mental health and children and young people 17 th october 2007 graham bryce child and adolescent...

Mental health andMental health andchildren and young people children and young people

1717thth October 2007 October 2007

Graham BryceGraham Bryce

Child and Adolescent PsychiatristChild and Adolescent Psychiatrist

NHS GGC Looked After Mental Health NHS GGC Looked After Mental Health TeamTeam

graham.bryce@yorkhill.scot.nhs.ukgraham.bryce@yorkhill.scot.nhs.uk

ProgrammeProgramme

Children and young people – some considerations

Epidemiology of mental health problems amongst children and young people

Problems and disordersMaking a differenceShould you all become child and

adolescent psychiatrists?

Children and young people – Children and young people – some considerations some considerations

Risk and resilience Developmental stageContext and family

Risk and resilienceRisk and resilience

Risk factors, including– Genes, CNS development and disorder,

learning – In parent - mental illness, criminality, drugs,

alcohol – Adversity, trauma, bullying

Protective factors, including– Temperament– Confiding relationships– Academic achievement

Developmental stageDevelopmental stage

Vulnerability How MH difficulties are

experiencedHow MH difficulties are expressedHow interventions are delivered

Context and familyContext and family

From protective to abusive and neglectful

Psychiatric disorder does not mean dysfunctional family

Family relationships are a significant factor in treatment

Attachment research

EpidemiologyEpidemiology

25% of Scots are age 18 or lessAbout 10% experience a significant

mental health problem

Enough to fill here…….Enough to fill here…….

…………and here, tooand here, too

EpidemiologyEpidemiology

25% of Scots are age 18 or lessAbout 10% experience a significant

mental health problem

EpidemiologyEpidemiology

25% of Scots are age 18 or lessAbout 10% experience a significant

mental health problemMales >> females

EpidemiologyEpidemiology

25% of Scots are age 18 or lessAbout 10% experience a significant

mental health problemMales >> femalesIncidence rises with age

EpidemiologyEpidemiology

25% of Scots are age 18 or lessAbout 10% experience a significant

mental health problemMales >> femalesIncidence rises with ageRisk and impact amplified by

deprivation

What are the common What are the common problems?problems?

Suicide and deliberate self harmPsychiatric disorders

Suicide and deliberate self Suicide and deliberate self harmharm

Suicide– Rate amongst 15 –25 year olds in Scotland

19.5/100,000 in males and 5.3/100,000 in females

– Mainly impulsive rather than long-planned– Underlying disorder (mood, substance use)– Precipitating event – trouble or anxiety provoking– About half refer to suicide in preceding 24hours

Deliberate self harm– Ratio of DSH to completed suicide

140:1 in males and 1000:1 in females

– Stressors, supports and coping skills

Suicide and deliberate self Suicide and deliberate self harm 2harm 2

Implications for all clinicians– Recognition of risk – Don’t be afraid to ask– Early assessment critical – Low risk of suicide does not mean trivial– Intervention

Prevents suicide May reduce repetition rate of DSH Reduces secondary harm from DSH

What are the common What are the common problems?problems?

Suicide and deliberate self harmPsychiatric disorders

MentalMental healthhealth

“What we understand by ‘mental health’

will depend on our values, preconceptions and assumptions”

Katherine Weare (2000)

What are the common What are the common disorders?disorders?

Disorders of behaviour and conduct

Emotional disordersDevelopmental disordersCo-morbidity common

See www.statistics.gov.uk.

What are the common What are the common disorders?disorders?

Disorders of behaviour and conduct

What are the common What are the common disorders?disorders?

Disorders of behaviour and conduct– Defiance, tantrums– Stealing, truancy, delinquency

What are the common What are the common disorders?disorders?

Disorders of behaviour and conduct

Emotional disorders

What are the common What are the common disorders?disorders?

Disorders of behaviour and conduct

Emotional disorders– Anxiety disorders inc. generalised

anxiety disorder, post traumatic stress disorder, phobias,

– Depressive disorders

What are the common What are the common disorders?disorders?

Disorders of behaviour and conduct

Emotional disordersDevelopmental disorders

What are the common What are the common disorders?disorders?

Disorders of behaviour and conductEmotional disordersDevelopmental disorders

– Attention deficit hyperactivity disorder (ADHD)

– Autism spectrum disorders (inc. Asperger’s syndrome)

– (Delays in motor, language development)

Less common but very Less common but very important disordersimportant disorders

Eating disordersObsessive compulsive disordersSomatising disordersPsychotic disorders

Scottish Early Onset Scottish Early Onset Psychosis StudyPsychosis Study

Prevalence– 103 subjects suitable for inclusion– Three year prevalence 5.9 per 100,000

population

CharacteristicsOutcomes

CharacteristicsCharacteristics

Mean age onset - 16.0 years Duration of Untreated Psychosis - 28 days Symptoms

– 51 % negative symptoms 47 % Anxiety 33 % psychosis Side effects

– 87% at least one 28% reported substance misuse 82 % had moderate-severe difficulty with

friendships 43% reported family relationships “unhealthy”

OutcomesOutcomes

Only one third had all needs met20% had > four unmet needsMore social unmet needs (e.g.

family relationships) than core clinical needs (e.g. symptoms, risk to self or others)

Making a differenceMaking a difference

PreventionEarly intervention

– Early in years– Early in problem cycle

Intervention in established problems

Interventions 1Interventions 1

Psychosocial 1– Individual therapies

Cognitive behaviour therapy – phobias, PTSD, depression

Other psychological therapies– Psychotherapy post abuse

Interventions 2Interventions 2

Psychosocial 2– Parent training– Family therapy– Multi-systemic interventions

Interventions 3Interventions 3

Pharmacological– Psychostimulants

Attention deficit hyperactivity disorder (ADHD)

– Antidepressants– Antipsychotics – Others

Specific considerations in Specific considerations in treatmenttreatment

Developmental stageFamilyConsentMental Health legislation

Should I become a child and Should I become a child and adolescent psychiatrist?adolescent psychiatrist?

The vast majority of mental health morbidity in children and young people is dealt with by families, schools, primary care and other universal services

Mental health sensitive practice in those domains makes a major contribution to the well-being of children and young people

But you’re all welcome………..

Further readingFurther reading

Introductory text– Goodman and Scott Child Psychiatry (1997)

Oxford, Blackwell– Philip Barker (2004) Basic Child Psychiatry Oxford,

Blackwell Definitive UK text

– Michael Rutter and Eric Taylor (eds) (2002) Child and Adolescent Psychiatry 4th Edition

Journals – Journal of Child Psychology and Psychiatry– Journal of American Academy of Child and

Adolescent Psychiatry

Mental health andMental health andchildren and young people children and young people

1717thth October 2007 October 2007

Graham BryceGraham Bryce

Child and Adolescent PsychiatristChild and Adolescent Psychiatrist

NHS GGC Looked After Mental Health NHS GGC Looked After Mental Health TeamTeam

graham.bryce@yorkhill.scot.nhs.ukgraham.bryce@yorkhill.scot.nhs.uk