By Steven McGinty

“Not fit for purpose” and “stuck in the dark ages”

These are two of the phrases used by the Care Minister, Norman Lamb, to describe mental health services for children and young people in England. The minister admitted that young people are being let down by the current system and has announced that a new taskforce will look into how the system should be improved.  To coincide with this review, I decided to look at the current situation for children and young people with mental illness, as well as highlight some of the main themes from the latest evidence.

The Office for National Statistics (ONS) reports that one in ten children and young people (aged 5-16) have a clinically diagnosed mental health disorder. This covers a broad range of disorders, including emotional disorders, such as anxiety and depression, as well as less common disorders such as autism spectrum disorders (ASD) and eating disorders. Approximately 2% of these young people will have more than one mental disorder. The most common combinations of disorders are conduct and emotional disorders and conduct and hyperkinetic disorders.

The likelihood of a young person developing a mental disorder is increased depending on a number of individual and family/ social factors. There are a whole range of risk factors, but some of these include:

• having a parent in prison
• experiencing abuse or neglect
• having a parent with a mental health condition
• having an autistic spectrum disorder (ASD)

It’s important to note that mental illness is complex, and that not everyone in these risk groups will struggle with it. This is particularly true when a young person is in receipt of consistent long-term support from at least one adult.

The impact of mental illness can be particularly difficult for young people. For instance, the National Child and Adolescent Mental Health Service (CAMHS) Support Service reported that young people who suffer from anxiety in childhood are 3.5 times more likely to suffer from depression or anxiety in adulthood. There is also an increased chance of young people coming into contact with the criminal justice system, with Young et al highlighting that 43% of young people in prison have attention deficit hyperactivity disorder (ADHD). The Centre for Mental Health also suggests that young people with mental health problems struggle to achieve academically, as well as in the employment market.

When a government minister condemns his own department, it’s evident that there are severe problems.  However, this does not have to be the case.

Below I’ve outlined some of the key lessons to come from evidence on what makes a good mental health service for children and young people.

• Early Intervention – mental health services should work to promote young people’s resilience, so that they can cope with life’s challenges. Opportunities should also be provided to improve young people’s wellbeing, particularly through sports and leisure activities.
• School involvement – teachers and other educational staff should be trained to identify children and young people who may be vulnerable to mental illness. Schools should also be used as locations to provide counselling to students.
• Consistent relationships – young people should have the opportunity to build relationships with professionals over a long period of time, to ensure that there is an effective engagement with the service. This is particularly the case for young people who have experienced trauma.
• Integrated services – an integrated approach should be taken in the commissioning of mental health services. Services should not only consider health services but also other services that young people would need access to, including housing and employment.
• User-led services – children and young people should be involved in the design and evaluation of programmes. Staff should be provided with training, so that they can support young people’s involvement in service design.

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Further reading:

• Exclusive: Children’s mental healthcare in crisis, Care Minister Norman Lamb admits (The Independent, 2014)
• Mental health of children and young people in Great Britain, 2004 (Office for National Statistics, 2004)
• Guidance for commissioners of child and adolescent mental health services (Joint Commissioning Panel for Mental Health, 2013)
• Better Mental Health Outcomes for Children and Young People (Child and Adolescent Mental Health Services (CAMHS) Support Services, Anon)
• The identification and management of ADHD offenders within the criminal justice system: a consensus statement from the UK Adult ADHD Network and criminal justice agencies (Young et al, 2011)
• Childhood mental health and life chances in post-war Britain: Insights from three national birth cohort studies (The Sainsbury Centre for Mental Health, 2009)
• Young People and Mental Health, Policy and Research Review (Schubotz and McArdle, 2014)
• The pursuit of happiness: a new ambition for our mental health (CentreForum Commission, 2014)
• Young adults (18-24) in transition, mental health and criminal justice (Centre for Mental Health, 2014)
• Children and young people’s mental health – every nurse’s business (Royal College of Nursing, 2014)
• Making integration a reality: Part 1 – Joining up the commissioning of young people’s services across health, social care, housing and youth services (Youth Access, 2014)

The Idox Information Service has a wealth of research reports, articles, case studies and evaluations on mental health service provision.