1. Mental Health of Children and Young People in England, 2017
Key Findings

2. Trends over time in 5 to 15 year olds, 1999 to 2017
This survey series provides England’s best source of data on trends in child mental health.
The analysis included a consistent set of disorders and a consistent age-group (5 to 15 year olds) across the survey series.

3. Any disorder in 5 to 15 year olds, 1999 to 2017
Source: NHS Digital. 5 to 15 year olds identified with a mental disorder, England.
(SLIDE 8 of Summary Report)
The prevalence of children and young people with a mental disorder increased from 9.7% in 1999 and 10.1% in 2004 to 11.2% in The rate in 2017 was higher than that in 1999, but not significantly higher than the 2004 rate.
The increase was observed in both boys (from 11.8% in 1999 and 12.2% in 2004 to 13.1% in 2017) and girls (from 7.5% in 1999 and 7.9% in 2004 to 9.3% in 2017).

4. Trends in Disorders, 1999 to 2017 (SLIDE 9 of Summary Report)
Source: NHS Digital. 5 to 15 year olds identified with a mental disorder, England.
(SLIDE 9 of Summary Report)
The increase has been largely driven by a rise in emotional disorder. From 4.3% in 1999 and 3.9% in 2004 to 5.8% in 2017.
The prevalence of behavioural and hyperactivity disorders have remained broadly stable.
Given the expected low prevalence, other less common disorders were not asked about in detail in the 1999 survey. As a result, comparable rates of autism spectrum disorder, eating and other less common disorders can only be compared for 2004 (1.5%) and 2017 (2.1%).
The prevalence of ASD in 5 to 15 year olds remained stable between 2004 (1.0%) and 2017 (1.3%). Eating disorder rates also did not significantly change between 2004 (0.1%) and 2017 (0.2%), although the survey sample was too small to reliably detect change in a low prevalence condition like eating disorder.

5. Emotional disorders, 1999 to 2017
Source: NHS Digital. 5 to 15 year olds identified with a mental disorder, England.
The increase since 2004 in emotional disorders is evident in both boys and girls.
In boys, from 4.2% in 1999 and 3.3% in 2004 to 5.6% in 2017.
And in girls, from 4.4% in 1999 and 4.5% in 2004 to 6.1% in 2017.

6. Children and Young People in 2017

7. 5 to 19 year olds in England
One in eight (12.8%) 5 to 19 year olds had a mental disorder.
One in twenty (5.0%) met the criteria for two or more individual mental disorders at the same time.
Source: NHS Digital. 5 to 19 year olds identified with one or more mental disorders, England.
(SLIDE 6 of Summary Report)
Now to focus on results from the 2017 survey.
We found, overall, one in eight (12.8%) 5 to 19 year olds had a mental disorder. To put this into context, a classroom of 24 children, 3 would have a disorder based on these results.
We also found one in twenty (5.0%) children and young people experienced more than one mental disorders at the same time.
This is known a comorbidity, and it is important to look at as it can have a substantial impact on a child’s health and wellbeing.
Background points:
Comorbidity highlights how children who have mental disorder often experience other disorders at the same time (for example, a child may experience anxiety and depression at the same time, or a hyperactivity disorders and behavioural disorder).

8. Preschool children (2 to 4 year olds)
One in eighteen (5.5%) preschool children had a mental disorder.
The prevalence of mental disorders for two to four year-olds in England has been surveyed for the first time so these figures are experimental statistics.
Source: NHS Digital. 2 to 4 year olds identified with any mental disorder, England.
(SLIDE 11 of Summary Report)
This survey also included preschool children (2-4 year olds) for the first time
Early childhood is an important phase for children, where a child develops language and other social skills.
This survey interviewed parents of preschool children and found one in eighteen preschool children experienced difficulties with their mental health.
These figures are classed as experimental statistics, as they have used an adapted version of the Development and Well-Being Assessment to be age appropriate for parents of 2 to 4 year olds.
Whilst it’s helpful produce headline findings, it is important to delve deeper into how the mental health of children and young people differed by age and sex.
Background info (if needed)
Specific disorders:
Oppositional defiant disorder 1.9%.
Autism spectrum disorder (ASD): 1.4%
Other disorders of specific relevance to this age group
sleeping (1.3%)
feeding (0.8%) disorders

9. Mental disorders were higher in older age groups
Source: NHS Digital. 2 to 19 year olds identified with any mental disorder, England.
As well as collecting information about preschool children, we:
interviewed parents and teachers of 5 to 10 year olds, finding around one in ten primary school aged children experienced a mental disorder
increased to one in seven secondary school aged children (11 to 16 year olds), based on information collected from parents, teachers and children themselves.
rates of mental disorders was highest in 17 to 19 year olds, with one in six young adults experiencing a mental disorder (based on information collected from the young person themselves, and a parent if they were living at the same address).
Background:
Early childhood is an important phase for children, where a child develops language and other social skills.
Primary school is a major stage in early childhood.
The move to secondary school coincides with the start of adolescence
Adolescence is an extended period of change.

