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Children and Young People Mental Health

Introduction

“By promoting good mental health and intervening early, particularly in the crucial childhood and teenage years, we can help to prevent mental illness from developing and mitigate its effects when it does.” - (see footnote 1).

Mental health has been defined as ‘the strength and capacity of our minds to grow and develop, to be able to overcome difficulties and challenges and to make the most of our abilities and opportunities (see footnote 2).

There has been increasing recognition and evidence in the UK of the importance of prioritising the mental and emotional wellbeing of children and young people and in tackling inequalities in childhood, not simply for children now, but for a healthier population and fairer society in the future (see footnote 3).

There is compelling evidence of the effectiveness of interventions to improve children’s and young people’s resilience and emotional well-being that demonstrates getting the right help at the right time is key (see footnote 4).

Beginning with a healthy pregnancy, a safe birth and a strong bond between a baby and its parents is vital and health promotion programmes’ delivered during pregnancy and the first years of life, when the foundations of future health and wellbeing are laid down, is vital. While it has been acknowledged for some time that this phase strongly influences outcomes in later life, recent evidence reinforces the importance of early intervention to reduce the impact of stress in pregnancy and to promote attachment and this is particularly true for children born into disadvantaged circumstances. Many problems which occur later in life, and lead to enormous expenditure on service provision, arise because children did not receive appropriate support in their early years (see footnote 5).

As children enter and progress through the education system, schools have an important role to play in promoting emotional health and wellbeing. Professionals working in schools require the knowledge and skills to promote emotional wellbeing and recognise potential problems, to intervene appropriately and to signpost to other services if the need arises. Throughout childhood and adolescence, those with complex needs require good quality and age-appropriate services and these services need to work cohesively to provide a range of services to meet their needs. Promoting emotional well being and supporting a child’s resilience to mental illness is the responsibility for all those who come into contact with children and young people.

Although children and young people are healthier now than ever, inequalities persist and evidence suggests that mental ill health affect one in ten of 5-16 year olds (see footnote 6).

Details on

adult mental health, unintentional injuries in children and young people, young carers, children in care, disability in children and young people, parenting, safeguarding in children and young people and teenage pregnancy can be found in other sections. |back to top

Key Issues and gaps

Nationally there is an expectation that there be a “parity of esteem” between mental and physical health services and that inequalities will be tackled. Children and young people’s emotional and mental wellbeing is everyone’s business, not just the interest of specialist services therefore joined up, multi-agency, multi disciplinary working is the key to successful service provision for children and young people. Commissioning high quality, effective children’s mental health and emotional wellbeing services is a safeguard for children and families, and a cost-effective investment over the medium to long term. There is an emerging body of evidence of the effectiveness of interventions to improve children’s and young people’s mental health and that getting the right help at the right time is key and there is an increased focus on the importance of prevention and early intervention.

Children and young people living in Haringey are potentially at greater risk of developing mental health problems than those living in both London and England as a whole. Socio-economic factors play a significant role in the development of mental health problems and with high rates of deprivation and unemployment, particularly in the centre and east of the borough, certain groups of children and young people living in Haringey are at greater risk. Children of parents with mental health problems are also at risk of experiencing mental ill health; levels of mental illness in adults in Haringey are nearly twice the national average. There are considerable numbers of children and young people in Haringey who are particularly vulnerable.

It is estimated that there are currently 2,534 children and adolescents with mental health problems living in Haringey. In view of the strong link between deprivation and mental health problems in children and young people, it is likely that prevalence rates are higher in the centre and east of the borough. Children aged 11 to16 from Black ethnic groups have a higher prevalence of mental health problems than other groups. Over 28 per cent of children living in Haringey are from Black ethnic groups. It is estimated that there will be 2,633 children aged 5 to16 with mental health problems living in Haringey by 2013, an increase of 4 per cent on 2010. By 2018 this will rise further to 2,817, an increase of 7 per cent on 213.

