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Mental health of children and young people: What’s changed? (Part 1)

Dr Lucie Shuker

Jo Fitzsimmons

29 Apr, 2019

 

Lucie Shuker and Jo Fitzsimmons sat down to discuss ‘Mental Health of Children and Young People in England, 2017’ which was published in November 2018. This is part one of their conversation.

 

This survey series provides England’s best source of data on trends in child mental health, and follows surveys carried out in 1999 and 2004, meaning we now have comparable data for 5 to 15-year-olds living in England across three decades. The 2017 survey spans the transition into adulthood by covering 17 to 19-year-olds for the first time.

You can read the report here, but here are some of the key facts:

  • One in eight (12.8%) 5 to 19-year-olds had at least one mental disorder when assessed in 2017.
  • Specific mental disorders were grouped into four broad categories: emotional, behavioural, hyperactivity and other less common disorders. Emotional disorders were the most prevalent type of disorder experienced by 5 to 19-year-olds in 2017 (8.1%).
  • Rates of mental disorders increased with age. 5.5% of 2 to 4-year-old children experienced a mental disorder, compared to 16.9% of 17 to 19-year-olds.
  • Data from this survey series reveal a slight increase over time in the prevalence of mental disorder in 5 to 15-year-olds, rising from 9.7% in 1999 and 10.1% in 2004, to 11.2% in 2017.
  • Emotional disorders have become more common in five to 15-year-olds – going from 4.3% in 1999 and 3.9% in 2004 to 5.8% in 2017. All other types of disorder, such as behavioural, hyperactivity and other less common disorders, have remained similar in prevalence for this age group since 1999.

Part 1 – What’s changed?

Lucie: ‘Part of the reason we should pay attention to this survey is the way it’s designed. It’s the only survey series in the UK to asses mental disorders using standardised diagnostic assessment in a general population. Which means we can understand the prevalence of particular disorders in 1999, 2004, 2017, you can see trends – which you don’t get in surveys that are just isolated snapshots. And these are standardised assessments where trained clinicians are looking at symptoms within the general population – they’re not just surveying those who are accessing services, and they’re not just picking up people’s own assessment of whether they have a disorder or not.

So I think, one of my thoughts when I saw the rate of increase in diagnosed mental disorders - they went from one in ten to one in nine – was that I expected that to be bigger. I thought we would see a bigger increase in diagnosed conditions around mental health in children and young people, because our awareness and conversations about this are so much greater.’

Jo: ‘In 25 years of youth work I’d say I’ve come across an increasing number of young people who are diagnosed with behavioural or conduct disorders…but yeah, it says here that these diagnoses have remained broadly stable, which is fascinating because experience would say that’s not the case at all.’

Lucie: ‘The section on autism might be relevant here.’

Jo: ‘That’s true, because that’s risen…’

Lucie: ‘Rates of diagnosis have risen when you look at health/practitioners’ records, but it says that in the general population rates haven’t increased. But I think that’s helpful to understand, because so often when we hear of increases in something, we don’t know is it really increasing or are we just better at spotting it? This would suggest rates of autism are not increasing but there’s greater awareness and recognition of it among families and practitioners.’

Jo: ‘Yes, but anecdotally, I could tell you of literally hundreds of parents who are waiting years to get a diagnosis. So actually, the behaviours - the parents are actually spotting it earlier - but it’s not unusual for it to then take between 5-8 years to get a diagnosis.

Lucie: ‘So even with increasing rates of diagnosis in services, there still a huge gap between experience and provision.’

Jo: ‘It’s a huge fight, financially. I know hundreds of families who are going through a process, but schools quite often block it because it has huge funding implications. Then if schools block it it’s very hard to move forward and get a diagnosis.’

Lucie: ‘Yes, so even if behavioural, hyperactivity and less common disorders have basically been stable, what this isn’t saying is how many children receive the help they need. It might be the case that there are still lots of children whose disorders aren’t diagnosed, and who don’t get the help they need.

Jo: ‘I think the autism question is massive. Whether that’s what church youth work looks like with young people on the spectrum…what that looks like with undiagnosed girls particularly, in schools work…what does it mean in supporting a family that come to your church with a child with autism. From entering a noisy church to doing the peace with somebody who’s like ‘do not touch me’, there’s so much that actually makes it really difficult for people on any part of the autistic spectrum to engage with church. I think there’s a huge stack of questions that Christian youth work hasn’t answered around that at all. It’s huge, it’s massive.

Lucie: ‘So regardless of whether or not rates of autism have increased, the point is, are we yet thinking about the needs of all young people? And it sounds like we have a long way to go.

Was there anything else in this section that you thought was interesting?’

Jo: ‘I thought the addition of the body dysmorphic disorder (BDD) to this survey is really interesting for inclusion, it’s certainly something we see a lot of.’

Lucie ‘It says that one in twenty (5.6%) of 17-19-year-old girls suffer with this, which seems like a really large number to me, even if we recognise all those familiar pressures on young women in terms of their body shape and appearance.’

Jo: ‘And I think there’s a correlation then between self-harming behaviour and body dysmorphia and eating disorders, around that whole sense of controlling your body.’

Lucie: ‘One of the things I think in terms of practical support that this raises is that youth work that stops at 18 doesn’t take account of extended adolescence and the ongoing need we see here. This research shows here that 10% of girls have an emotional disorder like anxiety or depression (6% in boys) and that rates increase with age. We need to recognise the particular vulnerability of older teenage girls.’

Jo: ‘One of the things we’ve always said within our training at Youthscape is that the two times we see the biggest fluctuations in mental health and huge spikes in self-harm are school years 6-7, and leaving school at 18. So that would make sense.’

Parts 2 of this conversation is linked below. Read the original research here.

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