Key Statistics about Children and Young PeopleThough we often associate mental health problems exclusively with adults, a huge number of children (0-16) and young people (16-24) in the UK are also affected by various forms of mental distress, with figures for those being diagnosed continuing to grow on a yearly basis.
According to the Mental Health Foundation, though estimates vary, research suggests that 20 per cent of children have a mental health problem in any given year with further research from The Office for National Statistics finding that one in ten children between the ages of 5 and 16 have a mental health disorder1, 2.
Children are extremely vulnerable to mental disorders and unlike adults who have the ability to identify, understand and seek help for a problem, a child may be confused and upset by what is happening to them. However, with organisations and the Government working hard to spread awareness and eliminate the stigma of mental illness, as children progress into young adults they will become more aware of what a mental illness is and will hopefully begin taking the first steps towards seeking help.
How common are mental health problems in children and young people?A 2004 survey conducted by The Office for National Statistics found that approximately one in ten children and young people aged 5 – 16 had a clinically diagnosed mental disorder. When that figure was broken down even further it was revealed that four per cent had an emotional disorder (anxiety of depression), Six per cent had a conduct disorder (behavioural problem), two per cent had a hyperkinetic disorder (such as ADHD), one per cent had a less common disorder (such as autism, eating disorder or mutism) and around two per cent were found to have more than one type of disorder2.
Among 5-10 year olds, boys (10 per cent) were twice as likely to develop a mental disorder than girls (five per cent). This trend continued into the higher age bracket of 11-16 year olds with boys at a 13 per cent risk compared to girls standing a 10 per cent risk.
The figures suggest that mental disorders in young people are much more common in males than in females and also shows that rates of mental health problems among children increases as they approach and eventually reach adolescence.
In contrast to this, statistics from older generations show that these disorders are more common in females which suggests that women may develop certain illnesses later on in life.
The survey also found that there were certain socio-demographic groups in which mental health problems were more prevalent, such as:
- Single parent families
- Reconstituted families
- In families were there were lots of siblings
- Where parents had no higher educational qualification
- Where neither parent was working
- Where there was low income
- Where there was disability
- Where families were living in socially or privately rented accommodation compared with those who owned their own properties
Areas of mental distress common among children and young peopleMental health problems will usually bring about a complex set of emotions which even adults have difficulty understanding let alone a child. Children suffering from mental distress may be unable to understand what they are experiencing and why they are feeling the way they do, often keeping their thoughts and feelings hidden away as they are unaware of the help available to them.
This section describes a range of mental health difficulties under separate headings which occur among children and young people in the UK:
Anxiety and Anxiety related problems
Anxiety is usually defined by heightened awareness, uneasiness, nervousness and dread or fear of either real or imagined dangers. Though it is entirely natural to feel a anxious now and then, perhaps before a test or a big meeting, when it becomes excessive to the point it is impacting our ability to go about our everyday activities this is an indication that it is progressing into problem and help should be sought.
Below is a list of anxiety in its variety of forms:
- Generalised anxiety disorder In this situation there is nothing specific which is causing or triggering the anxiety but there is an ongoing fear that something bad is going to happen. In the instance of a child, they may feel like they have no control over the situation which will result in physical side effects such as stomach aches, headaches and sleeplessness and relationships my also be affected.
- Hypochondriasis Hypochondriasis is the fear of having a fatal disease despite there being no evidence indicating this may happen. Similarly to the generalised anxiety disorder it can take on a physical form causing stomach aches, headaches and nausea. Often associated with young adults.
- Phobias Fear of a certain object, person or situation etc that gives the individual an overwhelming desire to avoid it despite it presenting no danger. Phobias become a serious issue when they start preventing a person from functioning on an everyday level.
- Separation anxiety Young children will often become distressed when separated from their parents, but this kind of anxiety in older childhood or adolescence may indicate a wider problem. This may occur when a young person experiences change or an upheaval of some description such as divorce of their parents, a bereavement or moving home and schools. Excessive crying when parents leave, difficulty sleeping or refusal to go to school are also all symptoms.
ADHD currently affects around 1.7 per cent of the UK population, most of whom are children3. The condition causes its sufferers to become easily distracted often with a short attention span. Children with ADHD may also find it difficult to interact and play with other children as they don't exhibit safety awareness or courtesy when it comes to taking turns and often become aggressive. ADHD is directly associated with school failure, exclusion and poor future prospects.
