‘Higgledy piggledy’: Systems of support for young people aged 14–24 with poor mental health

This report is part of the Nuffield Foundation’s Grown up? programme, which explores journeys to adulthood for young people aged 14–24, to inform policy and practice. It focuses on different aspects of their lives including the markers of adulthood, transitions from education to employment and their digital lives. No picture about journeys to adulthood of Gen Z would be complete without shining a light on their mental health.

‘Higgledy piggledy’: Systems of support for young people aged 14–24 with poor mental health is the third in a series of data commentaries under the Grown up? programme[ref]All published materials under this programme of work can be found at the Grown up? Journeys to adulthood project page.[/ref]. This data commentary is for anyone with an interest in mental health and young people aged 14–24, but will be particularly relevant for researchers, policymakers, and commissioners of services. It takes a broad lens in examining the mental health needs and services available for young people aged 14–24, as they move from being teenagers to young adults. It explores what is known about the prevalence of poor mental health in this age group and the support provided, drawing on data from prevalence surveys alongside administrative data, as well as insights from young people and practitioners. 

Together they map both formal and informal mental health support for 14-24 year olds. Formal support is provided through designated child or adult health services or professionals commissioned by NHS; informal support is provided by professionals or individuals with or without specific knowledge of mental health within different systems that young people interact with on a daily basis. They illuminate key issues that this generation faces in relation to mental health.

Key systems young people turn to for mental health support as identified by young people in the Youth Insight Group and deep dive workshops 

Why we focus on the mental health of 14–24 year olds

The World Health Organization explains mental health as a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn and work well, and contribute to their community[ref]World Health Organization (2023) A focus on adolescent mental health and well-being in Europe, central Asia and Canada Health Behaviour in School-aged Children international report from the 2021/2022 survey, Volume 1. Available from: https://www.who.int/europe/publications/i/item/9789289060356.[/ref]. Mental health is as important as physical health but perhaps not as well understood yet or given the same priority. It is a continuum of fluctuating experiences, ranging from positive or challenging everyday emotional states to mental health conditions that are characterised by persistent and severe symptoms that impact cognitive or behavioural functioning and interfere with everyday life. Living with poor mental health[ref]Key terms used in this document are explained in Mental health terminology in Higgledy piggledy’: Systems of support for young people aged 14–24 with poor mental health[/ref] requires access to support across the whole continuum of needs, from interventions that help prevent or alleviate the symptoms to medication or hospitalisations in situations of crisis.

Young people’s mental health is a priority issue for a number of reasons.

First, there has been a significant and concerning rise in the number of young people who require support with mental health conditions – 1 in 4 young people aged 16–24 years had a common mental health condition in 2023/4 compared to 1 in 6 in 2007[ref]Morris, S., et al. (2025) Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24/content.[/ref]. The precariousness of global and domestic events in recent years, the effects of COVID-19[ref]Lee, J., & Wong, KK-Y. (2024) Mental health inequalities, challenges and support needs during COVID-19: a qualitative study of 14-to-25-year-olds in London. BMJ Open14, e080161. Available from: https://doi.org/10.1136/bmjopen-2023-080161.[/ref], financial worries due to the higher cost of living[ref]Parra-Mujica, F., et al. (2023) Understanding the relationship between income and mental health among 16- to 24-year-olds: Analysis of 10 waves (2009–2020) of Understanding Society to enable modelling of income interventions. PLoS ONE 18, e0279845. Available from: https://doi.org/10.1371/journal.pone.0279845.[/ref], changes in daily life rhythms brought about by an ever-present digital realm[ref]Sala, A., Porcaro, L., & Gómez, E. (2024). Social Media Use and adolescents’ mental health and well-being: An umbrella review. Computers in Human Behavior Reports 14, 100404. Available from: https:/doi.org/10.1016/j.chbr.2024.100404.[/ref]^,[ref]Pierce, M., et al. (2025) Understanding drivers of recent trends in young people’s mental health. Youth Futures Foundation. Available from: Understanding-drivers-of-recent-trends-in-young-peoples-mental-health-July-2025-final.pdf [Accessed 03 February 2026].[/ref], and the thinning of social connections young people experience[ref]McCrory, E., & Chokhani, R. (2025) Social thinning in a digital age: The case for rebuilding the social foundations of adolescence. Nuffield Foundation. Available from https://www.nuffieldfoundation.org/evidence-and-impact/our-programmes/grown-up/social-thinning-in-a-digital-age-the-case-for-rebuilding-the-social-foundations-of-adolescence [Accessed 03 February 2026].[/ref], have all undoubtedly contributed to the growing number of young people experiencing low well-being[ref]The Children’s Society (2025) The Good Childhood report. Available from: https://www.childrenssociety.org.uk/information/professionals/resources/good-childhood-report-2025 [Accessed 03 February 2026].[/ref] and mental health conditions[ref]Marcheselli, F., et al (2023) Children and young people’s mental health in 2023. Available from: https://natcen.ac.uk/publications/children-and-young-peoples-mental-health-2023 [Accessed 03 February 2026].[/ref]^,[ref]Morris, S., et al. (2025) Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24/content.[/ref].

