Priorities for Mental Health Research in Children and Young People

There has been recent focus on the state of mental health for Children and Young People (CYP), and a variety of initiatives developed to improve this, such as the CYP Improving Access to Psychological Therapies (IAPT) programme, and the developing Government Green Paper for CYP mental health. However, there has been little focus on the role mental health research can play.

The McPin Foundation, a charity focussing on mental health research, recently published a report outlining their identified top ten research priorities for CYP, with the aim of influencing policy and practice.

How was the research carried out?

The McPin Foundation set up an Advisory Group with seven young people between the ages of 14 – 23 years, and a Steering Group that included a range of individuals – from research funding organisations to parents and teachers. The Groups created a Young People’s mental health survey, and asked members of the public to put forward research questions around the topic (n = 2566). The Groups then developed the largest theme identified from their data – Intervention and Services, and with the help of a second survey (n = 753), narrowed down the questions posed to 25.  The final 10 priorities were selected in a workshop which included the advisory and steering groups, in addition to new members to the project (e.g., young people, professionals, parents).

What kind of research priorities for CYP were identified?

The top 10 research questions included early identification and screening of mental health difficulties, calls for further evidence on the effectiveness of therapies/strategies/resources/training, and exploration of how family/parental relationships contribute to treatment outcomes for CYP. Further research priorities (Top 25) were also identified and were more varied, including exploring effective methods for supporting young men in recognising symptoms of mental ill-health (Priority 15), and the impact of waiting list times on treatment and mental health outcomes (Priority 21). The full list of research priorities can be viewed here.

What next?

The McPin Foundation are keen for young people, researchers, and potential partners (e.g., individuals, organisations etc.) to get in touch:

 

 

Young people

  • Young people can sign up to the Network and receive emails about taking part in research. To do so, sign up via mcpin.org/young-people/

Researchers

  • Researchers can ask the Young People’s Network for feedback on and help shaping their research that address the priorities identified in the report. In addition, the McPin Foundation are keen for researchers to keep them up to date with their research on the identified priorities. Get in touch via contact@mcpin.org.

Partners

  • Individuals may be interested in working with the McPin Foundation on the identified priorities – get in touch via contact@mcpin.org.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associate on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology). 

Children of the Millennium

The Centre for Mental Health, in partnership with the Institute of Education at UCL, recently published a report outlining the current understanding of conduct problems and their course through childhood. The study team (Gutman, Joshi, Khan, & Schoon, 2018) examined longitudinal data obtained from a sample of over 19,000 children born in the United Kingdom between 2000-2002 for the Millennium Cohort Study.

What is conduct disorder?

Clinical guidance from the National Institute for Health and Care Excellence (NICE) and the Social Care Institute for Excellence (SCIE) defines conduct disorders as “repetitive and persistent patterns of antisocial, aggression or defiant behaviour that amounts to significant and persistent violations of age-appropriate social expectations”. Examples of violations of age-appropriate social expectations include angry outbursts or physical aggression towards other children between the ages of 3-7 years; violence, robbery or substance misuse between the ages  of 12 – 17 years amongst others. The scale of the conduct problems is significant as the child or young person’s daily functioning is disrupted, and distress is experienced by those around them. The prevalence of conduct problems is around 5% (for children and young people between 5 – 16 years; Green, McGinnity, Meltzer, Ford, & Goodman, 2004), and is considered the most commonly diagnosed mental health condition for children between 5- 10 years.

Key results

Pathways of childhood conduct problems by gender

  • The prevalence of conduct problems is higher in boys, compared to girls, between the ages of 3 – 11 years (e.g., at 3 years old: boys = 22% and girls = 19%; at 11 years old: boys = 14% and girls = 9%).
  • Between 3 – 11 years old, the majority of girls (78%) and around half of boys (54%) had a low risk of developing severe conduct problems.

Pathways of childhood conduct problems and the impact of multiple risks over time

  • Between the ages of 3 – 14 years, the majority of children in the sample (56%) had a low risk of severe conduct problems, whereas 8% of children had a high risk.
  • Whilst 13% of children were identified to have a low risk of severe conduct disorder from 3 – 7 years, this increased by age 14.
  • A subset of children (23%) were identified as having a moderate to high risk of developing severe conduct problems by age 3 years, but this then declined with age.

Pathways of childhood conduct problems and co-occurring mental health difficulties

  • Different groups of children were identified who also presented who co-occurring mental health conditions (conduct problems, hyperactivity/inattention, emotional problems, and problems with peer interactions) between 3 – 11 years:
    • Low problems (52%)
    • Moderate externalising, low internalising (27%)
    • Moderate internalising, low externalising (12%)
    • Persistent high problems (8%)

Recommendations (for England only)

Gutman et al. (2018) proposed 10 recommendations for key stakeholders (e.g., the Government, NHS England, NICE), based on the findings of their report. Recommendations include calls for improved cross-agency working, quality of support available, and guidance. The full report can be viewed here.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associate on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology). 

 

 

Access to mental health services for children and young people

Background

Improving access to and engagement with mental health services is a central tenant of the Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) programme, which commenced in 2011. The Education Policy Institute (EPI) published their third report on mental health services for CYP on the 7th October, with the current report focussing on access to services. The report is timely, as the CYP IAPT programme will become self-sustaining from 2019.

Which methods were used to obtain data for the report?

The EPI sent Freedom of Information requests to service providers (Child and Adolescent Mental Health Services; CAMHS) across England. In 2018, 90% of services and 73% of local authorities (e.g., county councils) returned information requested (Service: 54/60 providers contacted; Local authorities: 111/152). However, the data returned varied in terms of quality and extent (e.g., missing data points). The Institute also analysed data from the Mental Health Forward View Dashboard, which highlights performance against targets for Clinical Commissioning Groups (e.g., responsible for planning and funding health services for the local area that they look after).

What did the report find?

 

 

 

 

Access to mental health services for CYP

  • The number of referrals have increased in the last five years by 26%.
  • 2% of referrals were rejected or were described as inappropriate – common reasons including the CYP did not meet the thresholds for treatment (i.e. the condition was not serious enough), or the condition was not suitable for intervention.
    • Of the referrals rejected, most services signposted CYP to a more appropriate service.
    • However, there was limited, or no follow-up after a referral was not accepted into CAMHS.
    • 27/111 local authorities reported no longer providing services based on supporting early help (e.g., support for CYP with mild-moderate mental health problems), or support in schools.

Waiting times (2017-18)

  • The average median waiting time (maximum number of days in brackets) was 34 days (267) to assessment and 60 days (345) to treatment.

What were the limitations of the report?

The Education Policy Institute highlights that the quality of the data received, as well as official published data, should be treated with caution, due to the lack of standards for reporting data and missing data from CAMHS providers. The report also emphasised that it is also unclear how the Government is currently progressing on its commitment to increasing the CAMHS workforce, which is an important foundation to consider when analysing access to treatment for CYP.

In sum, the report highlights that CYP continue to experience difficulties in accessing treatment (e.g., referrals accepted, waiting times) and emphasise that greater attention needs to be paid to early intervention and prevention – to take ‘demand out of the system’ (p.30). To do so, policy makers could focus on a child poverty reduction strategy and ‘whole school’ (p. 31) approach.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associate on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology).