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.