There was a total of 915 referrals to Children and Adolescent Mental Health Services (CAMHS) in 2009/10, a decrease of 11 per cent on the previous year. 52 per cent of referrals were for females and 48 per cent for males. Referrals for 10-18 year olds accounted for just below 63 per cent of all referrals. This is in line with national figures that found mental health problems to be more common amongst older children and adolescents.

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Who is at risk and why

The known risk factors for mental ill health in children and young people and the occurrence of these risk factors in Haringey fall into four main groups:

  • Child factors
  • Family factors
  • Environmental factors
  • Life events

1. Child factors

i) Long-term physical illness or disability

Children with physical health problems or disabilities appear to be especially vulnerable to mental ill health (see footnotes 7 & 8).

According to the 2001 Census, 4.6 per cent of children and young people under the age of 20 living in Haringey had a limiting long-term illness which is slightly higher than the rates for both London and England. This equates to over 2,500 children.

ii) Statements of special education needs

Children with mental ill health are three times more likely than other children to have special education needs.

As of January 2010 3,293 children attending Haringey schools had a statement of special education needs. This equates to approximately 10 per cent of all school aged children. The largest primary needs were for those assessed as having speech, language and communication needs (28.8 per cent), behaviour, emotional and social difficulties (21.7 per cent), and moderate learning difficulties (16.5 per cent). Approximately 58 per cent of children with a statement went to primary school and 42 per cent went to secondary school. Figure 1 shows the breakdown of statements of special education needs by type of primary need.

Figure 1: Breakdown of children with an education need in Haringey as at January 2010

iii) Crime

Young offenders are at high risk of suffering mental ill health; it is estimated that up to 40 per cent of young people in the youth justice system have mental ill health. (see footnote 9)

There were 223 ‘serious youth violence’ offences in Haringey in 2010/11, a reduction of 7.5 per cent compared with the previous year. This compares with an annual reduction in overall crime in Haringey of 6 per cent. 20 per cent of all offences were committed by 15 to 19 year olds and 11 per cent were committed by 10 to 17 year olds.

iv) Smoking, alcohol and substance misuse

Children with mental ill health are more likely than other children to smoke, drink alcohol and frequently use cannabis.

During 2009/10 there were 73 children and young people in Haringey in treatment for drug and alcohol problems. 53 of these were looked after by Haringey Youth Offending Service and 20 by Involve (external link), a commissioned service.

2. Family factors

i) Lone parent households

Children of lone parents are approximately twice as likely to have mental ill health compared to those living with married or cohabiting parents (see footnote 10).

Lone parents head up 27 per cent of all households with dependent children in Haringey which is a much higher proportion than for both London (21 per cent) and England (17 per cent). However, this figure varies considerably across the borough, for example in Northumberland Park one in three households with dependent children are headed by a lone parent compared to one in eight in Muswell Hill.

ii) Prevalence of mental ill health in adults

Children and young people who have a parent with mental ill health are at greater risk of mental ill health themselves.

Local data from GP registers (Quality and Outcomes Framework) suggest that 1.5 per cent of Haringey’s adult population have a mental health problem which is almost twice the national rate of 0.8 per cent.

iii) Children in the care of the local authority

Children in the care of local authorities are at particular risk of mental ill health. It is estimated that approximately 45 per cent of looked after children in the UK suffer from some form of mental ill health compared to 10 per cent from private households (see footnote 11).

At 31st March 2011, there were 613 children in the care of the local authority in Haringey. 58% of children were male and 42% female. A majority of children in care fall into the 10-15 year age bracket (36%).

Figure 2: Age and gender of children in care at 31 March 2011

Source: SSDA903 Children Looked after by Local Authorities in England

44% of children in care at 31 March 2011 were from Black ethnic backgrounds. This includes Black British, Black African and Black Caribbean backgrounds. 35% were from white backgrounds, including White UK and other white European groups.

