Mental Health Of Children In England
The mental health of childrenand young people in EnglandDecember 2016
ContentsBackground and aims3The importance of mental health for children and young people (CYP)4Facts about mental health illness in CYP6Why invest in CYP mental health?10Mental health statistics11Common mental health conditions in children and young peopleAnxiety disorders15Attention deficit hyperactivity disorder (ADHD)16Conduct disorder17Depression18Eating disorders19Schizophrenia20Self-harm and suicide21Useful resources22References24Picture credits31Acknowledgements322
Background and aimsBackgroundAimsThe emotional health and wellbeing of children is just as important astheir physical health and wellbeing. Over the past few years there hasbeen a growing recognition of the need to make dramatic improvementsto mental health services for children and young people (CYP). This hasresulted in:The purpose of this report is to: significant investment in these services the development of local transformation plans outlining how clinicalcommissioning groups (CCGs) and CCG consortia, working withpartner agencies will use the new funding to improve children’shealth and wellbeing and improve services for CYP with mentalhealth illness across the care pathway, ensuring these service areage appropriate describe the importance of mental healthin CYP describe the case for investing in mentalhealth provide a descriptive analysis of mentalhealth in CYP in England summarise the evidence of what works toimprove mental health in CYP in order toinform local transformation of services3
Mental health illnesses are a leading cause of health-relateddisabilities in CYP and can have adverse and long-lasting effects4
Risk and protective factors for CYP’s mental health5
Facts about mental health illness in CYP6
The relationship between mental and physical health7
Building resilience (the ability to cope with adversity and adapt to change)8
There are serious problems with the commissioning andprovision of children’s and adolescents’ mental health services**Findings from the House of Commons HealthCommittee (2014) Children and adolescents’ mentalhealth and CAMHS: Third report of session 2014-159
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Percentage of 15-year-olds reporting low life satisfaction (2014/15)11
Inequalities in reporting low life satisfaction (2014/15)Better Similar WorseCompared to EnglandSource: fingertips.phe.org.uk12
About 695,000 children aged 5 to 16 years in Englandhave a clinically significant mental health illnessNumbers do not add up as individuals may meet the criteria for more than one category13
Hospital admission rate for mental health illnesses for childrenper 100,000 population aged 0-17 years (2014/15)England87.4East MidlandsThere is a wide variationin the rate of children aged0-17 years admitted tohospital for mental healthillnesses83.3East of England78.8London94.2North EastHospital admissions were1.7x higher in the NorthWest (116.2 children per100,000 population)compared to Yorkshireand the Humber (69.3children per 100,000population)93.1North West116.2South East76.7South West86.0West Midlands85.7Yorkshire and the HumberCompared to EnglandLower Similar Higher69.3Source: fingertips.phe.org.uk14
Anxiety disorders15
Attention deficit hyperactivity disorder (ADHD)16
Conduct disorders17
Depression18
Eating disorders19
Schizophrenia20
Self-harm and suicide21
Useful resourcesWebsites k/camhswww.chimat.org.uk/PIMH Needs kwww.youngminds.org.uk22
Useful resourcesReports Department of Health, Department of Education (2013) Supporting the health andwellbeing of young carers Department of Health (2014) Annual Report of the Chief Medical Officer 2013 PublicMental Health Priorities: Investing in the Evidence Department of Health, Public Health England (2015) Promoting emotional wellbeingand positive mental health of children and young people Department of Health and NHS England (2015) Future in mind: Promoting,protecting and improving our children and young people’s mental health andwellbeing Local Government Association (2016) Best start in life: Promoting emotionalwellbeing and mental health for children and young people PHE and Children and Young People’s Mental Health Coalition (2015) Promotingchildren and young people’s emotional health and wellbeing: A whole school andcollege approach PHE and UCL Institute of Health Equity (2014) Local action on health inequalities:Building children and young people’s resilience in schools PHE (2015) Measuring mental wellbeing in children and young people PHE and Evidence Based Practice Unit (2016) Measuring and monitoring mentalwellbeing – a toolkit for schools and colleges23
