This report describes the findings of phase two of a review of quality and access across the system of mental health services for children and young people. Drawing on evidence gathered through fieldwork in 10 areas of England, it describes what makes it easier and what makes it harder for local systems to make sure that children and young people have timely access to high-quality mental health care. The fieldwork gathered the views of children, young people, families, and staff, reviewed local policies and plans, and tracked how individual children and young people moved through the system. It looked at three main areas: people’s experience of and involvement in care; access to high-quality care; and identifying and responding to mental health needs. The review identified examples good or innovative practice in each of the 10 areas visited. However, it also found that the current system is complex and disjointed. It found that: commissioners and service planners do not always collaborate to identify the needs of local people and plan services; services and teams do not always take a joined-up approach to planning and providing care; and that different parts of the system are regulated by different agencies and departments. In relation to services, the review found that services are under pressure, with long waiting lists and high eligibility criteria making it harder for children and young people to access the right support at the right time. The final chapter makes recommendations for national, regional and local action.