10. Differences between boys and girls
Source: NHS Digital. 2 to 19 year olds identified with any mental disorder, England.
Differences were also found between boys and girls.
For preschool children and primary school aged children, boys were more likely than girls to have a mental disorder. Primary school aged boys were nearly twice and likely as girls to have a mental disorder.
When children reached secondary school age, boys and girls had similar rates of mental disorders.
When children become young adults, one in four young women experienced a mental disorder. In comparison, one in 10 young men had a mental disorder.
Background info:
Why young women higher: The reasons for this are likely due to a complex interaction of biological and lifestyle factors, however the extent of influence of different factors remains unclear (NHS Choices, 2016).

11. Disorder types differed by age
Source: NHS Digital. 2 to 19 year olds identified with a mental disorder, England.
As well as differences by age and sex, differences were found in the types of disorders experienced by children.
For preschool and primary school aged children, behavioural disorders were the among the most common type of disorder.
When progressing to secondary school, emotional disorders were the most common type of mental disorder, with one in 11 secondary school aged children experiencing an emotional disorders.
And for 17 to 19 year olds, 1 in 7 young adults experienced an emotional disorder, with anxiety disorders presenting as the most common type of emotional disorder in children.
Background:
Less common disorders which specifically affected 2-4 year olds were also identified in our survey. For example, we found 1.3% of preschool children experienced difficulties with sleeping (beyond what would normally be expected of a young child)
In addition, rates in hyperactivity disorders and behavioural disorders reduced for 17 to 19 year olds:
For hyperactivity disorders, this lower prevalence rate may occur because once young people leave compulsory education, they may no longer display hyperactivity symptoms in more than one setting and so do not meet the criteria for a diagnosis.
And Behavioural disorders are typically only diagnosed in childhood, potentially leading to a reduction in 17 to 19 year olds..

12. Focus on 17 to 19 year old girls
Nearly one in four (23.9%) had a mental disorder.
Just over one in five (22.4%) young women had an emotional disorder .
One in two (52.7%) young women with a disorder reported having self-harmed or made a suicide attempt.
(SLIDE 15 of Summary Report)
Nearly one in four (23.9%) 17 to 19 girls had a mental disorder. Girls aged 17 to 19 were more than twice as likely as boys that age to have a disorder.
One in five young women had an emotional disorder. The majority of these were anxiety disorder (20.3%) compared to depression (6.5%).
And one in two young women with a disorder reported having self-harmed or made a suicide attempt. This compared to one in three boys (34.1%).
This highlights how young women are a high risk group in relation to mental health.
Background
Research indicates that the reasons for this higher rate of emotional disorders in girls aged 17 to 19 year old are likely to be complex. Some studies suggest the difference between the sexes increases around puberty (Wesselhoeft et al., 2015). Anxiety disorders, although common across all population groups, tend to disproportionately affect women and young people (Remes et al., 2016). The reasons for this are likely due to a complex interaction of biological and lifestyle factors, however the extent of influence of different factors remains unclear (NHS Choices, 2016).

13. Region (5 to 19 year olds)
As well as looking at how mental health varied by the age and sex of the child, it is also important to look at aspects of a child’s identity.
Where a child lives can influence their outcomes in life.
We looked at how the presence of mental disorders varied by regions in England, and found:
London had the lowest rates of mental disorders in the England (9%). Although rates of mental disorder varied by region, there was no clear trend across other areas of the country.
Background:
Differences between some regions are small. As these estimates are based on a sample, if we repeated this survey multiple times, the rates of mental disorders between regions may differ, as indicated by the margin of error in the chat. Therefore, reporting of regional differences should be treated with caution.
Source: NHS Digital. 5 to 19 year olds identified with any mental disorder, by region in England.

