A Report On The Mental Health Of Young People In Scotland

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A report on the mental health ofyoung people in ScotlandCommissioned by SAMHResearch by Jacki Gordon with Professor Stephen Platt 2017goingto be

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND “It’s paramount that young people aremade aware of the importance ofgood mental health and how to accessservices. If we can normalisediscussions around mental health,and the fact that everyone goesthrough periods of poor mentalhealth in their life, then I think peoplewould be more likely to recognise andadmit when they are struggling.”Chelsea Rocks, who became unwell at age 152

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND ContentsForewords 4SAMH Introduction 6Executive Summary 71. Full Report 82. What do recent reports tell us about the natureand extent of mental healthproblems and mentaland emotional wellbeing in 12-18 year oldsnationally in Scotland? 93. What do recent reports tell us about “whathappens” when young people, aged 12-18 years,seek help from services in Scotland? 15References 22Notes 263

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND 4ForewordThis year, SAMH launched our Going To Be campaign.We did this because an overwhelming number of peoplehave told us there is a lack of mental health educationand support for young people. They have also told us itis essential for children and young people to learn aboutmental health at a young age.Most children will never come into contact with specialist mental health services, yet allchildren have mental health. Diagnosis of a mental health problem should not be theonly mechanism to trigger support, but it’s often at that late stage when interventionstake place. We need to act faster. Improving the self-esteem, resilience and well-beingof all our young people must be a priority.Going To Be is all about campaigning for the future. It’s got to change. We can’t alwaysprevent young people from developing a mental health problem but we can give themevery chance to understand their mental health and normalise help- seeking withoutstigma.As adults we all remember a time when, as a young person, we thought about what wewere ‘going to be’. We probably chatted with friends about it. It is usually from a place ofhope and aspiration for the future. Experiencing a mental health problem shouldn’tchange that, but it does.SAMH believes the time is right to review, refocus and invest in early intervention andpreventative support for children and young people.Going To Be is our contribution to achieving this aim.Billy WatsonSAMH Chief Executive

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND 5Foreword from CaraWhen Cara was young she had hopes of becoming anartist. This was put on hold as she struggled with aneating disorder and Borderline Personality Disorderthroughout school without the support she needed.“At high school I was perfect, a good student with good grades. I tried to tell myteachers that I didn’t feel the same as my friends. The School could see something waswrong but they didn’t know where to send me or what to do. No one talked aboutmental health.“I went to the doctors consistently for 6 months to get the help I needed, but I was toldI couldn’t get help.“Because of my age I was too old to go to children’s mental health services and tooyoung for adult services. I was lost in the system for a year. I felt confused andoverlooked.“I should have received support at a younger age, but it took 5 years until I was 23 for adoctor to diagnose me with Borderline Personality Disorder. Now 25, I have started topiece together my life which is now stable.”

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND 6INTRODUCTIONHalf of mental health problems inadulthood begin before the age of 14.1By the time they’re 16, roughly 3children in every class will haveexperienced a mental healthproblem.2 And thousands willstruggle to get the help they need.Over 7,000 young people were turned away from CAMHSservices in the last year. That’s 19 young people everyday.3When it comes to finding help for your mental health, onlya quarter of young people know where to go.4There are more than 900,000 children and young peoplewho live in Scotland.5 Our mission is to change things forthese young people and for generations to come. So wecommissioned this report to help us understand themental health issues children and young people arefacing.It’s got to change:our initial recommendationsThere is much to do, and over the life of Going To Be we’ll becampaigning for many changes. But we think three things need tostart happening straight away:v By 2018, create a programme totrain all school staff in mentalhealthv By 2020, provide counsellingservices across Scotland’ssecondary schoolsv By 2020, let children and youngpeople stay in specialist servicestill age 25Visit www.samh.org.uk to join our movement for change.