Though not a mental illness, Autism is known to cause difficulties in communication and social interaction all of which affect a young persons ability to understand emotions of others, social behaviour or the concept of danger. The term also covers other disorders such as Asperger's syndrome.
Bipolar disorder otherwise known as manic depression is is an illness characterised by abnormal mood swings of periods of extreme highs and euphoria often followed by deep lows and unhappiness.
Though we tend to associate depression with adults the common condition also occurs in children and is usually noticed through a change in behaviour and or feelings of despair. Currently almost 80,000 children and young people suffer from severe depression4.
Additional symptoms include a change in eating habits, sleeping patterns, school performance, motivation and concentration and often manifests as anger and rage. If left to continue untreated many of these symptoms progress and destructive habits such as self harm and substance abuse (both of which are growing in this group). However, the condition is treatable especially if early diagnosis is sought and support is given from friends and family.
According to the Mental Health Foundation both anorexia nervosa and bulimia nervosa are the most common forms of eating disorders, affecting around 2 per cent of adult females5. Various research suggests that eating disorders tend to set in during teenage years, peaking around the age of 16.
- Anorexia nervosa A person suffering from anorexia nervosa often has an extremely distorted body image and an intense fear of gaining any weight. Though a sufferer may be hungry they inflict weight loss by banishing any calorific foods and fats. The condition is more common among girls usually beginning in mid teens and has very little to do with looking good and more to do with deep rooted emotional problems and the need for an element of control.
- Bulimia nervosa Though this condition is more common among girls, the number of boys affected each year is continuing to rise. The condition see's the sufferer alternate between binge eating and self induced purging (vomiting or use of laxatives and diuretics). Similarly to anorexia the condition is usually indicative of a deeper underlying issue and the sufferer will more often than not try to keep it hidden.
- Binge eating Binge eating is the term used to describe a disorder which see's sufferers eat extreme quantities of food, often when not hungry. Afterwards the young person will usually feel ashamed and embarrassed about the eating and may feel as though they are out of control. If the condition persists it is likely to cause weight gain which brings about additional conditions both physically and mentally.
Obsessive compulsive disorder is essentially reoccurring thoughts and obsessions which the sufferer will feel the need to carry out in a repetitive and ritualised fashion, for example counting, repeatedly checking if something is locked or closed, touching, excessively washing hands etc. Usually the compulsive acts stem from a fear that something bad may happen if they are not carried out.
Though schizophrenia is rare in young people there are cases in which children exhibit signs early on. Symptoms include a fear of other people, difficulty distinguishing reality from fantasy, hearing voices and delusions and generally sufferers will perceive the world quite differently from others and are withdrawn and often devoid of emotion.
Self-harm is usually a sign and expression of a deep rooted emotional problem and often young people use it as a way of coping with difficult feelings they may be having. Self-harm often involves making cuts in the skin with blades, glass or sharp objects and other methods such as rubbing, burning, scratching and swallowing objects. It is estimated that 1 in 15 young people have deliberately self-harmed, with additional evidence suggesting that UK rates of self-harm are higher than the rest of Europe6.
Suicide in young people is usually linked with depression, loss, abuse or other issues from which they feel there is no other way out. According to a study cited in the Samaritans report on young people and suicide, there are an estimated 24,000 suicide attempts made by 10 to 19 year olds in England and Wales each year, which amounts to one attempt every 20 minutes7.
Difficulty sleeping may take the form of nightmares, night terrors and or sleepwalking. Unlike many of the other types of distress listed in this section a sleep problem is not necessarily an indicator of an underlying issue and may have more to do with television programmes and eating habits etc. However, if the problem does persist for an extended period of this time this may indicate a deeper emotional cause.
Alcohol, drug and substance misuse can often result in serious physical consequences including that of addiction. Many young people turn to these substances as a way of escaping from complex emotional issues and mental health problems that would benefit from more appropriate interventions such as counselling.
Child AbuseFigures compiled by the NSPCC Child Protection Awareness and Diversity Department state that there were 31,919 children named on the child protection registers on the 31st March 20068.
Additional figures from the NSPCC suggest that some 7 per cent of children are physically abused by their parents or carers, 1 per cent of under 16s are sexually abused by a parent or carer, a further 3 per cent are sexually abused by another relative, 11 per cent are sexually abused by a non relative and 5 per cent are sexually abused by a stranger9.
