Mental Health of Children and Young People
Mental health services for children and young people are crucial for the long-term management of mental health in the adult community. By identifying young people in the early stages of emotional and mental distress, and putting in place preventative measures, support and treatment packages, the chances of a full and lasting recovery are maximised. This in turn reduces the burden on services through transition to adulthood and creates lifelong benefits for the young person, their family and for statutory health and social services.
Mental health problems in children and young people are associated with excess costs estimated as being between £11,030 and £59,130 annually per child.
The Child and Maternity Health Observatory Child Health Profile for Somerset (June 2016) indicated that hospital admission rates for 0-17 year olds due to mental health conditions are not significantly different from that of England as a whole; hospital admissions as a result of self-harm, however, are significantly higher (see self-harm page).
In October 2014, Public Health England launched a new Children and Young People's Mental Health and Wellbeing Profiling Tool. It collates and analyses a wide range of publically available data on risk, prevalence and detail (including cost data) on those services that support children with, or vulnerable to, mental illness. It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works.
Somerset compares favourably with national and regional norms on many indicators. However, in addition to self-harm hospital admissions (see above), the county is higher than the national and South West benchmarks for:-
- Hospital admissions for substance misuse (age 15-24)
- Hospital admissions for unintentional and deliberate injuries (under 15s and 15-24s)
Impact of Mental Ill Health in and shortly after Pregnancy
In March 2016, the Child and Maternity Health Observatory launched reports on Mental health in pregnancy, the postnatal period and babies and toddlers. featuring a range of indicators covering mothers, mums-to-be and very young children with mental or emotional health problems. The reports also contain a wealth of useful references and a glossary of relevant terms, and can be exported as a Word document. The report for Somerset local authority can be read here.
For more information, see our Perinatal and Infant Mental Health page.
Commissioning in Somerset
- Local authority services are commissioned through Children’s Social Care
- Specialist (Tier 3) community services are commissioned by the NHS Clinical Commissioning Group.
- In addition, in-patient care and specialist health residential placements are now commissioned by the NHS National Commissioning Board (Specialist Commissioning).
Positive Mental Health - Joint Strategy for Somerset 2014-19
A new joint strategy was published in December 2014, and is available here.
This strategy highlights the importance of children, young people and families in achieving positive mental health for Somerset. A dedicated work stream is already taking forward improvements in the pathway for children and young people with mental health problems, which includes commissioning developments across all tiers of provision and in services commissioned by both health and social care. The Emotional and Mental Health of Children and Young People Plan for Somerset specifically addresses issues of promotion and prevention.
In respect of children and young people, it covers themes such as:
- Perinatal mental health
- Family life and the role of universal services for children
- Early help and support
- Specialist mental health services
- Gaps and pressures
The strategy also identifies five actions to support the emotional health of children and young people:-
- Involve young people and their families in the co-design, co-production and co-delivery of services to support their health and wellbeing
- Make sure that everyone in the children and young people’s workforce is well informed about emotional and mental health
- invest in parenting programmes which are low cost, high value interventions which can be developed and delivered in a flexible and inclusive way
- Protect children, young people and families from risks such as exposure to bullying, violence, discrimination and from the effects of harmful drinking and substance misuse
- Invest in interventions for behaviour and for conduct disorder which have been identified as a ‘best buy for mental health’ with potential savings from each case through early intervention estimated at £150,000 for severe conduct problems and £75,000 for moderate conduct problems
The most recent Mental Health Needs Assessment, published in 2011, is available here,; a summary of Children and Young People's Emotional Health and Wellbeing data was published in 2015.
Child and Adolescent Mental Health Service (CAMHS)
The Somerset CAMHS provides a specialist mental health service for children and young people aged 0 – 18 (up to 19 for young people with additional needs), who may be experiencing a range of mental health problems. The overall goal of the service is to enable children and young people to achieve a fulfilling, meaningful life, and a positive sense of belonging in their community.
For more details of the service, please visit the CAMHS website.
Between April 2014 and March 2015, Somerset Partnership NHS Foundation Trust recorded a total of 1,601 CAMHS open referrals (note that all such activity is Tier 3). Inpatient activity (Tier 4) is very small.
CAMHS 'Pyramid of Need' in Somerset
The numbers of young people locally who may be expected to require CAMHS services at different levels of need are conventionally calculated using prevalence rates from the 2004 Mental Health of Children and Young People in Great Britain survey.
