An Introduction to Child and Adolescent Mental Health

Maddie Burton, Erica Pavord, Briony Williams

• Publisher: SAGE Publications Ltd
• Year: 2014
• Print ISBN: 9781446249444
• eBook ISBN: 9781473905139
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Anyone who works within children and adolescent mental health services will tell you what a challenging and complex world it is. To help prepare you, the authors have produced a clear introduction to child and adolescent mental health that takes you step-by-step on a journey through the subject. Beginning with the foundations, the book explores the common mental health concepts and influences that you can expect to encounter examining topics like the difference between emotional and mental health issues and how mental health problems develop. It then moves on to explore the vital skills that you will need to develop like effective communication and basic counselling skills, and introduces some of the common interventions like Cognitive Behavioural Therapy, Psychodynamic theory and Family work.

Written by a multi-disciplinary team of passionate and experienced experts, the book strikes an effective balance between introducing the relevant theory and showing how this can be applied in the real world. It is an essential starting point to the subject of child and adolescent mental health and suitable for any students planning to support this group.

1

CHILDREN AND YOUNG PEOPLE’S MENTAL HEALTH

MADDIE BURTON

Overview

• Child and adolescent mental health – strategic view

• Child and adolescent mental health – context today

• Defining child and adolescent mental health

• Theoretical models

• Risk and resilience

• Mental health conditions:

Depression

Anxiety

Self-harm

Suicidal behaviour

Eating disorders

Early onset psychosis and substance misuse

Emerging personality disorder

• Neuro-developmental conditions

INTRODUCTION

This chapter will provide an overview of child and adolescent mental health problems and services. Psychological, biological, social and environmental theories inform our understanding of mental health problems. It is generally understood that a combination of nature and nurture theories, used to inform an understanding of human development, also offer the most likely theoretical explanations for understanding child and adolescent mental health. It is about the inter-play and inter-relation between:

• Biological factors (brain development and genetics);

• Psychological variables such as coping mechanisms;

• Genetic and physiological characteristics;

• Environmental circumstances (positive or negative).

Another way of thinking about this is that an individual’s inherent genes are triggered by experiences in childhood. Alternatively, positive experiences can mitigate or offset genetic factors. The nature and process of risk and resilience theory also requires exploration in order to understand the complex interplay between all these theoretical models. Child and adolescent mental health encompasses a large area and it is difficult to fully explore them all within the confines of a chapter; so some areas have a larger focus here than others.

CHILD AND ADOLESCENT MENTAL HEALTH: A STRATEGIC VIEW

Child and adolescent mental health is a relatively new psychiatric healthcare specialism; the Child and Adolescent Mental Health Services (CAMHS) we have today were commissioned and established following the Together We Stand Health Advisory Service Report (1995). Prior to that date child psychiatry was commonly situated in Child Guidance Clinics or Child Behaviour Clinics, with children being typically referred with symptoms such as larceny, masturbation and conduct disorder. Child Guidance Clinics were based on local commitment rather than explicit government policy. Young people with conditions including eating disorders and psychosis were treated in adult in-patient psychiatric hospitals and units. Since 2010 hospital mangers now have an obligation to provide age appropriate facilities (Barber et al., 2012).

Current CAMHS provision as established in 1995 includes a tiered strategic service:

Tier 1: a primary level of care; professionals include:

• GPs

• Health visitors

• School nurses

• Social workers

• Teachers

• Juvenile justice workers

• Voluntary agencies

• Social services.

Tier 2: a service provided by professionals relating to workers in primary care; professionals include:

• Clinical child psychologists

• Paediatricians (especially community)

• Educational psychologists

• Child and adolescent psychiatrists

• Child and adolescent psychotherapists

• Community nurses/nurse specialists

• Family therapists.

Tier 3: a specialised service for more severe, complex or persistent disorders; professionals include:

• Child and adolescent psychiatrists

• Clinical child psychologists

• Nurses (community or in-patient)

• Child psychotherapists

• Occupational therapists

• Speech and language therapists

• Art, music and drama therapists

• Family therapists.

Tier 4: essential tertiary level services such as day units, highly specialised out-patient teams and in-patient units. All of the above Tier 3 professionals would be included in this tier.

CHILD AND ADOLESCENT MENTAL HEALTH TODAY

Many mental health problems have origins in childhood (Dogra et al., 2009). Half of lifetime mental health problems (excluding dementia) begin to emerge by age 14 and three-quarters by the mid-twenties (Department of Health, 2011a). The prevalence of many childhood mental health disorders has increased in the western world during the last 25 years, particularly conduct disorders, anxiety and depression (Street et al., 2007).

Ten per cent of five to fifteen year olds have a diagnosable mental health disorder. This suggests that around 1.1 million children and young people under eighteen would benefit from specialist services. There are up to 45,000 young people with a severe mental health disorder. Around forty per cent of children with a mental health disorder are not currently receiving any specialist service. (National Service Framework, 2004: Rationale 2.2)

Activity

Why do you think there is an increase in reports of mental health problems for children and young people in Britain today?

