Improving the mental health and wellbeing of children and young people

Dr Rhiannon Evans, Senior Lecturer, DECIPHer, School of Social Sciences, Cardiff University

Michelle Hughes, Specialist CAMHS Nurse, Cwm Taf University Health B

The mental health and wellbeing of children and young people remains a major public health concern. Many problems emerge during adolescence, with 50% of anxiety and impulse control disorders onsetting by the age of 11 years. Meanwhile, a recent study found that 16.4% of 16 years olds have engaged in self-harming practices in the past year. Services dedicated to addressing these problems are under increased pressure. During 2016 there were 19,000 referrals to Child and Adolescent Mental Health Services (CAMHS) in Wales, an increase of 3,000 from the previous year. Equally in 2015-2016 18,788 individuals aged <18 years in England and Wales were admitted to hospital or received treatment at an emergency department, a rise of 14% from 2013-2014.

In response to the evident strain on the system, the Welsh Government has recently launched a pilot scheme whereby NHS staff will provide mental health support to students indicating signs of anxiety, depression or self-harm. We should welcome this investment. In particular, it responds to a major need identified in a recent report by the Cardiff University led GW4 Children and Young People’s Self-harm and Suicide Research Collaboration, which indicated that secondary schools are struggling to manage student self-harm while they wait for specialist external support.

It is not sufficient to simply introduce a new provision. We need to consider the quality of service being delivered. There is an extensive body of research documenting how mental health professionals often negatively typify and stigmatise individuals who present with self-harm. Monitoring and evaluation must ensure that the new scheme is sensitive to the needs of the students who engage with it.

Cardiff University is currently leading a Health and Care Research Wales funded study in collaboration with the University of Bristol and Cwm Taf UHB, which will make a significant contribution in this area and offer guidance for further research. The study will look at the experiences of children, young people, carers and health professionals delivering or receiving support following an individual’s (aged <18 years) presentation for self-harm at an emergency department in Wales.

Beyond targeted support for individuals already presenting with a mental health problem, further investment is still required for more preventative approaches, especially within the school setting. The Universities of Bristol, Cardiff, Exeter and London School of Hygiene & Tropical Medicine, are currently undertaking a cluster randomised controlled trial of the WISE project, aiming to improve the mental health and wellbeing of staff and students.

The project delivers Mental Health First Aid (MHFA) training to secondary school teachers so that they can support their colleagues and improve the communication they have with students. This type of intervention is important as difficult teacher-student relationships predict psychiatric disorders, while positive relationships are associated with lower rates of student depression. This study demonstrates the need to consider various intervention leverage points within the system, and to not solely focus on intervening with the individual young person.