The more we know about mental health, the better

The Health and Social Care Board (HSCB) this month published a hugely comprehensive report into the mental health of local children and young people.

Northern Ireland’s poor mental health outcomes are well documented and, so, this unprecedented piece of work is extremely welcome.

The HSCB says that it “delivers for the first time ever, reliable prevalence estimates of common mental health problems” and will be crucial to policy development.

It would be possible to take almost any handful of data from the report and write an entire article focused on that small chunk of information.

Ultimately, however, the most interesting thing is this report in its totality (albeit, several of the findings are detailed below) and the effect it will have on mental health provision in NI.

Right now, there is an understandably tendency to tie everything together with Covid-19 and lockdown.

However, this report was over 18 months in the making, compiled by Ulster University, Queen’s University and the Mental Health Foundation and collecting data from over 3,000 NI children and young people.

There are two ways of looking at this. The first is that it comes with an asterisk, as it is unlikely to take into account the full effects of the pandemic. The second is that it is a potentially more robust snapshot of NI mental health, long-term, as any short-term adjustments caused by Covid-19 will be less of an issue.

Contents

The report will be of huge benefit to anyone with an active interest in mental health – especially third sector organisations working with children or young people.

It drills down into different categories of mental health issue, and examines local prevalence, including how these alter between boys and girls, over different age groups, and in different socioeconomic circumstances.

These categories include:

Emotional and Behavioural Problems - and findings include that one in eight children and young people in Northern Ireland experienced emotional difficulties, one in ten had conduct problems and one in seven problems with hyperactivity.

Oppositional Defiant and Conduct Disorders – an estimated one in ten young people have an oppositional defiant disorder (9.9%) and one in 20 have a conduct disorder (5.5%).

Mood and Anxiety Disorders -  one in eight young people (12.6%) met criteria for any mood or anxiety disorder; panic disorder was the most common diagnosis (6.8%), followed by separation anxiety disorder (5.2%), major depressive disorder (5.0%), social phobia (3.8%), obsessive compulsive disorder (3.1%) and generalised anxiety disorder (2.7%).

Stress Related Disorders - The prevalence of any stress related disorder was 4.9. The traumas most frequently reported by adolescents were witnessing violence (17.0%), having a serious accident (16.8%), and sudden death of a loved one (10.7%).

Per the report: “A significant proportion of children and young people in Northern Ireland experience mental health problems, including diagnosable mental health conditions.

“A 2017 survey of the Mental Health of Children and Young People in England found that one in eight (12.8%) 5-19 year olds had at least one clinically diagnosable mental health disorder, with one in 12 (8.1%) having an emotional disorder such as anxiety or depression and one in 20 (5.5%) having a behavioural or ‘conduct’ disorder.

“In the Youth Wellbeing NI Survey, one in eight children and young people (12.6%) had an emotional disorder such as anxiety or depression. Studies of adult populations indicate that Northern Ireland has 25% higher rates of common mental health disorders than England, Scotland and Wales… and, bearing in mind methodological differences, it appears that the picture is similar for young people.”

Closer look

The paper also looks at the rates at which young people are deemed at risk of other mental health problems, and at the various experiences and behaviours of our young people – including use of social media, bullying and any consumption of alcohol or drugs.

At-risk children and young people will, in general, require further assessment ahead of any diagnosis:

• 7.7% of children and young people had scores on a screening tool for autism spectrum disorder which suggested that further assessment was indicated.
• Nearly one in five (18.7%) adolescents reported six or more symptoms on a screening questionnaire for psychotic like experiences. Although relatively high in Northern Ireland, this was broadly comparable to other international studies, confirming that such experiences are fairly common.
• One in six young people (16.2%) engaged in a pattern of disordered eating and associated behaviours that might indicate the need for further clinical assessment.
• Almost one in ten (9.4%) 11-19 year olds reported self-injurious behaviour and close to one in eight (12.1%) reporting thinking about or attempting suicide.

The paper says that almost half of all young people in Northern Ireland have experienced at least one Adverse Childhood Experience (ACE), with 5.7% experiencing three or more.

Females were significantly more likely than males to report three or more ACEs (7.0% vs 4.6%) The most commonly-reported ACEs were parental separation (35.8%), parental mental health issues (10.7%) and emotional neglect (5.7%).

Concerns about social media are a key part of modern mental health discourse so it may surprise some people that only 4.7% of 11-19 year olds met the criteria for problematic social media use (which is not to say that this is a good result). Rates of problematic use were generally higher among females than males.

Around one in six (16.8%) of young people have experienced “traditional” bullying while 14.9% have experienced cyberbullying. Per the report: “Rates of ‘traditional’ bullying were higher for males than females (20.7% vs 13.0%). Rates of cyberbullying were higher for females than males (17.9% vs 11.9%).”

One fifth of all 11-19 year olds say they have smoked a cigarette while over one in ten had done so in the month before they were asked.

Almost one in five children aged 11-15 have tried alcohol. While only 2.5% of children in that age group met the criteria for problematic drinking, that figure jumps dramatically – to 40.9% - for children aged 16-19.

Future use

One article can only skim the surface of a report that is as weighty as this one commissioned by HSCB.

However, it is clear that health officials consider this a milestone piece of work that will inform major policy directions in coming years.

Per the report: “We know that more than 50% of adult mental disorders have their onset before the age of 18. [There are] identified links between the wellbeing of children and young people and parental experiences of mental ill-health, and lifestyle and environmental factors, including adverse childhood experiences.

“Further analysis of the results will provide more detailed information on the causes of mental health difficulties in young people. Societal-wide measures, based on our increased understanding of the pathways to mental health problems, will in the future allow us to usher in a new era of screening, prevention, early intervention, and improvements in the mental health of everyone…

“This report represents the first stage in the process of analysing and interpreting the rich data collected… we have presented initial findings and highlighted the potential implications but have avoided making specific recommendations, recognising that this entails further consideration and collaboration to affect meaningful, evidence based system change.

“The next stage will involve close collaboration with key stakeholders working in the fields of mental health, education and social care to consider the implications of the findings for future policy, service commissioning and practice in Northern Ireland. Importantly, these findings will inform the development of the NI Mental Health Strategy due for publication in 2021.”