Though the exact prevalence of child abuse is unknown, researchers believe it to be far higher than the figures of recorded cases suggest, with numbers such as the 112,000 children counselled by ChildLine in 2001/02 adding further weight to the mounting evidence. Of those 112,000 children, 21,000 sought advice about physical or sexual abuse10.
In addition, various studies have suggested that abused children are at a higher risk of going on to develop psychiatric disorders or other problems either in the short or longer term 11.
Unfortunately, suffering from some form of child abuse is a common occurrence and many sufferers will be emotionally scarred for the remainder of their lives. However there is support and help available which is specifically dedicated to those who have been abused as children.
Legal FrameworkThe Mental Health Act (2007)
In The Mental Health Act (1983) there were no specific provisions or lower age limits with regards to children, meaning that children and young people could be treated or detained against their will. However, the more recent Mental Health Act (2007) has made a number of changes to its predecessor including making primary care trusts responsible for providing 'age-appropriate' services for children, establishing guidelines for good practice around the hospital environment and implementing the use of Child and Adolescent Mental Health Services (CAMHS) in the assessment process12.
Consent to Treatment
Children aged 16 and below can receive medical treatment, including treatment for mental disorders, when a parent issues their consent. If a child is in care, the local authority takes the parent's place. A child can give consent for their own treatment if they are deemed to be 'Gillick competent' that is, they are considered to have sufficient intelligence and understanding of what is proposed so they can make their own informed decision. A person over the age of 16 is considered an adult and therefore has the right to make their own decisions about treatment.
This information shows just how difficult a mental health experience can be for an individual under the age of 16. Not only must they suffer with a disorder they usually know little about, but often their parents must know about it for them to receive any professional treatment. If the parent and child have a poor relationship, the experience can be even harder for the child and in some cases treatment may be refused in order to keep the illness from their parents13.
The National Service Framework for Children
The National Service Framework for Children, Young People and Maternity Services is a 10 year programme, which was published in September 2004 by the Department for Education and Skills. The framework sets standards for children's health and social services and is intended to stimulate long-term and sustained improvement in children's health. It also aims to ensure fair, high quality and integrated health and social care from pregnancy, right through to adulthood.
The framework states that all children and young people, from birth until their eighteenth birthday, who are affected by mental health problems should have access to 'timely, integrated, high-quality, multidisciplinary mental health services' to ensure effective assessment, treatment and support, for them and their family.
Key points can be found listed below or full guidance can be obtained from the department of health14:
- Supporting parenting, by providing information and support for parents to help them care for their children and equip them for life.
- The provision of child, young person- and family-centred services, tailored to individual needs and taking account of their views.
- The development of age-appropriate services responsive to need.
- Safeguarding and promoting the welfare of children and young people, preventing harm, promoting welfare and addressing needs.
- Implementing timely access to appropriate and effective services to meet the health, social, educational and emotional needs of children and young people who are ill, throughout their period of illness.
- The provision of high quality, evidence-based hospital care for children and young people in hospital, developed through clinical governance in appropriate settings.
- The development of coordinated, high quality family-centred services for disabled children and young people and for those with complex health needs, promoting social inclusion, enabling them to live ordinary lives.
- Promoting the mental health and psychological wellbeing of children and young people, by providing access to timely, integrated, high quality multidisciplinary mental health services to ensure effective assessment, treatment and support.
- Making sure children, young people, their parents or carers, and health care professionals in all settings can make decisions about medicines based on sound information about risk and benefit.
The Children and Young People’s Mental Health Coalition brings together leading children and young people and mental health charities to campaign with and on behalf of children and young people in relation to their mental health and well being.
The Coalition aim to achieve policy changes that will directly improve the mental health and well being of children and young people across the UK and will focus on the following four streams 15:
- The Early Years To include equipping parents with the knowledge and tools to improve their children’s mental wellbeing as well as their own.
- Building Emotional Resilience To resource children with self awareness and resilience to meet the challenges of growing up and enjoy good mental health.
- Reaching Adulthood To ensure adequate provision of care and flexible services for those entering into and adjusting to adulthood.
- Seldom Heard Voices To ensure that minority groups are able to access good quality support from services.