mental health and children and young people 17 th october 2007 graham bryce child and adolescent...
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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
[email protected]@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
[email protected]@yorkhill.scot.nhs.uk