INTRODUCTION

Mental health problems can take many forms and symptoms and will vary according to the individual and the circumstances they find themselves in. They can range from everyday anxieties or grief to more severe distress and can even lead to distortions in a person’s perception of reality. It is worth remembering that 1 in 4 of us will experience some kind of mental health problem each year. Recovery is full for many people and support is out there.

For detailed information on terms, definitions and statistics see the Mental Health Foundation’s pages on mental health problems (look under ‘Problems Treatments’). This also discusses the stigma that can surround terms if they are used as ‘labels’ such as ‘mental illness’. For the purposes of brief introductions this site uses terms such as ‘mental health problem’ and/or illness.

WHAT MIGHT CAUSE A MENTAL HEALTH PROBLEM IN A CHILD?

It is not really possible to identify all the reasons someone may have a mental health problem as so many factors can play a part. It may be due to life events that create stress or a chemical imbalance in the brain. Genetic factors can play a part. Or there may be no obvious cause.

If a child is responding to an actual issue such as bullying, bereavement, divorce or sexual abuse, you may want to look at other sections on our site. The children’s mental health charity, Young Minds, publishes factsheets covering issues that can affect the mental health of children, including the impact of divorce, illness in the family and domestic violence.

If you suspect that your child may have been taking drugs, which would affect behaviour and general mood, you can take the Royal College of Psychiatry’s ‘Alcohol and drugs – what parents need to know’ as a starting point.

ANXIETY DISORDERS

We all know how it feels to be anxious and this is a healthy reaction to challenges we face, but when an anxiety overwhelms us, and is out-of-proportion to the situation in a way that prevents us living fully, this could be described as an anxiety disorder. There are different ways that anxiety can manifest itself. Some of the more typical problems are phobias, obsessions, eating disorders and self-harming behaviour.

Signs of anxiety in a child

How can you tell if your child’s behaviour is typical for the developmental stage they are going through or a more worrying sign of a problem that may need outside help? The Mental Health Foundation’s booklet ‘The Anxious Child’ gives straightforward advice on how to help your child feel less anxious about normal separations and new situations by preparing them in simple steps. It also looks at reasons why a child might become anxious. There is often a concrete reason for their feelings – perhaps being bullied at school, family changes or problems. Anxiety can also run in families.

For information on symptoms and treatment of anxiety in children please see the section on anxiety in our Health ‘A-Z’.

Phobias & Obsessive-Compulsive Disorder (OCD)

Phobias can be fears of something specific, objects, situations or places for example. The National Phobics Society gives a breakdown of the most well-known anxiety disorders. The Mental Health Foundation factsheet on anxiety also gives useful background information and contacts.

Obsessive-Compulsive Disorder (OCD) has two aspects, obsessive thoughts that interrupt and are repetitive, and compulsive actions such as hand-washing, to somehow ease the irrational fear that is being experienced. Even if the young person is aware that the repetitive action is needless they are still unable to stop. It is recognised that children can have OCD and that the sooner it is treated the better for future health. The Royal College of Psychiatrists’ ‘Obsessive-compulsive disorder in young people’ describes the condition.

In addition to the general mental health advice and support organisations there are specific helplines.

The Maudsley Hospital’s Department for Children and Adolescents in London is the only national specialist clinic for young people with OCD.

The National Phobics Society has a network of support groups, an online bulletin board and a chatroom. They also have a list of factsheets available.

First Steps to Freedom offers advice and counselling to people who suffer from phobia or OCD and their carers.

Eating Disorders

It is not unusual for children to be hard to please at meal times. Some may refuse to eat certain foods and teenagers may diet. Sometimes people harm themselves by their approach to food. The Eating Disorders Association gives a really clear breakdown of how an eating disorder differs from normal behaviour and what symptoms you may notice. Girls are 10 times more likely to be affected, but it is important to remember boys can suffer from them too.

The Eating Disorders Association estimates that 90,000 people are receiving treatment in the UK. Two of the most common eating disorders are anorexia nervosa and bulimia nervosa and some of the symptoms can overlap.

Anorexia Nervosa

Anorexia nervosa means ‘loss of appetite’ but in fact someone with anorexia can have an appetite but restricts their intake of food. Food becomes the way of coping with the difficulties faced in life. Even the minimum normal body weight is not maintained. Most people who become anorexic will begin by everyday dieting. As the illness progresses, chemical changes in the body distort thinking so that body image and ideas about food become irrational.

