More than 500 children a day in England are being referred to NHS mental health services for anxiety, more than double the rate of before the pandemic began, the Guardian can reveal. In 2023-24 there were 204,526 new referrals of patients aged 17 or under where the primary cause was anxiety, official figures show. In 2019-20, the year before Covid-19 struck, the total was 98,953. In 2016-17 it was 3,879. The alarming increase means children are now being referred to NHS mental health services in England for anxiety at a rate of one every three minutes or almost 4,000 a week. Doctors, NHS officials and health leaders said in interviews that the surge in anxiety referrals was “staggering” and “shocking” and laid bare an urgent need to tackle the crisis in children’s mental health. Officials said the rise in demand for care was straining the capacity of the health service to provide timely treatment for anxiety, with thousands of children on “unacceptably long” waiting lists. Delays to treatment risked causing further harm at a crucial stage of their development, they said. A Guardian investigation can also disclose that mental health leaders fear the figures may only be the tip of the iceberg because many children are not seeking help or are unable to do so, despite increasing awareness. NHS data does not record the reasons for referrals for anxiety, but experts surveyed by the Guardian cited a range of factors behind the rise in children experiencing the condition. They include intensifying academic pressures, particularly related to exams, the powerful influence of social media and cyberbullying, growing pressures around appearance, widening inequalities, rising poverty levels and the cost of living crisis. Experts said the pandemic had caused “significant disruption” to children’s lives and amplified all the other pressures they already faced. More than four years after Covid first hit, many children remain uncertain about the world around them and anxious about their future, the experts said. Andy Bell, the chief executive of the Centre for Mental Health, a charity, said: “These stark figures underline the urgency of addressing children and young people’s mental health today. In the last few years, especially since 2020, there has been a sharp rise in the numbers of children and young people reporting diagnosable levels of mental health difficulties, including anxiety.” Bell said the new data told only a part of the story. Many children affected were not seeking help despite rising awareness, he said, “so these figures are likely to be the tip of the iceberg”. Emma Paveley, an interim assistant director of the NHS Confederation’s mental health network, said: “These figures show a staggering rise in the number of children and young people being referred for anxiety treatment.” While some of the increase could be attributed to more data being submitted by NHS organisations or schools offering mental health support, Paveley said it was clear that prevalence in children had increased, “with a significant rise during the pandemic and following the cost of living crisis”. Doctors said that even with wider awareness and more ways to access help, there was no doubt more children were suffering from anxiety than ever before. “This data tallies with what GPs are reporting from the frontline: increasing numbers of children and young people presenting with symptoms of anxiety and other related mental health conditions,” said Dr Victoria Tzortziou Brown, a vice-chair of the Royal College of GPs. Dr Elaine Lockhart, the chair of the Royal College of Psychiatrists’ child and adolescent faculty, said doctors in England had seen first-hand “a dramatic rise in the number of children and young people experiencing anxiety” in recent years. Bell said there were likely to be several contributing factors. “Our research indicates that academic pressures, particularly those related to exams, have intensified in the last decade. Rising levels of poverty and inequality have also contributed to increased anxiety among children and young people, including factors such as financial stress within households and the impact of racism. Evidence also suggests that online harms, such as cyberbullying and pressures around appearance, are relentless and can fuel anxiety in children. “The pandemic has amplified these pressures on children and young people by disrupting their routines and increasing feelings of isolation and uncertainty about the world and their futures.” With more children being referred for anxiety, many face long waits for support, Bell said. Paveley said some children were “having to wait far too long” to start treatment. “Our members also tell us that demand for care is outstripping their capacity to provide treatment, which is a big concern.” Lockhart said mental health services were struggling to manage rising demand for anxiety, with many children on “unacceptably long” waiting lists. “This can cause further harm at a crucial time in their lives and result in them developing more entrenched difficulties which take longer to treat,” she said. Tzortziou Brown said ministers should urgently address the long waiting lists for anxiety. Bell called for a comprehensive long-term plan to tackle the underlying causes of the deterioration in children’s mental health. Claire Murdoch, NHS England’s national mental health director, said mental health services were experiencing record demand due to children facing “unprecedented pressures”. “The NHS is expanding services to treat more children and young people than ever before, including rolling out hundreds of mental health teams in schools,” she said. Any parents or guardians concerned about their child’s mental health should explore the Every Mind Matters website for advice, or seek help via their GP or local mental health service, she added. The Department of Health and Social Care said it planned to provide specialist mental health support in every school and walk-in mental health hubs in every community. “It is unacceptable that too many children and young people are not receiving the care they deserve, and we know that waits for services are far too long,” a spokesperson added. “We are determined to change that.” In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978