Figure 3: Ethnicity of children in care in Haringey at March 2011

Source: SSDA903 Children Looked after by Local Authorities in England

A rapid health needs assessment was undertaken in August 2011 and workshops were held with young people and professionals to gather their views. During the workshops participants were asked to identify the key health issues. Both groups identified emotional health and well being as a priority.

In December 2010 there were 303 children living in the borough with a child protection plan.

3. Environmental factors

i) Social class

Children in families from lower socio-economic groups are more likely to have mental ill health than children in families from higher groups (see footnote 12).

Haringey has a higher proportion of families from the lowest socio-economic group than London as a whole and England. Figure 4 shows the breakdown of Haringey’s population by socio-economic group compared with London and England.

Figure 4: Haringey's population by socio-economic group compared with London and England

Source: ONS 2002

ii) Income / employment

There is a strong link between children’s mental ill health and family income, with a higher prevalence amongst children from families with low incomes. As income is highly dependent upon employment, there is also a higher prevalence of mental ill health among children in families where neither parent works.

The proportion of Haringey’s population claiming Job Seekers Allowance is consistently higher than the proportion for both London as a whole and England (see footnote 13).

Figure 5 shows the proportion of 16 to 64 year olds claiming Job Seekers Allowance in Haringey, London and England since 1999.

Figure 5: Job Seekers Allowance claimants

Source: DWP 2011

Figure 6 shows the employment levels in Haringey’s parliamentary constituencies between 2004/5 and 2009/10. It can be seen that the gap between employment levels in each constituency remained similar between 2005/6 and 2008/9 but became wider in 2009/10 as the numbers in employment fell in Tottenham and Haringey (in the east of the borough) but increased in Hornsey and Wood Green (in the west of the borough).

Figure 6: Employment levels in Haringey constituencies 2004/05 to 2009/10

Free school meals is another indicator of low income as they are given to children whose parents receive benefits such as income support and job seekers allowance. As of January 2010 there were 6,487 children (over 20 per cent of school aged children) receiving free school meals in Haringey.

iii) Housing tenure

Children living in rented accommodation, either social sector or private sector, are more likely to suffer from a mental health problem than those living in owner-occupier households.

According to the 2001 Census, 46 per cent of Haringey households are owner-occupiers which is significantly less than the figures for London as a whole (57 per cent) and England (69 per cent). However, this figure varies across the borough with much higher levels of ownership found in the west compared to the east. 20 per cent of Haringey’s households rent from the council, 20 per cent from private landlords and 11 per cent from registered social landlords such as housing associations.

iv) Homelessness

Evidence shows that there is a high prevalence of mental ill health among the homeless, including homeless children, and that homelessness is a risk factor (see footnote 14).

As at March 2010, there were 3,547 households living in temporary accommodation in Haringey. There were also 355 homeless acceptances during the period April 2009 to March 2010. This is a decline on 2009 when there were 4,548 households living in temporary accommodation and 946 homeless acceptances during the year.

4. Life events

Traumatic life events, such as the bereavement of a family member or displacement as a result of war, are associated with the onset of emotional and behavioural problems in children (see footnote 15) with the number of stressful life events appearing to have a cumulative effect factor.

i) Refugee and asylum seekers

Children of refugees and asylum seekers have been shown to have consistently higher levels of mental ill health, including post-traumatic stress, anxiety and depression (see footnote 16).

A local study of unaccompanied Albanian and Kosovo adolescents found high levels of mental ill health, with nearly a quarter (23 per cent) showing significant psychological distress (see footnote 17).

As at October 2010 there were 85 families seeking asylum in Haringey and as of December 2010 there were 40 unaccompanied minors.

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The level of need in the population

Although children and young people are healthier now than ever, inequalities persist and evidence suggests that mental ill health affect one in ten of 5-16 year olds (see footnote 18).

