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Level of need in the population

Background papers: children :: Emotional health and wellbeing of children and young people :: Level of need in the population

Determining an accurate number of young people with MH needs is not possible, in part because of stigma and a reluctance to discuss mental health. Therefore, much of the data presented in this chapter are local estimates derived from national prevalence data. Issues also exist relating to schools' capacity to assess need and interpret it correctly as an emotional, rather than a behavioural, issue. Medway has a larger proportion of people aged 0-14 and 15-24 years than the national average. Department for Education data indicates that, at January 2014, there were 45,040 pupils on the school roll in Medway; including 53.1% in State primary schools, 41.6% in State secondary schools, 1.4% in special schools and 0.3% in Pupil Referral Units.

A review of four studies of 1,021 children aged 2 to 5 years found that the average prevalence of any MH disorder was 19.6%.[1] Applying this rate to Medway's population gives a figure of 2,740 children aged 2 to 5 years living in Medway who have a MH disorder. National prevalence estimates for MH disorders in children aged 5-16 years were estimated in a 2004 study.6 The study found that nationally:


• The overall prevalence for MH disorder amongst children and young people aged 5-16 years residing within private households was 9.6%.
• Prevalence varies by age and sex, with boys more likely (11.4%) to have experienced/be experiencing a MH problem than girls (7.8%).
• 11-16 year-olds were more likely (11.5%) than 5-10 year-olds (7.7%) to experience MH problems
• One in 10 children aged five-15 years had a clinically significant MH problem (11% and 8% for boys and girls respectively):
    • 5.8% had clinically significant conduct disorders (e.g. stealing, defiance, fire-setting, aggression and/or anti-social behaviour)
    • 3.7% had clinically significant emotional disorders (e.g. separation anxiety, phobias, anxiety states and depression; these may manifest as physiological symptoms such as chronic headache, abdominal pain or nightmares)
    • 1.5% had clinically significant hyperkinetic disorders (e.g. disturbance of activity and attention, sufficiently serve to cause the child distress or impairment in social functioning)

Table 1 shows the estimated number of children with MH disorders in Medway, by applying the above prevalence rates (NB: some children have more than one disorder). Less common disorders include development disorders (e.g. delay in acquiring certain skills such as speech, bladder control and/or social ability; can be associated with autism), eating disorders (e.g. anorexia nervosa and bulimia nervosa), habit disorders (e.g. tics, sleeping problems and soiling); post-traumatic stress disorder; somatic disorders (e.g. chronic fatigue syndrome) and psychotic disorders (e.g. schizophrenia, bipolar disorder or drug-induced psychoses).

Emotional disorders Conduct disorders Hyperkinetic disorders Less common disorders
Males Females Males Females Males Females Males Females
5-10 years 220 245 685 275 270 40 220 40
11-16 years 425 600 855 505 255 40 170 110
Table 1: Estimated number of children living withing private households living with an mental health disorder in Medway, by type of disorder, by age group.[2]

Economic disadvantage is known to be associated with increased vulnerability to MH problems. Gillingham North, Chatham Central and Luton & Wayfield wards had the highest proportion of children living in low income families in 2011, with 35%, 33.5% and 31.8% children respectively in those wards living in low income families. Medway's child poverty rate is significantly higher than the England and regional averages. The proportion of LAC in Medway who may require MH interventions is considerably higher than nationally, and a considerably higher proportion of children are being identified as having SEN locally compared with the national average.

Cultural and socio-economic influences which are relevant to Medway's growing school age population who are from Ethnic Minority Groups (EMGs) may be important to this population's emotional health and wellbeing. Fourteen percent of Medway's under-25 population are from an EMG (the largest group being Asian/Asian British), compared with the Kent average of 10%.

Emotional disorders

A national study conducted in 2001[3] estimated prevalence rates for neurotic emotional disorders (e.g. anxiety, depression and phobias) in young people aged 16-19 years. Table 2 shows how many 16-19 year-olds would be expected to have a neurotic disorder if these prevalence rates were applied to the population of Medway.

  Males 16-19 years Females 16-19 years
Mixed anxiety & depressive 390 880
Generalised anxiety disorder 125 80
Depressive episode 70 195
All phobias 50 150
Obsessive Compulsive Disorder 70 65
Panic Disorder 40 45
Any Neurotic Disorder 660 1,360
Table 2: Estimated number of children with neurotic disorders living in private households in Medway.[3]
Development disorders

ADHD

The number of children with attention deficit hyperactivity disorder in Medway is considerably higher than expected. In total, 1328 children born between 01/09/1994 and 31/08/2009 living in Medway were identified through CarePlus in 2013. Data from CarePlus may be an under-estimation as some children with these conditions may be solely under the care of CAMHS rather than community paediatricians.

