Crisis talks

Are we too preoccupied with physical health, when research and
practice show a large increase in the number of young people with
mental health problems?

Concern about children’s diets and sedentary lifestyles is at an
all-time high. The government wants children to write “personal
health plans” setting out how they will eat well and exercise
perhaps for the rest of their lives and the likes of Jamie Oliver
are playing their role in driving policy.

But there are no celebrities highlighting the decline in
teenagers’ mental health which has been clearly shown in research
from the Institute of Psychiatry.(1) Young people in the 1990s were
found to be more likely to have mental health problems than those
in the 1970s. The proportion of teenagers with conduct problems
more than doubled between 1974 and 1999, from 7 per cent to 15 per
cent, and there were “increases” in emotional problems between 1986
and 1999, from 10 per cent to 17 per cent. All social classes and
types of families are affected and family break-ups were not the
main reason for increased problems, the study found.

Meanwhile, rates of self-harm in the UK have increased over the
past 10 years and are among the highest in Europe, according to the
National Institute for Health and Clinical Excellence. A continuing
national inquiry by the Mental Health Foundation has already
reported (2004) that professionals working with children lack
knowledge and training on managing self-harm.

However, child and adolescent mental health services (Camhs) are
thought to be improving and the mental health elements of the
National Service Framework for Children are broadly welcomed.

Oxford GP Ann McPherson, who chairs the adolescent health task
force for the Royal College of General Practitioners, says more
young people with mental health problems are visiting their GPs.
Yet the options available to GPs when a teenage patient with a
mental health problem steps into the consulting room are limited,
she says. The patient could be referred to a cognitive behaviour
therapist but the service is often oversubscribed. Trying to get a
patient into a local Camhs usually involves a long wait, which is
not much use for a young person in crisis. As for medication, there
is strong advice not to use a number of drugs, including Prozac and
Seroxat, for adolescents. And family doctors who do not receive
training in adolescent mental health can find it difficult to
converse with distressed teenagers.

But if the GP cannot help, where can an adolescent go next?
Schools should play a bigger role in educating young people about
mental well-being. Gavin Baylis, senior policy officer at
YoungMinds, says emotional awareness work should be carried out to
help pupils to identify problems early and to cope.

But he also believes that more Camhs services are needed to meet
the growing demand. YoungMinds hears many reports of long waiting
lists and patchy provision. Such anecdotal evidence is backed up in
a report by the Royal College of Psychiatrists(2) that found
“widespread recognition that the care of young people presenting
with acute, severe mental illness is often unsatisfactory. This can
involve a lack of any suitable bed, undue delay, or an
inappropriate admission to an adult or paediatric bed”.

But for Shaun Naidoo, project manager at the Health and
Education for Life Project (Help) in Liverpool, it will not be
enough to simply throw more money at Camhs.

“Providing more of the same type of services we already have is
not the answer. We need to find ways to do things differently,”
says Naidoo. Help is a three-year action research and support
programme for young people, funded by the National Institute for
Mental Health in England, and involves about 5,000 11- to
15-year-olds from 33 schools.

Help has found that adolescents are reluctant to talk to
professionals about mental health issues, and that they prefer to
turn to their friends for support.

Naidoo says: “Young people live in a complex world and are under
complex pressures that can be hard to handle. Our work is trying to
offer them strategies for coping, including ways of communicating
and expressing themselves creatively through music, sculpture and
poetry.

“Service providers don’t know what young people think and don’t
know how to run services for them. Money goes into promoting
adolescent mental health care provision, and the services are not
taken up by the young people.”

With the focus at schools so much on examination results and
league tables, teachers have little time for pastoral work. So at a
time when adolescent mental health is declining, teachers have less
space in the day for non-academic matters and it is left to
specialist staff such as counsellors and learning mentors to take
on more of the pastoral work.

At Yardleys secondary school in Birmingham, about 80 of its 900
students visit its support centre, which has three full-time staff.
Not all children who visit the centre have serious problems but
early intervention is the ethos. “We offer time, space, someone to
listen,” says Mark Prever, who manages the service and has worked
previously as a teacher and counsellor.

One option for exploring mental health issues in the school
curriculum could be in personal, social and health education
lessons. Prever, who has written a resource on this for teachers,
says schools sometimes struggle with this area.

He says: “Teachers aren’t trained in this subject. You need to
maintain your authority when discussing personal sensitive matters
with a group of young people, which is difficult. Often the tough
issues won’t be discussed and teachers will focus on
non-controversial topics such as how parliament works.”

So it seems that the most accessible professionals – teachers
and doctors – are often too busy or lacking in the right skills to
help young people with mental health problems.

A Royal College of Psychiatrists factsheet for young people
about depression recommends: “Simply talking to someone you trust,
and who you feel understands, can lighten the burden.”

If only it were that straightforward.

1. S Collishaw and colleagues, “Time trends in adolescent mental
   health”, Journal of Child Psychology and Psychiatry Volume 45,
   2004
2. Royal College of Psychiatrists, Acute In-patient Psychiatric
   Care for Young People with Severe Mental Illness, RCP, 2002,
   revised 2004

Mark Prever has written a resource pack ‘Exploring Mental
Health’ for people working with children. It was was devised
and published by BACP in association with major teaching unions. It
is a free resource and is available from  0870 443 5252.