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Mental health and wellbeing in children and adolescents
Editorial
On March 25, an important milestone was reached in making children’s and adolescents’ mental health, wellbeing, and development everyone’s business. A UK consortium, including the Royal College of Paediatrics and Child Health, the Royal College of Psychiatrists, the Royal College of General Practitioners, and others, launched a new website, MindEd, funded by the Department of Health and aimed at any adult who is working with children, young people, and families. It consists of free online information and education modules that support anyone interested in recognising what healthy behaviour and development is, how wellbeing can be supported, and which signs and symptoms need closer attention. Currently, 106 educational sessions are available, some are still in progress, and there will be weekly updates on new elements of the site. The topics range from general issues in mental health, to concrete sessions to educate school counsellors and health professionals. Mental health issues are common in children and young people. In a recent longitudinal study from Australia, George Patton and colleagues found that almost a third of boys and half of girls in secondary school had an episode of prominent depressive and anxiety symptoms. But many such episodes, especially when brief, did not continue into adult life. He concluded that these findings might give reason for hope that interventions that shorten episodes could prevent morbidity later in life. However, there are also groups of young people with mental disorders that are extremely difficult to reach. In an online World Report, Ted Alcorn describes the extraordinarily high prevalence of mental disorders in US youths who are detained in prisons for crimes that are at least in part explained by untreated mental health issues. Recognition is the vital first step to appropriate treatment and ultimately also prevention. In conjunction with the MindEd launch, a survey of 2105 adults in the UK revealed that 38% did not know which signs and symptoms they should look out for to assess children’s mental health, and the majority of those who did were concerned to raise the issue in case they were mistaken. 39% of men surveyed believed that many children diagnosed with a mental illness were just showing bad behaviour. Clearly, an educational site such as MindEd is desperately needed and should be required reading for every parent, teacher, and health professional who sees www.thelancet.com Vol 383 April 5, 2014
children. The site helpfully includes scenarios labelled as “red flag” signs when urgent help should be sought. Here is where the problems might start. Only a little over 2 weeks ago, Sue Bailey, President of the Royal College of Psychiatrists, and others warned in a letter to The Guardian that planned budget cuts to mental health services of 20% more than that for hospitals “will cost lives and contravenes the government’s promise to put mental and physical health care on an equal footing”. It is unimaginable that such cuts will not affect service provision for the most vulnerable young people, and adversely affect an already fragile continuity of care between adolescent and adult services. A report, Lost Generation, published last month by the charity Rethink Mental Illness, highlighted that already 50% of Early Intervention in Psychosis services, which were introduced almost 13 years ago to help young people aged 14–35 years have had their budgets decreased in the past year. Increased recognition of signs and symptoms that warrant help is an excellent first step. Swift access to evidence-based interventions needs to follow. Budget cuts for mental health services, and overworked and disillusioned general practitioners and community health workers, are ominous signs that at best the next step has not been thought through, and at worst the provision of internet-based education and interventions is hoped to fill the ensuing gap. Part of the MindEd initiative was also a systematic review of e-therapies and computer-based applications for the prevention and treatment of mental health problems and substance misuse in children and young people commissioned from the National Collaborating Centre for Mental Health. Unfortunately, the conclusion was that the evidence is very limited and of poor quality. The recommendation is to “invest in the development of e-Therapies for children and young people with mental health conditions to determine their true worth”. The really important investment following this excellent initiative is people. Every school needs a counsellor. Every general practitioner needs to have the time to explore thoroughly the issues at hand. Everyone working in the mental health services needs the time and resources to offer the best care and treatment to children, young people, and their families. Young minds deserve nothing less. The Lancet
Rob Lewine/Getty
Mental health and wellbeing in children and adolescents
See World Report Lancet 2014; published online April 4. http://dx.doi.org/10.1016/ S0140-6736(14)60449-9
For more on MindEd see https://www.minded.org.uk/ For the study by George Patton and colleagues see Articles Lancet 2014; published online Jan 16. http://dx.doi.org/10.1016/ S0140-6736(13)62116-9 For more on Lost Generation see http://www.rethink.org/ media/973932/LOST%20 GENERATION%20-%20 Rethink%20Mental%20 Illness%20report.pdf
