The epidemic of self harm in young people

The BBC  have obtained figures that suggest a rise of 20% in one year alone in the admission of young people to hospital following an episode of self harm. The PMHA did a survey last year that supports the idea of a rapid rise in these admissions,  suggesting that this finding is genuine. So why are more young people self harming,  and what can be done about it?
It’s impossible to generalise about why young people self harm. Some feel that the physical pain of cutting is preferable to the psychological state that they find themselves in, others use taking an overdose as a way to tell people how hopeless or angry they feel. The thing that seems to unite people who self harm is a psychological state that they find so unbeatable that they feel, even for a short time, like they would prefer the pain and/or risk of harm of a self harm episode to their current situation.
So an increase in self harm means an increase in the number of young people in these situations, at least to some extent. What has changed?
Well, when asked, for instance by Young Minds, young people talk about pressure. Pressure from school, to behave, to succeed or to conform. Pressure from peers to be a certain way in order to be popular. Pressure from the media to have a certain body, clothes or sexual habits. They talk about feeling isolated, including in their own families. And when they want to talk to someone , there is often no one to talk to. Any attempt to improve the situation needs to start from this perspective.

So, here’s our wish list

  • Young people can educate themselves about self harm at selfharm.co.uk, and look out for their peers.
  • Parents can talk to their children about mental health, feelings, and pressure, and make time in the day when no-one is staring at a screen, to give a chance for conversation. It’s often easier to bring up issues while doing something else, which may be one reason why shared activities as a family are associated with better wellbeing all round. Young Minds have an parent helpline, which can help if you’re worried.
  • Schools are under huge pressure. But they can act as great detectors of early problems, as well as providing counselling and other services.
  • Health services need to reach out to education and to parents, provide support and training, and respond promptly when young people get into difficulty.
  • Government needs to fund mental health adequately, and commit (all parties) to implement the forthcoming mental health taskforce recommendations.

We hope that things have got as bad as they are going to for young people’s mental health. Only by concerted effort by everyone listed above can even this rather meagre hope be realised.

CAMHS: the health select committee speaks

The House of Commons Health Select committee has produced a report on CAMHS.

The  Press notice provides a neat summary.

Hilary Cass has responded on behalf of the RCPCH:

“For too long policy makers have failed to tackle the crisis in child and adolescent mental health– so much so that it is now becoming a hidden epidemic.

“If a child with a physical illness is forced to travel hundreds of miles for a bed, if funding for hospital services are severely cut or if there is huge variation in the provision of care for children with a physical condition – it is deemed a national scandal. And yet we continue to see budget cuts and increases in waiting times for CAMH services, and increasing numbers of children and young people being held on adult mental health wards and high numbers still held in police cells.

“Today’s report paints a picture of a service in crisis, but provides some real solutions to transform the landscape.

“We fully support the emphasis on early intervention; children and young people with mental health problems can become adults with mental health problems. All professionals working with children and young people need to be better equipped to recognise and act on the signs of mental ill health in children and young people , with more care delivered outside the hospital setting.

“It is absolutely crucial that the prevalence study of child and adolescent mental health is conducted regularly and extended to under 5’s with better evidence collected on the mental health of children and young people from ethnic minorities. The current variation in services for children and young people with mental health needs is unacceptable and far too few paediatric departments have sufficient and timely paediatric liaison services.

“Adolescence is considered a risk period for serious mental health disorders, substance misuse, and risk-taking behaviours. We welcome the report’s focus on transition to adult mental health services and plans to review progress in this crucial area again in 2015.

“There is a clear message to the next Government: get to grips with the CAMHs crisis or put the mental health of thousands of children, young people and adults at risk.”

Max Davie, PMHA convenor, gives his personal view here

We in the PMHA are committed to support RCPCH and other bodies to continue to campaign for change, as well as engaging with the DH CAMHS task force (which Max attended yesterday).

If you are reading this as a non-member, please consider joining to help our work to continue (and other benefits to you!)

PMHA at the party conferences

Max Davie, PMHA convenor, reflects on the party conferences:

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For the past few weeks, I’ve been roaming the country with the RCPCH public affairs team. We’ve been talking about children and young people’s mental health at fringe meetings at the three major party conferences, along with colleagues from the RC Psych and the charity Young Minds. I’ve been able to talk to people from around the country about the problems with CAMHS, and discuss some possible solutions. For the benefit of PMHA members, here are some thematic reflections on the problems:

  • There isn’t enough money in the system

While there had been no concerted attempt to cut CAMHS, the brute reality of NHS and local authority funding has led to unprecedented reductions in budgets, by up to 40% in 4 years. This is in part due a lack of clear tariffs and targets, because in the NHS “money follows targets”. An understandable retreat by local authorities into their ‘core business’ has compounded matters.