14. Ethnic group (5 to 19 year olds)
Source: NHS Digital. 5 to 19 year olds identified with any mental disorder, England.
(SLIDE 17 of Summary Report)
This survey also looked at how rates of mental disorders varied by ethnic groups.
Rates were highest among children of White British (14.9%) background and lowest among children of Black / Black British (5.6%) and Asian / Asian British (5.2%) backgrounds.
This finding is consistent with the results from the last time we ran this survey.
HOWEVER
differences between ethnic groups are difficult to interpret due to the small numbers of minority ethnic backgrounds taking part in the survey.
The survey included only English speakers and was underpowered to examine variation by ethnicity in detail.
Given differences in ethnic populations in different areas, this may be a factor in the lower rate for London as a whole.
Background (from a paper authored by Anna Goodman):
In summary, the prevalence of common mental health problems in the main minority ethnic groups in Britain seems to be similar to or, in some specific minorities, lower than that of White British children. There is also some suggestion, albeit based on inconclusive evidence, of more psychosis in Black children, more disordered eating attitudes in South Asians, and greater unmet need for mental health services in Pakistani and Bangladeshi children.

15. Sexual Identity (14 to 19 year olds)
Young people who identified as lesbian, gay, bisexual or as another non-heterosexual sexual identity were more likely to have a mental disorder
Source: NHS Digital. 14 to 19 year olds identified with any mental disorder, England.
(SLIDE 16 of Summary Report)
This survey also asked children aged 14 to 19 about their sexual identity.
We found one in ten children aged 14 to 19 identified as a non-heterosexual identity (that is, gay/lesbian, bisexual or another sexual identity).
And in relation to mental health, we found young people who identified as lesbian, gay, bisexual or with an other sexual identity were more likely to have a mental disorder (34.9%) than those who identified as heterosexual (13.2%).

16. Social and Family Context (5 to 19 year olds)
Children with a mental disorder were more likely to live in a family that struggles to function well, as well as where a parent struggles with poor mental health.
Source: NHS Digital. 5 to 19 year olds identified with any mental disorder, England.
(SLIDE 18 of Summary Report)
This survey also collected information on a range of social and family indicators.
These can be found in the topic repots published today.
Highlighting two of these factors:
Children with a mental disorder are more likely to live in a family that struggles to function well. For example, families who do not get on well together or struggle to understand each other)
Mental disorders in children were associated with parental mental health. For example, children who have a parent who struggles with their mental health were more likely to have a disorder themselves.
There will be many reasons for this:
unhealthy family dynamics or poor parental mental health may contribute to mental disorders in children,
However families, and in particular parents, dealing with the needs of a child with poor mental health may struggle to cope.
In either case, the findings of this report will be a valuable resource for policy makers and service providers working not only with children, but also with their families and schools.

17. Behaviours and Mental Disorders

18. 11 to 19 year olds with a disorder spend more time on social media
(SLIDE 21 of Summary Report)
We found that 11 to 19 year olds with a disorder spend more time on social media.
The chart here includes daily social media users and their use on a typical school day.
A higher proportion (41.6%) of 11 to 19 year olds without a disorder spent less than one hour on social media per day than those with a disorder (25.1%).
A higher proportion with a mental disorder spend more than four hours on a social media on a typical school day compared to those without a disorder (29.4% compared to 12.0%).
The same associations held true for a non-school day.
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BACKGROUND
A list of twenty one social media sites was presented and 11 to 19 year olds were asked which they had used, if any. Those that selected one or more were classified as social media users, and were asked how much time they spent online on a typical school day and non-school day.

19. Perceived impact of social media
(SLIDE 21 of Summary Report)
Young people were asked what they thought the personal impact of their social media use was via a series of agree/disagree statements.
We found that young people with a mental disorder were more likely to agree that:
They compare themselves to others
The number of likes, comments and shares impact on their mood
They spend more time on social media than they mean to, and
They can’t be honest about their feelings

20. One in five (21.2%) 11 to 19 year olds were cyberbullied in the last year
(SLIDE 22 of Summary Report)
21.2% of 11 to 19 year olds reported they had been cyberbullied online in past year. Girls were more likely than boys to have been cyberbullied: one in four girls experienced this (25.8%) compared with one in six boys (16.7%).
Young people with a mental disorder (41.5%) were more than twice as likely as those without a disorder (18.1%) to have been cyberbullied in the past year. This relationship was similar for boys (33.4% compared to 14.8%) and girls. (46.5% compared to 21.7%)
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BACKGROUND
Young people were asked whether: they had received unwanted or nasty s, texts or messages; someone had posted nasty things about them online; they had been ignored or left out of things online; or someone had posted inappropriate pictures of them online, without their permission. Cyberbullying was asked about in relation to the past year. Young people were asked whether they had been cyberbullied themselves, and whether they had cyberbullied others. Both are likely to be subject to social desirability biases in reporting and may represent underestimates.

