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Dear Editor,
The Institute of Health Promotion and Education (IHPE) fully agrees with the Centre for Mental Health report findings that the Government should invest in children and young people by training and employing more health visitors and school nurses.(1) Mental health is a critical issue for babies, children and young people, and investing in evidence-based interventions, such as those highlighted in the report, will have major impacts.
Over recent years public health grants have been dramatically reduced and this has led to a disinvestment in school nursing and health visiting services. In 2010 there were approximately 3000 FTE school nurses in the UK. Current estimates suggest there are now significantly less than 1000 FTE.(2) There is also an estimated national shortage of 5,000 health visitors in England.(3)
Presently, there is considerable variation in delivery of services across the country and, in some areas, this has impeded the delivery of the Healthy Child Programme and the ability to focus on key public health priorities including mental health.(4)
The Centre for Mental Health report clearly identifies the many different factors that can influence the mental health of children and young people including:
• social,
• psychological,
• biological,
• financial,
• environmental, and
• structural.(5)
Action to promote mental health and prevent mental health difficulties is needed in each of these dimensions, and health visitors and school nurses have vital roles to play.(6,7)
Health visitors play a crucial role in promoting mental health for families with young children by providing care, education, and timely referrals to specialist mental health services.(6) They can identify families at risk of perinatal mental illness and provide support for family relationships.
All families throughout the country should have access to a health visiting service that works with them from pregnancy to a child reaching the age of five. However, the cuts to the public health budget have been incredibly damaging. For example, many health visitors find themselves firefighting instead of working much further upstream, helping stop problems developing in the first place or preventing them getting worse.(4)
Promoting and protecting children’s mental health is a central role of school nurses, impacting strongly on overall health and educational attainment.(7) This relationship works both ways, as general health and improved access to education are closely linked to improvements in mental health.
Issues to which school nurses can contribute include life skills, bullying, and risks associated with substance use; working alongside PSHE leads, senior leadership teams and parents in support of thriving, inclusive school communities.(7) Within life skills nurses may include communication, consent, handling peer pressure, prejudice, use of social media, being safe (e.g. online) and where to receive support. This is why the IHPE strongly recommends that there should be a school nurse for every secondary school and cluster of primary schools.(8)
Over recent years the mental health of young people has achieved considerable media coverage. However, adequate finances and evidence-based interventions have yet to follow this rhetoric. We agree with recommendations for a ‘whole education’ approach, closely linking health and education policies.
Crucially, if the Government takes urgent action to rebuild and strengthen the health visiting and school nursing workforce, we believe that there would be considerable impacts on the mental health of children and young people.
References
1) Iacobucci G. Charity calls for more health visitors and school nurses to tackle rise in child mental ill health BMJ 2025; 389:r710 doi:10.1136/bmj.r710. https://www.bmj.com/content/389/bmj.r710.full
Children’s mental health - pivotal roles for health visitors and school nurses.
Dear Editor,
The Institute of Health Promotion and Education (IHPE) fully agrees with the Centre for Mental Health report findings that the Government should invest in children and young people by training and employing more health visitors and school nurses.(1) Mental health is a critical issue for babies, children and young people, and investing in evidence-based interventions, such as those highlighted in the report, will have major impacts.
Over recent years public health grants have been dramatically reduced and this has led to a disinvestment in school nursing and health visiting services. In 2010 there were approximately 3000 FTE school nurses in the UK. Current estimates suggest there are now significantly less than 1000 FTE.(2) There is also an estimated national shortage of 5,000 health visitors in England.(3)
Presently, there is considerable variation in delivery of services across the country and, in some areas, this has impeded the delivery of the Healthy Child Programme and the ability to focus on key public health priorities including mental health.(4)
The Centre for Mental Health report clearly identifies the many different factors that can influence the mental health of children and young people including:
• social,
• psychological,
• biological,
• financial,
• environmental, and
• structural.(5)
Action to promote mental health and prevent mental health difficulties is needed in each of these dimensions, and health visitors and school nurses have vital roles to play.(6,7)
Health visitors play a crucial role in promoting mental health for families with young children by providing care, education, and timely referrals to specialist mental health services.(6) They can identify families at risk of perinatal mental illness and provide support for family relationships.
All families throughout the country should have access to a health visiting service that works with them from pregnancy to a child reaching the age of five. However, the cuts to the public health budget have been incredibly damaging. For example, many health visitors find themselves firefighting instead of working much further upstream, helping stop problems developing in the first place or preventing them getting worse.(4)
Promoting and protecting children’s mental health is a central role of school nurses, impacting strongly on overall health and educational attainment.(7) This relationship works both ways, as general health and improved access to education are closely linked to improvements in mental health.
Issues to which school nurses can contribute include life skills, bullying, and risks associated with substance use; working alongside PSHE leads, senior leadership teams and parents in support of thriving, inclusive school communities.(7) Within life skills nurses may include communication, consent, handling peer pressure, prejudice, use of social media, being safe (e.g. online) and where to receive support. This is why the IHPE strongly recommends that there should be a school nurse for every secondary school and cluster of primary schools.(8)
Over recent years the mental health of young people has achieved considerable media coverage. However, adequate finances and evidence-based interventions have yet to follow this rhetoric. We agree with recommendations for a ‘whole education’ approach, closely linking health and education policies.
Crucially, if the Government takes urgent action to rebuild and strengthen the health visiting and school nursing workforce, we believe that there would be considerable impacts on the mental health of children and young people.
References
1) Iacobucci G. Charity calls for more health visitors and school nurses to tackle rise in child mental ill health BMJ 2025; 389:r710 doi:10.1136/bmj.r710.
https://www.bmj.com/content/389/bmj.r710.full
2) Watson M C, Neil K E and Tilford S. IHPE Position Statement: School Nursing. Altrincham: Institute of Health Promotion and Education, 2024.
https://ihpe.org.uk/wp-content/uploads/2024/07/IHPE-Position-Statement-S...
3) Conti, G and Dow, A. Using FOI data to assess the state of Health Visiting Services in England before and during COVID-19. London: UCL, 2021.
https://discovery.ucl.ac.uk/id/eprint/10132710/#:~:text=There%20was%20al...
4) IHV. State of Health Visiting, UK survey report. From disparity to opportunity:
The case for rebuilding health visiting. London: IHV, 2025.
https://ihv.org.uk/our-work/publications-reports/
5) Centre for Mental Health. Invest in childhood: priorities for preventing mental ill health among children and young people. 8 April 2025.
https://www.centreformentalhealth.org.uk/wp-content/uploads/2025/04/Cent...
6) Morton A. The role of the health visitor: where are we now? Paediatr Child Health 2024;34(7):234–8.
https://www.sciencedirect.com/science/article/abs/pii/S1751722224000568
7) Sutton S, White S. The role of the school nurse in the UK: where are we now? Paediatr Child Health 2024;34(3):99–103.
https://www.sciencedirect.com/science/article/abs/pii/S1751722223002135
8) Watson M, Neil K. Positive health promotion: the Ottawa Charter approach. Perspectives in Public Health. 2025;145(1):11-13.
doi:10.1177/17579139241266174.
https://journals.sagepub.com/doi/10.1177/17579139241266174
Competing interests: No competing interests