In this episode of our MQ Open Mind podcast, Professor Rory O’Connor and Craig Perryman chat with two guests Professor Kathryn Abel and mother Haley Peterson about adolescent mental health and improving CAMHS (Children and Adolescent Mental Health Services).
Mental illness is known to often start at an early age. In fact, 75% of lifelong mental illnesses begin in childhood or adolescence. Professor Kathryn Abel is Professor of psychological medicine and a psychiatrist at the University of Manchester looking into what can be done to help.
Vulnerability To Strength
Kathryn remembers working in the late 80s and early 90s researching drugs for mood disorders or psychiatric problems. This was where she realised how much she enjoyed research. When a respected colleague, Fiona Godley, who went on to become the first female editor of the British medical journal, suggested she became a psychiatrist she decided to follow that insightful suggestion. Having experienced depression herself, the idea appealed to her personal experience.
Kathryn studied at The Institute of Psychiatry, going on to receive her consultant certificate in psychology in 2001 and was offered an opportunity to open the first centre 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 vulnerability in children, something Hayley knows the importance of all too well.
Hayley and Winston’s Story
Hayley’s experiences with navigating CAMHS recently supports the need for work by Kathryn and people in her field. Hayley is a mother of four whose oldest, Winston, at the time of the interview aged 13, has been in need of support from services.
“I’ve been questioning whether or not Winston has ADHD since year two of primary school. He was always a boisterous little boy, quite classic signs, struggling to concentrate, he was getting behind with school work or unaware of dangers. He even tried to leave school a couple of times. I flagged it up at Primary School to the teachers but I was 25 when I had Winston, I was a first time Mom. The teachers just said ‘no he’s just a boisterous boy, you’re being silly’. I felt fobbed off.” Hayley Peterson, mother of four
When things continued to worsen for Winston in his behaviour, Hayley began her own research. She was told by the school again the Winston was “not a child in crisis. That’s a good thing.” He began to develop coping mechanisms such as fidgeting with rubbers and subsequently ripping holes in his clothes. But despite help from additional needs services things continued to develop. By this point he was referred to CAMHS.
“Winston was at high school by the time we were seen by CAMHS. But they said ‘school aren’t seen what you’re seeing at home. We’re going to discharge him.’ I felt a bit kind of pushed into it to be honest and made to feel a little bit silly about it.”
When things worsened yet again, Hayley contacted CAMHS to ask to be referred again only to be told Winston couldn’t be seen because it 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 private assessment considering Winston is coming towards exam periods, a period of time in a young person’s life known to cause stress.
The Rise of ADHD and Autism
Hayley’s experience, and Winston’s, highlights a number of issues that parents up and down the country will be experiencing, Professor Rory says in the episode. He adds that if we exclude the pandemic and look at the period over the last 10 years, there’s growing evidence of increased mental health problems amongst young people and increased evidence of neurodivergent conditions, greater diagnosis of ADHD and of autism.
So what is the evidence telling us about the increase or otherwise of mental health problems? Kathryn confirms the change is there, a steady increase. But she also confirms some surprises, including that the pandemic didn’t really make a difference to the increase of mental health problems.
According to this episode, the pandemic steadily increased the number of kids both turning up to primary care or general practice with a range of mental health symptoms. Not necessarily an illness, but a range of complaints or symptoms. And those kids are brought by their parents.
“About 50% of kids who present to primary care to GPs with any kind of mental health symptom do not require any further treatment or assessment which is very good news. They don’t continue to have longer term psychiatric problems. But what I hear from parents is ‘what’s going to happen to my kid now? If they’ve got this diagnosis or they’re presenting with these problems, a lot of which are anxiety-related, what’s the likely outcome for them?’” Professor Kathryn Abel
Increase in Children’s Mental Ill Health
While Hayley’s son Winston presented much earlier with slightly different neurodiversity neurodevelopmental problems, it’s children who presented in teenage years rather than earlier, who develop psychotic illnesses (hallucinations or delusions) or quite serious kinds of symptoms even fleetingly, says Kathryn. Sadly, these children tend to have the more difficult longer-term outcomes, needing to be seen by secondary services, go into inpatient services or to be treated long-term with medicines.
Mental Health Distress statistics over the past 20 years, according to Kathryn in this podcast:
- An increase in the number of children being referred for similar symptoms to Winston’s outlined above.
- Those referrals tend to be more boys than girls.
- An increase in diagnosis of ADHD and autism spectrum disorders or ASD.
- High rates of anorexia presentation (occurring for a “very brief period” eg, about six months)
- Increased rates of self harm presentations
- Self harm is mostly found in young women and tends to be transient over periods of distress.
- No change in numbers at the “more severe” end of both ADHD and autism.
- No change in the rates of presentation of Psychotic disorders
- No change in the rates of severe eating disorders, in girls in particular, like severe anorexia
- Rates of children presenting with mental health distress slightly decreased when mental health support workers came into schools.
So while there is increased presentation of mental health distress to services, most of that is not very severe and managing that distress in school seems to work well when funded appropriately. Kathryn thinks there’s a clear reason for the increased rates of presentation.
“People have become much more aware of presenting a problem as a mental health problem that needs treatment, they’re much more open to thinking about treatment pathways for kids and they’re also much more likely to go to the GP and ask for help.”
Addressing Distress vs Medicalisation – Finding A Balance
Looking at referrals to CAMHS, in 2021 and 2022, Kathryn says about half a million children and young people were referred into specialist services. This is an increase, figures which Kathryn says have doubled since 1999.
However, of the referrals to services, about quarter are unsuccessful, says Kathryn, primarily because they’re not deemed to be of a sufficient severity for those specialist services. These services are designed to deal with severe and enduring mental illness not the presentation of some psychological symptoms psychological distress.
“We don’t want to discourage people presenting with distress but we also don’t want to medicalise children and adolescents. We need to understand where the balance lies between the two.”
And balance is what research can help move us towards. Support MQ mental health research to help researchers like Kathryn get us closer to finding that balance.