21. One in twelve (8%) had cyberbullied others in the past year
(SLIDE 22 of Summary Report)
8% of 11 to 19 year olds reported they had cyberbullied others in the past year. About one in ten boys (9.5%) had cyberbullied others, and about one in sixteen girls had (6.4%).
Young people with a mental disorder were twice as likely to report having cyberbullied others (14.6%) as young people without a disorder (6.9%).
Rates were similar in boys (15.7% compared to 8.8%) and girls (13.9% compared to 4.9%).

22. Risky behaviours in 11 to 16 year olds
Children with a disorder more likely to have
Taken illicit drugs ( 13.9% compared to 4.1%)
Drunk alcohol (36.3% compared to 22.7%)
Tried a cigarette (22.5% compared to 7.3%)
(SLIDE 23 of Summary Report)
Rates of illicit drug use were three times higher in 11 to 16 year olds with a mental disorder (13.9%) than in those without a disorder (4.1%).
Rates of drinking were higher in young people with a mental disorder. More than a third (36.3%) of 11 to 16 year olds with a disorder had tried an alcoholic drink compared to about a quarter (22.7%) with no disorder.
Smoking was also associated with the presence of a mental disorder. 11 to 16 year olds with a disorder were three times more likely to have tried a cigarette (22.5%) than those without a disorder (7.3%).
The pattern was similar for having tried an e-cigarette, with 24.1% of 11 to 16 year olds with a mental disorder having used one compared with 11.2% of children without a disorder.
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BACKGROUND
As part of the self-completion part of their interview children and young people aged 11 to 19 were presented with a list of drugs and asked to select all the ones that they had ever tried.
Young people aged 11 to 19 were asked about drinking as part of the self-completion part of their interview. Children were classified as having tried an alcoholic drink if they reported having had ‘more than just a sip or two’.
Young people aged 11 to 19 were asked about smoking as part of the self-completion part of their interview. Children were classified as having smoked a cigarette or e-cigarette if they had tried it at least once.

23. Education and Services

24. Children with a disorder more likely to have
Education
Children with a disorder more likely to have
Played truant (8.5% compared to 0.8%)
Been excluded (6.8% compared to 0.5%)
(SLIDE 25 of Summary Report)
TRUANCY
Teachers of children aged 5 to 16 were asked about unauthorised absences from school.
Overall, 1.7% of children aged 5 to 16 were reported to have ever played truant from primary or secondary school.
Children with a disorder were around ten times more likely to play truant (8.5%) than children without a disorder (0.8%). Truancy rates varied by type of disorder present, and were highest in children with an emotional disorder (9.7%) or behavioural disorder (11.2%).
EXCLUSION
Parents of 5 to 16 year olds were asked whether their child had ever been excluded from primary or secondary school.
School exclusion was also more common in children with a disorder (6.8%) than in those without (0.5%).

25. Contact with services among children with a disorder
66.4% - professional service contact
25.2% - mental health specialist
48.6% - informal support
(SLIDE 27 of Summary Report)
Two-thirds (66.4%) of 5 to 19 year olds with a disorder had contact with a professional service in the past year because of worries about mental health. Teachers were the most commonly cited source (48.5%).
Around a quarter (25.2%) had contact with a mental health specialist.
Around half (48.6%) of children with a disorder had contact with informal sources of support (such as family and friends and the internet) because of mental health worries. Family and friends were the most common source of informal support (44.6%) to children with a disorder.
One in four (24.1%) children with a disorder had no contact with either professional services or informal support in relation to worries about their mental health.
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BACKGROUND
Parents of children aged 5 to 16 were asked whether in the past year they had been in contact with a range of types of professional services and informal sources of support because they were worried about their child’s emotions, behaviour, concentration, or how their child was getting on with other people. Young people aged 17 to 19 were asked about their own contact with services and support directly. For ease, throughout this report contact with services and support is described in relation to children, although it should be noted that in the case of children aged 5 to 16 contact may have been with the parent, although due to their worries about their child