My heart leaps up when I behold
A rainbow in the sky:
So was it when my life began;
So is it now I am a man;
So be it when I shall grow old,
Or let me die!
The Child is father of the Man;
(excerpt from William Wordsworth’s poem ‘My Heart Leaps Up’ 1802)
Wordsworth’s observation that ‘the child is father of the man’ has significant implications for how we treat children in our society. Wordsworth was suggesting that early experiences help shape the people we will become in adulthood. For him it was a pleasant experience, seeing a rainbow, which gave him the revelation. For many though, childhood is a challenging period, with many stressful, painful experiences, arising from poverty, bullying, pressures to compete and achieve, crises of self-identity, and these days the problems of navigating social media. Such experiences are unlikely to make hearts leap. In fact, research shows that experiences like these can affect emotional and mental well-being, potentially causing mental health problems which can last well into adulthood.
NHS data obtained in 2017 showed that 1 in 8 (12.8%) of 5 to 19 year olds had at least one mental health disorder, and that prevalence of mental disorder in 5 to 15year olds had risen from 9.7% in 1999 to 11.2% by 2017. In one survey, 70% of children and teenagers diagnosed with a mental health problem were found not to have received appropriate and timely treatment (Children’s Society, 2008).
Our brains develop rapidly over the first five years of life. There is now scientific evidence that chronic stress during this period, such as extreme poverty or recurrent abuse, can have an impact on this development, leading to impairment of cognitive and emotional abilities. Such impairments can limit performance at school, and later in the workplace, and can lead to serious mental health problems in later life.
There is some evidence that half of adult mental disorder starts by the age of 14 and it is mostly during the teenage years that serious problems such as schizophrenia and eating disorders begin to emerge. Self-harming behaviour such as cutting and burning, often signs of emotional distress, have become more prevalent over recent years, with estimates that 1 in 10 young people have self-harmed in some way.
It clearly goes without saying that we need to address these issues early if we want to improve the quality of life, not only of children, but also of the adults that they will become. For most of us this would be reason enough to intervene, but there have been suggestions that reducing mental health problems which have their roots in childhood may even be cost effective.
So, what should these early interventions look like? Some have been considered in the Government’s Green Paper published in December 2017. Others have been suggested in response to this document. Early Interventions can be considered under three main areas: promotion of mental health; prevention of mental health problems; and treatment, or therapy, for mental health problems.
Promotion of Mental Health, would seek to help allchildren develop the skills they need to manage their emotional life, establish and manage good social relationships, self-regulate their behaviour, and become confident self-assured individuals. Skill development programmes could be established in schools as part of the normal curriculum.
Prevention of mental health problems needs to emphasise early detection of signs that a child is experiencing difficulties. These could be extremes or changes in emotionality and mood, such as increased anxiety, or withdrawal; problems in self-regulation of behaviour, such as aggression; difficulties in managing social relationships; or a drop off in performance at school. Liaison between education, primary and secondary healthcare, and social care agencies would be vital to ensure that those at risk are identified and provided with the support they need.
Specially trained staff in schools would have identification of early signs as a key responsibility. Children identified in this way would be provided with support, either on an individual or group basis, and have these signs monitored. If such support proves ineffective and the child appears to be developing a more formal mental health problem, they could then be referred on to specialist mental health services.
Another arm of a preventive approach would provide support to parents, where necessary ensuring availability of services to address their mental health needs, as well as providing opportunities for skills development in the challenging area of parenting.
Children’s Specialist Mental Health Services have long been thought of as the ‘Cinderella’ of mental health service provision, which in turn has been seen as the ‘Cinderella’ of physical healthcare services. Children’s Specialist Mental Health Services must be adequately funded to be able to provide assessment and treatment with the minimum of delay. These services will need to liaise closely with schools and support services within their local area and will need to have an advisory and training role. Children’s services would also need to be closely integrated with adult mental health services, particularly early intervention and adult community teams, in order to facilitate transfer and continuity of care. It has been suggested that continuity of service provision should be available at least to age 25.
The Government have proposed to implement some of these interventions in ‘trailblazer’ sites by the end of 2019, with a roll-out achieving coverage of 20 – 25% of the country by 2023. Given the pain and misery being suffered now by many tens of thousands of children and the magnitude of problems which are being stored up for the future, this is a very unambitious response.
Article by Mathew Littlewood
Mental Health Advisor