Mental ill health in childhood is strongly linked to mental ill health later in life. Half of all adults with mental ill health experience their first symptoms by the age of fourteen, and three-quarters by the age of twenty-four.A

Prevention and treatment of mental ill health in childhood not only helps children and families at the time, but sets children up to be happier, healthier adults in the future.B It can also help young people to avoid risky or criminal behaviour.

Children and young people’s mental health services are provided in a variety of settings, from schools and GP practices to mental health inpatient services.

Services are split into four tiers (Figure 1), with Tier 1 part of the general responsibility of all professionals who work with children, Tiers 2 and 3 commissioned on a local level by health and social care bodies, and Tier 4 commissioned at a regional level by NHS England.

Typically, children and young people will enter at Tier 1 and will be stepped up from one tier to the next as appropriate, though they may enter services at any level, and may receive services from more than one tier at once.

Figure 1: Child and Adolescent Mental Health Services (CAMHS) tier structure C

Figure 1: Child and Adolescent Mental Health Services (CAMHS) tier structure

Children and young people’s mental health conditions fall into three broad categories, detailed in Box 1.

Box 1:Categories of mental health condition seen in children and young people D E F

In each of the disorders discussed here, the question of whether a child or young person’s emotions or behaviours are a problem is considered against the typical emotions or behaviour of peers of the same age.

Conduct disorders: Conduct disorders are characterised by antisocial, aggressive or defiant behaviour, where this behaviour is part of a long-term pattern. Conduct disorders in childhood are associated with a significantly increased rate of mental health problems in adult life; up to 50% of children and young people with a conduct disorder go on to develop antisocial personality disorder.

Emotional disorders: Emotional disorders include depression and anxiety disorders. Young people with emotional disorders may experience sadness, sleep disturbance, irritability, as well as loss of appetite, interest and attention.

Hyperkinetic disorders: The most common type of hyperkinetic disorder is Attention Deficit Hyperactivity Disorder (ADHD). ADHD is characterised by hyperactivity, impulsivity and inattention. Hyperactivity describes an excess of physical movement or visible restlessness; impulsivity describes poor decision-making behaviour, with actions taken without forethought; inattention describes difficulty paying attention or sustaining effort.

 

Around one in five children with a mental health condition have more than one such condition.G  In particular, more than 40% of children and young people with a diagnosis of conduct disorder also have a diagnosis of ADHD.1

As well as mental health conditions common in children and young people, severe and enduring mental illnesses such as schizophrenia and bipolar disorder (see Section 3) can develop in adolescence. Early identification of these illnesses and appropriate early intervention can aid recovery, reduce the risk of relapse, and improve service users’ long-term outcomes.H

The age range of ‘children and young people’ in this section varies by data source. In general, we are considering children and young people age 0-18.

Notes

  1. Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merinkangas, K.R. & Walters, E.E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593-602. http://archpsyc.jamanetwork.com/article.aspx?articleid=208678
  2. Khan, L., Parsonage, M. & Stubbs, J. (2014). Investing in children’s mental health: A review of evidence on the costs and benefits of increased service provision. Centre for Mental Health. http://www.centreformentalhealth.org.uk/investing-in-children-report
  3. Kurtz, Z. (1996) Treating Children Well. Mental Health Foundation
  4. National Collaborating Centre for Mental Health (2013). Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management. NICE Clinical Guidance 158. http://www.nice.org.uk/guidance/cg158
  5. National Collaborating Centre for Mental Health (2005). Depression in Children and Young People: Identification and management in primary, community and secondary care. NICE Clinical Guidance 28. http://www.nccmh.org.uk/downloads/Depression_in_children/cg028fullguideline.pdf (PDF document)
  6. National Collaborating Centre for Mental Health (2013). Attention Deficit Hyperactivity Disorder: The NICE guideline on diagnosis and management of ADHD in children, young people and adults. NICE Clinical Guidance 72. http://www.nccmh.org.uk/downloads/ADHD/ADHD%20published%20full%20guideline%20-%20amended%20June%202013.pdf (PDF document)
  7. Khan, L., Parsonage, M. & Stubbs, J. (2014). Investing in children’s mental health: A review of evidence on the costs and benefits of increased service provision. Centre for Mental Health. http://www.centreformentalhealth.org.uk/investing-in-children-report
  8. Rethink Mental Illness. (2014) Lost Generation. https://www.rethink.org/media/973932/LOST%20GENERATION%20-%20Rethink%20Mental%20Illness%20report.pdf (PDF document)

References

  1. National Collaborating Centre for Mental Health (2013). Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management. NICE Clinical Guidance 158. http://www.nice.org.uk/guidance/cg158