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND EXECUTIVESUMMARYSAMH commissioned this report toreview published and unpublishedevidence from the last five years about: the nature and extent of mental healthproblems, and of mental andemotional wellbeing, in 12-18 year oldsnationally in Scotland; and what happens when young people,aged 12-18 years, seek help for theirmental health from both statutory andnon-statutory services in Scotland.MethodsA rapid review of relevant articles andreports was undertaken in March 2017.This involved searches of publishedarticles and identification of unpublishedreports.This report is not a systematic review. It isa selective account of some recentdevelopments in understanding thenature and extent of mental healthproblems and mental wellbeing amongyoung people, and their experiences inaccessing support from services, inScotland.What do recent reports tell us about thenature and extent of mental healthproblems and mental and emotionalwellbeing in 12-18 year olds nationally inScotland? Inequalities are evident, withassociations between mental healthand gender, age, ethnicity, socialposition, deprivation and being lookedafter/accommodated. Generally speaking, older boys and girls(S4 pupils) have worse mental healththan younger ones (S2 pupils) Girls, in particular, those at age 15,experience poorer mental health thanboys Stresses of school-life featureprominently, with a particular increasein girls reporting high levels of pressurefrom schoolwork Bullying at a young age can affectmental health in later life Young people are increasinglyexperiencing emotional andpsychological health problemsWhat do recent reports tell us about‘what happens’ when young people,aged 12-18 years, seek help fromservices in Scotland? While the majority of young peoplereferred to Child and AdolescentMental Health Services (CAMHS) areseen within 18 weeks, almost 20%experience longer waits. Around a fifth of referrals to CAMHSare rejected, with no informationprovided about what happens next tothose young people. There are considerable variationsacross health boards in waiting times. Long waits can leave young peoplefeeling anxious about their ability tocope. Young people experience a diverserange of barriers to help-seekingincluding fears about not being takenseriously, being judged, and aboutconfidentiality. Young people would welcome betterinformation on where to go for help,and more and better support fromnon-professionals. The importance of prevention, earlyintervention and trust are recurringthemes.7

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND 8GOING TO BE ALL RIGHT?2017Scope1.1 MethodsThe researchers were asked to reviewexisting literature on:In March 2017, a rapid review wasundertaken of relevant articles publishedover the past five years. These wereidentified via searches of the followingdatabases: the nature and extent of mental healthproblems and mental and emotionalwellbeing in 12-18 year olds nationally inScotland; and what happens when young people,aged 12-18 years seek help fromservices (statutory and non-statutory)in Scotland.For the second question, the interesttherefore lay in not only service uptake,but also what supports and hinders suchuptake, and views / experiences ofaccessing services.In addition, the report was to outline keyaspects of the Scottish strategiclandscape relevant to these points ofinterest. More specifically, SAMH’sinterest was in developments over thepast five years as they relate to youngpeople in Scotland. Applied Social Science Index &Abstracts (ASSIA) PsycINFO CINAHL MEDLINE Web of Science (SSCI, SCI)Appendix 1 provides the search termsthat were used to search thesedatabases. Abstracts for each of theidentified articles were downloaded, andfor those that were directly relevant tothe research questions, the full articleswere sourced and read. In addition,unpublished reports were identifiedthrough: the commissioners’ knowledge ofrelevant (Scottish) reports contacting selected national statutoryand non-statutory in Scotland to ask ifthey had, or knew of any reports thatwere relevant to the researchquestions on-line searches regarding youngpeople’s mental health in Scotland.1.2 A note on scope and limitationsof methods and this reportWhile information and findings weredistilled for this report, it should be notedthat this report is not intended to be, andshould not be viewed as, a systematicreview. Thus, this report is not acomprehensive account of all evidence(or strategic context) that is relevant tothe questions of interest to SAMH.Rather, it is a selective account of somerecent developments in understandingthe nature and extent of mental healthproblems and mental wellbeing amongyoung people, and their experiences inaccessing support from services, inScotland.