The Eating Disorders Association has more details on anorexia and offers support. For more information on clinical signs and treatment, please see the section on anorexia by our paediatrician.

Bulimia nervosa

People suffering from bulimia will typically eat huge amounts of food and then want to rid themselves of the food through induced vomiting and/or the use of laxatives. This condition tends to start later than anorexia, typically in the early to mid-twenties, and may follow anorexia.

For further details on bulimia see the Eating Disorders Association site.

Binge Eating

This has only recently been recognised as a condition in its own right. It is estimated that this condition affects many more people than other eating disorders. It involves binge eating but without purging through vomiting or laxatives.

The Eating Disorders Association site has a section on binge eating and other disorders.

For information on lesser known eating disorders see the Anorexia Nervosa & Related Eating Disorders site (ANRED).

Eating disorders can cause physical problems, most of which are reversible once normal eating is resumed.

In order to treat an eating disorder it is important to try to have the child’s willingness to be helped. Sometimes people are unsure about ‘getting better’ as this means giving up a mechanism they have relied upon to cope with emotional problems.

Eating disorders can involve a great deal of secrecy as the young person tries to cope and hide the problem so it is useful to have contacts they can go to directly. ‘How do I know if I have an Eating Disorder?’ on the Eating Disorders Association website talks directly to young people. Their youth helpline offers information, counselling and advice. You can also ask for leaflets (free to callers) some of which are written specifically for young people.

Self-harming behaviour

Self-harming behaviour is when a person deliberately injures him or herself. It is more common in girls. It could involve cutting or burning oneself, taking overdoses - eating disorders are a form of self-harm too. It is generally done in secret. Self-injury is always a sign that something is very wrong for the young person.

The Royal College of Psychiatry’s ‘Deliberate self-harm in young people’ gives excellent advice on the complexities of why someone might self-harm.

It is important that the young person has access to someone they can talk to. This may be a teacher, or someone available locally through youth services.

A useful booklet addressed at young people, ‘Worried about self-injury?’, is available from Young Minds, and suggests ways that a young person can look for help.

The National Self-Harm Network is at PO Box 16190, London NW1 3WW.

The Samaritans can be called 24 hours a day, or visited at their local centre. You can send e-mail to jo. Telephone: .

Suicide Attempts

Although there has been an increase in suicide attempts over the years it is still rare in children under 14. The Royal College of Psychiatrists booklet ‘Suicide and attempted suicide’ gives advice on signs to look out for and is a good starting point. If a child has attempted suicide they should have an urgent assessment by a doctor to check for any overdoses (some drugs even in small doses can be fatal and may have a delayed reaction). It is crucial that a specialist mental health assessment is completed as a young person that does not receive support is at risk of making further attempts.

DEPRESSION

Depression may be triggered for a number of reasons, as a reaction to loss or significant change for example. But there may not be an obvious cause. If sad feelings seem to linger and your child’s sense of self-worth and confidence are affected it may be a sign of depression. For more information on clinical signs and treatment you can link to our section on depression by our paediatrician.

The Young Minds publication, ‘Depression in children and young people’, is a starting point for recognising depression in children and even toddlers. ’Do you ever feel depressed?’ is addressed at young people and is worth reading for ideas on what a child may be experiencing.

The Northern Ireland Association for Mental Health services include counselling, information and self-help-groups and can be reached on (Monday - Friday, 9am to 5pm) and via e-mail.

Depression Alliance has a network of national support groups and online information on many different conditions.

BIPOLAR AFFECTIVE DISORDER (MANIC DEPRESSION)

Bipolar Affective Disorder is a form of depression that affects mood and behaviour. Although it is a serious condition, there are successful treatments to control symptoms and many people can live full lives. It is rare before puberty and its main features are the extremes of mood, swinging from being depressed (not just feeling low, but seriously depressed) to being unusually ‘high’ and manic. Someone affected may be very tired, or incredibly energetic, withdrawn and down, or reckless. They may express bizarre thoughts. In children the mood swings may be ongoing with a rapid change and few periods of calm.

The American Child & Adolescent Bipolar Foundation has detailed information on symptoms, potential misdiagnoses and how to get help. There can be a genetic component to the condition but other factors play a part.

