By Elizabeth Hampson, Director, Monitor Deloitte

Deloitte-uk-wellbeing-blog

Yesterday was Time to Talk Day (7th February) – a day to encourage everyone in the UK to talk about mental health.1 This week is also Child and Adolescent Mental Health Week (4-10 February) and, in view of my interests in mental health and wellbeing, this week’s blog provides an overview of recent developments and insights about mental health and resilience in children and young people.

The challenge

In November 2018, NHS Digital published the results of a major survey that collected information about mental health and wellbeing in England. The survey comprised interviews with some 9,117 children (and their parents) aged two to 19, conducted between January and October 2017. Previous major surveys of the mental health of children and young people were conducted in 1999 and 2004, providing a time series from which key trends can be derived.2

Trends data from the survey series reveal a slight increase over the past 20 years in the prevalence of mental disorder in five to 15 year olds (the age group covered on all surveys in this series) - from 9.7 per cent in 1999 to 10.1 per cent in 2004, rising to 11.2 per cent in 2017. Emotional disorders (anxiety and depression), in 5 to 15 year olds increased from 3.9 per cent in 2004 to 5.8 per cent in 2018, while all other types of disorder, including behavioural, hyperactivity and less common disorder have remained broadly stable.

  • The 2017 survey, which covered a wider range of age bands than previous surveys, identified the following: one in eight (12.8 per cent) of five to 19 year olds had at least one mental disorder when assessed in 2017 and one in 20 (five per cent) met the criteria for two or more disorders
  • emotional disorders - including anxiety disorders affected one in twelve (8.1 per cent) five to 19 year olds, with higher rates among girls (10 per cent compared to 6.2 per cent of boys). Anxiety disorders (7.2 per cent) were more common than depressive disorders (2.1 per cent)
  • one in twenty (4.6 per cent) of five to 19 year olds had behavioural (or conduct) disorders (characterised by repetitive and persistent patterns of disruptive and violent behaviour in which the rights of others, and social norms or rules, are violated), with rates higher in boys (5.8 per cent) than girls (3.4 per cent)
  • hyperactivity disorders (characterised by inattention, impulsivity, and hyperactivity) were prevalent in one in sixty (1.6 per cent) five to 19 year olds, with rates higher in boys (2.6 per cent) than girls (0.6 per cent)
  • other less common disorders, include autism spectrum disorders (ASD), eating disorders, tic disorders, and a number of very low prevalence conditions. About one in fifty (2.1 per cent) 5 to 19 year olds were identified with one or more of these other disorders.3

There is limited understanding of the exact cause of the growth in mental health conditions in young people, but there is increasing speculation that social media is at least partially responsible. In fact, the above survey shows a correlation between social media use and mental health conditions, but only for girls. What the survey doesn’t show though is whether the link is causal (i.e. a contributory cause of the mental health condition) or just a correlation (occurring because it occurs alongside or is related, but not causal).4

For me personally, however, what I found particularly concerning alongside the big rise in emotional disorder for teenage girls was the findings on mental disorders of school age boys and that almost 10 per cent of boys with a disorder were excluded from schools, compared with 2.4 per cent of girls with a disorder. Exclusion rates varied by type of disorder and were highest in those with hyperactivity (11.7 per cent) or a behavioural disorder (11.6 per cent). About one child in twenty with a hyperactivity (4.9 per cent) or behavioural disorder (5.7 per cent) had been excluded from school on three or more occasions. This disruption in education clearly has a huge impact on these children’s’ life chances.