There has also been a lot of public, academic, and political discussion about the true scale of poor mental health among young people[ref]Cosma, A., et al. (2025) The changing epidemiology of child and adolescent mental health requires an immediate policy response. Public Health in Practice 10. Available from: https://doi.org/10.1016/j.puhip.2025.100655.[/ref] and the rising number of young people being out of education or work due to poor mental health[ref]Department for Work and Pensions (2026) Independent Report. Young People and work: interim report available from Young people and work: interim report – GOV.UK [accessed on 2 June 2026][/ref]. Are young people being over or under-diagnosed? Is poor mental health a result of challenges faced by young people in modern life or ‘concept creep’ resulting from greater awareness and greater prominence in media? Some of these questions are set to be explored in the reviews led by NHS national advisor Professor Peter Fonagy – looking into mental health conditions, attention deficit hyperactivity disorder (ADHD) and autism[ref]Department of Health and Social Care (2025) Independent review into mental health conditions, ADHD and autism: terms of reference. Available from: https://www.gov.uk/government/publications/independent-review-into-mental-health-conditions-adhd-and-autism-terms-of-reference.[/ref] – and by Alan Milburn – investigating causes of inactivity and unemployment among young people aged 16–24[ref]Department for Work and Pensions (2026) Independent Report. Young People and work: interim report available from Young people and work: interim report – GOV.UK [accessed on 2 June 2026][/ref]. 

Second, supporting mental health needs is particularly important during adolescence and early adulthood.Research shows that the brain continues to mature well into the 20s with many structural and neurodevelopmental changes that may heighten young people’s behavioural and emotional vulnerabilities[ref]Mousley, A., et al. (2025) Topological turning points across the human lifespan. Nat Commun 16, 10055. Available from: https://doi.org/10.1038/s41467-025-65974-8.[/ref]. Indeed, around two thirds of all mental health conditions emerge during adolescent years, making the provision of support during this time even more important[ref]Solmi, M., et al. (2022) Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 27, 281–295. Available from: https://doi.org/10.1038/s41380-021-01161-7.[/ref]. Effective mental health support from birth and in adolescence can make a life-long difference, impacting future life satisfaction, employment prospects and even income levels[ref]Cardoso, F., & McHayle, Z. (2024) The economic and social costs of mental ill health. Centre for Mental Health. Available from: https://www.centreformentalhealth.org.uk/publications/the-economic-and-social-costs-of-mental-ill-health/.[/ref]. However, the evidence on what works for young people is still limited[ref]Du Toit, S., et al. (2025) Psychosocial Interventions for Preventing Mental Health Conditions in Adolescents With Emotional Problems: A Meta-Analysis. Journal of Adolescent Health 76, 187–209. Available from: https://doi.org/10.1016/j.jadohealth.2024.09.030.[/ref].

