Mental Health of Children and Young People Methodology, Key Findings and Next Steps

Speakers Tim Vizard (ONS Principal Researcher) Salah Merad (Survey Methodologist) Katharine Sadler (NatCen Research Director) Professor Tamsin Ford (Professor of Child and Adolescent Psychiatry)

Agenda Agenda Speaker Aims of the survey Tim Vizard Measuring Mental Disorders in Children Tamsin Ford Designing the Survey Katharine Sadler Tea and Coffee break  

Agenda Agenda Speaker Sampling and Weighting Salah Merad Collecting the data Tim Vizard Key findings Katharine Sadler Next Steps Tamsin Ford Question and Answer

Aims of the survey Tim Vizard, Office for National Statistics What the survey was about Why did we need to collect it And what did we hope to achieve from this survey

2017 Mental Health of Children and Young People Survey First official estimates of the mental health of children and young people since 2004. This survey applied rigorous, detailed and consistent methods to assess for a range of different types of disorder according to International Classification of Disease (ICD-10) diagnostic criteria. All cases were reviewed by clinically-trained raters. First survey since 2004. That means a gap of 13 years since the last survey. If you are lucky enough to be under the age of 30 – you would have been eligible to to take part in the 2004 survey. This survey is different from other studies which use brief tools to screen for nonspecific psychiatric distress or dissatisfaction. We used rigorous, detailed and consistent methods to assess for a range of different types of disorder according to International Classification of Disease (ICD-10) diagnostic criteria Furthermore - All cases were reviewed by clinically-trained raters.

2017 Mental Health of Children and Young People Survey Previous surveys: The mental health of children and adolescents in Great Britain (1999) The mental health of young people looked after by local authorities in England (2002) Mental health of children and young people in Great Britain (2004) Three years on: Survey of the development and emotional well-being of children and young people (2007) The Survey of the Mental Health of Children and Young People 2017 (MHCYP) is the third in a series of national surveys of the mental health of children and young people. The first of these was: The mental health of children and adolescents in Great Britain (1999). Looked at mental health of 5-15 year olds in Britain A focussed follow up of looked after children took place in 2002 The next cross-sectional survey took place in 2004. Again looking at the mental health of children in Great Britain, but including 16 year olds in the survey for the first time. A further follow up conducted in 2007 ONS, in collaboration with Professor Robert Goodman and Professor Tamsin Ford, carried out all the previous surveys in the child mental health series.

Aims and rationale of 2017 survey Covered 2 to 19 year olds in England. First time 2-4 year olds and 17-19 year olds had been included. Collect robust data on a range of topics Estimate the proportion of children and young people in England living with a mental disorder Produce trends in disorders through comparisons with previous surveys in the series So what were the aims of this survey: Covered 2-19 year olds in England. Change from previous surveys – collecting England only. Survey commissioned by DHSC and NHS Digital, covering health in England. Other parts of GB have different arrangements to collect this information. The inclusion of preschool children (2 to 4 year olds) provided a rare insight into the mental health of the children prior to entering the education system. Including young adults (17 to 19 year olds) corresponds research suggesting a broadening definition of the age of adolescence [www.thelancet.com/journals/lanchi/article/PIIS2352-4642(18)30022-1/fulltext]. Collect robust data on a range of topics relating to the mental health of children and young people Estimate the proportion of children and young people in England living with a mental disorder (and the types of mental disorders experienced) Produce trends in disorders through comparisons with previous surveys in the series

Aims and rationale of 2017 survey Compare circumstances of children and young people with mental disorders to children and young people without disorders Improve understanding of the state of children and young people’s mental health Inform the design of mental health services for children and young people Enable the circumstances of children and young people with different mental disorders to be compared with those of children and young people without Improve understanding of the state of children and young people’s mental health Inform the design of mental health services for children and young people

Survey Team # Commissioning department and data owner. Responsible for agreeing the survey content, respondent materials, fieldwork, processing the data, report writing and data archiving. Responsible for the sample design, questionnaire programming, fieldwork, weighting of the results and report writing. Providing expertise and specifically overseeing the clinical assessment of children’s mental health. NHS Digital: Commissioned the Survey, and are the data owners. Natcen: Lead contractor. Responsible for agreeing the survey content, respondent materials, fieldwork, processing the data and report writing.. ONS: Responsible for the sample design, questionnaire programming, fieldwork, weighting of the results and report writing. Youth In Mind: Providing expertise and specifically overseeing the clinical assessment of children’s mental health.

