Young People and Mental Health

The other topic reports in this series include 5 to 10 year olds and refer to ‘children’. This report mostly focuses on 11 to 19 year olds, and therefore also uses the term ‘young people’. The term ‘mental disorder’ is used, although we are sensitive to the negative connotations this word can have. It is used because the survey did not just screen for general mental health problems, but applied operationalised diagnostic criteria for specific disorders (see the Survey Design and Methods Report for detail). This report focuses on older children and young people, which has implications for the number of cases available for analysis. The base size for the hyperactivity disorders and/or less common disorder groups falls below 50 cases for some analyses, and so some of these disorders have been combined to form a ‘neurodevelopmental

and preventive interventions, with the aim of targeting symptoms prior to the development of more serious mental health conditions. The physical presence of these hubs in the community aid in the establishment of a local dialogue; centers frequently engage with local sports clubs, schools, universities, and private businesses to enhance educational opportunities and fundraising. This priority of bolstering the knowledge of youth mental health is a key factor and central to the headspace model; this recognition and destigmatization of a mental health service further enhances the accessibility of the headspace services and generates a safe and attrac- tive environment for young people to approach. For young people to access the services offered by headspace, they need to know about them, 77 making the community outreach and

There were a total of 30,409 new registrations in 2016-17. Figure 3.5 illustrates the use of the Kooth online service by hour of the day and day of the week. It shows that the service is busiest in the after-school period. It also shows that young people are using the service when in school and late into the night, including after 10pm when the structured counselling element is not available. 69.1 per cent of total log-ins occurred outside of the traditional working week (9am to 5pm Monday to Friday). This indicates that young people are more likely to want to access mental health support outside of traditional clinic opening hours, which poses challenges for the way in which child and adolescent mental health services are currently structured.

The Mental Health of Children and Young People (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, young people and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer Assisted Self Interview (CASI), between January and October 2017. A short paper or online questionnaire was completed by a nominated teacher for children aged 5 to 16 years old. Data collection varied with the selected child’s age:

This survey has found that one in twenty children and young people experienced two or more mental disorders. Classification systems such as ICD-10 (used in this report) consider mental disorders to be self-contained and distinct from each other. However, mental disorders are complex combinations of psychological problems which often have overlapping characteristics with individuals experiencing one mental disorder having substantially increased odds of having another mental disorder (Clark et al., 2017). Additionally, each disorder does not have its own clear-cut cause, instead mental health issues generally occur as a result of interactions between multiple biological, behavioural, psychosocial and cultural factors (Clark et al., 2017). The importance of considering the associations between co-occurring mental disorders can be seen in the finding that nearly three quarters of children with a hyperactivity disorder in this survey had two or more disorders. This compared to about half of children with emotional, behavioural or less common disorders having two or more disorders. Previous research into this area has also shown that children with a hyperactivity disorder 4 often have a comorbid mental disorder (Larson et al.,

The Mental Health of Children and Young People (MHCYP) surveywas previously conducted with 5 to 15 year olds in 1999 and 5 to 16 year olds in 2004, who were living in Britain and sampled from Child Benefit records. For the 2017 survey, a stratified multistage random probability sample of children was drawn from the NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP.

There are numerous barriers to young people receiving the support they need with regard to mental health problems. These include bureaucratic referral procedures, long waiting lists to attend statutory services and liaison between CAMHS and adult mental health services (Wilson, 2001). Pressures on time and resources mean that workers often have to deal with presenting problems rather than underlying causes (Grenier, 1996). Geographic boundaries and the ad hoc availability of services can present difficulties in the treatment of people living in temporary accommodation or on the streets. Services may also be provided some distance from place of residence, necessitating clear communication channels between authorities and recognition of respective responsibilities (Hargreaves, 1999). Floating support could play a part here, as it is able to meet changing needs by continual adaptation. By moving location when the young person moves, the abrupt withdrawal of services and all the problems that ensue can be avoided (Fitzpatrick, 2000).

Parents of 5 to 16 year olds and young people aged 17 to 19 were asked whether they had been in contact with any professional services (from a list of examples) or informal sources of support in the past year because of worries about the child or young person’s mental health. Professional services included contact with a mental health specialist, GP or teachers. Informal sources of support included family and friends, the internet or self-help groups. Specialist service records were not examined in this survey. Note that while the wording of the question establishes that contact with services or support took place, the nature or extent of that contact was not established. In theory, contact could have involved a single interaction.

The Mental Health of Children and Young People (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, young people and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer

The Mental Health of Children and Young People (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, young people and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer Assisted Self Interview (CASI), between January and October 2017. A short paper or online questionnaire was completed by a nominated teacher for children aged 5 to 16 years old. Data collection varied with the selected child’s age:

The Mental Health of Children and Young People (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, young people and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer

understanding of the personal challenges and needs of professionals: limited flexibility and time in their work resulting in a failure to fulfil the demands of young pa- tients, insufficient interprofessional exchange and collab- oration, and the experience of a diffuse responsibility and lack of clarity in the patient-professional-dyad as well as in the system during the transition process. Closer cooperation between CAMHS and AMHS professionals is needed. Barriers to communication and misunderstand- ings could be overcome through joint, interdisciplinary work in case conferences or quality circles. Advanced training programs could strengthen professionals’ capacity for engaging young patients in care, help qualifying clini- cians in these specialist fields and develop new standards for a smooth workflow. Such training should take the de- velopmental and clinical characteristics of the transition from adolescence to adulthood, diagnostic skills, special arrangements for care provision, and communicative and relationship issues with young people into account. Spe- cialized curricula and training should be systematically de- veloped, evaluated and implemented by research projects. These steps could overcome some of the barriers ad- dressed in the discussions. In view of the clinicians ’ im- pression that young patients and their families assume too little responsibility in the process of care and recovery, the importance of active patient (and carer) participation in treatment should proactively be addressed by mental health professionals.

