When help comes too late: what we learned about access to mental health support for children at risk of violence 

At the Youth Endowment Fund (YEF), our mission is simple but urgent — to prevent children and young people from becoming involved in violence. 

We know that mental health plays a huge part in this. When children don’t get the right support early on, distress can turn into crisis — and sometimes, that crisis can lead to harm. 

That’s why we commissioned new research, led by Dr Abigail Bentley, to understand how well the current system supports children who are vulnerable to violence. The study was part of our wider partnership with the Department for Education, exploring how the systems around children — from schools to health services — can either protect or expose them to risk. 

The project combined a rapid evidence review, analysis of public data, and interviews and focus groups with over 100 professionals, young people, and families. Together, their voices paint a stark picture of a system that’s often reactive, unequal, and fragmented. 

Reactive rather than proactive system 

The report highlighted a reactive system where help often arrives too late. Professionals described high thresholds and referral processes that favour crisis response over early intervention. Children are therefore reaching services only after significant harm has already taken place. Long waits and rigid eligibility criteria, with a perceived focus on the young people most at risk mean that many other young people, such as those who may be displaying externalising behaviours, are assessed but not treated.  

Too often, support only arrives when a young person reaches crisis point. Professionals told us about high thresholds, long waiting lists and referral systems that favour crisis response over early intervention. 

This means that many children — particularly those showing distress through challenging or “externalising” behaviours — are assessed but never actually treated. The system steps in after significant harm has already happened, rather than helping before things spiral. 

Racial inequity and lack of trust 

The report also raises the issue of racialisation and exposes how structural racism and cultural exclusion shape access and trust. Interviewees reported that Black children are more likely to have their behaviour framed as a ‘discipline’ problem rather than distress, leading to exclusion from services. Structural racism and cultural exclusion also erode trust with families feeling unheard and assessments missing context leading to young people disengaging.  

The hot potato 

There is also the ‘hot potato’ effect with services passing complex cases between one another – constantly assessing but not treating, causing many young people to fall through the gaps. Children and their families described being redirected repeatedly between CAMHS, education, social care and the police.  

What next? 

The project also highlighted important evidence gaps. We need better data to enable us to follow real access journeys over time. We also need more research with the inclusion of under-represented groups (especially girls and neurodivergent children) and stronger evaluation of community based and culturally rooted support. These improvements would help us to better understand who truly gets help, who doesn’t, and why.  

Later this year, YEF will also publish results from a Randomised Controlled Trial conducted by Anna Freud and the Institute of Fiscal Studies, of the Your Choice Programme. The programme aims to reduce violence for at-risk 11–18-year-olds by training youth workers to deliver CBT.  It also places cultural sensitivity at the centre, aiming to build trust and access for groups less likely to receive help. The RCT will assess effectiveness and explore the efficiency of children’s access to the therapy. It will be important to see the extent to which its results align with the patterns reported here.  

Read the report

Download YEF’s Access to mental health support for children and young people involved in or at risk of serious youth violence across England and Wales

Review here