes clear that young people at risk of serious violence face huge barriers when trying to access mental health support. Too often, support arrives after a crisis, or not at all.  

She adds: “Parents, caregivers, practitioners and young people described a system that excludes those with the most complex needs — labelling them as ‘too risky’ or ‘too difficult’. This is a profound disservice to those who need care and stability most. Real, system-level change is needed to build services that are flexible, relational and inclusive, so that appropriate support reaches young people when it is most needed”. 

Jon Yates, CEO at the YEF, said: “Too often, children vulnerable to violence only get help once a crisis has already hit. Youth justice and mental health professionals are doing their best under huge pressure — but the system is letting them, and the children they serve, down. We need fresh solutions: putting mental health experts in schools and Pupil Referral Units, making it easier for children to get access to therapy and making sure children have trusted adults they can turn to before things spiral out of control.”