C & YP and mental health
There are two separate but not unconnected issues which should be considered within the context of identifying, assessing and managing the risks faced by children affected by mental health problems:
- children and young people who themselves are experiencing mental health problems; and
- children and young people whose lives are affected by parental mental illness or mental health problems.
Stigma is a particular issue causing many people not to admit to experiencing mental health problems or seeking help for themselves or their children.
The emotional well-being of children and young people is just as important as their physical health. Most children grow up mentally healthy, but certain risk factors, can lead to some children being more likely to experience mental health problems. Events that happen to children will not usually lead to problems with their mental health on their own, but some extremely traumatic events can trigger mental health problems (Post Traumatic Stress Disorder) for children and young people.
There are certain ‘risk factors’ that make some children and young people more likely to experience problems than other children, but they do not necessarily mean difficulties are bound to come up or are even probable. Some of these factors include:
- having a long-term physical illness;
- having a parent or carer who has had mental health problems, problems with alcohol or been in trouble with the law;
- experiencing the death of someone close to them;
- having parents who separate or divorce;
- having been severely bullied or physically or sexually abused;
- living in poverty or being homeless;
- experiencing discrimination, perhaps because of their race, sexuality or religion;
- acting as a carer for a relative, taking on adult responsibilities;
- having long-standing educational difficulties; and
- insecure attachments with primary carer.
Changes of environment can act as triggers, such as moving home or school. Teenagers often experience emotional turmoil as sexual maturation develops through the stressful period of adolescence. Adolescence is often described as a period of storm and stress where teenagers attempt to define their own identity. During this period of identity formation many children particularly those with other difficulties will experiment with alcohol, drugs or other substances that can alter how they feel. This experimentation with substances can often contribute to mood swings either exacerbating or camouflaging mental health problems. Self-harm, parasuicide and suicide is a significant risk for young people during adolescence.
For some young people, this will not be a transitory issue and mental health problems will severely limit their capacity to participate actively in everyday life and will continue into adulthood. Some will develop severe difficulties and behaviour that challenges families and services, including personality disorders and sexually-predatory behaviour. A small number of children with mental health problems may pose risks to themselves and others. For some, their vulnerability, suggestibility and risk levels may be heightened as a result of their mental illness. For others, their need to control, coupled with lack of insight or regard for others, feelings and needs, may lead to them exploiting the vulnerabilities of other children. It is imperative that services work in close partnership to address the difficulties and mitigate the risks for these children and for others.
For children and young people experiencing such difficulties, it is extremely important that they are able to access the right support and services and that their issues are taken seriously, a focus on children's welfare is paramount. The need to work collaboratively across services to ensure effective responses that take account of the child's or young person's family and wider social circumstances is fundamentally important.
Effective risk assessment is required as part of this response. Child and adolescent mental health services can provide an important resource in helping children and young people overcome the emotional and psychological effects of abuse and neglect. It is important that children and young people's mental health is not seen as only the preserve of psychiatric services, as the causes of mental ill-health are bound up with a range of environmental, social, educational and biological factors.
Further helpful information can be found in the following publications or on the links noted below.
The SCIE Report, Think child, think parent, think familyidentifies the need for a multi-agency approach with senior level commitment and includes recommendations for practice in relation to assessment, care planning/provision and review at practitioner, organisational and strategic level. The guidance covers England and Wales, but is nevertheless valuable for practitioners working in Scotland.
The COMPASS mental health team is dedicated to asylum seekers and refugees.