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On March 25, an important milestone was reached in making children’s and adolescents’ mental health, wellbeing, and development everyone’s business. A UK consortium, including the Royal College of Paediatrics and Child Health, the Royal College of Psychiatrists, the Royal College of General Practitioners, and others, launched a new website, MindEd, funded by the Department of Health and aimed at any adult who is working with children, young people, and families. It consists of free online information and education modules that support anyone interested in recognising what healthy behaviour and development is, how wellbeing can be supported, and which signs and symptoms need closer attention. Currently, 106 educational sessions are available, some are still in progress, and there will be weekly updates on new elements of the site. The topics range from general issues in mental health, to concrete sessions to educate school counsellors and health professionals. Mental health issues are common in children and young people. In a recent longitudinal study from Australia, George Patton and colleagues found that almost a third of boys and half of girls in secondary school had an episode of prominent depressive and anxiety symptoms. But many such episodes, especially when brief, did not continue into adult life. He concluded that these findings might give reason for hope that interventions that shorten episodes could prevent morbidity later in life. However, there are also groups of young people with mental disorders that are extremely difficult to reach. In an online World Report, Ted Alcorn describes the extraordinarily high prevalence of mental disorders in US youths who are detained in prisons for crimes that are at least in part explained by untreated mental health issues. Recognition is the vital first step to appropriate treatment and ultimately also prevention. In conjunction with the MindEd launch, a survey of 2105 adults in the UK revealed that 38% did not know which signs and symptoms they should look out for to assess children’s mental health, and the majority of those who did were concerned to raise the issue in case they were mistaken. 39% of men surveyed believed that many children diagnosed with a mental illness were just showing bad behaviour. Clearly, an educational site such as MindEd is desperately needed and should be required reading for every parent, teacher, and health professional who sees www.thelancet.com Vol 383 April 5, 2014
children. The site helpfully includes scenarios labelled as “red flag” signs when urgent help should be sought. Here is where the problems might start. Only a little over 2 weeks ago, Sue Bailey, President of the Royal College of Psychiatrists, and others warned in a letter to The Guardian that planned budget cuts to mental health services of 20% more than that for hospitals “will cost lives and contravenes the government’s promise to put mental and physical health care on an equal footing”. It is unimaginable that such cuts will not affect service provision for the most vulnerable young people, and adversely affect an already fragile continuity of care between adolescent and adult services. A report, Lost Generation, published last month by the charity Rethink Mental Illness, highlighted that already 50% of Early Intervention in Psychosis services, which were introduced almost 13 years ago to help young people aged 14–35 years have had their budgets decreased in the past year. Increased recognition of signs and symptoms that warrant help is an excellent first step. Swift access to evidence-based interventions needs to follow. Budget cuts for mental health services, and overworked and disillusioned general practitioners and community health workers, are ominous signs that at best the next step has not been thought through, and at worst the provision of internet-based education and interventions is hoped to fill the ensuing gap. Part of the MindEd initiative was also a systematic review of e-therapies and computer-based applications for the prevention and treatment of mental health problems and substance misuse in children and young people commissioned from the National Collaborating Centre for Mental Health. Unfortunately, the conclusion was that the evidence is very limited and of poor quality. The recommendation is to “invest in the development of e-Therapies for children and young people with mental health conditions to determine their true worth”. The really important investment following this excellent initiative is people. Every school needs a counsellor. Every general practitioner needs to have the time to explore thoroughly the issues at hand. Everyone working in the mental health services needs the time and resources to offer the best care and treatment to children, young people, and their families. Young minds deserve nothing less. The Lancet
Rob Lewine/Getty
Mental health and wellbeing in children and adolescents
See World Report Lancet 2014; published online April 4. http://dx.doi.org/10.1016/ S0140-6736(14)60449-9
For more on MindEd see https://www.minded.org.uk/ For the study by George Patton and colleagues see Articles Lancet 2014; published online Jan 16. http://dx.doi.org/10.1016/ S0140-6736(13)62116-9 For more on Lost Generation see http://www.rethink.org/ media/973932/LOST%20 GENERATION%20-%20 Rethink%20Mental%20 Illness%20report.pdf
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