Thirteen years is a long time. The long wait for fresh NHS data on the mental health of children and young people in England prompted much speculation. There were concerns that the new survey would show a significant increase in poor mental health, largely as a result of social media, which has grown wildly in popularity among young people since 2004.
While this appears not to have come to pass, the picture is far from rosy. Rates of disorders are still high – and they are on the up. We know that the prevalence data is likely to be the tip of the iceberg, afterall we’re looking at diagnosed illnesses. What about sub-threshold groups?
While by no means a new observation, the striking correlation between poverty and mental health problems cannot be ignored. While 6.8% of children and young people from the highest income households in England had a mental illness, the proportion is over twice as high (14.7%) for those in households with the lowest income. Surely this raises important questions about service design to make support as universally accessible as possible?
The observation that around ¼ of children and young people with mental health disorders do not access help is a further worry and we need to better understand the reasons for this. In any case, whilst parental engagement is important, we must extend our efforts to finding innovative ways to directly engage children and young people – on their terms, using their language.
The report showed that children with a mental disorder were more likely than those without one to have experienced adversity, including parental separation or financial crisis at home.
This is perhaps unsurprising to anyone who has worked within mental health services.
The notion that developmental trauma can impact mental health down the line is far from new; we welcome this area being the subject of research attention of late. While the shift towards asking ‘what happened?’ as opposed ‘what’s wrong?’ at the point of entry to services is a welcome one, we must also consider what support services are available to children at the time of the adversity, before any symptoms might emerge, and certainly before a diagnosis or even referral to services.
The report also shines a light on young women as a “high risk group” in relation to mental health, with rates of emotional mental disorder and self-harm being higher in this group than other demographic groups. Nearly a quarter (23.9%) of young women aged between 17 and 19 had a mental disorder – double that of young men.
Focusing on services to meet the needs of this cohort is essential to stem the increase in emotional mental disorders.
Disturbingly, nearly one in two of those in their late teens with mental health problems had self-harmed or attempted suicide. Again, are the right services in place? Is accessibility an issue? Are we paying enough attention to the role of trauma or are we too quick to dismiss self-harm as result of a fundamental personality flaw?
Do we know enough about what helps and, crucially, what doesn’t?
The Children’s Commissioner’s report, published on the same day as the NHS Prevalence Survey, showed that we are still turning too many young people away who have been referred to CAMHS. 37% were not accepted for treatment.
We welcome the Commissioner’s call for much greater investment in early help. Where are those young people who have tried but failed to access CAMHS going?
Are we listening enough to what children, young people and their parents tell us they need? Or do we tell them what they can have based on what is available?
On the subject of social media, evidence of a link to mental health remains unclear. After contributing to the Royal Society for Public Health (RSPH)-led All Party Parliamentary Group inquiry on this topic in the Summer, we expect to hear more on its conclusions in the coming weeks.
Until then, we know that children between the ages of 11 and 19 with mental health problems are more likely to use social media: nearly one in three were on social media for about four hours every day. Those who don’t have mental health problems were two to three times less likely to spend as much time on it. We eagerly await the RSPH’s findings on this issue.
Finally – and this is by no means an exhaustive summary – It’s also interesting (though not necessarily unexpected) to see that teachers are most commonly contacted by children with mental health illnesses. The recent green paper has highlighted the need for increased support for teachers and school-based staff. Let’s hope that this is sufficient and sustainable.
No doubt the depth and breadth of this report will prove invaluable as we strive to improve the support we offer our children and young people.
We support the need for an early intervention and prevention focus. We also believe more much research is required to not only answer the ‘what’ questions (what works and what doesn’t) but also the ‘how’ questions: how should services be delivered? We advocate a blend of traditional and innovative methodologies, through partnership working and with a strong focus on choice.
What this report has done, is confirm that this is a problem that is not going away anytime soon. Action is needed now to address the issues highlighted and resolve the mental health crisis we have been battling for too long.
Dr Lynne Green
Clinical Director, XenZone