It is important to get treatment. Your GP will make referrals if necessary to other specialists and in some cases it may be necessary for the child or young person to have in-patient care at a specialist unit. If the young person is felt to be at sufficient risk of harm in some cases they may be admitted against their own will. (See Compulsory Admissions) Some useful information on the condition and treatments, including details on medication, is given in the ‘Bipolar affective disorder (manic depression)’ factsheet by the Royal College of Psychiatrists.

The Manic Depression Fellowship supports people with the condition and their families. Telephone: . E-mail: mdf.

SCHIZOPHRENIA

This is a serious mental disorder and it affects how a person is able to function in terms of thought and behaviour. For information on this condition, which is rare in children before puberty, see ‘Schizophrenia’ by the Royal College of Psychiatrists, which describes the different symptoms, ‘positive’ and ‘negative’, that can develop over a long period or in a matter of days. They include delusions of thought, disturbed thinking, becoming withdrawn, losing interest in taking care of themselves in the normal ways. This can put a terrible strain on family relationships.

Your GP will be able to rule out other medical conditions that could account for the symptoms but other specialist advice will be necessary. Medication can keep symptoms under control and therefore allow normal life to resume. People do not all respond to the same drugs in the same way, so it may take time to find the most appropriate treatment. The Royal College of Psychiatrists also describes the type of drugs that will be offered, stressing how important it is to offer other support as a combined approach to treatment.

Rethink (formerly the National Schizophrenia Fellowship) provides services and information to people with any form of severe mental illness, not only schizophrenia.

POST TRAUMATIC STRESS DISORDER

Following a traumatic event (witnessing a serious accident for example) it is natural to experience stress and some distress. For more information on how to help a child who has been through a shocking experience and the signs to look out for to show that professional help may be needed see our paediatrician’s section on Post Traumatic Stress Disorder. The Royal College of Psychiatrists has a factsheet on traumatic stress in children.

ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD)

Although ADHD is not classed as a ‘mental health illness’ many of the symptoms overlap with other conditions and so for diagnostic purposes it is worth knowing more about ADHD. Typically the child will have problems with concentration, tending to be easily distracted, and may act suddenly on impulse. The signs will have been showing from the toddler stage. It is hard to get a diagnosis as young children can be naturally restless and there are no simple tests – parents may need to be persistent in order to get a diagnosis. It affects approximately one in every 100 primary school children.

For information on clinical signs and treatment, you can link to our paediatrician’s section on ADHD.

Relevant articles:

See ADHD in the News.

HOW TO GET HELP

Your GP should be able to help assess what the problem may be and if necessary put you in contact with specialist help. The Mental Health Foundation’s ‘How to get Help - If You Have a Mental Health Problem’ will talk you through the first steps to finding support. If you don’t feel you can speak to someone in the medical care system it is possible to find advice through other organisations. There are many phone helplines that will be able to put you in touch with local services and support groups. The Young Minds Parents' Information Service is set up specifically to give information and advice to anyone who is concerned with the mental health of a child or young person and can be reached on .

It may be that the problem your child is experiencing has been picked up on at school, and the teacher can discuss ways of seeking help. This could be through contacting the Special Educational Needs Co-ordinator (SENCO) or the local education authority’s educational psychologist. Mental health problems might come under the umbrella of special educational needs as this encompasses not only more obvious disabilities but also emotionally vulnerable children. There is however a procedure to go through, and criteria that need to be met in order to access this support.

The Child Psychotherapy Trust site has a factsheet explaining what child psychotherapists do. (You will need Adobe Acrobat Reader tothe file but this is easy to download.)

MINDinfoline offers support and information on mental health including legal issues on telephone number , Monday to Fridays from 9.15am – 5.15pm.

SANE run a phone line offering support and information on services to anyone with a mental illness or their family and friends on telephone number from 12 noon to 2am.

Youth Access has details of local advice, information and counselling services for young people on .

The Northern Ireland Association for Mental Health has excellent information on conditions and treatment. The organisation can be reached on .

The Scottish Association for Mental Health is reachable on or via e-mail on enquire.

We have listed specialist helplines in the relevant sections below. For general parent support networks you could contact:

·Exploring Parenthood advice line:

· At Parentline Plus, trained volunteers take calls on any issue that puts parents under stress on a free, confidential 24-hour hotline on .

·Parent Network, a national network of self-help groups for parents: Telephone:

WHO ARE THE PROFESSIONALS AND WHAT DO THEY DO?