Prevalence of mental health problems amongst all children

Large-scale national surveys carried out in 1999 and 2004 suggest that approximately one in ten children have a mental health problem although this varies by sex and age. The prevalence rates found in the most recent survey for inner London are contained in figure 7 below.

Figure 7: Prevalence rates of all mental health disorders by gender and age for inner London

Source: Green, 2005

Applying these prevalence rates to the 2010 estimate of Haringey’s population means that just over 2,500 (2,534) children aged 5 to 16 in the borough have a mental health problem (figure 8).

Figure 8: Estimated prevalence of mental health disorders by gender and age for Haringey

Green (see footnote 19) found that boys account for over 64 per cent of all children aged 5 to 16 years old with a mental health problem. They also found that mental health problems are more common amongst older children and adolescents with the 11 to 16 year old age group accounting for 58 per cent of all children with a disorder.

As deprivation is a risk factor for mental ill health in children and young people, it is likely that higher rates will be found in the centre and east of the borough where deprivation levels are high.

Prevalence of mental health problems by diagnosis

Green identified four broad categories of mental health problems:

  • Emotional disorders, which includes anxiety and depression
  • Conduct disorders
  • Hyperkinetic disorders
  • Less common disorders, which includes eating and psychotic disorders.

Boys were found to be more likely than girls to have a conduct or hyperkinetic disorder and girls were more likely to suffer from emotional disorders. 1.9 per cent of children have more than one diagnosis.

Figure 9 shows prevalence rates by diagnosis for inner London. The overall prevalence rate of 8.6 per cent includes some children who had more than one type of illness.

Figure 9: Prevalence rates by diagnosis for inner London

Figure 10: Estimated number of children by diagnosis in Haringey.

Some variations in the prevalence of mental health problems by ethnic group have been identified. Green found higher prevalence in Black children aged 11 to16 (14 per cent compared to 3 to 12 per cent for other groups), lower prevalence in Indian children of all ages (3 per cent compared to 7 to 10 per cent for other groups), and lower prevalence of hyperkinetic disorders among non-white groups. Similar variations have also been observed in previous studies, as well as in clinical practice.

In view of the small numbers involved estimates have not been provided for prevalence rates by ethnic group for Haringey. However, children aged 11-16 from Black ethnic groups have a higher prevalence of mental ill health than other groups and over 28 per cent of 0-17 year olds living in Haringey are from Black ethnic groups.

Prevalence of mental ill health in looked after children

A large scale study of Looked After Children aged 5 to 17 years old conducted in 2002 found 45 per cent had mental ill health. (see footnote 20). The study found that 5 to 10 year-olds in the care of the local authority were over five times more likely to have mental ill health than the general population (42 per cent compared with 8 per cent). 11 to 15 year-olds in the care of the local authority were between four and five times more likely to have mental ill health than the general population (49 per cent compared with 11 per cent). Figure 11 shows prevalence rates by diagnosis.

Figure 11: Prevalence rates by diagnosis for looked after children.

Source: Meltzer et al, 2003

As at 31 March 2011, there were 613 children in the care of the local authority in Haringey.

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Current services in relation to need

Traditionally the CAMHS tiers are used to conceptualise the different elements of services available to support mental health well-being, although the model is open to local interpretation and understanding:

  • Tier 1 Universal services, early identification and prevention (GPs, health visitors, teachers, youth workers etc)
  • Tier 2 Uni-disciplinary working, consultation, assessment, training (primary mental health workers, psychologists, paediatric clinics)
  • Tier 3 Multi-disciplinary team, child psychiatry out patient, specialized mental health working
  • Tier 4 Highly specialised services such as in-patient units or intensive outreach services for those with the most severe problems

Below is a diagram to show how the tiers of a comprehensive CAMHS could be considered within a universal context.