ReferencesPage 3 Department of Health, NHS England (2015) Future in mind: Promoting, protecting and improving our children andyoung people’s mental health and wellbeing NHS England (2015) Local transformation plans for children and young people’s mental health and wellbeing NHS England (2016) The five year forward view for mental health NHS England (2016) Implementing the five year forward view for mental healthPage 4 Department of Health (2011) No health without mental healthPage 5 Commonwealth of Australia (2012-13) Kids matter: Australian primary school mental health initiative Department for Education (2016) Mental health and behaviour in schools: Departmental advice for school staffPage 6 10% of children aged 5-16 years suffer from a clinically significant mental health illnessDepartment of Health (2013) Our children deserve better: Prevention pays Percentage of people with lifetime mental illness who experience symptoms in childhoodKessler R, Berglund P, Demler O et al Arch Gen Psychiatry. 2005;62(6):593-602 Lifetime Prevalence and Age-ofOnset Distributions of DSM-IV Disorders in the National Comorbidity Survey 25% of children who need treatment receive it 60% of looked after children have some form of emotional or mental health illness Young people in prison are 18x more likely to take their own lives than other of the same ageChildren and young people’s health outcome forum (2012) Report of the children and young people’s healthoutcomes forum – mental health subgroup Boys aged 11-15 years are 1.3x more likely to have a mental illness compared to girls aged 11-15 yearsDepartment of Health (2013) Our children deserve better: Prevention pays24
ReferencesPage 7Department of Health and NHS England (2015) Future in mind: Promoting, protecting and improving our children andyoung people’s mental health and wellbeingPage 8Department of Health (2014) Public mental health priorities: Investing in the evidencePage 9House of Commons Health Committee (2014) Children and adolescents’ mental health and CAMHS: Third report ofsession 2014-15Page 10 Mental health excess costsDepartment of Health (2013) Our children deserve better: Prevention pays NHS expenditure, early intervention and measured benefitsDepartment of Health and NHS England (2015) Future in mind: Promoting, protecting and improving our childrenand young people’s mental health and wellbeingPage 13 Overall prevalence rate, prevalence of ADHD and depression in 2014 from Children and young people’s mentalhealth and wellbeing Fingertips tool available at fingertips.phe.org.uk Prevalence rates of anxiety and depression from ONS (2005) Mental health of children and young people in GreatBritain, 2004 (Table 4.1) applied to 2014 population estimates from fingertips.phe.org.uk (anxiety: 3.3%,depression: 0.9%)25
ReferencesPage 15 Anxiety disorders, causes and prevalenceCentre for Mental Health (2015) Investing in children’s mental health Anxiety disorders prevalenceONS (2005) Mental health of children and young people in Great Britain, 2004 (Table 4.1) Anxiety disorders associated with other mental health conditionsCentre for Mental Health (2015) Investing in children’s mental health Outcomes of anxiety disorders and cost-benefit of cognitive behavioural therapyCentre for Mental Health (2015) Investing in children’s mental health Actions to manage anxietyDepartment for Education (2016) Mental health and behaviour in schools: Departmental advice for school staffPage 16 Prevalence of ADHDONS (2005) Mental health of children and young people in Great Britain, 2004 (Table 4.1) ADHD prevalence, risk factors and outcomesCentre for Mental Health (2015) Investing in children’s mental health Estimated annual UK costs associated with ADHD in adolescentsTelford C, Green C, Logan S, et al. Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivitydisorder. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 337-344 Long term costs of ADHDMental Health (2014) The lifetime costs of attention deficit hyperactivity disorder Actions to manage ADHDDepartment for Education (2016) Mental health and behaviour in schools: Departmental advice for school staffNICE guidelines (2016) Attention deficit hyperactivity disorder: diagnosis and management26
ReferencesPage 16 Only a minority of children receive evidence-based treatmentCentre for Mental Health (2015) Investing in children’s mental healthPage 17 Prevalence of conduct disordersONS (2005) Mental health of children and young people in Great Britain, 2004 (Table 4.1) Conduct disorders outcomesCentre for Mental Health (2015) Investing in children’s mental health Case for prevention of conduct disordersDepartment for Health (2012) Our children deserve better: Prevention pays Cost of managing conduct disordersDepartment for Health (2012) Our children deserve better: Prevention paysCentre for Mental Health (2015) Investing in children’s mental health Actions to manage conduct disordersThe British Psychological Society and the Royal College of Psychiatrists (2013) Antisocial behaviour and conductdisorders in children and young people: Recognition, intervention and management. NICE Clinical GuidelineNumber 158Page 18 Prevalence of depressionONS (2005) Mental health of children and young people in Great Britain, 2004 (Table 4.1) PrognosisNational Collaborating Centre for Mental Health (2005) Depression in children and young people: Identification andmanagement in primary, community and secondary care27