Child and Family Consultation Services (Child Guidance Clinics) are centres that assess problems and find ways to work with both the child and the family. The services are free and may involve a few meetings or more regular sessions over a longer period of time. There may be a waiting list for services; this will vary from area to area.

You can access the services at your local Child and Family Consultation Service by talking to your GP, health visitor, social worker or teacher, all of whom can refer you. In some areas it is possible to self-refer. Young Minds' Parents' Information Service can tell you where your local centre is located.

There are various specialists based at the centres who you may come into contact with. The Young Minds information leaflet on child and adolescent mental health services gives more details on these resources and the roles of the different professionals, the kinds of problems they will normally deal with and the treatments they offer. Some of these professionals will also work as part of GP surgeries, hospitals and outpatient clinics.

You may need to download Adobe Acrobat Reader (this is free) in order to see the leaflet from YoungMinds.

The London-based Institute of Family Therapy provides some background information on Family Therapy. They also take referrals from around the country.

Cognitive Behavioural therapy is based in the idea that symptom changes will follow a change in thinking. It focuses on changing behaviour and negative thought patterns. For more information see the British Association for Behaviour and Cognitive Psychotherapies website.

For more information on finding professional help, see our section on Counsellors & Therapists.

LEGAL ADVICE & COMPULSORY ADMISSIONS (‘SECTIONING’)

Most people will be able to receive treatment in the community or at outpatient clinics. If necessary, assessments and treatment may involve time as an in-patient in a hospital or specialist unit. Rethink (formerly the National Schizophrenia Fellowship) estimates that for 90% of cases this will be voluntary admission, where patient consent has been given. If consent is not given and the problem is felt to be a serious health and/or safety risk then the authorities can apply for a ‘compulsory admission’. This would fall under one of the sections of the Mental Health Act 1983 and is called being ‘on section’. There are rights to appeal.

The Mental Health Act 1983 has been under review in recent years, resulting in a draft Mental Health Bill in June 2002 which was subsequently revised in 2004. The draft Mental Health Bill sets out a new legal framework that covers the compulsory treatment of people who are suffering from mental disorders, with new safeguards to protect the rights of children and young people. Under the draft bill, children under the age of 18 would gain the right to refuse treatment. You can read the draft bill, explanatory notes and an easy-to read version, as well as a summary of the white paper that preceded it, ‘Reforming the Mental Health Act’. See also this summary of the reaction to the bill.

In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 is expected to be implemented in April 2005. See a summary from the Scottish Executive and the Scottish Association for Mental Health site for an independent view on the new legislation.

We have outlined the provisions for compulsory admission under existing legislation in England and Wales below.

How does the age of the child affect compulsory admissions?

The Mental Health Act 1983 has no lower age limit and so can apply to children and teenagers. Usually before medical treatment of a child takes place, consent would be obtained from the parent, or person with parental responsibility. In some cases the child can give their own consent, for example:

·if the child is under 16 and the doctor considers the child to be of sufficient understanding and intelligence to give consent. This is known as ‘Gillick competent’. If a Gillick competent child refuses treatment it is possible for this refusal to be overridden by the courts or the child’s parents. If there is a mental health problem the chances of being considered Gillick competent may diminish.

·16 & 17 year olds can give consent for treatment, but if they are considered incapable of consenting, then consent of parents will be needed. If the young person refuses treatment, the courts or parent can override their decision. In the new draft Mental Health Bill, young people aged 16 and 17 year olds are treated as adults, with the right to refuse treatment.

·18 year olds are no longer considered minors and not subject to parental responsibility.

Compulsory admissions to hospital would apply under section 2 or 3 of the Act. Rethink has a good section on legal rights. Section 2 covers admission to hospital for someone with a mental health problem/illness for a maximum of 28 days. This cannot be extended. This could be for an assessment to be made and treatment given. It is possible for this to be without parental consent.

Admission under section 3 of the Act covers longer admissions, over 28 days and up to six months. This can then be extended. The authorities must seek permission from the nearest relatives; if parents object to this admission the authorities must go to a county court judge where they would have to ask the judge to say that the nearest relatives were acting unreasonably. However, the authorities can ask for an interim order if they feel admission is urgent. For more details on Section 2 & 3 of the Act see Rethink’s ‘Compulsory admission’.

MIND can offer legal advice on its MindinfoLine