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND 91What do recent reports tell us about the nature and extent ofmental health problems and mental and emotional wellbeingin 12-18 year olds nationally in Scotland?‘The extensive inequalities in mentalhealth outcomes by gender, age andSIMD demonstrate the need for a rangeof national policies to give direction toand support this agenda. These includepolicies on nutrition and physical activity,drugs, alcohol, suicide prevention,poverty, inequality and also many othersthat less directly shape the context formental health.’(Tod et al. 2013, page 97)This chapter draws heavily andselectively from four key sources offindings regarding the mental health ofScottish young people: Scottish Schools Adolescent Lifestyleand Substance Use Survey (SALSUS)as reported in Black, C and Martin, C.(2015) Children’s and Young People’s mentalhealth indicator data as reported byTod et al. (2013) Scottish Health Behaviour in Schoolaged Children (HBSC) Study asreported in HBSC briefing papers byCosma et al. (2016a,b) and HBSCjournal articles Scottish Health Survey (SHeS) asreported by Brown et al. (2016) in TheScottish Health Survey 2015: mainreport.Short descriptions of these four largescale pieces of research are provided inAppendix 2.TerminologyIt should be noted that the term ‘mentalhealth’ is not used in a consistent manneracross all research reported. Thus,sometimes the term ‘mental health’refers to mental wellbeing, whereas atother times, it is used as a general termthat can encompass mental healthproblems. Furthermore, research studiescan differ in the terms used to refer todifficulties or distress, variously usingterms such as ‘mental health problems’,‘psychological problems’ and ‘emotionalproblems.Main findings Inequalities are evident, withassociations between mental healthand gender, age, ethnicity, socialposition, deprivation and being lookedafter/accommodated. Generally speaking, older boys and girls(S4 pupils) have poorer mental healththan younger ones (S2 pupils). Girls, in particular, those at age 15,experience poorer mental health thanboys. Stresses of school-life featureprominently, with a particular increasein girls reporting high levels of pressurefrom schoolwork. Bullying at a young age can affectmental health in later life. Young people are increasinglyexperiencing emotional andpsychological health problems2.1 Overview: current mental healthand wellbeing among young peopleLarge-scale national studies of youngpeople in Scotland are in agreement that,generally speaking: Mental health and wellbeing worsenswith age, and in the case of the HealthBehaviour of School-aged Children(HBSC) research which also measureslife satisfaction, high life satisfactionalso diminishes with age. Boys have better mental health andwellbeing than girls (more details onthis are provided later). Mental health and wellbeing is lower for15 year old girls than otherdemographic groups of young people.Reporting on its most current picture ofScottish adolescents’ mental health(from 2014 data collected in schools),findings from the HBSC survey (Cosma etal. 2016a,b) indicate: the majority indicate feeling highlysatisfied with their life; two fifths responded that they are veryhappy at present; two fifths responded that they feltpressure from school work; almost a quarter reported havingexperienced two or morepsychological complaints (e.g. havingdifficulty sleeping, or feeling low,irritable or nervous) within the previousweek; less than one in five responded thatthey always feel confident; less than one in in five reported thatthey never feel left out or excluded.

