Reducing CAMHS Referrals & the Economic Case for Prevention
“We have indeed seen a reduction in the number of referrals to external mental health support services.” – Headteacher of St Winefride’s Catholic Primary School
More than one million children in England had an active referral to children and young people’s mental health services in 2024-25. The Children’s Commissioner’s fifth annual report found 1,048,965 children with an active referral: almost double the number in 2018-19, and nearly 10% more than the year before.
Capacity has not kept pace. More than one in three referred children were still waiting for treatment, and over 60,000 had waited more than two years. Real-terms spending on these services rose by 2% to £1.1 billion, against a rise in referrals of almost 10%.
The Commissioner has called for the forthcoming national mental health strategy to include a dedicated focus on children, jointly owned by the Department of Health and Social Care and the Department for Education.
For commissioners, the conclusion is hard to avoid. Specialist services cannot simply grow their way out of this. Demand has to be reduced upstream, before children’s needs escalate.
The policy direction: from sickness to prevention
The 10 Year Health Plan is built around three shifts: hospital to community, analogue to digital, and sickness to prevention. For children’s mental health, schools sit at the centre of that shift.
Mental Health Support Teams are expanding rapidly. In June 2026, the government reported that nearly six million children and young people could access an MHST through their school or college, with full coverage of schools and colleges planned by the end of 2029.
MHSTs offer early help for children with mild to moderate needs. But they are not designed to teach every child, every week, the skills that prevent needs developing in the first place. The Centre for Mental Health’s 2026 evaluation of myHappymind recommended exactly this join-up: stronger links between universal wellbeing programmes in schools and MHST provision, so children move smoothly from prevention to specialist help when they need it.
Why universal prevention in schools works
Targeted services can only reach children who are referred. A universal programme, taught to whole year groups, reaches every child, including those who would never be referred, or who would only be referred once their needs had escalated.
When children learn how their brain works, have words for their feelings and practise strategies to regulate themselves, schools can respond to emerging needs earlier. The Centre for Mental Health’s evaluation of myHappymind in Hampshire and the Isle of Wight and Bradford found that pupils were equipped with strategies early, enabling schools to address emotional and behavioural needs before they escalate, which suggests a reduced need for external referrals and crisis support.
School leaders describe the same pattern. The Headteacher of St Winefride’s Catholic Primary School told the evaluators: “We have indeed seen a reduction in the number of referrals to external mental health support services.”
The economic case
Our 2025/26 National Impact Report brings together data from over 1,000 schools on outcomes since each school began delivering the programme. Headteachers and SENCOs estimated the number of children positively affected on key measures, including:
- 7,551 CAMHS referrals avoided
- 11,174 MHST referrals avoided
- 18,895 SENCO referrals avoided
- 4,016 exclusions and suspensions avoided
Applying standard NHS, education and local authority unit costs to these estimates gives £62,993,093 in net cash-releasing benefit against £3,408,651 invested: a return of 18.5 times. At place level, separate analyses calculate returns of 46 times in Hampshire and the Isle of Wight and 14.4 times in Bradford.
Beyond referrals: attendance, attainment and inequalities
Mental health and education outcomes are closely linked. A child with a mental health problem is seven times more likely to miss 15 or more days of school, and the poorest 20% of children are four times more likely to face serious mental health difficulties by age 11.
Independent analyses of local authority data in Bury and Sefton found that schools delivering myHappymind improved faster than comparison schools, with the largest gains where deprivation and SEN were highest:
- in Bury’s most deprived communities, persistent absence fell 3.4 times faster in myHappymind schools
- in Bury’s schools with high levels of SEN, persistent absence fell 7.4 times faster
- in Sefton, attendance improved 2.1 times faster across myHappymind schools
These analyses show consistent associations rather than proof of cause. But for commissioners focused on health inequalities, including the Core20PLUS5 approach to the most deprived 20% of the population, a programme whose strongest results appear in the most deprived communities is worth attention. Because every child in a school takes part, it also avoids the gaps that open up when support depends on a referral, a diagnosis or a parent knowing how to ask for help.
What to look for when commissioning prevention
If you are considering a school-based prevention programme, six questions help separate the strongest options:
- Is it universal? Does it reach every child, or only those already identified?
- Is it delivered by school staff? Programmes taught by the adults children see every day do not depend on clinical capacity and can scale.
- What is the evidence? Look for independent evaluation and outcome data from places like yours.
- How will impact be measured? Ask what data you will receive, how often, and at what level.
- Does it join up with MHSTs and specialist services? A shared language between prevention and treatment helps children move between them.
- Does it reach families? Support that continues at home strengthens what happens in school.
Commissioning at place level
myHappymind is NHS-backed and commissioned by 50+ local authorities and NHS places across the UK, reaching over one million children, parents and staff. It is delivered digitally by school staff, with ready-to-teach lessons, staff CPD and a Parent App, so it can scale across a place without waiting on a specialist workforce.
If you are building the case for prevention in your area, our team can share place-level outcomes and talk through what commissioning could look like for you.