UNIVERSAL SERVICES TIER 1 - Those in contact with children need to be able to have sufficient knowledge of children's mental health to be able to: identify those who need help; offer advice and support to those with mild or minor problems; and have sufficient knowledge of specialist services to be able to refer on appropriately when necessary.
Services at this level include: GPs, health visitors, teachers, Midwives, early years providers, GetSet services, school nurses, social workers, youth workers and voluntary agencies.
TIER 2 – Targeted Services who are child mental health professionals, working in community and primary care settings, in a uni-disciplinary way. Tier 2 workers can provide assessment and treatment for children who have mild to moderate mental health difficulties and outreach to identify severe or complex needs which require more specialist interventions. Tier 2 workers also support families and other practitioners at tier 1 with assessment and training. Services at this level include: Primary Mental Health Link Workers, Educational Psychologists, paediatric clinics, schools and youth services, Health Visitors, School Nurses, Specialist midwife, targeted youth support services, Parent and Family Support Advisors (PFSAs), SENCo, School Counsellors and the Voluntary Sector (CRUSE, Barnardos, HELP charity, SARASAS, Young Minds)
TIER 3 – Specialist Services who are child mental health professionals working in multidisciplinary teams in community mental health clinics, GP surgeries, schools and community centres, providing specialized service for children and young people with more severe, complex and persistent mental health conditions.
Services include: child and adolescent psychiatrists, specialist social workers, clinical psychologists, community psychiatric nurses, art therapists and mental health practitioners
TIER 4 - Specialist Services. Tertiary level services for children with the most serious mental health problems. These can include secure forensic units or other specialist units and teams, which can either be day units or in-patient units. These units and other specialist teams, usually serve more than one district or region. Services include: Wessex House.
Mental health disorders
The British Child and Adolescent Mental Health Surveys in 1999 and 2004 found that 1 in 10 children and young people under the age of 16 had a diagnosable mental disorder. Among the 5 to 10 year olds, 10% of boys and 5% of girls had a mental health problem while among the 11 to 16 year olds the prevalence was 13% for boys and 10% for girls. To estimate the numbers of children and young people affected by mental health disorders in Somerset, we applied the prevalence rates found in the National CAMHS prevalence survey (Green et al 2004) to the population estimates for the relevant age-group. If we do this for children aged 5-16, we obtain the totals shown in the figure below:
Somerset children affected by mental health disorder
Mental Health at School or College
The 2016 Somerset Children and Young People Survey (SCYPS) involved asking almost 9,000 young people between 8 and 17 questions on a range of health and wellbeing issues. These included a number of questions on self-esteem, coping with worries, etc. Findings included:-
- 45% of secondary boys in Somerset and only 25% of secondary girls in Somerset recorded levels of high self-esteem compared with 52% and 34%, respectively in a wider sample of other parts of England.
- 36% of secondary school boys and 56% of girls in 2016 said that they worry ‘quite a lot’ or ‘a lot’ about exams and tests;
- 71% of secondary pupils said they know an adult they trust who they can talk to if they are worried about something
- The most common activity amongst secondary pupils when they have a problem that worried them or they are feeling stressed is 'Playing computer games' (boys) and 'playing music' (girls). 'Talking to someone about it' comes third.
- 54% of FE/Sixth Form boys and 75% of girls said they had experienced emotional or psychological problems that interfered with their life at some point;
- 18% of FE/Sixth Form boys and 31% of girls responded that they have received counselling or other help for depression or other emotional problems at some point in their lives;
- In the same age group, 1 in 3 girls and 1 in 6 boys responded that they have harmed themselves at some point in their lives.
Emotion Coaching Training
Somerset Public Health have commissioned Bath Spa University and EHCAP (a Somerset based social enterprise) to provide Emotion Coaching Training to the children and young people’s workforce in Somerset. Training will be offered in each of the five districts and will allow participants to take on leadership roles within their own organisations. Working with both professionals and young people, the training will increase understanding of emotional health and wellbeing and enable a better appreciation of when and how to refer on for help.
Analysis of the Somerset Children and Young People Survey results show that Year 8 students in schools who received Emotion Coaching are:-
- more likely to enjoy lessons in 2016 than in 2014 (84% vs. 72%);
- more likely to say that their school cares whether they are happy or not (49% vs. 44%);
- more likely to be able to say ‘no’ to someone who is asking them to do something that they don’t want to do (66% vs. 59%)
- less likely to say they deliberately hurt someone in the last year (10% vs. 16%).
For more details, see the Somerset Children and Young People Health and Wellbeing website