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Child mental health issues need to be addressed

January 16, 2008

Professor Robert Goodman in the Department of Child and Adolescent Psychiatry at the Institute of Psychiatry at King's was interviewed in the Guardian this month on the topic of common child and adolescent mental health problems which commonly affect around 10 per cent of all children and adolescents.  So much so that they cause substantial distress with problems markedly interfering with children’s lives.

He comments: "The problems are not usually outgrown in the short term – even three years on, most of the affected individuals are still experiencing a lot of symptoms.  Although there are good evidence-based treatments, it is only a minority (and probably a small minority) who receive these.   No social group is immune from these difficulties, but disabled, deprived and excluded groups suffer disproportionately.  For example, around half of all children and adolescents who are “looked after” by local authorities have definite mental health problems, and many of the rest have borderline problems.

Professor Goodman masterminded recent Department of Health (DoH) surveys that produced these dramatic figures - indicating that a 10th of British children at any one time suffer emotional, behavioural or concentration difficulties and says understandably that we should be appalled by them.  "If it had been diabetes, it would have been a national scandal.” He said.

He continues:   "Our Anglo-Saxon way of life - laissez-faire, everyone for themselves - is economically successful but not child-friendly." He is backed up by last year's Unicef research showing that children from Britain and the US are the least happy in the developed world.

One source of reference is the website Youth In Mind to which Goodman has contributed advice, which has been set up as a source for more parents teachers and youths to get appropriate advice and help and feel less alone.

Youth In Mind offers the first national directory of mental health services available to the general public. It's a reviewed resource bank of hundreds of books and websites. But its biggest innovation is the chance to take online the questionnaire that was a basic tool of the DoH surveys.

The questionnaire asks 25 to 33 questions that can be completed in under 10 minutes by worried parents or teachers, or by 11- to 17-year-olds themselves. Questions like: Does your child think things out before acting? Does he/she steal from home, school or elsewhere? Is he/she kind and helpful? are instantly analysed in a brief report indicating possible causes for concern.

Demand for such a service is soaring. Of the disturbed 10%, half have behavioural problems, 40% anxiety or depression, 15% attention-deficit hyperactivity disorder (ADHD), and 8% autistic spectrum disorders (some children have multiple problems). Goodman says that behaviour is significantly worse than 25 years ago, with "a steep social gradient in emotional problems. Nowadays more deprived children have more emotional difficulties."

Everyone has their pet explanation - lack of fish oil, TV-watching, illegal drugs, lack of exercise. Likely candidates in Goodman's eyes are widening inequality, family breakdown, school pressures and a materialist, consumerist society. "Not having the right trainers has become a much worse stress."

"Both behaviour and ADHD are much worse in Britain. Norwegians live in a much more equal society, with shorter working days, more time spent with families, particularly on outdoor sports at weekends, public values publicly shared. They eat lots of oily fish, too! Italy has a much more intact family structure: people typically live surrounded by family and lifelong friends. They enforce social rules differently. Minor peccadilloes like running children are tolerated. By contrast, infringements of personal space and property are immediately sanctioned, and not only by parents. Italians are physically and emotionally warm, too. That pattern is pretty much exactly what parenting programmes like ours are about."

Over the past 20 years, the Institute of Psychiatry and the Maudsley have pioneered the scientific understanding of parenting, led by Professor Stephen Scott; obsessive compulsive disorder (OCD), led by Dr Isobel Heyman; and hemiplegia (a kind of cerebral palsy affecting one in 1,000), led by Goodman himself.

Yet developing a reliable statistical tool to analyse the needs of whole populations may turn out the most important of all, globally. The questionnaire, in over 70 languages, is available free from for any non-profit, non-charging organisation.

"Doing these surveys made me realise how much unnecessary suffering was caused by common mental-health problems," says Goodman. "These problems were not being treated. Yet I knew that for many of them, there were effective treatments."  He gives as examples parent management training for behavioural disorders and cognitive behavioural therapy for OCD, anxiety and depression. The DoH surveys showed that only around a quarter of those in need got specialist help; and this was not necessarily the right kind.

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