For the first time WHO Regional Office for Europe brings together all of data available at the Regional level on child and youth mental health. One in seven children and adolescents aged 0–19 years old lives with a mental health condition, and this number is increasing over time. Females are particularly affected with one in four females aged 15–19 years old living with a mental health condition. Suicide is the leading cause of death for young people aged 15–29 years old, and males are three times as likely to die by suicide. Everyday environments such as schools and online spaces are not adequately supporting the mental health of children and young people (CAY). One in five countries lack policies to support CAY mental health. Community CAY mental health services are lacking in one in four countries, and the mental health treatment received by CAY varies greatly across the Region. There is a clear need for action to better support the mental health of CAY. Previous recommendations are confirmed, and nine actions are proposed to strengthen and standardize the quality of care for CAY living with mental health conditions across the Region. 

P. 5 This landmark report brings together, for the first time, comprehensive data and evidence on the mental health of children and youth across 53 Member States. It documents not only the growing burden of mental and substance-use conditions but also the gaps in response. It is deeply concerning that one in five countries lack policies or plans for child and adolescent mental health, and services remain concentrated in hospitals rather than in communities where young people live, learn and play.  Going forward, we need to work together to strengthen the quality of care for child and youth mental health. This includes ensuring a ‘mental health in all policies’ approach to include mental health across education, social welfare and law enforcement governance, strengthening data collection and research, and better supporting the capacity of our front line workers to deliver high-quality care for this population. 

P.11 The mental health of children and young people (CAY) is worsening over time. Over 30 million – approximately one in seven – children and adolescents aged 0–19 years old are living with a mental health condition across the Region. The impact is so high that mental health and substance use conditions are the leading cause of disease burden for those aged 0–29 years. Prevalence increases with age, with over one in five (22%) of adolescents aged 15–19 years old living with a mental health condition. Females are more impacted than males, and one in four females aged 15–19 years old lives with a mental health condition. The prevalence of mental health conditions in CAY aged 0–19 years old has increased by one third (34%) since 2010, and the prevalence of CAY living with anxiety conditions has almost doubled in this time (increased by 86.66% since 2010). Data on adolescent mental health and well-being shows a decline since 2018 with females, those from low socioeconomic backgrounds and older adolescents being more likely to report negative outcomes. One third of adolescents report experiencing nervousness, irritability and difficulties getting to sleep, and one in four reported feeling low. Suicide is a major public health concern. It is a leading cause of death across all age groups and the leading cause of death for young people aged 15–29 years old. For CAY under 30 years old, males are three times more likely to die by suicide than females. Positively, suicide rates have decreased since the year 2000. Potential emerging issues for adolescent mental health and well-being include online behaviours and changing substance use behaviours. An increase in problematic gaming and problematic social media has been observed since 2018 with one in ten reporting these behaviours, and a rise in adolescents using e-cigarettes or “vaping” has been seen. Alcohol is the most used substance amongst adolescents, followed by e-cigarettes. 

P.19 The results were divided into eight themes as follows and are discussed in more detail throughout the report. Theme 1 - 1. CAYMH and substance use conditions Epidemiological data and estimates on CAYMH and neurodevelopmental and substance use conditions provides information about population trends and demand for CAYMH services across the Region. 

P.21 Substance use conditions affect less than one in 100 children and adolescents aged 0–19 years old Over 1.7 million children and adolescents (0.79% of the population) aged 0–19 years are living with a substance use condition across the Region (Table 3: Point prevalence (cases at any given point in the year) of substance use in children and adolescents aged 0–19 years across the Region)

P.27 Table 9. Percentage of children and adolescents living with substance use conditions by age groups.

P.31 Females are more at risk of problematic social media use and males are more at risk of problematic gaming Females reported higher levels of continuous online contact and problematic social media use than males (23). More males were at risk of problematic gaming than females (23), with this being most frequently reported by 11-year-olds (14%) (23).

Problematic social media use was most recorded among 13-year-olds (23). Alcohol is the most used substance, followed by e-cigarettes or “vaping” More adolescents reported having used alcohol (35%) at least once when compared to e-cigarettes (18%), cigarettes (13%) and cannabis (12%) (22).

Substance use increased with age, and the type of substance use varied depending on socioeconomic status More males than females reported substance use at age 11, and this gender gap narrowed or disappeared from age 13 (22). Use of substances increased sharply with age (22). Adolescents from low-affluence families showed a higher prevalence of cigarette smoking, while e-cigarettes and alcohol use were more prevalent among high-affluence adolescents (22).

There have been mixed trends in the use of substances over time From 2018 to 2022, an overall increase in alcohol use was observed among older females, as was a decrease in alcohol use among 15-year-old males (22). Smoking decreased between 2018 and 2022 for 15-year-old males (22).