Sample Design 18,029 children and young people (aged 2 to 19 years old) in England were asked to take part in the survey. Contact details were obtained from the NHS Patient Register. Sample Design We sampled from the NHS patient register. Provided a person level sampling frame of children and young people. Allowed the direct sampling of children based on their age, reducing sampling of ineligible addresses. Our aim was to collect data about the health and wellbeing of 9500 children and young people Therefore, 18,029 children and young people (aged 2 to 19 years old) in England were asked to take part in the survey.

Questionnaire Design Questionnaire was developed following consultation with experts and tested in a large scale pilot. The survey asked about mental disorders experienced by children and young people, alongside a range of topics related to health and wellbeing. Clinical rating of data took place to identify presence of mental disorders.

Fieldwork and Weighting Information on 9,117 children and young people was collected from parents, children and teachers. Data was weighted to be representative of all 2 to 19 year olds in England, accounting for those who did not take part in the survey.

Analysis and reporting Results from the survey were made available in a series of topic reports (https://digital.nhs.uk/pubs/mhcypsurvey17).

Official Statistic The figures on children and young people aged 5 to 19 years old in this survey are Official Statistics. The figures on preschool children (2 to 4 year olds) in this survey are Experimental Statistics. The figures on children and young people aged 5 to 19 years old in the survey are Official Statistics. All official statistics should comply with the UK Statistics Authority’s Code of Practice for Official Statistics which promotes the production and dissemination of official statistics that inform decision making. The figures on preschool children (2 to 4 year olds) in this summary are Experimental Statistics. Experimental Statistics are official statistics published in order to involve users and stakeholders in their development and as a means to build in quality at an early stage. Limitations apply to the interpretation of these data.

What is Mental Health?

What is Mental Health? http://www.themillennialminds.com/survey/ Mental Health is a complex subject, covering lots of dimensions This slide comes from a student research project at a University in America. It sought views of millennials (those who would have been children in 2004) about their mental health. Survey respondents were asked to freely associate words with the term “mental health.” Words like depression and anxiety were listed frequently, and therefore appear bigger. http://www.themillennialminds.com/survey/

Mental Disorders Distinction between mental health and mental wellbeing. Although are related, but nevertheless, distinct concepts. Our survey assessed mental disorders in children and young people Mental disorders were identified according to the standardised diagnostic criteria (ICD-10 and DSM-5). Firstly, it is important to draw a distinction between Mental Health and other terms commonly used alongside it, such mental wellbeing. Prominent health practitioners caution against using these terms together (Such as Chief Medial Officer Dame Sally Davis)(Davies, 2014), explaining how it cannot be assumed that mental illness (i.e. the presence of one or more mental disorders) simply represents the absence or opposite of mental wellbeing. - Our survey assessed mental disorders in children and young people - Did not just screen for general mental health problems, but applied operationalised diagnostic criteria for specific disorders. - Mental disorders were identified according to the standardised diagnostic criteria (ICD-10 and DSM-5).

Mental Disorders are complex Classification systems consider mental disorders to be self-contained and distinct from each other. Mental disorders are complex combinations of psychological problems which often have overlapping characteristics (Clark et al., 2017). I’d like to end on some research by Lee Anna Clark and colleagues looking at understanding and classifying mental disorders. Classification systems such as ICD-10 and DSM-5 consider mental disorders to be self-contained and distinct from each other. However, mental disorders are complex combinations of psychological problems which often have overlapping characteristics with individuals experiencing one mental disorder having substantially increased odds of having another mental disorder (Clark et al., 2017). Additionally, each disorder does not have its own clear-cut cause, instead mental health issues generally occur as a result of interactions between multiple biological, behavioural, psychosocial and cultural factors (Clark et al., 2017). Clark, L.A., Cuthbert, B., Lewis-Fernández, R., et al. (2017). Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC). Psychological Science in the Public Interest, 18(2), pp. 72-145