young mental healthThe number of children and young people with mental health issues continues to increase, but why is this and what can be done to address it? In this guest feature from Mental Health Today, Sophie Goodchild investigates:

Being young used to be cause for celebration. Instead, the childhood and teenage years have become for thousands a time of 'angst,' forever associated with feelings of depression and anxiety as they struggle to cope with the pressures of the modern age.

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An estimated one million – or one in 10 – five to 16-year-olds has a diagnosable mental illness as well as conduct disorder (HSCIC, 2005). Half will go on to develop mental illness in adult life and be at greater risk of getting involved in crime, drug abuse and suicide.

The numbers of teens and young people looking for help too are increasing. More than 5,000 young people aged 16 to 25 used the Anxiety UK site in January 2014 compared with just over 3,500 the year before. Other charities have identified a similar trend.

YouthNet recorded nearly 11,000 visitors in the same month, a rise of nearly 1,500 on 2013’s figure of 9,611. If prevalence rates for mental disorders stay the same and the population grows as predicted then the UK is facing a potential crisis, according to the Mental Health Foundation. It calculates that 100,000 more children will need treatment in 2030 compared with 2013 (MHF, 2013).

Technology has partly been blamed for fuelling anxiety because young people can’t switch off, along with a host of other factors including exam stress, easy access to explicit online pornography, cyber bullying and the relentless demands of social media to be popular. "Children are under unprecedented pressures," warns Lucie Russell, director of campaigns and media at charity YoungMinds. "They live their lives in the public domain constantly seeking reassurance and being their own 'brand.'"

To illustrate this, Russell reveals how an acquaintance told her recently how their sister had refused to go to school because of her popularity on Facebook. "She'd changed her Facebook status and didn't get enough 'likes,'" explains Russell. "Children are defined by what people say about them online."

Addressing problems
How to deal with this phenomenon of young angst is a major concern now being addressed by experts including economist and former government 'happiness tsar' Professor Lord Richard Layard. A recent enquiry that he led into the wellbeing of children in the 21st century examined how the damage caused by mental illness in childhood can be prevented.

The conclusion of the Mental Health and Wellbeing in Children Forum is that work needs to begin in schools, within healthcare and also in communities. The Forum's findings (Layard & Hagell, 2015), published in February, argue that schools should measure pupil wellbeing regularly, that they should make the wellbeing of pupils an explicit objective and train all teachers so they can notice and promote child wellbeing and mental health.

In addition, all healthcare professionals including GPs and nurses should be trained to identify the signs of and depression in mothers, and every community should have a child wellbeing strategy.

"All research shows that happier children learn better," Layard says. "Academic results and personal wellbeing are not rivals, as [the Department for Education] currently believe, but complements. Every school should have a wellbeing policy which includes mental health awareness.”

Adopting these recommendations may be a challenge if additional funding is required. However, Lord Layard, who also co-authored The Children's Society Good Childhood inquiry and is wellbeing program director at the Centre for Economic Performance at the London School of Economics, insists that effective help can be delivered at low cost, for example through training programmes delivered online and via smart phones. "Early intervention is crucial if we are to stem the rising tide of childhood mental illness and reduce the wider negative impacts on society," he says. "Yes there are costs involved. But the savings will be great and will often exceed the cost. We simply cannot afford not to do it."

Identifying vulnerability
This focus on identifying vulnerability to mental health problems early is supported by other experts. There are 'great benefits' to be had from routine checks for all schoolchildren, according to Simon Williams of the Feinberg School of Medicine at NorthWestern University in the US, and not only those deemed 'most at risk.' This view is based on a review of existing studies by Williams while at the Institute of Public Health at Cambridge University. Some screening studies have shown that up to three-in-four of those at risk of mental health problems were not already known to a school or clinical professional and were not currently receiving treatment, according to Williams.

In a comment article published in the British Medical Journal (2013), he argued that children as young as seven should be tested if problems are to be diagnosed and treated earlier – otherwise the cost to society is considerable. "We have had physical screens in schools for over a century, isn’t it about time we also had mental health checks?" says Williams. "More generally, there are a number of reasons why the school is the best environment to provide mental health education and intervention in the form of counselling. The main reasons concern equity, expertise, and cost-effectiveness."

Given around three-quarters of adult mental illness begins in childhood, these checks, administered by school counsellors or specially trained staff would identify children with depression, anxiety, anger and disruptive behaviour, he says.

Risk of false labelling
But some charities and experts are cautious about school-based screening especially at such an early age. Russell argues it could lead to false labelling of children and that there is limited evidence that school-based screening works. Besides, there is no use identifying these children unless there is a comprehensive programme in place to support them, she says. "It's a good idea in principle schools monitoring the wellbeing of children, but what will they then do with the results?"

YoungMinds has produced its own online 'resilience' toolkit, which is targeted at everyone in the school community including teachers and dinner ladies. The aim is to teach every child skills for coping with all that life throws at them. This is not a substitute for trained counsellors though, according to Russell who says they are needed in schools to help young people who are "really struggling."

This view of the importance of 'embedded' support is shared by Dr Jessica Deighton from University College London and the Anna Freud Centre, who has been involved in research looking at schools-based mental health programmes specifically the Targeted Mental Health in Schools Initiative (TaMHS) launched by the government in 2008. The findings of the study she co-authored demonstrated that this programme did have an impact in primary schools with a promising reduction in behavioural problems among children.

"The primary purpose of teachers is obviously to teach but the reality is they'll have two to five young people in a classroom with behaviour problems which aren't just about underlying mental health problems but about classroom management," she says. "Any programme though needs to be evidence-based and have local relevance. And all professionals and agencies need to be talking to each other to make a difference."

Poor information sharing was an issue highlighted in a report published in March by the Children and Young People's Mental Health and Wellbeing Taskforce. This warned of 'ingrained and systemic problems' facing existing children and young people's mental health services.

The message from this report, from experts and charities is that strong leadership is needed right across the system if we are to have a chance of helping young people and to prevent thousands more being effectively robbed of their youth. As Russell concludes: "If we are really going to make a difference and give young people the skills to cope then we have to do it properly."

References:
Health & Social Care Information Centre (2005) Mental Health of Children and Young People in Great Britain 2004. London: HSCIC. Available at: www.hscic.gov.uk/pubs/mentalhealth04
Layard R & Hagell A (2015) Mental Health and Wellbeing in Children. Doha: World Innovation Summit for Health.
Mental Health Foundation (2013) Starting Today: The Future of Mental Health Services. London: MHF.
Williams SN (2013) Bring in Universal Mental Health Checks in Schools. British Medical Journal 347:f5478.Available at: www.bmj.com/content/347/bmj.f5478