ReferencesPage 18 Risk factors for depressionONS (2005) Mental health of children and young people in Great Britain, 2004National Collaborating Centre for Mental Health (2005) Depression in children and young people: Identification andmanagement in primary, community and secondary care Cost effectiveness of behavioural therapy and parents seeking medical careCentre for Mental Health (2015) Investing in children’s mental health Actions to manage depressionNICE guidelines [CG28] (2005, updated 2015) Depression in children and young people: identification andmanagementPage 19 Eating disorder definition and prevalenceBEAT (2015) The costs of eating disorders. Social, health and economic impacts Anorexia and bulimia nervosa rders/Pages/Introduction.aspx (accessed July 2016) 1 in 5 of the most seriously affected will die prematurelyCentre for Mental Health (2015) Investing in children’s mental health Risk factors for eating disordersBEAT (2015) The costs of eating disorders. Social, health and economic to-know/ Physical impacts of eating disordersBEAT (2015) The costs of eating disorders. Social, health and economic sorders/anorexia-nervosa (accessed July rders/bulimia-nervosa (accessed July 2016)28
ReferencesPage 19 Costs associated with eating disordersBEAT (2015) The costs of eating disorders. Social, health and economic impacts Actions to manage eating disordersBEAT (2015) The costs of eating disorders. Social, health and economic impactsDepartment for Education (2016) Mental health and behaviour in schools: Departmental advice for school staffPage 20 Schizophrenia - prevalence, symptoms, risk factors and physical outcomesNational Collaborating Centre for Mental Health (2012) Psychosis and schizophrenia in children and young people Costs associated with schizophreniaPersonal Social Services Research Unit, London School of Economics and Political Science (2011) Mental healthpromotion and prevention: The economic case Outcomes and management for CYP with schizophreniaNational Institute for Clinical Excellence (2015) Psychosis and schizophrenia in children and young people:Evidence updatePage 21 Self harm - prevalence, risk factors, support and suicide riskNational Workforce Programme (2011) Self-harm in children and young people handbook Self harm - costs of hospital admissionEarly Intervention Foundation (2015) Spending on later intervention: How we can do better for less29
ReferencesPage 21 Suicide - risk factorsButterworth S, Suicide and self-harm in young people: risk factors and interventions available e and Self-harm in young people.pdf (accessed August2016) Suicide - actions to reduce suicidesDepartment of Health (2012) Preventing suicide in England: a cross-government outcomes strategy to save livesNational Confidential Inquiry into Suicides and Homicides by People with Mental Illness (2016) Suicide by childrenand young people in England30
Picture credits Abuse by Dr Marilena KorkodilosBaby by Edward Boatman from the Noun ProjectBone by Dr Marilena KorkodilosBrain by Chameleon Design from the Noun ProjectBoy’s silhouette by Dr Marilena KorkodilosBusiness people by Honnos Bondor from the Noun ProjectChildren by Gilad Fried from the Noun ProjectChurch by Creative Stall from the Noun ProjectCommunity by Dr Marilena KorkodilosConversation by Michael Downey from the Noun ProjectCurrency by Nimal Raj from the Noun ProjectDanger by Dr Marilena KorkodilosDegree by Dr Marilena KorkodilosDoctor by Megan Strickland from the Noun ProjectDrugs by Dr Marilena KorkodilosDrunk by Dr Marilena KorkodilosEducation by Chris Matthews from the Noun ProjectFace by Dr Marilena KorkodilosFriend by Dr Marilena KorkodilosGirl and boy by Dr Marilena KorkodilosGenetics by Edward Boatman from the Noun ProjectGrave by Dr Marilena KorkodilosHeart by Chameleon Design from the Noun ProjectHouse by Dr Marilena KorkodilosIndividual responsibility by CO. Department of Health Care andPolicy Financing, US from the Noun Project Intestine by Dr Marilena Korkodilos Mental Health by Edward Boatman from the Noun Project Integrated heath systems by CO. Department of Health Careand Policy Financing, US from the Noun Project Kidney by Edward Boatman from the Noun projectMaze by Dr Marilena KorkodilosMoney by Dr Marilena KorkodilosMedicine by Dr Marilena KorkodilosPathway by Dr Marilena KorkodilosPartners by Dr Marilena KorkodilosPiggy Bank by Lloyd Humphreys from the Noun ProjectPill by Dr Marilena KorkodilosPlan by Dr Marilena KorkodilosPrison by Dr Marilena KorkodilosPregnant by OCHA Visual Information Unit by the Noun ProjectPuzzle by Becky Warren from the Noun ProjectReflect by Dr Marilena KorkodilosResearch by Dr Marilena KorkodilosRibbon by Fission Strategy from the Noun ProjectSchool by Dr Marilena KorkodilosSearch by Dr Marilena KorkodilosSkills by Rflor from the Noun ProjectSocial Services by Edward Boatman from the Noun ProjectStudent by Gerald Wildmoser from the Noun ProjectSwirl by Dr Marilena KorkodilosTablet by Dr Marilena KorkodilosTeacher by Dr Marilena KorkodilosTelevision by Edward Boatman from the Noun ProjectTooth by Edward Boatman from the Noun ProjectTreatment by Dr Marilena KorkodilosThinking by Ahmed Sagarwala from the Noun ProjectUterus by Max Paladii from the Noun ProjectWaiting room by Edward Boatman from the Noun Project31