Third, adolescence is also a time when a number of major life transitions are taking place – from secondary school to further education, A levels or apprenticeships, marked with rigorous GCSE exam regime; transitions to university or employment; and the transition from child to adult status and the many things that may come with that, including the first romantic relations, moving out of family home, and starting a family. All of these important life transitions impact on a young person’s mental health and well-being and vice versa. Poor mental health during important life milestones can influence young people’s ability to accomplish them successfully and can limit their future life chances.

Finally, turning 18 marks the legal transition from childhood to adulthood across the UK[ref]UK Government (1989) Children Act 1989. Available from: https://www.legislation.gov.uk/ukpga/1989/41/contents.[/ref]^,[ref]UK Government (1995) The Children (Northern Ireland) Order 1995. Available from: https://www.legislation.gov.uk/nisi/1995/755/contents/made.[/ref]^,[ref]UK Government (2014) Social Services and Well-being (Wales) Act 2014. Available from: https://www.legislation.gov.uk/anaw/2014/4/section/3.[/ref]^,[ref]UK Government (1995) Children (Scotland) Act 1995. Available from: https://www.legislation.gov.uk/ukpga/1995/36/section/93.[/ref] in accordance with the United Nations Convention on the Rights of the Child[ref]In some cases the law may recognise children aged 16 and 17 as adults for specific purposes. However, social care services and mental health services across the UK consider individuals under the age of 18 as children.[/ref]^,[ref]UNICEF (1989) The United Nations Convention on the Rights of the Child. Available from: https://www.unicef.org.uk/what-we-do/un-convention-child-rights/.[/ref]. It is not just a milestone determining new things young people can do, like getting married or being able to buy alcohol. It also determines what support services young people can or cannot access, including with their mental health needs. Reaching the age of 18 is often described as a ‘cliff edge’, when suddenly all the scaffolding of support offered by child-specific services – whether in education, social care or mental health – falls away and young people are left to navigate a complex and often less supportive landscape of adult services on their own. This sharp boundary in service provision is at odds with young people’s later transitions to adulthood[ref]Batcheler, R., Oppenheim, C., & Sarygulov A. (2025) Rethinking journeys to adulthood: An introduction. Available from: https://www.nuffieldfoundation.org/evidence-and-impact/our-programmes/grown-up/rethinking-journeys-to-adulthood [Accessed 24 February 2026].[/ref] and evidence on brain development extending into early adulthood. Therefore, support needs to be better aligned and attuned to the specific phase of the young person’s development, rather than an arbitrary cut-off. The conceptualisation of transition points and age thresholds is an evolving issue within the mental health services landscape.

Over the last 10–15 years, mental health overall and the mental health of young people specifically have received greater focus in national policies, creating more opportunities for young people to access support, particularly under the age of 18. Some of the most significant policy and practice developments include: a goal of parity of esteem between mental and physical health; new evidence based approaches to mental health support overall as well as for specific conditions; an increase in early and preventative interventions; expansion of talking therapies’ availability; establishment and ongoing expansion of mental health support in schools and colleges; and new integrated approaches – such as the community-located support hubs.  

However, there remain major issues with support for young people with poor mental health – the level of need still outpacing provision[ref]NHS Providers (2024) Forgotten generation: shaping better services for children and young people. Available from https://nhsproviders.org/resources/forgotten-generation-shaping-better-services-for-children-and-young-people [Accessed 03 February 2026].[/ref], uneven funding allocations for mental health services across the country[ref]Children’s Commissioner (2025) Children and young people’s mental health services 2023-24. Available from https://assets.childrenscommissioner.gov.uk/wpuploads/2025/05/cco-childrens-mental-health-annual-briefing-may-2025.pdf [Accessed 03 February 2026].[/ref], and twists and turns in policy implementation all contribute to a postcode lottery of what is available in different locations as well as across the childhood/adulthood boundary[ref]Wongsa-art, P., et al. (2024) Varying coefficient panel data models and methods under correlated error components: Application to disparities in mental health services in England. Regional Science and Urban Economics 106, 104009. Available from: https://doi.org/10.1016/j.regsciurbeco.2024.104009.[/ref]^,[ref]Cleverley, K., Lenters, L. & McCann, E. (2020) “Objectively terrifying”: A qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18. BMC Psychiatry 20. Available from: https://doi.org/10.1186/s12888-020-02516-0.[/ref].

