The latest figures on children attending A&E with mental health concerns are deeply alarming. A 36% rise in attendances, alongside a six-fold increase in the number of children waiting more than 72 hours, demands we ask why so many children reach crisis point before they can access the support they need? 

The answer cannot simply be to create more capacity in emergency departments. A&E has an essential role to play when a child is in immediate danger, but it is the most expensive and least therapeutic setting in which to provide ongoing psychological support. An emergency department is designed to respond to crisis. It should not become the place where children first encounter mental health services. 

No child should have to wait three days in an emergency department for mental health support. Yet when community-based services are unavailable or difficult to access, that becomes increasingly predictable. By the time a child reaches A&E, problems that might have been addressed months or even years earlier may have escalated to the point where urgent intervention is unavoidable. 

This is why we need to look at the stages passed before reaching A&E. 

Early intervention is not simply about responding more quickly when a child develops a mental health difficulty. It means ensuring that children and families can access appropriate, evidence-based support before problems become entrenched or reach crisis point. 

Schools and community settings have an important role to play here. They are places where difficulties can be identified earlier and where support could be delivered in more familiar and less intimidating environments than a hospital emergency department. 

But early intervention only works if there is a workforce with the right skills to deliver it. Expanding access to mental health support must therefore go hand in hand with investment in training, supervision and professional standards. Children and families deserve interventions that are grounded in evidence and delivered by practitioners who are properly trained and accredited. 

 Cognitive behavioural therapies, (CBT), for example, are evidence-based psychological therapies that can help children and young people develop practical strategies for managing difficulties such as anxiety and low mood.

The important point is not that CBT is the answer to every mental health problem, but that children should have timely access to appropriate evidence-based psychological therapies as part of a wider system of support. 

The Government's Mental Health Strategy and the Children and Young People's Mental Health inquiry being carried out jointly by the Education and Health & Social Care Committees provide an opportunity to consider what that system should look like. The forthcoming review into ADHD and autism services is another. Both need to look beyond individual services and consider the entire pathway around children and young people – by that I mean identification, assessment, early intervention, psychological support and, where necessary, crisis care. 

We should also be wary of measuring progress simply by asking whether we have increased crisis capacity. Emergency services need sufficient resources to respond when children are in acute psychological distress. But if increasing numbers of children are reaching emergency departments because they could not access appropriate help earlier, increasing capacity at the point of crisis risks treating the symptom rather than the cause. 

The ambition should be different. We should be asking how effectively our mental health system prevents children from reaching crisis in the first place. Do they receive adequate support early on? Are they accessing the NICE-recommended evidence-based treatments for their conditions or issues? Are there any other barriers or challenges that are impacting their mental health such as family issues?  

There is a story behind every child who arrives at A&E in mental health crisis. Sometimes an emergency response will be unavoidable. But when a child has been struggling for months without timely access to evidence-based support we should ask whether the system reached them early enough. 

Children should not have to become emergencies before they become priorities. If we want to reduce pressure on A&E and improve outcomes for children, we need to invest in the services that can reach them earlier. That should be in schools, in communities and wherever children and families can access support before crisis becomes the only remaining option.