While school nurses are well placed for primary care level mental health work with young people and while the literature details some efforts to develop, quantify and evaluate this aspect of their role, there are also indications that there may be difficulties engaging school nurses in such work – not necessarily through a lack of willingness but through a lack of confidence or limited relevant training (Leighton et al. 2003, DeBell 2006, NISHYP 2006, Wilson et al. 2008). Pressures on time and the demands of other important public health issues like sexual health and healthy eating may also be obstacles (Ball 2009). The aim of this study was therefore to explore the views of school nurses regarding mental health problems in young people and their potential for engaging in mental health work with this client group.

Community-based mental health services for children and young people (CYP) can offer alternatives to inpatient settings and treat CYP in less restrictive environments. However, there has been limited implementation of such alternative models, and their efficacy is still inconclusive. Notably, little is known of the experiences of CYP and their parents with these alterna- tive models and their level of satisfaction with the care provided. Therefore, the main aim of this review was to understand those experiences of the accessibility of alternative models to inpatient care, as well as overall CYP/parental satisfaction. A searching strategy of peer-reviewed articles was conducted from January 1990 to December 2018, with updated searches conducted in June 2019. The initial search resulted in 495 articles, of which 19 were included in this review. A narrative synthesis grouped the studies according to emerging themes: alternative models, tele-psychiatry and interventions applied to crisis, and experiences and satisfaction with crisis provision. The identified articles highlighted increased satisfaction in CYP with alternative models in comparison with care as usual. However, the parental experiential data identified high levels of parental burden and a range of complex emotional reactions associated with engagement with crisis services. Furthermore, we identified a number of interventions, telepsychiatric and mobile solutions that may be effective when applied to urgent and emergency care for CYP experiencing a mental health crisis. Lastly, both parental and CYP experiences highlighted a number of perceived barriers associated with help-seeking from crisis services.

charities, academics, educators, the public and the media. Uses of the data include: informing and monitoring policy; monitoring the prevalence of health or illness and changes in health or health related behaviours in children and young people; informing the planning of services for this age group; and writing media articles. Universities, charities and the commercial sector use the data for health and social research. User needs have been gathered and considered at all points in the collection and publication of this information. This has been guided by a steering group consisting of representatives from NHS Digital, DHSC, PHE, DfE, NHS England, Anna Freud National Centre for Children and Families, academic leads in Child and Adolescent Mental Health, and academic leads in Contemporary Psychoanalysis and

The survey benefited from an expert steering group, we would like to thank Miranda Wolpert, Peter Fonagy, Catherine Newsome, Lucy Heyes, Helen Duncan, Jessica Sharp, David Lockwood, Jeremy Clark, Alexandra Lazaro, and Nilum Patel. NHS Digital commissioned the survey series with funding from the Department of Health and Social Care. We are particularly grateful to Dan Collinson, Alison Neave, Steven Webster, Jane Town, Ben Osborne and Kate Croft for their thoughtful

This section of the interview is about the child’s level of activity and concentration over the last 6 months. Nearly all young people are overactive or lose concentration at times, but what we would like to know is how the child compares with other young people of their own age. We are interested in how they are usually – not on the occasional 'off day'.

Productive interviews (involving one or more participants in each household) were achieved for 9,117 children (1,463 2 to 4 year olds; 3,597 5 to 10 year olds; 3,121 11 to 16 year olds; 936 17 to 19 year olds), and 3,595 teachers (54% of eligible children). The survey included the detailed and comprehensive Development and Well-Being Assessment (DAWBA). This allowed the assessment of emotional, hyperactivity, behavioural and less common disorders, like autism. After interviews were complete, eleven trained clinical raters reviewed the data to reach disorder codings for each participant. Raters applied the diagnostic criteria for specific disorders set out in the tenth International Classification of Disease (ICD-10) (WHO, 1992) and the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) (APA, 2013).

Clinical and youth-work professionals act alongside ‘community gatekeepers’, reaching out to meet young people where they are at, to establish trusting relationships. Young people can ask for help with a variety of issues, from housing or jobs, to MH, and are supported to take up leadership roles in their community by delivering projects they are interested in. An independent evaluation of three INTEGRATE projects concluded that they had successfully engaged marginalised groups of young people who were involved in, or at risk of, offending. Young people reported an improvement in their mental wellbeing, which was confirmed by clinician-rated measures. However, they were still found to be reluctant to use mainstream MH services. 54

commissioning group (CCG) and require collaboration across CCGs and, in some cases, local authorities. Examples of such interventions/services include psychodynamic psychotherapy; specialist eating disorder teams who are able to offer a range of interventions including eating disorder-focused family therapy for anorexia nervosa; dialectical behaviour therapy or other evidence-based treatment for young people who repeatedly self-harm; and treatments for young people with psychoses. As self-harm and anorexia are both common reasons for admission to hospital, the provision of such services also has the potential to reduce the need for hospital admission as well as improving outcomes. In addition, there should be access to what are sometimes called crisis/home- treatment services providing intervention aimed at reducing the need for hospital admission.