There is a mixed picture of theories with no definitive answers! There is increased recognition and alertness to the possibility of mental health problems. Mental health is now perhaps considered as an explanation and understanding of presenting behaviours. The mental health agenda is now much more publicised than previously, in part due to the media and to government health awareness programmes. This has led to a more open discourse and together with all other health issues information is now much more readily available via the internet. Both parents and children are in some cases more likely to ask for help than in the past. Some Early Years settings professionals are now taking more interest in emotional and mental health. Children’s centres which began with Sure Start in the last decade are paying more attention and recognising the significance of poor emotional and mental health in children, their carers and families. They have instigated active programmes and links with health care professionals such as health visitors and local child and adolescent Tier 2 and 3 services. The Healthy Child Programme: Pregnancy and the First Five Years of Life (Department of Health, 2009) has a strong emphasis and commitment to improving attachment quality between parents and children, a strong indicator of the now recognised importance of attachment and improved social and emotional wellbeing. Early Years, teacher training programmes and social work training are rather slower in catching up with infant, child and adolescent mental health issues and understanding, as integral parts of their training. It is unfortunately at the moment patchy and in some areas non-existent. However the health driven agenda has raised awareness in education settings with programmes such as the three-year Targeted Mental Health in Schools (TaMHS) from 2008 to 2011 (Chimat, 2012), although this was a trial in specific areas in the country and only covered the 5–13 age group. Other initiatives have included Social and Emotional Aspects of Learning (SEAL, 2010) and Personal, Social and Health Education (PSHE, 2011).

CONTEXT OF CHILD AND ADOLESCENT MENTAL HEALTH

Science now evidences that infants are not too young to experience mental health problems. Those who have experienced significant maltreatment exhibit clinical symptoms of post-traumatic stress disorder (PTSD) (National Scientific Council on the Developing Child, 2004: 3). How these difficulties can be ameliorated does however offer hope for repair and will be discussed in Chapter 6.

Mental ill health is an interpretation of illness and the medicalisation of behaviours considered to be beyond the norm. What we are often presented with is a set of behaviours which could be seen to be acting out of the individual internal working model. So behaviours can be understood from a psychological perspective rather than a tendency for an interpretation of illness as such. Acting out is a process which aims to get the hurt addressed and is a defence mechanism (see Chapter 2), defending one from anxiety. Acting out is an emotional and externally visible response to feelings which are unmanageable.

Children and young people referred to CAMHS at Tier 2 and above are always thought about systemically; within their current and previous contexts of family or carers and including other systems around the child or young person, such as educational and community settings. It is important for all those working with children and young people throughout all tiers to be mindful of the child or young person’s context. Professionals and clinicians will be attentive in history taking a full developmental history of the individual and the family beginning at a point prior to conception. Almost always a history provides the clues with which to help understanding of behaviours and other presentations.

A diagnosis of conditions would be agreed, for example the signs and symptoms recognised in depression and eating disorders. Any condition has been with a child or young person for a relatively shorter time period than if the condition was presenting for the first time in adulthood. There is an important window of opportunity for intervention which would ideally be systemic and include the system around the child. The resulting changes brought about by interventions have more chance of success and for changes to be successful before the condition exacerbates, continuing into adulthood and becoming more concrete and difficult to treat.

One of the differences between a CAMHS and adult mental health model is that CAMHS is always a combination of medical and psychological interpretations and interventions, whereas an adult mental health model has been primarily medical in both interpretation and intervention. It is also relevant at this point to state that only GPs (although this is now less likely), and child and adolescent psychiatrists make clinical diagnoses. So it is important for children and young people where there are concerns over their mental health to be referred to a Tier 2 or 3 CAMHS team for a thorough assessment.

DEFINING CHILDREN AND YOUNG PEOPLE’S MENTAL HEALTH

Mental health is a broad concept, culturally determined, which can be complicated to interpret. It is also important to remember that meanings around mental health are culture bound and are subject to change. Universally it includes freedom from persistent problems with emotions, behaviour and social relationships (Kurtz, 1992, cited in Together We Stand, 1995: 18).

Mental health is aptly defined for children and young people by Hill (cited in Together We Stand, 1995: 15) as:

Not being easy to maintain within a context of ever changing circumstances and events which are dependent on individual potential and experience. It involves the capacity to develop in the following areas:

• Physically, emotionally, intellectually and spiritually

• The ability to initiate, develop and sustain mutually satisfying personal relationships

• The ability to become aware of others and empathise with them

• The ability to use psychological distress as a developmental process, so that it does not hinder or impair further development.

In children and young people mental health is more specifically indicated by:

• A capacity to enter into and sustain mutually satisfying personal relationships.

• Continuing progression of psychological development.

• An ability to play and learn so that attainments are appropriate for age and intellectual level.

• A developing moral sense of right and wrong.

• The degree of psychological distress and maladaptive behaviour being within normal limits for the child’s age and context.

Examples of potential mental health problems would include somatising features (physical symptoms with psychological origins) such as headaches, enuresis and encopresis (faecal soiling), tummy aches and sleep disturbances, self-harm, suicidal behaviours, risk taking, mood changes, behaviour changes, relationship and attachment difficulties, substance misuse, changed eating patterns, isolation and social withdrawal.

Examples of mental illness/disorder include eating disorders, anxiety disorders, depression, psychosis, conduct disorder, neuro-developmental conditions, such as attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders (ASD) – although it is now considered more appropriate to use the term autistic spectrum conditions (ASC) – developmental disorder, habit disorder, post-traumatic stress disorder and somatic disorders.

Mental health problems are relatively common but include mental health disorders, as above, which tend to be more persistent. There is a considerable overlap across ...

Table of contents

• Cover page
• Halftitle
• Sage
• Title
• Copyright
• Contents
• About the authors
• Acknowledgements
• Introduction
• 1 Business-to-Business Markets and Marketing
• 2 Buyer Behaviour
• 3 Inter-Firm Relationships and Networks
• 4 Responsible Business-to-Business Strategy
• 5 Researching Business-to-Business Markets
• 6 Business Market Segmentation
• 7 Market Communication
• 8 Relationship Communication
• Index