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND 10‘These findings underline theimportance of school-based SSSin adolescence ’Findings from the NSPCC review ofChildLine 2015-2016 offer another lensthrough which to consider issues thataffect young people and cause themdistress and which prompt them to reachout for external support. Such findingsmay tell us more about (prior or acute)unmet needs than needs generally, butare nevertheless of potential interesthere. This review reports that: Nationally/UK-wide, young people aged12-15 were most likely to talk toChildLine about family relationships,low self-esteem/unhappiness andbullying, whereas those aged 16-18were most likely to talk to the serviceabout low self-esteem/ unhappiness,family relationships, and sex andrelationships. Looking at Scottish data only, the mostcommon primary concerns were lowself-esteem/unhappiness whichaccounted for 16% of calls and familyrelationships, which accounted for 12%.Other issues featuring among the ‘topten’ concerns were: self-harm; suicidalfeelings; friendship issues; bullying/online bullying; sex/relationships/puberty/sexual health; problems inschool; mental health/ depression; andsexuality and gender identity (NSPCC2016).2.2 Socio-economic and schoolbased inequalitiesEvidence is inconsistent on whether/howhealth, (including mental health) inadolescence is patterned by socioeconomic position, with ‘several but notall studies suggest[ing] “relative equality”’during this life-stage’ (Sweeting et al.2016, page 8).Analysis of data obtained from Scottishschool-pupils in 2013 has indicated thatmental health and wellbeing are poorerfor those who live in less affluentcircumstances - a finding that is evidentwhen looking at the Scottish Index ofMultiple Deprivation (SIMD), receipt ofFree School Meals and, most strongly inrelation to perceived family affluence(Black and Martin 2015).Research involving 2,503 Scottish pupilsin S2 - S4 (aged 13 to 15 years) points tocomplexities in the relationship betweenobjective and perceived socio-economicstatus (SES) and psychological wellbeing, and raises questions aboutwhether other types of social standingare equally, or more, strongly correlatedwith mental health difficulties6. Thisresearch looked at two objective SESmeasures (residential deprivation, basedon SIMD, family affluence7, one perceivedSES measure (subjective socioeconomic status)8 and three additionalsubjective social status (SSS) dimensionsthat related to perceived social standingwithin the school context: social statusamong their peer group (‘SSS-peer’),social status in terms of doing well atschool (‘SSS-scholastic’) and socialstatus in terms of being sporty (‘SSSsports’). Analyses found thatassociations between objective SES andpsychological wellbeing were weak andinconsistent. However, there were clearassociations (for both boys and girls)between: lower subjective SES and increasedpsychological distress lower SSS-peer and increasedpsychological distress but reducedanger lower SSS-scholastic and increasedpsychological distress and anger lower SSS-sports and increasedpsychological distress.The school-based subjective socialstatus dimensions were more stronglyassociated with psychological distressthan either the objective or subjectiveSES measures.The authors conclude:‘These findings underline the importanceof school-based SSS in adolescence They also highlight the need for a focuson school-based social status amongthose working to promote adolescenthealth/well-being’ (Sweeting and Hunt2014, Page 39).2.3 Age: a complex pictureWhen looking at young people as a group(and not taking gender into account),recent studies suggest that increasingage is associated with poorer metalhealth and wellbeing in young people.More specifically, studies have indicatedthat, among young people, withincreasing age: mental wellbeing decreases (Brown etal. 2016) and mental health problemsgenerally increase9 (Tod et al. 2013) there are decreases in the percentageswho report happiness and high lifesatisfaction (Cosma et al. 2016a; Tod etal. 2013) and in levels of confidence(Cosma et al. 2016b) larger percentages report two or morepsychological complaints within theprevious week and higher levels ofpsychological stress (Cosma et al.2016a) pro-social behaviour deteriorates10(Tod et al. 2013).

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND Research has consistently highlightedhowever that the relationship betweenage and mental health is notstraightforward. Recent analysis (usinglogistic regression11) has indicated thatage alone is not a key driver of mentalhealth and wellbeing but rather reflectsother factors which change as pupils getolder:‘While the prevalence of mental healthand wellbeing problems has divergedbetween girls and boys in recent years,the main drivers have not. Pressure ofschool work and number of friendshipsare central to mental health andwellbeing’ (Black and Martin 2015, page51).Several other factors are also associatedwith mental health and wellbeing (e.g.family affluence, physical health),although these are not as strong driversof mental health and wellbeing as factorsto do with school and with friendships.Once the diverse range of factors areintegrated into analyses, it would appearthat age in, and of, itself does not have alarge impact on mental health andwellbeing (Black and Martin, 2015). Thus,the picture is a complex one that ischaracterised by the interplay of manyfactors.2.4 A gender perspectiveThere are marked gender differences inthe mental health of young people. Thepicture is, however, made more complexby some interactions between genderand age (reported below).Notwithstanding these interactions,identified gender differences haveincluded: mental wellbeing being higher in boysthan in girls (Brown et al. 2016, Tod et al.2013) overall, boys being less likely to havecommon mental health problems,emotional symptoms or to reportsadness (Tod et al. 2013) boys being more likely than girls toreport happiness (Cosma et al. 2016a,Tod et al. 2013) and feeling confident‘always’ (Cosma et al. 2016b) girls being more likely than boys toreport recent psychologicalcomplaints (Cosma et al. 2016a) girls scoring better for pro-socialbehaviour than boys, being less likely tohave conduct problems (Tod et al.2013, Black and Martin 2015), and beingmore resilient to engaging in violence inlate adolescence (McVie 2014) boys being more likely to report peerrelationship problems than girls (Blackand Martin 2015). girls experiencing school pressuresmore than boys (particularly, at age 15when the gap between girls and boys isat its greatest) (Currie et al. 2015) girls being less likely to suffer fromdrug-related disorders (Tod et al. 2013) girls being less likely to completesuicide (Tod et al. 2013).Thus, while boys are more likely to reportbehavioural problems than is the casewith girls, girls are more likely to reportemotional problems than boys.As Currie and colleagues comment in aneditorial in the Journal of the RoyalCollege of Physicians:‘What is the most worrying are the trendsreported on girls’ mental health. Theseshow that the mental health andwellbeing of adolescent girls has beendeclining over recent years’ (Currie et al.2015, page 258).11Findings from calls to ChildLine (NSPCC2016) tell a similar story. For girls - mentalhealth and wellbeing concerns, includinglow self-esteem/unhappiness, are themost common reasons for contactingChildLine. This review also echoes thefindings in relation to boys reportedabove insofar as relationships, andconcerns about their own behaviour,feature more commonly than among thegirls.This same ChildLine review also reportsthat across the UK: for girls, suicidal feelings and self-harmare among the most common reasonsfor seeking help from ChildLine for boys, bullying (including onlinebullying) is the focus of a higherproportion of counselling sessionsthan for girls.2.5 15 year old girlsMany studies point to the high levels ofemotional problems and low mentalwellbeing that are found among girls aged15 years. For example, 44% of 15 year oldgirls reported having two or morepsychological health issues (includingfeeling low, irritable, nervous, dizzy, andhaving sleep difficulties). As acomparison, such difficulties werereported by 21% of boys of this age(Currie et al. 2015).More specifically, studies highlight that asa group, 15 year old girls have poorermental health and wellbeing than otherdemographic groups. For example,compared with other age/gender groups,15 year old girls have been shown toreport: a higher rate of emotional problemsand of hyperactivity (Black and Martin2015)

