We know that at least 1 in 10 children under the age of 15 experiences some level of mental disorder (ONS 1999 and 2004).  Many others may experience less serious mental health problems.  However we are somehow reluctant to identify these children and in many cases GPs and others do not recognise the symptoms.  Frequently expressions of mental distress demonstrate themselves in anger and ‘bad behaviour’, leading many people to believe that all the child needs is a bit of tough discipline.  However these children are expressing – in the only way they know how – the deep distress they are feeling.  Much of this distress arises from poor or fractured attachment, i.e. the relationship with the main carer has not been good enough in the early months and years of life, leaving the child anxious, needy and angry.

The stigma that still attaches to mental illness is at the heart of our unwillingness as a society to see that young children have mental disorders and to make any co-ordinated attempt to identify those children who are struggling mentally/emotionally.  We find it easier to talk of ‘emotional well being’ and mental health ‘issues’ rather than about mental disorders or illness.  Use of these ‘softer’ terms can have the effect of obscuring more serious problems, making it less likely that treatment will be sought. Whilst government policy (No Health Without Mental Health 2012) is to ensure parity of mental health and physical health, funding and actions fall well behind this goal.

Poor mental health in childhood and adolescent can result in a range of negative outcomes, including low educational attainment, subsequent unemployment, difficulties in forming relationships, involvement with the justice and care systems  (see the CMOs report 2012).  The on-going lifelong costs, both emotional and financial are considerable – both for the individual and the state.  There is good research to show that there are very significant lifetime costs to the state of failure to diagnose and treat mental disorders in childhood and adolescence (Knapp et al 2013).  This failure affects us all through levels of crime, unhappy relationships, broken families and higher taxes.  Children’s mental health is, as has been said many times by many experts, everyone’s business.

Unless we identify and treat mental illness at the earliest stage in life, psycho morbidity generally in our society will not decrease and costs will continue to rise.  So what can be done?

  1. more equity of funding between physical and mental health.  If mental illnesses/disorders were broken down into categories in the way physical disorders are the inequity would be more evident.  As it is ‘mental health’ is lumped together in health budgets and the real shortfall is glossed over.  Monies can not instantly be taken from other areas of health care so double funding in the short term must be arranged.
  2. ensure that everyone working with children and families is trained to identify mental disorders and problems, at the earliest stage. Crucial practitioners are midwives and health visitors who are in prime positions to spot early attachment problems – pre and post birth.  Teachers also need to understand the central role they play in the lives of children in developing their mental/emotional resilience.
  3. adequately financed child and adolescent mental health services (CAMHS), including perinatal mental health, support to families who are struggling emotionally and accessible services for older adolescents moving into young adulthood.  As it is CAMHS receive a tiny proportion of mental health monies which, given that a high proportion of mental disorders first become evident in childhood, is very wrong. Again double funding for a period will be necessary.
  4. a public health approach to children’s mental health to ensure that all of us recognises ‘mental’ as well as ‘physical’, and to deal with stigma through education material etc.
  5. proper mental health screening of children and young people to be undertaken routinely and included in physical health screening, to pick up mental disorders at the earliest and most treatable stage.  (Parents may be allowed to opt out but every encouragement should be given to ensure that they do not choose to do so.)
  6. opportunities to be offered to new parents, and to parents across the childhood and adolescent life span, to learn and understand more about their children’s mental health needs and how to develop their resilience into young adulthood.
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