Figure 12: CAMHS service model

1. Tier 1 – Universal services (prevention and early intervention)

Supporting children with mental health difficulties is the business of all services working with children. Staff working in universal services such as schools, primary care, health visiting have a pivotal role in promoting emotional well-being and supporting children with issues of emotional wellbeing and/or emerging metal health disorders. They are key to ensuring early identification, assessment and intervention of mental health difficulties.

The commissioning strategy recognises that the professionals working in these services need to have sufficient knowledge to identify children and young people who need help; offer advice and support to those with less severe problems and to refer on where necessary. A Common Assessment Framework (CAF) is in operation and is used by universal services to refer a child or young person for further mental health assessment and/or intervention.

2. Tier 2 – early advice, training and consultation for universal services

The two statutory systems; local authority and health are operating in changing and challenging times. They commission tier 3 and tier 4 Child and Adolescent Mental Health Services. However tier 2 services are limited since the cessation of grant funding for the Targeted Mental Health in Schools Project (TAMHS).

The local authority is implementing a financial savings programme that has resulted in a number of services/teams having to review their service offer e.g. The Youth, Community and Participation Service and our schools will have budgets to commission services on behalf of their school community. All these challenges do provide opportunities to ensure we are implementing and targeting Tier 1 and 2 services focussed on evidence based outcomes.

One area where the PCT has sustained tier 2 support for mental health is in the commissioning of the Parent Infant Psychology Service – working with families identified by health visitors and children’s’ centres and provider advise and training to both thee universal services. This service is unique in the country and is pioneering effective outcome measurement in this area.

3. Tier 3 - Specialist mental health services

Both London Borough of Haringey (LBH) and the PCT commission services directly from providers of mental health services to provide assessment and intervention to children with mental health difficulties. The main local providers of commissioned services to children with mental health problems are Barnet, Enfield and Haringey Mental Health Trust (BEHMHT), Tavistock and Portman NHS Foundation Trust, the Royal Free Hospital, and Open Door (a voluntary sector organisation), also providing services. There is one single point of entry to all these CAMHS services.

Services are provided in a range of settings including schools, young people’s homes, GP practices, specialist CAMHS clinics. The services are provided by specialists who work in partnership with a range of professionals including social workers, teachers and GPs, which helps to ensure that there is co-ordinated and integrated support for children, young people and their families so that, as far as is possible, they can remain at home and continue attending school, training or employment.

Whilst all children can be seen in many of the services described above, specialist services for ‘looked after’ and adopted children are commissioned from the Tavistock and Portman NHS Foundation Trust, which are delivered locally, to improve the outcomes for the most vulnerable.

3b. Tavistock Haringey Service – Mental Health & Emotional Well-being for Haringey Looked after Children and Young People

The service is specifically commissioned by Haringey Council to provide a mental health service for Haringey’s Looked after Children and Young People.

The service aims to support children and young people in care by offering a flexible and tailored service which is able to respond speedily to the diverse needs of this complex group. The service provides opportunities for social workers to discuss concerns and dilemmas regarding the emotional and psychological issues of the children and young people they work with through a variety of consultation surgeries within Social Services. Clinicians work closely with social work colleagues and other key adults to support the ‘team around the child’ and facilitate enhanced understanding of the child’s emotional and psychological needs. Direct therapeutic assessment is offered if appropriate, and treatment follows if indicated.

The team works with children and young people who are in transition between placements, where placements are breaking down, or where there are court proceedings, as well as with children and young people who are more settled in care. Clinicians and social workers aim to promote placement stability if at all possible.

Tavistock-Haringey works in partnership with voluntary organisations, such as Open Door, to give children and young people access to appropriate counselling and support services.

4. Inpatient and highly specialist mental health services - Tier 4

Inpatient and highly specialist services are jointly commissioned for children and young people with severe mental health problems, such as severe eating disorders, psychoses, and major depression.  These services are largely provided by Barnet, Enfield and Haringey Mental Health Trust.

