The number of young people suffering from a diagnosable mental health condition is high and continues to increase:
• Approximately 1 in 12 young people self-harm
• Around 3 children in every class suffers from a mental health condition
• 1 in 10 young people age 5-16 years old have a mental health illness
• More than half of adults with mental health problems had their diagnosis in childhood, however less than half of these had appropriate treatment
Correct identification of a mental health illness at an early stage is extremely important to ensure the most appropriate treatment can be given to a young person. This helps to prevent serious risks, suffering and a lifetime of morbidity.
My blog post looks further into what the signs and symptoms of a mental health condition can be in a young person. It also offers advice and support on what to do if you suspect a young person is struggling with their mental health.
Spotting the signs and symptoms
The mental wellbeing of a child is just as important as their physical health and often, young people who suffer from mental health issues such as depression and anxiety do not get the help they need. One reason for this could be that the young person will try and hide their feelings and signs can be subtle.
If a child in your care is showing any of the behaviours listed below, they may require further support for their mental health:
• Refusing to go to school and decline in academic performance
• An increase of medically unexplained symptoms such as stomach aches, headaches or chest pains
• Low mood which has been consistent for more than 2 weeks
• Poor sleep, feeling tired all the time or poor concentration
• Change in appetite leading to rapid weight loss or weight gain
• Social isolation and giving up hobbies
• Poor self-care
• Presenting as hopeless about their future
• Talking negatively about themselves
• An increase in irritability, recklessness or aggression
• Looking sad or worried all the time, or showing a lack of expression
It might also be important to look out for unusual marks on the young person. Unexplained scars, cuts or even swelling from possibly punching something, can be a sign of a mental health problem. This may become evident if a young person declines physical examinations and starts to cover up more.
What to do if you suspect a mental health problem in a young person?
It is important to always reassure the young person and their parent or carer and explain to them that they are not alone. Often the mental illness is common and treatable and you can help them access the support and treatment they need.
NHS or private?
Many families have private insurance but they do not realise that this covers mental health until it is pointed out to them.
A private referral will ensure the young person is seen very swiftly by a consultant, rather than waiting a long time on the NHS and then probably see a junior clinician. Privately, there are many success stories as the young person can get amazing and positive guidance treatments without a wait.
Often it is a big relief for a young person to finally share information and to hear there is help.
Consider the parent/carer
It is helpful to have a system in place to manage the parent or carer in a consultation:
• If the young person has come with their parent, ensure the parent feels heard
• Do this whilst building a rapport with the young person and making them feel comfortable
• Suggest you spend a brief period with the young person alone and bring the parent back in at the end
• When the parents have left the room, explain ‘confidentiality’ to the young person and check with them at the end of your time together what they do and do not want sharing
Young people can often disclose self-harm or suicidal ideas when they are seen alone and when they understand confidentiality.
Normally, if you explain to a young person that it is important to be open with parents, at the end of your discussions, you can help contain any parental distress and manage the situation better.
Offer practical help to parents/carers
If you are concerned about self-harm, (cutting, ligatures, or overdose) or suicidal thoughts, advise parents of the following (if confidentiality permits):
• Ensure any medications which are not required are disposed of and any remaining medications are in a locked cabinet
• Remove any razor blades, pencil sharpeners, shoe laces, small make up mirrors (which could be smashed), maybe dressing gown cords and belts, and similar items from the young person’s room
This may feel intrusive but it will make the parent/carer feel safer, even if they may not show appreciation. Tell the young person beforehand that you are going to advise parents to do this so the situation is managed.
Help the young person identify triggers
Help the young person try to identify their triggers for self-harm and the early warning signs of becoming distressed. These could include:
• Chewing their sleeve
• Isolating themselves in their room
You can also discuss distractions they could use at the point of early warning signs. This could include ringing friends, watching funny YouTube clips, holding ice tightly or biting on a lemon.
If you suspect an eating disorder
If you think a young person may be suffering from an eating disorder, it is important to closely monitor their weight as well as their sitting and standing blood pressure, pulse, ECG and bloods. Blood tests should include U+E, potassium, glucose, magnesium and calcium until they are picked up by mental health services. Early identification can help prevent a rapid decline in their physical health.
Talk to the young person prior to leaving your surgery, about how parents can help if they are having self-harm thoughts. Consider if there is a signal that they may be willing to give their parent when they spot their early warning signs of distress. This could include:
• Squeezing their hand
• Asking the parent to do a specific form of distraction with them
• Giving the parent a red card or a text with a code word
Young people sometimes find this easier than vocalising how they are feeling. Ask them how they would want the parents to react if they give this signal. If they know the parent will not overreact they are more likely to access their help.
Finally, you can refer the young person to mental health services (NHS or private) for support or call a child and adolescent psychiatrist for a discussion if you would like further advice.
Why is it important to access help quickly for young people?
• Once a young person has been open about their mental health issues, it is important they see there is prompt support available and that it is taken seriously
• Research shows that early intervention can prevent considerable longer term morbidity and mental health issues in adult life
• Most mild and moderate mental illnesses that are treated promptly with evidence-based interventions are likely to lead to a full recovery
• The NHS route may feel frustrating, however without any treatment at all, young people are likely to continue to have poor functioning or risks may increase with time.