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1.2 Child and adolescent mental health

The last survey of the prevalence of mental health problems in children and young people in the UK was conducted in 2004. At that time, nearly 850,000 (9.6%) children and young people aged 5-16 were estimated to have a diagnosable mental health disorder. The study found that the prevalence was greater among 11-16 year olds at 11.5%, or about 510,000 young people, compared to 7.7%, or nearly 340,000 children aged 5-10. [5] Applying the national prevalence to South Gloucestershire it is possible to estimate that around 4,800 children and young people aged 5-19 may have a mental health problem.

It is well documented that a range of risk and protective factors can affect whether a child or young person will develop a mental health problem. These factors can relate to a child’s personality, family, socio-economic status and environment, as Table 1 shows. An awareness of these factors can support professionals to develop effective prevention and early intervention services, as well as services for those in need of more intensive support. [6]

Table 1: risk and protective factors, CYP mental health

Child risk factors Family risk factors External risk factors Protective factors

Poverty

Family breakdown

Single parent family

Parental mental ill health

Parental criminality, alcoholism, or substance abuse

Overt parental conflict

Lack of boundaries

Frequent family moves/being homeless

Over protection

Hostile and rejecting relationships

Failure to adapt to the child’s developmental needs

Caring for a disabled parent

School non-attendance

Learning disability

Abuse

Domestic violence

Prematurity or low birth weight

Shy, anxious or difficult temperament

Physical illness

Lack of boundaries

Looked-after children

Lack of attachment to carer

Academic failure

Low self-esteem

Young offenders

Chronic illness

Unclear discipline at school

Failure to recognise children as individuals at school

School exclusion, including school refusal

Bullying, including cyber bullying

Peer rejection/peer pressure

A good start in life and positive parenting

Being loved and feeling secure

Living in a stable home environment

Parental employment

Good parental mental health

Activities and interests

Positive peer relationships

Emotional resilience and positive thinking

Sense of humour

Full engagement with education

The development of effective services also needs to consider the relationship between mental and physical health, as approximately 12% of young people live with a long-term condition that can increase their risk of poor mental health between two to six times. Conversely, having a mental health problem puts children and young people at greater risk of physical illness, with depression increasing the risk of morbidity by 50%. Furthermore, individuals with mental health problems, such as schizophrenia or bipolar disorder, die 16-25 years sooner than the general population. [7]

The cumulative effects of adverse experiences and environmental circumstances, such as domestic violence, and poverty, all leave their mark. A single risk factor is thought to result in a 1-2% chance of developing a mental health problem; increasing to an 8% chance in the presence of three risk factors, and a 20% chance with four risk factors. [8] Without help and support at the right time and in the right place, risky behaviours and poor psychological resilience can persist into adulthood. [9]

Approximately 10% of the population of South Gloucestershire are living within some of the most deprived neighbourhoods in England (see Figure 2) [10]. Socio-economic disadvantage is a significant risk factor for poor mental health in children and young people, with those growing up in the poorest households at three times greater risk for developing a mental health problem compared to those growing up in less deprived homes. [11],[12] Furthermore, deprivation can underpin a range of other risk factors within the family unit, schools, and communities, touching on every aspect of a child’s future, including their mental health outcomes. [13]The map shows differences in deprivation within South Gloucestershire and the chart shows the percentage of the population who live in areas at each level of deprivation

 

Figure 2 – The map shows differences in deprivation within South Gloucestershire and the chart shows the percentage of the population who live in areas at each level of deprivation (from Public Health England’s South Gloucestershire Health Profile)

To put a halt to the accumulation of risk factors in children and young people, early intervention services have proven effective at providing swift action in response to emerging problems from conception to young adulthood. Importantly, early intervention offers the chance to make lasting improvements to the lives of children and young people, terminating the transmission of persistent social problems from generation to generation. [14]

 

[5] Green et al. (2005). Mental health of children and young people in Great Britain, 2004. A survey carried out by the Office for National Statistics on behalf of the Department of Health and the Scottish Executive. Basingstoke: Palgrave Macmillan.

[6] RCN (2014) Mental health in children and young people. Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0003/596451/RCNguidance_CYPmental_health_WEB.pdf

[7] Future in Mind

[8] DfEE (2001) Promoting children’s mental health with early years and school settings. Available at: http://www.mentalhealthpromotion.net/resources/promoting-childrens-mental-health-with-early-years-and-school-settings.pdf

[9] Law et al. How big an issue is children and young people’s mental health? Young Minds doc from Steve

[10] South Glos health profile PHE

[11] Green H, McGinnity A, Meltzer H, Ford T, Goodman R: Mental health of children and young people in Great Britain, 2004. A survey carried out by the Office for National Statistics on behalf of the Department of Health and the Scottish Executive. Basingstoke: Palgrave Macmillan, 2005.

[12] CMO 2010 report

[13] Marmot review

[14] Cabinet Office (2011) Early intervention: the next steps. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284086/early-intervention-next-steps2.pdf