Working to facilitate early mental health support for young people

Unmet need in mental health care for children and adolescents

Alarming statistics from the Mental Health Foundation indicate that there is clearly an unmet need in the provision of childhood mental health care and that mental health issues among children and adolescents are becoming increasingly common ^[1].

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During the last 5 years, the number of hospital admissions for self-harm has risen by 93% among girls and by 45% among boys aged 10 to 14 ^[2]. It has been estimated that around 10% of all 5‑16 year-olds in the UK are affected by some kind of mental health problem ^[3].

While a range of mental health disorders, such as ADHD, autism, anorexia nervosa, bipolar disorder, schizophrenia and panic disorder have been shown to have increased risk recurrence ratios within families ^[4], there is also a strong body of evidence showing the negative effects of various traumas to childhood mental health ^[5].

It is often thought that a child is coping well because they do not complain, however they may be struggling and feeling alone. The risk of childhood anxieties has increased with the popularisation of social media and constant exposure to the wider world via the internet. Peer-pressure, bullying, social isolation and self-image concerns are all risk factors for mental illness.

Research has shown that half of all lifetime cases of mental illness begin by age 14 ^[6] with many mental illness diagnoses in adulthood stemming from the undiagnosed sources in the patient's childhood, when the early signs were not adequately addressed ^[7,8]. It is important that we now work to facilitate the early recognition of mental health problems and initiate appropriate interventions as early as possible.

Furthermore, children with mental health problems may show lower performance at school, be more likely to have suicidal thoughts, and be less likely to have a stable lifestyle than their peers with no mental health problems. ^[5]

Currently, the proportion of children and young people with mental health issues who do not receive the necessary support at a sufficiently early age is estimated to be as high as 70% ^[1]. In the UK, around 200,000 young people are referred for specialist mental health services every year ^[2], yet it was reported in 2015 that around a fifth of the children referred for mental health support did not receive the help they needed ^[9].

The costs to the National Health Service (NHS), as a result of poor mental health, have been estimated to be £105 billion a year in England alone ^[9]. Although it is known that mental health interventions are most successful when started early, only 6% of the total mental health budget is spent on services for children and young people ^[2], despite them representing almost a quarter of the total population.

Initiatives to prevent childhood mental health problems

Provision of effective mental health support in childhood can prevent mental health issues escalating into serious problems in adulthood ^[10]. Mental health issues can seriously impair an individual's educational potential, self-worth and social interactions, all of which can negatively impact the path they follow to adulthood.

A specialist division of the NHS, Child and Adolescent Mental Health Services (CAMHS), offers assessment and treatment of children and young people with emotional, behavioural or mental health difficulties. Unfortunately, this service has not been able to sustain growth in line with the increasing demand for mental health support ^[2]. Consequently, children referred to benefit from their services are having to wait a long time for an appointment.

The University of Derby Online Learning has developed a Continuing Professional Development (CPD) online course ‘Child and Adolescent Mental Health’, which starts again on June 26^th, to help professionals and carers support children suffering with mental health problems receive valuable support while they are waiting for expert intervention ^[11].

The CAMHS course explores some of the key mental health issues that children may experience, including depression, anxiety, self-harm, autistic spectrum disorder and attention-deficit hyperactivity disorder.

The course is designed for people who work with children and young people, yet do not have expertise in child and adolescent mental health. CAMHS offers the opportunity to learn about child and adolescent mental health issues and how they impact the young person and their family.

Furthermore, the course will provide guidance on how to identify children at risk; enable participants to recognise the signs of a mental health issue developing; and detail effective strategies for working with children who are presenting with a mental health issue and providing them with low-level support.

Additional initiatives are also being introduced nationally, based on the success of interventions developed to reduce the risk of mental illness among children ^{[12, 13]}, preventative mental health programmes are to be introduced to 100 primary schools and 50 secondary schools across the UK.

The initiative aims to address risk factors for mental health problems and develop protective strategies. Trained instructors will use a classroom format to explain mental health to teenagers and teach them how to combat anxiety and suicidal thoughts. Younger children will be encouraged not to dwell on disturbing thoughts and receive lessons on happiness and mindfulness.

It is hoped that such initiatives represent the start of a brighter future for children suffering from mental health issues, and that this will translate into benefits for society as a whole.

References

1. Mental Health Foundation (2017). Available at: https://www.mentalhealth.org.uk/
2. The Children's Society (2015). A teenager’s pathway through the mental health system. Available at: https://www.childrenssociety.org.uk/
3. Green h, McGinnity A, Meltzer h et al. (2005) Mental Health of Children and Young People in Great Britain, 2004. Basingstoke: Palgrave Macmillan
4. NIMH (1997). Genetics and Mental Disorders: Report of the National Institute of Mental Health’s Genetics Workgroup. Available at: https://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/genetics-and-mental-disorders-report-of-the-national-institute-of-mental-healths-genetics-workgroup.shtml
5. NIMH (2015). Helping Children and Adolescents Cope with Violence and Disasters: What Parents Can Do. Available at: https://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasters-parents/index.shtml  
6. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27.
7. Murphy M and Fonagy P (2012). Mental health problems in children and young people. In: Annual Report of the Chief Medical Officer 2012. London: Department of Health.
8. Jones P (2013). Adult mental health disorders and their age at onset. Br J Psychiatry 2013;202(s54):s5–s10.
9. NSPCC (2016) It’s time: campaign report. London: NSPCC. Available at: https://www.nspcc.org.uk/
10. NSPCC (2016). How safe are our children? Available at: https://www.nspcc.org.uk/globalassets/documents/research-reports/how-safe-children-2016-report.pdf
11. University of Derby Child and Adolescent Mental Health Course (2017). Available at: https://www.derby.ac.uk/short-courses-cpd/online/child-and-adolescent-mental-health/
12. Das JK, Salam RA, Lassi ZS, et al. Interventions for Adolescent Mental Health: An Overview of Systematic Reviews. The Journal of Adolescent Health. 2016;59(4 Suppl):S49‑S60.
13. Mendelson T, Tandon SD, et al. Prevention of Depression in Childhood and Adolescence. Child Adolesc Psychiatr Clin N Am. 2016;25(2):201‑218.

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