Following the National Review of Child Adolescent Mental Health Services in 2008, the services provided for 12 to18 year olds with complex mental health problems across Barnet, Enfield and Haringey are, at the time of writing, under review. A consultation took place in 2011 Transforming Child and Adolescent Mental Health Services (CAMHS) in-patient Services for young people living in Barnet, Enfield & Haringey. Current inpatient provision is being reconfigured to provide local alternatives to out of area placement and intensive community treatment options in addition to inpatient services.

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Service users and carers opinion

A rapid health needs assessment looking at the needs of looked after children was completed in 2011. A workshop was held with looked after children to gain their views. Overwhelmingly, the young people said that they received little or no information on health issues. The majority of the group did not know what mental health was so time was taken to explore mental health, ill mental health, feeling sad/low/ worried, depression, anxiety, more complex cases etc. They had not received any information or advice on if they were concerned about mental health.

The young people wanted professionals they come into contact with to listen more and they wanted to know who to speak to about certain subjects i.e. bullying. None of the young people felt they were prepared for leaving care. The recommendations in the rapid health needs assessment will be taken forward by commissioners.

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Expert opinion and evidence base

Nationally there is an expectation that there be ‘parity of esteem’ between mental and physical health services and that inequalities will be tackled. Children and young people’s emotional and mental wellbeing is everyone’s business, not just the interest of specialist services therefore joined up, multi-agency, multidisciplinary working is key to successful service provision for children and young people. Commissioning high quality, effective children’s mental health and emotional wellbeing services is a safeguard for children and families, and a cost effective investment over the medium to long term.

There is compelling evidence of the effectiveness of interventions to improve children’s and young people’s resilience and emotional well being that demonstrates getting the right help at the right time is key. There is an increased focus on the importance of prevention and early intervention.

i) National service framework for children, young people and maternity services (see footnote 21)

The national service framework (NSF) was published in 2004 and aims to improve the quality and equity of services through national standards for health and social care and aims to ensure services work together to help children and young people. The vision set out in the NSF is:

  • An improvement in the mental health of all children and young people.
  • Multi-agency services, working in partnership, promote the mental health of all children and young people, provide early intervention and also meet the needs of those with established or complex problems.
  • All children and young people, from birth to their eighteenth birthday, who have mental health problems and disorders have access to timely, integrated, high quality, multidisciplinary mental health services to ensure effective assessment, treatment and support, for them and their families.

Standard nine of the NSF focuses on the mental health and psychological wellbeing of children and young people.

ii) National CAMHS Review 2008 (see footnote 22)

The independent review looked at how mainstream and universal settings are meeting the educational, care and support of children and young people at risk of and experiencing emerging emotional, behavioural, psychological and mental health problems. The authors acknowledged there has been significant progress within all services contributing to mental health and psychological wellbeing, following the national service framework in 2004. However to continue to meet these challenges they suggest three fundamental changes;

  • Everybody needs to recognise and act upon the contribution they make to supporting children’s mental health and psychological well-being. And they need to recognise the contribution others make.
  • Local areas have to understand the needs of all their children and young people – at population and individual level – and engage effectively with children, young people and their families in developing approaches to meet those needs.
  • The whole of the children’s workforce needs to be appropriately trained and, along with the wider community, well informed. For practitioners, this involves having access to the best evidence and knowledge on improving outcomes for children and young people.

iii) The Health needs assessment of young people in London with complex emotional, behavioural and mental health problems who are or may be at risk of committing a serious crime (see footnote 23)

The needs assessment concluded that mental health services alone cannot meet the needs of these complex, vulnerable young people and their families. They pose problems that require multi-system responses and collaboration and co-operation across statutory and voluntary sector agencies including:

  • Strengthen commissioning of multi-system responses
  • Strengthen the youth offending teams
  • Strengthen specialist CAMHS (tier 3)
  • Strengthen the provision of community forensic CAMHS and very specialised services
  • Strengthen governance structures

iv) No Health Without Mental Health: A cross-Government mental health outcomes strategy for people of all ages (see footnote 24)