Key insights, findings and areas for further research 

1. Data shows the gap between rising mental health needs among young people and the support available to them:

• This generation of young people has a high level of need as measured by diagnostic tools and screening. Around 1 in 4 young people aged 16–24 have a common mental health condition (CMHC) and around 1 in 7 have symptoms of a CMHC corresponding to a severe level of need.
• There is a gap between the level of need and the level of access to support. Around 1 in 10 young people aged 16–24 had been in contact with mental health services but only around 1 in 25 had 2 contacts or more, indicating limited access to treatment. To understand the level of unmet needs, it is important that prevalence of mental health is considered alongside the administrative data on access to services.
• Many young people who would benefit from access to support either are choosing not to access it or experience long waits or other barriers in access. 1 in 2 young people with the level of mental health symptoms that would benefit from treatment are not accessing treatment.
• The system relies heavily on medication with over 840,000 young people aged 15–24 – 1 in 8 young people – prescribed some medicine for mental health in 2025. This may or may not be the right response, depending on the mental health condition, but the young people we engaged with were concerned about the limited options beyond medication.

2. Formal and informal mental health services for young people are fragmented and complex – as mapped by young people and professionals:

• The full scale of what is provided outside formal mental health services – in education, community, and digital places – is difficult to assess. However, this support plays a crucial role in prevention and early intervention and is valued by young people. An example map of systems of support for young people aged 14–24 years with poor mental health drawn by young people and professionals and shown below illustrates the complexity of support available. 
• Despite the expansion of mental health support teams in schools and new elements of integration through a range of hubs, prevention and early intervention approaches are under-developed and partial.
• Availability of support is determined by where young people live with some new initiatives as yet only available as pilots, alongside variations in spending levels and commissioning. Information about what is available is difficult to navigate.

Example map of systems of support for young people aged 14–24 years with poor mental health

Light blue – mostly available for young people under 18
Dark blue – mostly available for adults 18+
Purple – available across 18 birthday boundary
Yellow – age range depends on commissioning arrangements in areas
Dashed line – indicates where the same service is mapped in more than one system

Link to full description of data

3. Digital support is rapidly expanding and can play an important role in the wider infrastructure of services for young people’s mental health needs:

• There is rightly a great deal of concern about the harms of social media and AI developments to young people’s mental health and well-being, and how to regulate to protect young people in the context of rapid changes in technology. We explore this in other outputs from the Grown up? programme. Important areas for further exploration are understanding the reach and impact of the current digital support available, its potential to act as a digital front door to other services, and how to manage risk and oversight.

4. There is a mismatch between the spectrum of mental health needs – including mild, severe, and multi-faceted conditions – and the way in which services and support are structured:

• While there is more evidence built around outcomes when a mental health condition meets a clinical threshold, there is less evidence around early intervention and when needs are below a clinical threshold. This is the case for all young people, but particularly for those who have experienced trauma, looked after children, and minoritised and neurodivergent young people.
• The system is ill-equipped to respond to young people who have a combination of vulnerabilities in their lives, such as young people who are not in education, employment or training (NEET), growing up in the care system, and living in poverty. The impact on mental health outcomes of multi-dimensional interventions across different aspects of young people’s lives needs to be better understood.
• There is a gap in provision for young people with moderate needs, who fall between a relatively low level of difficulties and the more serious ones who need secondary mental health services.