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND lower life satisfaction and health-related quality of life (Cosma et al.2016a) higher levels of school pressure and offeeling left out (Cosma et al. 2016b).It has been further suggested thatanother factor negatively impacting ongirls’ mental wellbeing may stem fromtheir self-perceptions of their looks andbody size, with 55% of 15-year-olds girlsreporting that they are too fat (Currie etal. 2015).2.6 Pupils in GlasgowData from the HBSC survey (2006) wereanalysed to consider the mental healthand wellbeing of pupils (Primary 7, S2 andS4) in Glasgow as compared with those inthe rest of Scotland (Levin 2012).This analysis indicated that thepercentages of pupils reporting beingvery happy, always confident and neverleft out were greater among pupils inGlasgow compared with pupils in the restof Scotland.The author concludes with a commenton potential implications for improvingadult health outcomes in Glasgow, andthereby tackling the much disputednotion of a ‘Glasgow effect’:‘The current study highlights the need forfurther examination of the health of thepopulation in Glasgow compared withthe rest of Scotland during adolescence.The key to understanding the Glasgoweffect and to overcoming the associatednegative health outcomes in adulthoodmay lie in this period of transition anddevelopment, where many healthbehaviours are formed and carriedthrough to adulthood.’ (Levin 2012, page102).122.7 Ethnicity2.9 DisabilityScottish pupils with mixed or multipleethnicities have been reported as beingmore likely to report poor mental healthand wellbeing than those from otherethnicities (Black and Martin 2015).Ninety-one disabled children and youngpeople in Scotland completed aquestionnaire about their quality of life.Respondents were aged between 5 and18 years of age, with 70% between 13 and18. Using KIDSCREEN -27, a standardisedinstrument to assess children’s andadolescents’ subjective health and wellbeing: 43% reported that their life hadbeen ‘extremely’ or ‘very’ enjoyable in theprevious week; one in three reportedoften feeling sad and depressed;‘significant minorities’ (20% - 27%) gavenegative responses concerning howoften they felt lonely, sad, so bad they didnot want to do anything, or unhappy withthe way they were, with those aged 14 -18being most likely to feel lonely andunhappy (Sylvester et al. 2014). Theauthors conclude:2.8 Looked after andaccommodated children andyoung peopleChildren and young people who areclassed as ‘looked after’ (LA) and ‘lookedafter and accommodated’ (LAAC), havebeen identified as being especially at riskof self-harm. An anonymous self-reportsurvey across 10 schools within six localauthority regions in West CentralScotland was conducted with 102 pupils,aged 11-17 years old, who were, or hadpreviously been LA or LAAC12. This studyfound that 32% of the LA/LAC had selfharmed and/or thought about harmingthemselves. (Harkness-Murphy et al.2013). The authors conclude:‘A recent claim by the British Associationfor Counselling and Psychotherapy(BACP) argues there is a lack ofcounselling services within mainstreamsecondary education institutions inScotland (BACP: media centre, 201113).With a lack of counselling support and noroutine screening that is sensitive todetecting vulnerability to self-harm, thereis a considerable missed opportunity torespond to the psychological needs ofScotland’s young people’ (page 298).Compared with findings from a largerEuropean study using the samequestionnaire with mostly non-disabledchildren, the Scottish sample scoredlower in every area (Sylvester et al. 2014,page 763).