The Government intends a wholesale shift in emphasis to put mental health outcomes alongside physical health indicators in assessments of the quality of the NHS. The strategy takes a cross-Government approach focusing on outcomes that are meaningful to people of all ages including children, young people and their families. It is accompanied by a range of supporting documents, including an economic analysis and the four year plan for the talking therapies programme, which includes a focus on children and young people. There is broad consensus about the policy framework for children's mental health services. Many of the aspirations of the National Service Framework for children’s mental health and psychological wellbeing and its underpinning principles remain relevant. The strategy takes this vision forward in the context of the Government’s wide ranging programme of NHS reform and a stronger focus on outcomes.

v) NHS Operating Framework for 2011/12 (see footnote 25)

The operating framework outlines the priorities for the NHS for 2011. The following priorities have direct relevance to children’s mental health and emotional wellbeing:

  • developing an expanded and stronger health visiting service
  • Expanding the Family Nurse Partnership programme
  • Implementing the mental health strategy in particular, improving young people’s access to evidence-based early intervention services
  • Extending access to talking therapies (IAPT) to children and young people
  • Improving children and young people’s physical and mental health
  • Improving safeguarding for children following the publication of the Munroe Review

vi) The National Institute for Health and Clinical Excellence (NICE)

NICE is responsible for providing national guidance on promoting good health and preventing and treating ill health. NICE has published a range of guidance to support CAMHS, which include:

  • Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults (see footnote 26)
  • Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care (see footnote 27)
  • Antisocial personality disorder: Treatment, management and prevention (see footnote 28)
  • Autism in children and young people (see footnote 29)
  • Borderline personality disorder (see footnote 30)
  • Depression in children and young people (see footnote 31)
  • Eating disorders (see footnote 32)
  • Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (see footnote 33)
  • Self-harm (longer term management) (see footnote 34)
  • Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder (see footnote 35)
  • Post-traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care (see footnote 36)
  • Looked-after children and young people: Promoting the quality of life of looked-after children and young people (see footnote 37)
  • Promoting children's social and emotional wellbeing in primary education (see footnote 38)
  • Promoting young people's social and emotional wellbeing in secondary education (see footnote 39)
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Projected service use in 3-5 years and 5-10 years

The total number of children and young people with a mental health problem living in Haringey is predicted to rise to 2,633 by 2013. This is an increase of 122 children (plus 4 per cent) on 2010.

Figure 13: Estimated prevalence of mental health disorders by gender and age for Haringey 2013

By 2018 this number is predicted to rise further to 2,817 children, an increase of 184 children (plus 7 per cent) on 2013.

Figure 14: Estimated prevalence of mental health disorders by gender and age for Haringey 2018

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Unmet needs and service gaps

2010/11 data from a tier 3 service shows that 53 per cent of users of the young people’s service came from the west of the borough and 47 per cent from the east of the borough. As risk factors for mental ill health are higher in the centre and east of the borough, this suggests under-utilisation of the service by those groups in most need.

There is a need to co-ordinate prevention and early intervention commissioned services particularly services in schools, services targeting the 10-18 age group (as this age group accounted for just under 63% of referrals to CAMHS) and the commissioned services in children centres.

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Recommendations for Commissioning

Planning and service development

  • Planning and commissioning of services should take account of the predicted population growth
  • Commissioners could consider increasing prevention and early intervention capacity particularly to the at risk groups
  • Commissioners could consider plans to work with schools to proactively agree and focus on emotional wellbeing and opportunities to support them in commissioning tier 2 CAMHS services since the cessation of TAMHS. This should include marketing the full range of services to local stakeholders as a  priority
  • There would appear to be an under representation of males in referrals to tier 3 and tier 4 services which suggests that there are significant numbers of boys and young men in Haringey who would benefit from services.
  • Waiting times for appointments for Barnet, Enfield and Haringey Mental Health Trust services have increased year on year this goes against all the evidence around the importance of early intervention and efforts should go into reducing these.
  • Commissioners could consider integrating the findings from the assessment against the markers of good practice into future service specifications.
  • Data on residency of services users provided by Open Door shows that 53 per cent came from the west of the borough and 47 per cent from the east of the borough in 2010/11. As risk factors for mental ill health are higher in the centre and east of the borough, this suggests under-utilisation of the service by those groups in most need.

