Following on from World Mental Health Day on 10 October, this first of two blog posts describes the scale of the challenge in understanding what contributes to mental health and the need for policy to help parents to help their children.
Mental health is the bedrock of a healthy and productive society and yet remains one of the least well understood contributors to individual, national and global indicators of wellbeing.
Setting the scene: What is mental health?
From the outset, it should be emphasized that mental health and mental disorder are not synonymous. Mental health represents a lifespan process, from childhood and adolescence through adulthood and later stages of life, where an individual experiences adaptive emotional, behavioural, psychological and social wellbeing consistent with their age and developmental stage (more commonly referred to as ‘typical’ development).
Mental disorder refers to a wide range of mental health conditions at certain times that affect mood, thinking and behaviour; they may be specific to a particular age or stage of development (referred to as ‘atypical’ development) or may be long-lasting, affecting multiple stages of life (e.g. childhood – adolescence – adulthood). Mental disorders may be grouped into two primary domains: clinically discernible neurodevelopmental problems (e.g. ADHD) and neuropsychiatric problems (e.g. anxiety, depression, schizophrenia). Some of these conditions can be predated by more broad-based symptoms that may or may not develop into clinical illness (e.g. anxiety, low mood, social difficulties).
However, historically, mental health and mental disorder have often been treated synonymously in discussions addressing particular mental health challenges. Before the Covid-19 pandemic, there was a preceding societal pandemic – rising rates of mental disorder globally – and new and sustained investment is needed to tackle it. However, there is also a renewed opportunity after Covid-19 to improve understanding of how mental health could be promoted, enhanced and supported across sensitive life-stages, particularly among vulnerable and at-risk groups.
While evidence-based training, support and capacity building among multiple frontline professional groups (e.g. teachers, social-workers, GPs and others) is essential if we are to realistically support children’s mental health, another group is critical to the promotion of positive mental health outcomes for children and adolescents – parents.
Revisiting the role of parents: The original “influencers”
On the inside sleeve of a music album from the early 2000s, the following words appear – mums and dads of the world be patient with your children. When I first read these words (having just purchased the album, in the days before the world of streaming options), I thought it was a simple and yet immensely powerful summary of decades of international research aimed at helping parents to understand how best to support children and young people. Yet, young people’s mental health (children and adolescents under the age of 18 years) is recognised to be at ever increasing risk. How can we help parents to help children develop positive mental health and wellbeing? New research1 is helping to illuminate how this objective may be met with the prospect of interrupting intergenerational transmission patterns of poor mental health and related life chances.
Mental health disorders are the single largest cause of disability in the UK, affecting one in four people across their lifespan with an estimated annual cost to the economy greater than £100 billion and a global cost expected to be greater than $16 trillion by 2030. Among children and adolescents, greater than 70% of serious adult mental health conditions, including psychiatric disorders, develop before the age of 18 years, with estimates ranging from one in five to one in ten children in the UK affected by mental health problems, including anxiety, depression, conduct problems, self-harm, psychosis and suicide.
While acknowledging the difficulties in determining whether recently measured increases reflect genuinely worsening mental health or, rather, greater awareness and willingness to report, it is noteworthy that there has been a threefold increase in the number of teenagers who report self-harm in England in the last decade (one in five 15 year olds). Suicide is the second leading cause of death for young people (less than 20 years old), with the UK prevalence rates for anxiety and depression (factors often common to multiple other mental health problems) among the highest in young people aged between five and 18 years living in OECD countries.
Knowledge regarding the biological underpinnings of poor mental health is growing through greater understanding of genetic and epigenetic processes that may underlie multiple mental health disorders. However social and environmental processes still remain a substantive influence on children’s mental health trajectories (even when genetic factors are considered), and may be changing rapidly with the continued digitisation of society.
In 2020, the world as we knew it fundamentally changed. Every nation witnessed the adverse health, social, economic, scholastic, and emotional effects of the Covid-19 pandemic. Among many areas of adverse impacts, the mental health of multiple sectors of UK society, including children and adolescents, has been severely affected.
In England alone, there were 80,226 more under-18 year olds referred to NHS mental health services between April and December 2020 (372,438) than the same period in 2019 (292,212). The number of children and young people needing emergency care because they were in a mental health crisis rose by 20% (to 18,269), with an extra 600,000 mental health treatment sessions provided to under-18s in England between April and December 2020.
Adults also experienced a substantial increase in reported rates of mental health problems, with those experiencing an episode of severe depression rising from one in ten prior to March 2020 to one in five by June 2021. Of course, we are only beginning to experience the pervasive impacts of the pandemic on mental health and other outcomes, with prevalence rates expected to rise further in the coming years.
The second of this two-part blog series turns to suggestions about how to tackle this.
i Harold, G. T., Leve, L. D., Sellers, R. (2017). How can genetically-informed research help inform the next generation of interparental and parenting interventions? Child Development. ISSN 0009-3920.
With helpful contributions from: Ruth Sellers, Saul Becker, Ashton Brown, Wendy Browne, Anita Thapar and Sui-Mee Chan.