Mental Health
Mental illness has been shown to have a similar effect on life-expectancy to smoking. Nationally, mental health problems affect one in ten children and young people; a figure that rises to one in five for young adults. The Children and Young People’s Mental Health and Wellbeing Profiling Tool provides a wide range of national, regional and local data on the risk factors, prevalence and services that support children who are vulnerable to, or have a mental illness.
Risk factors
Locally, there is evidence for a greater level of vulnerability to mental illness amongst children and young people. This is highlighted in an array of risk factors than range from poverty to obesity and migration. The association between poverty and mental illness is complex and likely to be self-perpetuating. There is evidence that the former can lead to poor health outcomes in adulthood, whilst the latter has been linked with a decline in financial circumstances. Obesity also poses a risk factor for poor mental health due to the related psychological effects of social isolation, low self-esteem and bullying. Migration and its associated difficulties in adjusting to a new environment inevitably present another risk factor for mental health problems in childhood.
Derby performs significantly worse than the national average across the following risk factors, which show that:
- 22.1% of children under 20 and 22.9% of children under 16 live in relative poverty.
- 1.39% of children in Reception year are underweight.
- 20.8% of Year 6 children are obese.
- 5.1% of young people aged 16-24 provide unpaid care and 1.6% provide 20 or more hours of unpaid care per week.
- 1.98% of school children are Gypsy/Roma.
- 2.3 per 1,000 households are registered as homeless.
- 8.2% of households have lone parents with dependent children.
- 5.1% of families are “out of work”, with dependent children where no adult is in employment.
- 5.22% of households with dependent children have at least one person with a long term health problem or disability.
- 276.1 per 100,000 children aged 0-15 have a parent in alcohol treatment.
Prevalence
It is important to note that there are some caveats concerning national prevalence indicators – namely that they have been derived from the ONS survey ‘Mental health of children and young people in Great Britain’ (2004) and the Adult Psychiatric Morbidity Survey undertaken in 2007. Nonetheless, the latest profile indicates that, amongst children aged 5-16:
- The estimated prevalence of mental health disorders is 9.8% locally and 9.3% nationally.
- The estimated prevalence of emotional disorders is 3.8% locally and 3.6% nationally.
- The estimated prevalence of conduct disorders is 6.1% locally and 5.6% nationally.
- The estimated prevalence of hyperkinetic disorders is 1.7% locally and 1.5% nationally.
Nationally, women are more likely to have an eating disorder, but only one in five are estimated to be in receipt of treatment. It is projected that 4,321 16-24 year-olds in Derby have an eating disorder. Attention deficit hyperactivity disorder (ADHD) is characterised by impulsivity and impairments in attention and concentration. In Derby, 4,604 16-24 year-olds are estimated to have ADHD.
Services
Unintentional and deliberate injuries are a leading cause of hospitalisation in children and young people. Both national and local trends indicate a recent increase in the rate of hospital admissions for self-harm in children and young people. Within the latest period of 2010/11-12/13, this was one and a half times greater locally than nationally (527.1 per 100,000 compared with 352.3 per 100,000). The rate of child hospital admissions for unintentional and deliberate injuries has recently dropped and is significantly below the national average.
Derby performs comparably with the national average across the following health service indicators:
- The rate of hospital admissions for mental health disorders amongst 0-17 year-olds (72.0 per 100,000).
- The rate of hospital admissions due to alcohol-specific conditions in children under 18 (43.9 per 100,000).
- The rate of hospital admissions due to substance misuse in those aged 15-24 (103.5 per 100,000).
- The rate of hospital admissions for unintentional and deliberate injuries in young people aged 15-24 (138.0 per 10,000).
Derby performs significantly worse than the national average across the following social care indicators:
- Rate of children under 18 in need during the year (769 per 10,000).
- Rate of new cases of children under 18 identified as in need during the year (385 per 10,000).
- Percentage of children in need due to abuse, neglect or family dysfunction (75.2%).
- Rate of looked after children under 18 (80.5 per 10,000).
- Percentage of looked after children who had an annual health assessment (79.4%).
- Percentage of looked after children under 5 whose development assessments were up-to-date (58.3%).
- Rate of children under 18 who were the subject of a child protection plan at the end of the year (53.8 per 10,000).
- Rate of children under 18 who became the subject of a child protection plan during the year (74.7 per 10,000).
- Rate of first time entrants to the youth justice system aged 10-17 (536 per 100,000).
There is a strong link between pupil attainment and wellbeing. The early educational environment can serve as a protective factor against mental illness, but can also be the first setting in which initial difficulties first emerge.
Derby performs significantly worse than the national average across the following educational indicators:
- Percentage of children achieving a good level of development at the end of reception (60.3%).
- Percentage of secondary school pupils who have received a fixed period exclusion (8.5%).
- Percentage of school pupils who received a fixed period exclusion due to persistent disruptive behaviour (1.02%).
- Percentage of 16-18 year-olds not in education, employment or training (6.4%).
CAMHS RISE - Rapid Intervention, Support and Empowerment
CAMHS RISE is a rapid response service for GPs and others in primary care to ensure the best possible support for young people who have seriously self-harmed or are having suicidal thoughts. This service is currently available in the south of Derbyshire – the areas covered by NHS Southern Derbyshire Clinical Commissioning Group and NHS Erewash Clinical Commissioning Group.
What service does the CAMHS RISE team provide?
Sometimes it can be difficult for GPs to confidently assess whether a young person in mental distress is in urgent need of emergency care. The CAMHS RISE team – which is made up of experienced mental health nurses and occupational therapists from Derbyshire Healthcare NHS Foundation Trust, overseen by a consultant psychiatrist – will speak with the GP and provide specialist advice. Where the team recommends that a young person goes to the children’s emergency department at Royal Derby Hospital, the team (who are based at the hospital) will make every effort to meet with that young person, maximising the continuity of care. Where a visit to hospital is not required, but a more detailed mental health assessment is needed, the team will arrange that with the GP and the young person.
The end result should be that young people get the care and support that meets their needs – and there should be fewer young people being admitted unnecessarily to hospital.
Learn more at www.derbyshcft.nhs.uk/camhs-rise