Child and adolescent mental health – a guide for healthcare professionals
June 2006
Barriers to receiving treatment
Children and young people face a number of barriers to receiving appropriate mental healthcare. These can be practical. The location of services may make them inaccessible to young people, and opening times may be inconvenient, for example, only during school hours. Service provision needs to be flexible and innovative in order to reach young people, with a diverse range of venues and styles of service that reflect the different needs of individuals. A holistic approach, supporting the young person and their family beyond their mental health problems can also be effective. [Go to note 76]. It can be helpful to combine CAMHS with other services aimed at young people, such as general medical and sexual healthcare. This could disguise the reason for attending services, and thus reduce stigma attached to mental health services. [Go to note 74]. Further, young people often access healthcare for a reason other than the main problem, which may then become clear later. [Go to note 77]. There are also problems with long waiting times for appointments, which can discourage young people from attending. [Go to note 51]. (Read more here)
Barriers can also be social and psychological. Evidence suggests that there is a lack of understanding among young people as to what mental health is: they view it as a serious illness or ‘madness’, and as such, not applicable to them. [Go to note 51]. More focused information needs to be provided, targeted specifically at young people, explaining what mental health is and how and where to find help. Parents also need information and support to help their child receive treatment. There is stigma attached to mental health problems, which can result in an unwillingness to admit a problem or seek help from peers, parents or professionals. Young people may have difficulty building up the courage to receive treatment. They can be wary of mental health professionals, and it can take time for a sufficient level of trust to build to allow the patient to relax and open up. Young people need to feel respected and listened to by health professionals, not judged. They also strongly value confidentiality, and there needs to be support available to help them through treatment. [Go to note 76]. It is also important that they receive consistency of care, not having to repeat their story to different professionals, and that there is after-care support where necessary. [Go to note 51]. The children’s NSF has recognised some of these problems, and has made recommendations to address some of them. [Go to note 7]. CAMHS need to take account of what young people say they want, and balance this with what they can realistically provide. [Go to note 78].
Many of the health inequalities discussed in the chapter 'Health inequalities' can act as barriers to receiving care, such as the difficulties faced by young people from BME groups, refugees and asylum seekers, and looked after children.
Stigma and discrimination
Stigma arises from the socially constructed negative stereotypes associated with mental health problems. Discrimination is the unfair treatment of an individual, which limits or denies opportunities. Discrimination can arise from attributed rather than actual characteristics. [Go to notes 79 and 80]. Research has shown that those with mental health problems often face stigmatisation and discrimination by society, and that this is a key barrier to social inclusion. Indeed, 83 per cent of respondents to the Social Exclusion Unit consultation, 'Mental health and social exclusion' (2004), identified stigma as a major concern. [Go to note 79]. The report outlined the major issues surrounding discrimination on the basis of mental health. Further, discrimination can exacerbate mental health problems, leading to poor self-esteem, depression, anxiety and isolation. [Go to note 81] Discrimination for other reasons, such as race, can also lead to mental health problems. Discrimination can result in barriers to accessing mental health services; the fear of stigmatisation may lead people to be reluctant to seek treatment, and hide diagnoses from friends and family. Evidence also reveals that discrimination is ever-present among health professionals. A survey of psychiatrists, community psychiatric nurses and primary care specialists found that 55 per cent of their clients had faced discrimination when accessing services. [Go to note 82]
One of the major causes of stigmatisation and discrimination is a lack of understanding in society of mental health. The media has an important role to play in this. Much of the British media portrays people with mental health problems in a negative or deprecating manner, especially in linking mental health problems with violence. A study of British tabloid newspapers found that 40 per cent of daily tabloid articles about mental health used derogatory terms such as ‘nutter’ or ‘loony’. [Go to note 83]. The media could, alternatively, be a major way of educating the public about the reality of mental health issues. The National Institute of Mental Health in England sets out in its five-year strategic plan (2004-09), 'From here to equality', how it plans to work with different forms of media to redress the imbalance and promote more accurate reporting. [Go to note 80]. The NIMHE is also working with the independent regulator of communications in the UK, Ofcom, to monitor complaints about the portrayal of mental health problems received by its committee on Older and Disabled Persons. Promoting mental health and educating the public in this area is discussed in the chapter on mental health promotion here.
There are various programmes in place to tackle discrimination against those with poor mental health. It is important that for any action to be effective, it is well funded, and planned over the long term [Go to note 80]; it takes time to change peoples’ attitudes, and short-term initiatives may be ineffective. In 2001, the DH launched 'Mind out for mental health', a campaign aimed at tackling mental health discrimination, focusing on young people, the media and employers. [Go to note 84]. The Royal College of Psychiatrists has also run an anti-stigma campaign, 'Changing minds'. [Go to note 85]. The NIMHE is taking forward the government’s work in this area in England, and launched 'From here to equality' in 2004 to tackle stigma and discrimination on mental health grounds. SHIFT, which is a part of the NIMHE, was set up to carry out this work. [Go to note 86]. The Disability Discrimination Act 2005 (DDA) has already outlawed discrimination against people with disabilities in various areas of life. A substantial number of people with mental health problems in Britain are covered by this legislation [Go to note 79], although people with mental health problems may not view themselves as disabled, and as such may be unaware of their rights. The Disability Rights Commission (DRC) was set up in 2000 to work towards eliminating discrimination against disabled people and promote equality of opportunity. The NIMHE and DRC have agreed to work collaboratively together on mental health discrimination. [Go to note 80]. In 2004, the DRC launched an 18-month formal investigation into inequalities in healthcare provision to people with long-term mental health problems and learning disabilities. This investigation considers people of all ages, and focuses on physical health, as evidence shows that these groups often have worse physical health than the general population. The investigation aims to identify measures to facilitate access to healthcare, and examine the adequacy of steps already undertaken by PCTs and government to reduce inequalities. [Go to note 87].
Young people tend to have more discriminatory attitudes to mental health problems than adults. A survey found that 61 per cent of young people admitted to using derogatory language in relation to those with mental health problems, and 55 per cent would not want others to know if they had such a problem [Go to note 84]. Initiatives are therefore being undertaken to change these attitudes, including educating young people about mental health. The NIMHE has identified this as one of the priorities of 'From here to equality'. It will work with the DfES to address mental health in the school curriculum and produce guidelines offering advice to professionals working in schools. The DH Healthy Schools Programme will support schools in promoting emotional wellbeing and reducing prejudice and discriminatory behaviour [Go to note 80].
- Innovative services are needed to meet the needs of young people, and access to such services must be improved. Examples include a range of venues that differ from the traditional clinical setting, and easy access to a mixture of services.
- The media should be encouraged to portray those with mental health problems in a positive light, including children and young people.
- Current strategies to address stigma and discrimination against those with mental health problems must be fully implemented. They should be monitored to ensure that they are adequate and effective.