  • We think of CAMHS services, when we should be thinking about a local CAMHS system.

Services have, in response to cuts, raised the drawbridge to referrals, and shrunk their scope. Paradoxically, once children are in services, there are perverse incentives to pass then to ever more expensive echelons of the system. Meanwhile, other children and young people are lost between services as they don’t ‘fit’ anywhere. Only by re-imagining CAMHS as a comprehensive system, supported by specialists and incorporating education, health, social care and the charitable sector, can we maximise our resources.

  • Early intervention needs more priority

More lucrative specialist services have been prioritised by cash-strapped mental health trusts, but parenting programmes and universal mental health education for children are low cost, effective interventions which need political priority.

  •  Professional cultures need to be more collaborative and inclusive

There is a pervasive myth that mental health can only be done by specialist CAMHS. This is encouraged by lack of engagement by many CAMHS services with the wider system. This leads not only to poor integration, but also another lost opportunity for early intervention outside of specialist CAMHS.

  •  Parity of esteem needs to be more than just a phrase

Many of my first points can be encapsulated in this: parity was enshrined in the health and social care act, and yet mental health continues to be a poor relation of physical health. Recent policy announcements, especially by the liberal democrats, are welcome, but a robust plan is required to embed parity across the NHS.

  •  No CAMHS system will serve children and young people unless it listens to these young people

The best speech I heard at our meetings was by Lisa Murphy, from the RCPCH youth panel, who talked passionately about the need for a responsive system which listened and respected young people as individuals. How we achieve this while embedding robust commissioning and manage a continuing squeeze on finances is the challenge of the next five years.

 It was fascinating to visit the conferences, with their bustle, intrigue and hubbub of chat and speeches. Mental health had never been higher up the political agenda, and we hope that we have played a small part in keeping this vital issue somewhat at the forefront of politicians’ minds.

 

Sluggish Cognitive Tempo: the next big thing in diagnosis?

This blog ://www.slate.com/articles/health_and_science/medical_examiner/2014/09/sluggish_cognitive_tempo_is_it_a_disease_independent_of_adhd_and_can_drugs.single.html is very good, and recommended.
Briefly, sluggish cognitive tempo is a terribly-named new conception of children who have poor concentration, not due to the ‘fizziness’ of the ADHD brain, but due to slow processing in the absence of other learning disabilities. The slate article rejects SCT partly on the basis that it’s just an exaggeration of normality, but PMHA members will know that this argument could apply to whole swathes of the diagnostic textbook, from ADHD to hypertension.
So should we be looking at diagnosing this condition in our clinics? At present, it’s very hard to be clear, as the evidence base is tiny for usefulness of this concept, and it is likely to be mainly treated with educational intervention.
But we would be interested in your thoughts…

neurocognitive deficits in ADHD and conduct disorder. Same same

Really interesting work reported here http://www.sciencedaily.com/releases/2014/08/140812121542.htm?
Essentially, the basis of young people with ADHD, conduct disorder and substance misuse show very similar neurocognitive patterns. This might suggest some shared causation, and possible intervention targets which cut across all conditions. We shall see, but if the cognitive deficits can be targeted specifically, that would be a revolution in conical and diagnostic practice.

Autism and substance misuse: assume nothing

This excellent blog post http://blogs.psychcentral.com/science-addiction/2014/07/people-on-autism-spectrum-at-increased-risk-for-substance-abuse/ tangles with the complexity of the relationship between ASD and substance misuse. Essentially, able people with ASD seem quite prone to addictive behaviour. This may not be a surprise, but because people with ASD are often socially isolated it might be assumed that they don’t get exposed to substances socially. This work is another reminder to see the person, and not the diagnosis.
Of course the next question is how this relates to mental health problems in this population….

Can you diagnose ADHD without childhood symptoms?

http://www.medicalnewstoday.com/releases/279619.php?tw

US researchers have found that the move in Dsm 5 to increase the age of onset criteria from 7 to 12 did not significantly alter the profile of the population diagnosed, although did increase the proportion of predominantly inattentive diagnoses.
Many UK clinicians are alarmed at the explosion of ADHD diagnosis in the US, and may view this with some suspicion. Increasingly, as prevalence rates across the Atlantic exceed 10%, we are diagnosing quite distinct populations, as European clinicians diagnose a fat Mir select group. This limits the applicability of this finding to a UK context.