1. Mental health and children and young people 17 th October 2007 Graham Bryce Child and Adolescent Psychiatrist NHS GGC Looked After Mental Health Team graham.bryce@yorkhill.scot.nhs.uk

2. Programme Children and young people – some considerations Epidemiology of mental health problems amongst children and young people Problems and disorders Making a difference Should you all become child and adolescent psychiatrists?

3. Children and young people – some considerations Risk and resilience Developmental stage Context and family

4. Risk 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

5. Developmental stage Vulnerability How MH difficulties are experienced How MH difficulties are expressed How interventions are delivered

6. Context 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

7. Epidemiology 25% of Scots are age 18 or less About 10% experience a significant mental health problem

8. Enough to fill here…….

9. ……and here, too

10. Epidemiology 25% of Scots are age 18 or less About 10% experience a significant mental health problem

11. Epidemiology 25% of Scots are age 18 or less About 10% experience a significant mental health problem Males >> females

12. Epidemiology 25% of Scots are age 18 or less About 10% experience a significant mental health problem Males >> females Incidence rises with age

13. Epidemiology 25% of Scots are age 18 or less About 10% experience a significant mental health problem Males >> females Incidence rises with age Risk and impact amplified by deprivation

14. What are the common problems? Suicide and deliberate self harm Psychiatric disorders

15. Suicide and deliberate self harm 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

16. Suicide and deliberate self harm 2 Implications for all clinicians – Recognition of risk – Dont 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

17. What are the common problems? Suicide and deliberate self harm Psychiatric disorders

18. Mental health What we understand by mental health will depend on our values, preconceptions and assumptions Katherine Weare (2000)

19. What are the common disorders? Disorders of behaviour and conduct Emotional disorders Developmental disorders Co-morbidity common

20. See www.statistics.gov.uk.

21. What are the common disorders? Disorders of behaviour and conduct

22. What are the common disorders? Disorders of behaviour and conduct – Defiance, tantrums – Stealing, truancy, delinquency

23. What are the common disorders? Disorders of behaviour and conduct Emotional disorders

24. What are the common disorders? Disorders of behaviour and conduct Emotional disorders – Anxiety disorders inc. generalised anxiety disorder, post traumatic stress disorder, phobias, – Depressive disorders

25. What are the common disorders? Disorders of behaviour and conduct Emotional disorders Developmental disorders

26. What are the common disorders? Disorders of behaviour and conduct Emotional disorders Developmental disorders – Attention deficit hyperactivity disorder (ADHD) – Autism spectrum disorders (inc. Aspergers syndrome) – (Delays in motor, language development)

27. Less common but very important disorders Eating disorders Obsessive compulsive disorders Somatising disorders Psychotic disorders

28. Scottish Early Onset Psychosis Study Prevalence – 103 subjects suitable for inclusion – Three year prevalence 5.9 per 100,000 population Characteristics Outcomes

29. Characteristics 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

30. Outcomes Only one third had all needs met 20% had > four unmet needs More social unmet needs (e.g. family relationships) than core clinical needs (e.g. symptoms, risk to self or others)

31. Making a difference Prevention Early intervention – Early in years – Early in problem cycle Intervention in established problems

32. Interventions 1 Psychosocial 1 – Individual therapies Cognitive behaviour therapy –phobias, PTSD, depression Other psychological therapies –Psychotherapy post abuse

33. Interventions 2 Psychosocial 2 – Parent training – Family therapy – Multi-systemic interventions

34. Interventions 3 Pharmacological – Psychostimulants Attention deficit hyperactivity disorder (ADHD) – Antidepressants – Antipsychotics – Others

35. Specific considerations in treatment Developmental stage Family Consent Mental Health legislation

36. Should I become a child and 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 youre all welcome………..

37. Further 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 4 th Edition Journals – Journal of Child Psychology and Psychiatry – Journal of American Academy of Child and Adolescent Psychiatry

38. Mental health and children and young people 17 th October 2007 Graham Bryce Child and Adolescent Psychiatrist NHS GGC Looked After Mental Health Team graham.bryce@yorkhill.scot.nhs.uk