5. There is a glaring need for better transitions between child and adult mental health services and more integrated approaches to transition across all systems:

• The transition points disrupt access to support for young people and create additional stressors. Each system (for example education, or children’s social services) has its own approach to transition, multiplying opportunities for young people to fall through the gaps.
• There is a paucity of data on and analysis of young people’s transitions into adulthood in terms of their mental health needs and the services available, specifically including the period of early adulthood from 18–24 years old.

6. It is vital to strengthen the data infrastructure in the UK to inform effective decision-making and commissioning of services:

• We identify key gaps in the data available which need to filled, particularly in relation to i) consistent and comparable data across the 14–24 age range; ii) a more detailed picture by age, group, and place and intersections therein; iii) several physical or mental conditions occurring together; iv) understanding changes over time in long-term and fluctuating conditions; and v) transitions between child and adult mental health services.

7. Understanding how well specific interventions work is needed:

• This data commentary focused on the scale of and access to mental health support within different systems rather than on specific interventions. Understanding the impact of these interventions is a critical component of developing a comprehensive and effective approach to meeting young people’s mental health needs. The evidence base for preventative approaches is much weaker again but is also a vital component.

8. Putting young people and their support networks at the centre of policy and practice is critical to ensuring things work for young people:

• Young people often struggle to access narrowly defined siloed services. Better evidence of what formal and informal support would meet their needs is required.
• There are barriers that prevent young people seeking help, which need to be understood. While the focus is rightly on the availability of services, diagnostic tools, and the suitability of responses, two other issues have been persistently raised by young people: First, the impact of public debate about young people’s mental health on their perception of ‘being a burden’ on an overstretched system. Second, whether ‘generational bias’ is potentially shaping decisions around commissioning support services for young people at the lower end of the continuum of needs.
• Evidence needs to be built up with young people and professionals about what to include in the ‘toolbox’ for young people to help them regulate emotional needs, manage conditions, and build resilience.
• Parents, wider family, siblings, and carers are in many cases a key part of the scaffolding of support for young people’s mental health needs, yet there is a real lack of research and guidance for parents and carers of those 16+ – particularly in transition and post-18, when mental health needs are persistent or severe.

The mental health of young people is high on the agenda today for decision makers, commissioners, practitioners, parents, and carers, and young people themselves. We are at a critical juncture with future policies and practice responses being considered, whether through the Children’s Wellbeing and Schools Act, important reviews led by Professor Fonagy and Alan Milburn, or the development of community hubs such as Young Future Hubs or 24/7 Neighbourhood Mental Health Centres.

It is critically important that these and any future developments in this space are informed by:

• The evidence from research which highlights the need to move away from rigid boundaries between childhood and adulthood, and to address the gaps in data and focus on young people aged 14–24.
• The range of factors which are driving the rise in mental health conditions, making it essential to have multifaceted approaches in response.
• An assessment of the extent to which the current landscape of services meets the whole spectrum of needs. This must include consideration of more radical reform, focused on early intervention and integrated approaches.
• The need to support real-life social connections through continuing to invest in youth spaces and places in the community, across the different phases and stages of a young person’s life.
• The voices and experiences of young people whose journeys to adulthood are currently affected by the gaps in mental health support. Their involvement in co-producing a more holistic approach is vital to its success – one which challenges the siloed working of the different systems and stretches across different areas of young people’s lives.

Across the globe, the increase in young people’s mental health has already led to the development of systems and services that provide more holistic and uninterrupted mental health support as young people become adults[ref]McGorry, P.D., et al. (2022) Designing and scaling up integrated youth mental health care. World Psychiatry 21, 61–76. Available from: https://doi.org/10.1002/wps.20938 [Accessed 08 April 2026].[/ref]. Domestically, while some data, policies, and practice have been developed on the issue, there is still some way to go to ensure that provision of support across the country is more flexible, wide ranging, and informed by needs of this age group.