AcknowledgementsI am grateful to the following individuals for their comments/help with the report: Jake Abbas, head of local knowledge and intelligence services, PHE Shelley Aldred, programme lead, health and wellbeing, PHE London Gillian Bryant, senior health intelligence analyst, Mental health, dementia and neurology network, PHE Eustace de Sousa, national lead, children, young people and families, PHE Francesca Edelmann, senior knowledge transfer facilitator, knowledge and intelligence services (London), PHE Lucy Fordham, press officer, PHE London Gregor Henderson, director of wellbeing and mental health, PHE Lily Makurah, deputy national lead, mental health and wellbeing, PHE Claire Robson, public health delivery manager, children, young people and families team, PHE Clare Semke, regional communications manager London, PHE Wendy Nicholson, national lead nurse, children, young people and families, PHE32
About Public Health EnglandPublic Health England exists to protect and improve the nation’s health and wellbeing, and reduce healthinequalities. We do this through world-class science, knowledge and intelligence, advocacy, partnershipsand the delivery of specialist public health services. We are an executive agency of the Department ofHealth, and are a distinct delivery organisation with operational autonomy to advise and supportgovernment, local authorities and the NHS in a professionally independent manner.Public Health EnglandWellington House133-155 Waterloo RoadLondon SE1 8UGTel: 020 7654 8000www.gov.uk/pheTwitter: @PHE ukFacebook: www.facebook.com/PublicHealthEnglandPrepared by: Dr Marilena Korkodilos, deputy director, specialist public health services, PHE (London) Crown copyright 2016You may re-use this information (excluding logos) free of charge in any format or medium, under the termsof the Open Government Licence v3.0. To view this licence, visit OGL or emailpsi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you willneed to obtain permission from the copyright holders concerned.Published: December 2016PHE publications gateway number: 201641733
NHS England (2016) The five year forward view for mental health NHS England (2016) Implementing the five year forward view for mental health Page 4 Department of Health (2011) No health without mental health Page 5 Commonwealth of Australia (2012-13) Kids matter: Australian primary school mental health initiative
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
Children's Mental Health As a part of Children's Mental Health Awareness Week, addressing the mental health needs of children, youth and families is fundamental to the future of Fort Bend County. COVID-19 has had a significant impact on our communities and we must not overlook the psychological impact on our children's mental health.
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
A mental health policy (1996) and plan (2007-2011) existed. Emergency and disaster plans for mental health did not exist. Legislation A new Mental Health Act 846 2012 was passed in 2012 and was awaiting Government to establish the Mental Health Board. Financing of mental health services Mental health had a ring-fenced budget of 1.4% of
mental health is about much more than mental illness, and that there are significant benefits to be gained by approaching mental health from a public health perspective. Positive mental health, mental wellness and mental health promotion have emerged as the missing pieces in a system that has traditionally been
No Health Without Mental Health: A Cross Governmental Strategy (2011). 1. Why is the emotional and mental health of children and young people important? Good mental and emotional health is essential to enable children and young people to fulfil their potential. Emotional and mental health problems are a common group of disorders affecting about 1
of mental health conditions and, just as importantly, what promotes good mental health in children. National policy Given this concerning trend of worsening mental health among children, what is the government doing in response? At the end of 2017, the government published 114 Chapter 8: Mental Health Promotion in Primary Schools
