Mental health and school absences

Absence from school has become a pressing issue in the UK, particularly since the pandemic. Persistent absence, defined as missing 10% or more of school sessions, has risen sharply, with rates remaining well above pre-Covid levels. While illness continues to play a role, wider factors such as anxiety, mental health challenges and disengagement from learning since lockdowns have also contributed. This trend is raising concerns about the long-term impact on attainment, wellbeing and social development, and has become a priority issue for schools, local authorities and government.

We are also seeing a rise in children experiencing poor mental health, with a 50% increase in the last 3 years, and one in six of those aged 5 to 16 are likely to have a mental health problem. It is important we start to understand the multi-faceted drivers of this increase.

• Absences from school contribute significantly to children experiencing mental health issues (measured as hospital attendance with a mental health condition diagnosis or stress-related presentation)
• The probability of a child experiencing mental ill health rises from 1.82% with no absence to 3.7% with 20% absence, and to 5.27% with 30% absence
• The impact is greater for children with special educational needs and disabilities (SEND) support, chronic health conditions, or an Education, Health and Care (EHC) plan
• The relationship is two-way: children with a mental health condition miss almost three times more school (16% of sessions) than those without (6%)
• Having some forms of additional school support — such as EHC plans, specific SEND provision and eligibility for free school meals — appears to be associated with a lower increase in absence among pupils experiencing mental ill health

Research 

Despite improvements in academic outcomes, England's children rank lowest in Europe for wellbeing, according to PISA (Programme for International Student Assessment) data, collected by the Organisation for Economic Co-operation and Development (OECD). Mental health disorders now account for a staggering 45 percent of the overall disease burden for 10 to 24-year-olds, with suicide tragically emerging as the second leading cause of death. Despite the crucial role that schools play in safeguarding children’s wellbeing, school absence rates have risen since COVID-19 pandemic. Whilst before COVID-19 the overall absence rate was 4.7%, this jumped to 7.6% in 2021/22 and by 2022/23 had only come down slightly to 7.4% (Department for Education 2025).

Children’s lives are shaped by multiple, interconnected environments- home, school and community. A more holistic approach is needed to explore how such influences interact with each other to influence children’s mental health. We have created a novel data infrastructure that allows for a richer, more complex understanding of how child mental ill health affects their school absences and the other way around, accounting for wider socio-economic and intergenerational factors, which has previously not been possible.

To account for a wide array of drivers of child mental ill health and their interplay, we have linked a child’s educational (National Pupil Database) and health records (NHS hospital records) to the health records and sociodemographic characteristics of their parents (using Census 2021, NHS Talking Therapies and hospital records), as well as contextual factors (Ordnance survey data and Indices of Multiple Deprivation) in England.

This holistic population-wide causal analysis of the bi-directional relationship between mental health and school absences accounts for the influences of education settings as well as contextual factors and wider socio-economic determinants. We find that absence from school can have a detrimental effect on child mental health, while mental health issues further impede school attendance. The bi-directional relationship is further exacerbated by various vulnerabilities. However, the effect of mental ill health on school absences is lessened for children with certain types of SEND support, indicating the important role that schools play in safeguarding children’s wellbeing.

Our econometric analysis reveals the following results:

• For children aged 5 to 16 years living in two-parent households in England, absences from school significantly contribute to experiencing mental ill health.
• The probability of presenting at hospital with mental health issues more than doubles (increases from 1.82% to 3.77%), when absences increase from 0% to 20%, and nearly triples (increases to 5.27%) at 30% absence.
• The effect of school absences on child mental ill health is amplified if the child has other vulnerabilities, for example, a chronic physical health condition, an Education, Health and Care (EHC) plan or any type of special educational needs and disability (SEND) support, or are eligible for free school meals.
• The effect is two-way, with child mental ill health also increasing a child's absence from school.
• The predicted level of absence is nearly three times as great for children who present at hospital with mental health issues (16% of total sessions in the year) compared with children who do not (6%).

While having SEND support, an EHC plan, a chronic physical health condition, or being eligible for free school meals, is associated with a higher level of absence from school, the increase for those experiencing mental ill health is lessened for children with certain forms of SEND support or other vulnerabilities.

Policy recommendations 

Our research provides further evidence that:

• if we are to improve school attendance, we need to address the increase in mental ill health amongst children;
• schools play an important role in children’s mental health, providing not only opportunities for learning, but also socialisation, peer support, structure, belonging and purpose; research into what interventions improve and support children’s mental health, which could potentially be provided through schools, is needed and should be a focus;
• children should be supported to attend school as higher levels of attendance generally have a positive impact on mental health; however, it must be recognised that this national level analysis does not allow for individual circumstances and further research would be beneficial to understand the mechanisms influencing this relationship;
• identification of those children who need additional support is important, as our research indicates the negative impact of mental health on school attendance is reduced where support is in place for certain types of SEND support. More research is needed on how to coordinate such support and reach every child who needs it.