Prevention and early intervention

  • Parents and carers need information on child development, the causes of emotional distress and signs of mental ill health so that they can support their children and build resilience.
  • Haringey council’s children and young people service needs to promote its reorganised and focussed prevention and early intervention strategy with stakeholders particularly the support to schools, the 10-18 age group (as this age group accounted for just below 63% of referrals to CAMHS) and the commissioned services in children centres.

Data and information

  • Commissioners could consider reviewing service specification monitoring activity to capture all aspects of activity including regular reporting on services users’ views and how feedback has improved service delivery and outcomes.

Stakeholder and user views

  • Further interviews with GPs should be conducted to see if the views are universal.

Training and education

  • To improve local practitioners awareness of services commissioners could consider developing regular brief interventions training for professionals to increase early intervention
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Recommendations for further needs assessments

Needs assessment of young people with complex health needs undergoing transition from child to adult services

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Key Contact

Mary dos Santos Justo, Childrens Commissioning Manager mary.dossantosjusto@nclondon.nhs.uk

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Footnotes

  1. Department of Health (2011) No health without mental health: A cross government mental health outcomes strategy for people of all ages (PDF, 704KB - external link)
  2. Young Minds (2006). Looking after your mental health. Information sheet. London: Young Minds
  3. The Marmot Review (2010) Fair Society, Healthy Lives. Strategic Review of Health Inequalities in England post 2010 (external link)
  4. HM Government (2011). Early Intervention: The Next Steps. An Independent Report to Her Majesty’s Government. Graham Allen MP
  5. HM Government (2011). Early Intervention: Smart Investment, Massive Savings. The Second Independent Report to Her Majesty’s Government. Graham Allen MP.
  6. Green, H., McGinnity, A., Meltzer, H., Ford, T and Goodman, R. (2005) Mental health of children and young people in Great Britain 2004. London: Palgrave
  7. Meltzer, H., Gatward, R., Goodman, R. and Ford, T. (2000) The mental health of children and adolescents in Great Britain. London: The Stationery Office
  8. Rutter, M., Tizard, J. and Whitmore, K. 1970. Education, health and behaviour. London: Longmans
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  26. http://publications.nice.org.uk/attention-deficit-hyperactivity-disorder-cg72 (external link)
  27. http://publications.nice.org.uk/bipolar-disorder-cg38 (external link)
  28. http://publications.nice.org.uk/antisocial-personality-disorder-cg77 (external link)
  29. http://guidance.nice.org.uk/CG128 (external link)
  30. http://guidance.nice.org.uk/CG78 (external link)
  31. http://guidance.nice.org.uk/CG28 (external link)
  32. http://guidance.nice.org.uk/CG9 (external link)
  33. http://publications.nice.org.uk/self-harm-cg16 (external link)
  34. http://guidance.nice.org.uk/CG133 (external link)
  35. http://publications.nice.org.uk/obsessive-compulsive-disorder-cg31/guidance (external link)
  36. http://publications.nice.org.uk/post-traumatic-stress-disorder-ptsd-cg26 (external link)
  37. http://publications.nice.org.uk/looked-after-children-and-young-people-ph28 (external link)
  38. http://publications.nice.org.uk/promoting-childrens-social-and-emotional-wellbeing-in-primary-education-ph12 (external link)
  39. http://publications.nice.org.uk/promoting-young-peoples-social-and-emotional-wellbeing-in-secondary-education-ph20 (external link)
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