Auto Draft | MQ Mental Health Research

In This episode from our MQ Open Mind podcast, Professor Rory O’Connor and Craig Perryman chat with two guests, Professor Kathryn Abel and mum Haley Peterson, about adolescent mental health and improving CAMHS (Children’s Mental Health Services and adolescents).

It is known that mental illnesses usually begin at a young age. In fact, 75% of lifelong mental illnesses begin in childhood or adolescence. Professor Kathryn Abel is a professor of psychological medicine and psychiatrist at the University of Manchester, studying what can be done to help.

Vulnerability to force

Kathryn remembers working in the late 80s and early 90s researching drugs for mood disorders or psychiatric problems. It was then that she realized how much she enjoyed research. When a respected colleague of hers, Fiona Godley, who became the first editor of the British medical journal, suggested that she become a psychiatrist, she decided to follow her revealing suggestion. Having experienced depression herself, the idea appealed to her personal experience.

Kathryn studied at the Institute of Psychiatry, received her consultant psychology certificate in 2001 and was offered the opportunity to open the first center in Europe for women’s mental health, the focus of which was vulnerable women and their children.

Kathryn’s main area of ​​interest throughout her career is the overlap between parental maternal health, particularly mental health and child outcomes, child development and child vulnerability, something Hayley is familiar with very well the importance.

The story of Hayley and Winston

Hayley’s recent experiences navigating CAMHS support the need for Kathryn and those in her field to work. Hayley is a mother of four, whose eldest son, Winston, who was 13 at the time of the interview, needed support from services.

“I’ve been wondering if Winston has ADHD since the second year of elementary school. He was always a boisterous child, quite classic signs, who had trouble concentrating, fell behind on schoolwork or was unaware of the dangers. He even tried to quit school a couple of times. I mentioned it to teachers in elementary school, but I was 25 when I had Winston, a first-time mom. The teachers just said ‘no, he’s just a boisterous boy, you’re being silly.’ “I felt cheated.” Hayley Peterson, mother of four

When things continued to get worse for Winston in his behavior, Hayley began her own investigation. The school told him again that Winston “was not a child in crisis. That’s good.” He began to develop coping mechanisms, such as playing with rubber bands and subsequently putting holes in his clothes. But despite help from additional needs services, things continued to develop. At this point he was referred to CAMHS .

“Winston was in secondary school when CAMHS served us. But they said ‘at school you don’t see what you see at home’. We are going to discharge him. To be honest, I felt a bit pressured and felt a bit silly about it.”

When things got worse once again, Hayley contacted CAMHS to ask to be referred again, but was told they couldn’t care for Winston because he was within a 12-month period of being discharged. With no further guidance on where to turn or what to do next, Hayley is now contemplating a private assessment considering Winston is approaching exam periods, a period in a young person’s life that is known to cause stress.

The rise of ADHD and autism

Hayley’s experience and Winston’s highlight a number of issues that parents across the country will experience, Professor Rory says in the episode. He adds that if we exclude the pandemic and look at the period of the last 10 years, there is growing evidence of an increase in mental health problems among young people and of neurodivergent conditions, an increased diagnosis of ADHD and autism.

So what does the evidence tell us about whether mental health problems are increasing or not? Kathryn confirms that the change is there, a constant increase. But she also confirms some surprises, including that the pandemic didn’t really play a role in the rise in mental health problems.

According to this episode, the pandemic steadily increased the number of children presenting to primary care or general practice with a range of mental health symptoms. Not necessarily one disease, but a variety of complaints or symptoms. And those children are brought by their parents.

“Approximately 50% of children who present to primary care GPs with any type of mental health symptoms do not require any further treatment or assessment, which is very good news. They do not continue to have long-term psychiatric problems. But what I hear from parents is ‘what’s going to happen to my child now?’ If they have this diagnosis or present with these problems, many of which are related to anxiety, what is the likely outcome for them?’” Professor Kathryn Abel

Increase in mental illness in children

Although Hayley’s son Winston presented with slightly different neurodevelopmental problems much earlier, it is children who presented in adolescence and not earlier who develop psychotic illnesses (hallucinations or delusions) or quite serious types of symptoms, even fleetingly, says Kathryn. Unfortunately, these children tend to have more difficult long-term outcomes, as they need to be cared for in secondary services, inpatient care or treated long-term with medication.

Mental health distress statistics from the last 20 years, according to Kathryn in this podcast:

  • An increase in the number of children referred for symptoms similar to Winston’s described above.
  • Those references tend to be more boys than girls.
  • An increase in the diagnosis of ADHD and autism spectrum disorders or ASD.
  • High rates of anorexia occurrence (occurring over a “very short period”, e.g. around six months)
  • Increased rates of self-harm presentations
  • Self-harm is found primarily in young women and tends to be transient during periods of distress.
  • There was no change in the numbers at the “more severe” end of both ADHD and autism.
  • No change in rates of presentation of psychotic disorders
  • No change in rates of serious eating disorders, particularly in girls, such as severe anorexia
  • Rates of children presenting with mental health problems decreased slightly when mental health support workers came into schools.

So while there is an increased presentation of mental health problems to services, most of them are not very serious and management of those problems in school seems to work well when adequately funded. Kathryn believes there is a clear reason for the increase in filing rates.

“People have become much more aware of presenting a problem as a mental health problem that needs treatment, they are much more open to thinking about treatment pathways for children and they are also much more likely to go to their GP and ask aid. .”

Addressing distress in the face of medicalization: finding a balance

Regarding referrals to CAMHS, in 2021 and 2022, Kathryn says around half a million children and young people were referred to specialist services. This is an increase, figures that Kathryn says have doubled since 1999.

However, about a quarter of referrals to services are unsuccessful, Kathryn says, mainly because they are not considered to be of sufficient severity for those specialist services. These services are designed to treat serious and long-lasting mental illness, not the presentation of some psychological symptoms of psychological distress.

“We don’t want to discourage people who have distress, but we also don’t want to medicalize children and adolescents. “We need to understand where the balance lies between the two.”

And balance is what research can help us move toward. Support MQ mental health research to help researchers like Kathryn get us closer to finding that balance.

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