GOING TO BE ALL RIGHT? – A REPORT ON THE MENTAL HEALTH OF YOUNG PEOPLE IN SCOTLAND 13Dramatic increases have been seen inpsychological health complaints(including feeling low, irritable,nervous, dizzy, and having sleepdifficulties2.10 Being bullied2.11 Changes over time in ScotlandAnalysis of six sweeps of Scottish HBSCdata (over the period 1994 - 2014)involving over 42,000 pupils (aged 11, 13and 15 years old) show that overall, 10.6%indicated that they had been bullied atleast two to three times per month in thepreceding two months, and while therewere no significant gender differences,bullying victimisation rates decreasedwith pupils’ age (Cosma et al. 2017).Analysis of data over a prolonged periodindicate:This latter study showed thatassociations between bullyingvictimisation and (lowered) mentalwellbeing vary by age and gender. Femalevictims reported less confidence andhappiness and more psychologicalcomplaints than those who had not beenbullied (Cosma et al. 2017).Using longitudinal data from theEdinburgh Study of Youth Transitions andCrime, a study of around 4,300 youngpeople in Scotland on the impact ofbullying (between the age of 13 and 16years) on negative outcomes at age 17years concluded that ‘extreme bullying asa victim in the early teenage years had aprofound effect on long-term mentalhealth’ (McVie 2014, page 12). Emotional problems, and to a lesserextent peer relationship problems,have deteriorated over time with themain change happening between 2010and 2013 (Black and Martin 2015). Conduct problems and pro-socialbehaviour have been improvinggradually since 2006, and hyperactivityhas marginally improved14 (Black andMartin 2015). While mental wellbeing scores (asindicated by the Warwick-EdinburghMental Well-being Scale [WEMWBS] )remained fairly stable between 2010and 2013, there has been a slightdecrease in the average mentalwellbeing score among 15 year old girls:the findings suggest that, on average,15 years old girls’ wellbeing deterioratedover this time period (Black and Martin2015). An increase in emotional problemsfrom 2010 to 2013 has been evident in13 year old girls, although this effectwas not as strong as in 15 year old girls(Black and Martin 2015). Life at school seems to be increasinglystressful in terms of the pressure fromschoolwork, with a widening gender gap(Currie et al. 2015). Between 2006 and2014, the percentage of 15 year old girlsreporting high levels of pressure fromschool work has risen steeply between(Cosma et al. 2016b). Dramatic increases have been seen inpsychological health complaints(including feeling low, irritable, nervous,dizzy, and having sleep difficulties(Currie et al. 2015). Feeling confident ‘always’ has beendecreasing gradually among both boysand girls (Cosma et al. 2016b). There has been a widening gender gapin emotional problems, mainly becauseof the increases in emotional problemsamong girls aged 15, and to a lesserextent, among girls aged 13 (Black andMartin 2015). Bullying victimisation rates haveincreased between 1994 and 2014 formost age-gender groups (but notamong 13-year-old boys and 15-yearold girls) with the steepest increasebeing eviden

Half of mental health problems in adulthood begin before the age of 14.1 By the time they're 16, roughly 3 children in every class will have experienced a mental health . mental health issues children and young people are facing. It's got to change: our initial recommendations

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