Autism/ASD

A 2006 study[4] estimated the national prevalence of autism in children aged 9-10 years at 38.9 per 10,000, and that of other autism spectrum disorders (ASDs) at 77.2 per 10,000 (total prevalence of all ASDs: 116.1 per 10,000). A further study in 20099 estimated the national prevalence of other autism spectrum conditions in children aged 5-9 years as 157 per 10,000.

Applying this to Medway's 2014 population estimate:


• Predicted prevalence of autism spectrum conditions amongst children aged 5-9: 275
• Predicted prevalence of all ASDs amongst children aged 9-10 years: 75 (including 25 with autism)

In 2013, 1,605 Medway children aged 4-19 years with ASD were identified through CarePlus. This figure is considerably higher than predicted through using nationally prevalence estimates.

When a child or young person is diagnosed with ASD in Medway, education services, Medway's Autism Outreach Team and, where appropriate, the social care team, are automatically notified. The Autism Outreach Team supports mainstream schools, enabling successful inclusion of diagnosed pupils. Information from the team supports the likelihood that ASD is particularly high in Medway. Table 3 shows the cumulative number of children diagnosed and supported by the team since it was established in 2003.

  October 2004 April 2007 July 2008 September 2010 July 2011 June 2012 June 2013
Number of pupils (cumulative) 294 631 899 949 986 1,009 1,089
Table 3: Number of children and young people diagnosed with ASD and supported by the autism outreach team attending mainstream schools.[5]

A CAMHS Needs Assessment for Medway, undertaken in 2009, noted a year-on-year increase in ASD since 2003. It is currently not understood why the prevalence of ASD is substantially higher than national estimates in Medway.

Psychotic disorders

Young people with Bipolar disorder are often under the care of specialist CAMHS and it is vital that they and their families are helped to understand the condition, as intervening early in an episode can prevent escalation. There are several types of BPAD and tailored treatment is required accordingly.

The prevalence of psychosis in children aged between five and 18 years has been estimated to be 0.4% nationally (the figure across all ages in the UK is 0.7%), which would be 190 cases in Medway.

Self-harm

Self-harm is most common in young people aged 11 to 25 years.10 Evidence shows a rise in hospital admissions for self-harm by young people in recent years. There appears to be a difference in the female-to-male ratio for emergency hospital admissions for self-harm in Medway from 2010-2013 with increasing age, 8:1 females to males in 10 to 14 year olds and 3:1 in 15 to 19-year-olds. For all age groups except males aged 10 to 14 years, A&E attendances appear to have risen over recent years (figure 1a). This finding is most striking for females aged 15-19 years.

Figure 1: A&E attendances of Medway resident children and young people attending young people attending any hospital where the primary and/or secondary diagnosis was 'Intentional Self-Harm', by age group
Figure 1: A&E attendances of Medway resident children and young people attending young people attending any hospital where the primary and/or secondary diagnosis was ‘Intentional Self-Harm’, by age group
Figure 2: Emergency hospital admissions of Medway resident children and young people attending young people attending any hospital where the primary and/or secondary diagnosis was 'Intentional Self-Harm', by age group
Figure 2: Emergency hospital admissions of Medway resident children and young people attending young people attending any hospital where the primary and/or secondary diagnosis was ‘Intentional Self-Harm’, by age group

Although it is acknowledged that not all self-harm will be reported, figure 1b shows that the incidence of emergency admissions for self-harm reduced in Medway from 2009/10 to 2012/13 in the 15 to 19 year old age group but appears to have risen from 2012/13 to 2013/14. For males and females aged 20-24 years, an overall decline in the number of admissions for self- harm has been seen since 2006/07. Admissions for females aged 10-14 appear to have risen steadily since 2006/07. The trends shown in figures 1a and 1b should be interpreted with caution given the small numbers of admissions/ attendances. For 2010/11- 2012/13, the rate of hospital admissions for self-harm amongst those aged 10-24 years for Medway is significantly lower than the England average.


References

[1]   Egger HL, Angold A. Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology Journal of Child Psychology and Psychiatry 2006; 47: 313-37.
[2]   Green H. Office for National Statistics mmid-year population estimates for 2012 2004;
[3]   Singleton N, Bumpstead R, O'Brian M, et al. Psychiatric morbidity among adults living in private households (2000) 2001; London: The Stationary Office.
[4]   Baird G, Simonoff E, Pickles A, et al. Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). The Lancet 2006; 368 (9531): 210-215.
[5]   July 2014; Medway Autism Outreach Service.