As a mental health nurse passionate about the health and welfare of young people, I was saddened to read about the increasing risk for young women in the latest Mental Health and Wellbeing in England Adult Psychiatric Morbidity Survey 2014.
This is the fourth Adult Psychiatric Morbidity Survey (APMS) which aims to determine the amount of people aged 16 and over, living in private households in England, receiving treatment for mental illness. Previous surveys were reported in 1993, 2000 and 2007. The survey consisted of an interview informed by structured assessments and screening instruments for mental disorders (7,528 participants). A sub-group of this original sample were then invited to be clinically assessed in more detail for psychotic disorder, attention-deficit/hyperactivity disorder and autism (630 participants).
This year’s survey reveals that, in England, young women have emerged as a particularly high-risk group. Young women were found to have high rates of common mental disorders such as depression, generalised anxiety disorder, panic disorder, phobias and obsessive compulsive disorder. This group also engaged in self-harming behaviour with 1 in 4 young women aged 16 to 24 year’s old disclosing having self-harmed at some point. This is about twice the rate for young men in the same age group. Young women were also found to be showing signs of post-traumatic stress disorder in the 16-24 age range.
Within the report, there was real concern expressed about the apparent upward trend in self-harming behaviour among young women. Possible hypotheses for this increasing issue include bullying on social media as one influence. The data generated through the Adult Psychiatric Morbidity Survey suggests that this is a strategy young people employ to manage difficult or uncomfortable feelings of anger, tension, anxiety or depression. It seems reasonable then that there is a public health or social need for young people to develop other coping strategies possibly through school based mental health programmes or the effective use of school based counselling.
Mental health services
However, both governments in England and Wales have committed themselves to programmes of work to improve mental health provision for young people. These include The Together for Children and Young People multi-agency service improvement programme and the Future in Mind programme.
Services for the age group 16-24 fall across two parts of the health system. Child and adolescent mental health services (CAMHS) are offered until aged 18, then, typically, adult mental health services start for people aged 18+. There is a known challenge for this transitional period: CAMHS services operate differently to adult services; they have different criteria for access and different methods of providing care. This coincides with an age where there is an increasing risk of mental health need, particularly for females. There have also been problems with accessing mental health services in a timely fashion because the waiting lists are so long. This indeed was the clinical problem that prompted me to work with a local CAMHS. Together we developed a ‘triage clinic’ where all referred children were seen for a brief initial assessment. This enabled us to determine whether they had a mental health condition, whether they had been referred to the right service, and how urgently they needed to be offered treatment. In doing so, the waiting list was eliminated. There are elements of that initiative that other CAMHS might find useful, whether adopted directly or adapted to meet their specific service needs.
Let’s use the findings from the Adult Psychiatric Morbidity Survey 2014 as a trigger to develop innovative practice across agencies for young women with mental health issues.
Dr Nicola Evans has previously received funding from the National Institute for Health Research and The Health Foundation.