Child and adolescent mental health – a guide for healthcare professionals
June 2006
Introduction
Mental health problems are difficult to define. The term covers a wide range of problems, from the worries and concerns of everyday life, to severe and debilitating disorders such as depression. These problems become a cause for concern when they severely affect the individual’s ability to function on a day-to-day basis. It is often not easy to distinguish between normal and abnormal behaviour; the boundaries are not clear cut, and different social and cultural customs influence what is considered to be unusual. [Go to notes 4 and 5].
Similarly, different professionals may use different terminology to describe a condition: ‘A child psychologist might categorise certain symptoms in a child as 'conduct disorder'. An education psychologist, seeing the same symptoms in a child in the classroom, may describe them primarily as 'emotional and behavioural difficulties'.’ [Go to note 6].
The following definition is used in the National service framework for children, young people and maternity services: ‘Mental health problems may be reflected in difficulties and/or disabilities in the realms of personal relationships, psychological development, the capacity for play and learning and in distress and maladaptive behaviour. They are relatively common, and may or may not be persistent. When these problems are persistent, severe and affect functioning on a day-to-day basis they are defined as mental health disorders.’ [Go to note 7] The Office for National Statistics (ONS) uses the term mental health disorders as ‘implying a clinically recognised set of symptoms or behaviour associated in most cases with considerable distress and substantial interference with personal functions’. [Go to note 2]
Different levels of severity of mental health problems can be distinguished, as described in the BMA publication Growing up in Britain:
- mental health problems: relatively minor conditions such as sleep disorders or excessive temper tantrum
- mental health disorders: a marked deviation from normality, together with impaired personal functioning or development, and significant suffering
- mental illness: severe forms of psychiatric disorder, particularly of the kind also found in adulthood, for example, schizophrenia, depressive disorders and obsessive disorders. [Go to note 8]
Statistics show that at any one time in the UK, one in ten children under 16 years of age has a clinically diagnosed mental health disorder, and among 11-16 year olds, 13 per cent of boys and 10 per cent of girls are affected. [Go to note 2] The government has recognised that mental health problems among children and young people is an important area of concern, and has set out guidelines and targets for provision of care, making resources available to help achieve these targets.
It should be noted that this report will not cover learning disabilities, although this is an important group, and includes particularly vulnerable children and young people. The Royal College of Psychiatrists states that: a general learning difficulty (ie difficulties in learning, understanding and doing things compared to other children of the same age) is not a mental illness. Unlike mental illness, from which people may recover, it is a lifelong condition. Children with learning disability, however, are more likely to develop mental health problems than other children. [Go to note 9]. Approximately 40 per cent of children with learning disabilities will have a significant mental health problem, with emotional and conduct disorders being the most common. [Go to note 10]. The Health Inequalities section highlights the need for more mental health services aimed at children and young people with learning disabilities.
Good mental health is not merely the absence of a problem. Those with good mental health are able to develop emotionally, intellectually and creatively, and have the resilience to cope with problems that life might throw at them. They are able to form effective and satisfying relationships, and live life to the full. [Go to notes 11 and 12]. The key to good mental health in children and young people is an approach that involves the whole person. Life events impact in a variety of ways on the emotional wellbeing of every child and young person. The way that children are parented, their diet and exercise, their school and education, and experimentation with drink, drugs and other substances, along with many other factors will all affect a child’s mental wellbeing or mental ill health.
This report is aimed at healthcare professionals and policy makers. It examines the types of problems faced by children and young people aged five to 17 years and the prevalence of mental health problems among this age group. It discusses barriers to the necessary provision of treatment, including stigma and discrimination. It considers the strategies in place to provide care, looking at the situation in England, Scotland, Wales and Northern Ireland, and how effective these strategies are proving in practice. It goes on to look at mental health promotion, and finally makes recommendations for action and lists sources of further information.