- A Review of Recent Evidence into Children and Young People’s Mental Health
- Lorraine Khan, Centre for Mental Health (June 2016)
There is good evidence on what gives children and young people the best start in life in terms of their mental wellbeing, on the risk factors which compromise healthy emotional and behavioural development, and on the particular children at greater risk due to an accumulation of these risk factors. There is also a clear steer on what works to support children and young people with mental health needs and on the very real difference that can be made to their life chances by intervening at the first sign of symptoms.
Despite this, research suggests a 10-year average delay between the time that young people first experience symptoms and receive help. Furthermore, only a quarter of school-age children with a diagnosable problem receive any intervention at all, despite most parents of these children seeking professional advice.
When children and families do seek help, they are frequently confused by a maze of largely fragmented services and often face lengthy delays to get the help they need. There is currently contradictory evidence on whether children and young people’s mental health is stabilising or deteriorating.
This document seeks to piece together the evidence about children and young people’s mental health and wellbeing in the UK, based on the most recent high-quality research. It breaks down findings into four age groups: pregnancy to age four years; children aged five to 10; 11- to 15-year-olds; and young adults aged 16-25.
Access to help
Getting help at the first sign of symptoms is critical, and yet at every age, only a minority of those with diagnosable mental health problems receive help to address them. Stigma can create a “conspiracy of silence” about mental health difficulties which prevents older children from seeking help or disclosing distress.
Poor mental health literacy is another major barrier for parents, children, teachers and other professionals, causing uncertainty about whether there is a need to seek help and prompting delays. Many parents, children and professionals do not know what help is available or how to get it; they find services unappealing, frightening or experience lengthy periods waiting to get help.
1. Pregnancy to four
During pregnancy, poor maternal mental health, over-exposure to excessive stress hormones and also to some substances (e.g. tobacco and alcohol) can have a toxic effect on a child’s brain development and later mental health.
After birth, a healthy attachment to a caregiver helps to protect babies from adversity and stress: acting as a “buffer” with the world outside and slowly helping infants self-regulate in the face of adversity and frustration.
Infants and toddlers facing greater risk of poor mental health include those whose mothers have untreated mental health problems, whose parents misuse substances, who are subject to maltreatment and neglect, and who live in prolonged poverty. It is the number of risks and their cumulative effect over time that undermines children’s developing mental health, rather than any one particular risk factor.
2. Five to 10
During primary school years, family environment remains an important influence on children’s mental health. Early educational environments have the potential to provide new, nourishing and potentially protective experiences. But they can also expose children to additional risks. Schools, and the tasks they require of children, can be the context within which difficulties first begin to surface or become entrenched. Bullying is a major risk factor for poor mental health during primary school years. Children who are both bullied and bully others face higher risks of poor outcomes in adult life, including imprisonment and suicide.
Most children aged 5-10 enjoy good mental health but just over two children in every primary school class will have a diagnosable mental health condition. Many more will have borderline difficulties. Some children continue to face higher risk of poor mental health due to exposure to serious, prolonged or multiple risks in family and school environments (e.g. maltreatment and victimisation in both home and school). At this age, boys are more likely to have problems which meet the threshold for diagnosis than girls. And for some children in this age group difficulties can further multiply and become entrenched, which in turn raises the risk of poorer life chances.
Schools are one of the few contexts within which universal programmes to prevent mental health problems have been noted to result in population-level improvements, especially during primary school years. Many evidence based programmes focus on improving social and emotional awareness and helping young people to improve their ability to self-regulate when faced with worries, frustration and setbacks.
3. 11- to 15-year-olds
Mental health difficulties begin to increase during teenage years. During secondary school, one child in eight will have one or more mental health conditions at any time. The number of children (mainly boys) with severe behavioural problems is higher among this age group; rates of anxiety, depression and self-harm (mainly affecting girls) are also higher. Despite this, teenagers tend to be less likely to know when their mental health is deteriorating and feel stigma keenly.
Self-harm is also relatively common in this age group, especially among girls, lesbian, gay, bisexual and transgender young people and those with a diagnosable mental health condition. It is an important risk factor for suicide (particularly if accompanied by depression) among older teenagers. Some studies have found rising levels of emotional problems and deteriorating life satisfaction among girls in this age group. Recent surveys suggest that girls are concerned about media-driven pressures to be thin, sexual harassment, harmful content online and academic pressures.
Misuse of alcohol, smoking and drug taking are all associated with poorer mental health in this age group. There are encouraging signs that alcohol and substance misuse have been decreasing over the last decade; however, for those who continue, reliance and binge drinking may be getting worse.
If approaching a professional, just under half would approach a teacher or member of school staff. Generic counselling services tended to be preferred to more formal mental health, clinical services or cognitive behavioural approaches. Young people generally value help that is genuine, warm, confidential, non-patronising, that co-produces solutions and builds on strong relationships.
4. 16- to 25-year-olds
Adolescence and young adult years are the peak age for the first onset of adult mental health problems. This is also the stage at which the effects of childhood abuse and trauma may result in mental health crisis. Three quarters of adults with a diagnosable mental health problem will have experienced first symptoms of poor mental health by the age of 24. It is also at this time that more severe mental health diagnoses emerge, such as psychosis and personality disorders. Around 20 per cent of 16-25 year olds will experience a diagnosable mental health problem.
This stage provides vital opportunities for intervention. There is good evidence that intervening early in the course of many mental illnesses can significantly reduce later impairment – including for serious illnesses such as psychosis. Yet studies show that many people with mental illnesses fail to receive help for around a decade after first symptoms emerge. Suicidal thoughts were most likely to be reported in this age band. This age group is also more likely to screen positive for PTSD with males being more likely than females at this age to have higher rates of trauma symptoms.
Women are the most likely to have an eating disorder but only one in five is likely to be in receipt of treatment; this is despite the fact that poor outcomes have been associated with later presentation to services for anorexia nervosa.
Young adults as a whole are the most likely age group to develop mental health problems, but least likely to recognise that they have a problem that might benefit from treatment. For this age group, friends, digital sources and intimate partners often become frequent sources of help. Those who do seek formal help, or who need continuity of support from early teenage years, can be faced with frustrating gaps between child and adult services which are counterproductive to recovery and progress.
- Kadra Abdinasir is head of children and young people’s mental health, the Centre for Mental Health, and strategic lead for the Children and Young People’s Mental Health Coalition