Moreover, this week’s publication of the tenth edition of The Prince’s Trust Youth Index – which measures the overall happiness and confidence of young people throughout the UK reveals that young people across the UK fear for their emotional health more than ever before. Nearly two thirds (65 per cent) of young people report that they ‘always’ or ’often’ feel stressed, an increase from 28 per cent in 2010. Moreover, those in the youngest age group, 16 to 18 year-olds, are significantly more stressed than the 19 to 25 year-olds, with 70 per cent saying they ‘always’ or ’often’ feel stressed. General levels of anxiety are also at an all-time high, with 55 per cent of young people saying they ‘always’ or ‘often’ feel anxious. This is an increase of 18 percentage points since the questions was first asked in 2009. For young people who are not in education or employment, the figure is higher still with 62 per cent saying they ‘always’ or ‘often’ feel anxious.5

The Prince’s Trust report also shows that young people's worries about the future are further marred by the online world of social media and that young people’s overall wellbeing score has flat-lined at its lowest level since the study was launched a decade ago. There has also been a doubling in the number of young people in the UK who say that they do not believe that life is worth living over the last decade. In 2009, only nine per cent of 16-25 years agreed with the statement that ‘life is really worth living.’ This has now risen to 18 per cent - one fifth of young people surveyed in the study.6

Potential solutions

On a more positive note, on the 4th of February, the Department for Education announced a new programme of interventions in which 370 senior and junior schools will take part in a series of trials including mindfulness practices and raising awareness around mental health.7 While this programme is a great start, the recent survey results and the fact that only 25 per cent of children experiencing mental health issues currently receive support, demonstrates that there is much still to be done.8

A report published by the Centre for Mental Health in July 2014 summarised the available evidence on the effectiveness and value for money of interventions for child and adolescent mental health problems. It showed that earlier intervention on conduct disorders (intervention at primary school rather than secondary school) had a stronger ROI.9

Although technology and social media are increasingly seen as a major contributory factor to the rise of mental health conditions in young people, technology could also be part of the solution. Indeed, digital health technology shows promise in treating emotional disorders, depression and anxiety in adults.10 While there are indications that young people find mental health apps acceptable, there is currently no evidence to support their safety and effectiveness, and no studies for children under the age of nine.11

While the role of technology and mindfulness will in time help tackle this growing problem, there is much more than needs to be done now. There is also a need to focus on interpersonal and early relationships which influence the way children engage with the world. For example, more needs to be done at schools, where young people spend most of their day, where friendships and relationships form, and where adolescents find their self-worth. It’s also where mental health issues can become evident – and often exacerbated.

While the Department for Education’s programme is a step in the right direction, the evidence suggests that the time has come to tackle this issue on as many fronts as possible and do all we can to prioritise the mental health and well-being of our younger generation. Importantly and within our own gift, it’s also essential that we give our children and young people every opportunity and encouragement to talk about their fears anxiety and concerns whether at school at home or in a neutral safe environment. As the title of the blog says – It’s Time to Talk.

Deloitte-uk-elizabeth-hampson

Elizabeth Hampson, Director, Monitor Deloitte

Liz is a Director in Monitor Deloitte. She leads health policy advisory and health innovation strategy projects with central government, industry, charities and payers in a range of countries.

Email | LinkedIn

______________________________________________________________________

1 https://www.time-to-change.org.uk/time-talk-day
2 https://files.digital.nhs.uk/F6/A5706C/MHCYP%202017%20Summary.pdf
3 Ibid.
4 Ibid.
5 https://www.princes-trust.org.uk/about-the-trust/news-views/ebay-youth-index-2019
6 https://www.princes-trust.org.uk/about-the-trust/research-policies-reports/youth-index-2019
7 https://www.gov.uk/government/news/one-of-the-largest-mental-health-trials-launches-in-schools
8 https://www.centreformentalhealth.org.uk/
9 https://www.researchgate.net/publication/308084274_Investing_in_children's_mental_health_a_review_of_evidence_on_the_
costs_and_benefits_of_increased_service_provision

10 https://www.mentalhealth.org.uk/a-to-z/d/digital-mental-health
11 https://www.nationalelfservice.net/treatment/digital-health/mental-health-apps-for-young-people-an-evidence-free-zone/

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