Emotional Mental Health and Wellbeing of Children and Young People in South Tyneside

National prevalence of mental health problems in children and young people

In 2017 ONS carried out the third Mental Health of Children and Young People in England survey (MHCYP survey) of 9,117 children and young people aged 2-19 years old living in England and registered with a GP. The survey combines reports from children, their parents, and teachers to identify if the child or young person met the International Classification of Disease (ICD-10) diagnostic criteria (WHO, 2016) [The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines (who.int)] for a range of different types of disorder. Those who took part in the survey are contacted to repeat the survey annually.  

The most recently published survey - 2022 [Mental Health of Children and Young People in England 2022 - wave 3 follow up to the 2017 survey - NHS England Digital] shows that there are now 1 in 6 CYP aged between 7-16, in England at risk of poor mental health.  This is an increase from 1 in 9 in the 2017 survey, however, has remained stable since 2020. In the age group 17-19, there has been an increase in rates of probable mental health need at each survey point; the 2017 rate was 1 in 10, this remained stable until 2021 when it increased to 1 in 6, then increased to 1 in 4 in 2022.

Other findings in the 2022 survey show that 1 in 8 11-16-year-olds who use social media have been bullied online; 1 in 5 (over 19%) of 7-16-year-olds lived in households that experienced a reduction in household income in the previous year.

As can been seen from the graph within the weblink attached, trends in the MHCYP survey show a gradual rise in mental disorders overall, largely accounted for by a proportionally large increase in emotional disorders since 2004 (the chart does not include ages over 16, where prevalence is much higher for emotional disorders. [Mental Health of Children and Young People in England, 2017]

There are approximately 4,000 children and young people seeking formal help and support through a range of commissioned children and young people's emotional wellbeing and mental health services (locally accepted referrals data).  However, many more may in fact seek support through use of informal networks and charity/voluntary services.

Population

South Tyneside is around 25 square miles (64 square kilometres) wide, with a population of around 148,000 of which 21.9% are aged 0-18.  According to the most recent census data, there has been an overall decline in the population of around 400 since the 2011 census.

The table below shows the number of families who are supported through children's social care (numbers and rates per 10k children); the data has been taken from 2017 to 2022 year-end figures and shows an overall increase in demand on the social care system.  Whilst the number at the year-end fluctuates, this shows an increase in 2021 and current in-year data indicates that last year's year end figure has already been exceeded to date (over 1500).

Since 2020, there has been a significant increase in the number of children and young people who are elected home schooled, and there are currently 257 children and young people in South Tyneside who are electively home educated.

Deprivation and Poverty

There are socioeconomic factors that attribute to the health and wellbeing of children and young people, such as the links to long term health conditions, mental health conditions, employment prospects and healthy standards of living. South Tyneside has worse health outcomes than other, less deprived Authorities as well as worse health outcomes in its most deprived neighbourhoods.  In 2021, South Tyneside was one of the most deprived areas in England (ranking 12th of 316 English Local Authorities) [Exploring local income deprivation (ons.gov.uk).  

There are additional pressures on families such as the cost-of-living crisis, which is pushing families further into poverty.  Data from the rising cost of living and its impact on individuals in Great Britain analysis shows that around 1 in 3 of those who reported an increase in their cost of living, also reported spending less on food shopping, or shopping around more. [The rising cost of living and its impact on individuals in Great Britain - Office for National Statistics (ons.gov.uk)].

Statistics from the Anti-Poverty Strategy show that:

• 39% of children were living in poverty in 2020 / 21.
• 45% of South Tyneside neighbourhoods are in the most deprived 20% nationally.
• A quarter of our population live in the 10% most deprived areas in England.
• 13.9% of households in South Tyneside are in fuel poverty.
• There is a prevalence of low paid jobs in South Tyneside with 1 in 5 below the living wage.
• Around 3,790 children in South Tyneside are impacted by the "two-child limit" in relation to Universal Credit and Child Tax Credit.

From research that has been undertaken by Loughborough University, we know that:

• Regionally, the north east has seen the sharpest increase in child poverty levels at 38% - up 7 percentage points from 2010/11.
• Around one in 8 children of a class of 30 are now living in poverty.
• In 202/21 655 of children in poverty lived in a working house (where at least 1 adult is in work).
• 40% of children in lone parent households were in poverty (compared to 24% of those in couple parent households).
• Children from black and minority ethnic groups are more likely to be in poverty, at 46%, compared with 26% of children in white British families.

There has been an increase in the number of children and young people who are eligible for free school meals - in 2022 this was around 2 million pupils nationally. [BBC: Rising number of children on free school meals] In 2022, the north east had around 30% children and young people who were eligible for free school meals, which is a high eligibility rate in comparison to other areas. These children and young people tend to not achieve a good level of development as those who are not eligible for free school meals.

Obesity prevalence is highest among the most deprived groups in society. Children who reside in the most deprived parts of the country are more than twice as likely to be living with obesity than those in the least deprived areas.  Those who are living with obesity will have a high risk of associated health conditions such as; type 2 diabetes, cardiovascular disease, live and respiratory disease and cancer.  Obesity can also impact on mental health.  As of November 2023 (when data was collected), there were around 1 in 5 children and young people living with obesity in England. ^[Obesity Profile - OHID (phe.org.uk)]

In addition, those families with children who have special educational needs are more likely to be more adversely affected by poverty than those who do not. 

Young People Not in Education, Employment or Training (NEET)

The term NEET is used to identify young people usually aged 16-18 (but also up to the age of 24 if they have special educational needs or disabilities), who are not in education, employment or training.

South Tyneside's latest available data (full data up to March 2024 with comparisons to neighbours and North East and England) shows that, whilst we have been above the regional and England average, this is now slightly lower - please see table below:

Percentage of Young People Recorded as NEET and Not Known - (Years 12 and 13 combined) Compared with South Tyneside's Closest (statistical) Neighbours

Research has shown that family income affects children's lives and development in a variety of ways. Children who have lived in persistent poverty during their first seven years have cognitive development scores on average 20% below those of children who have never experienced poverty.

The Child Poverty Action Group (GPAG), have summarised the impact of poverty on children and young people as:

Maternal and Infant Health

Perinatal mental health is a term used to describe a woman's mental health during pregnancy and in the year following birth. It encompasses a range of mental health conditions such as antenatal and postnatal depression, anxiety, perinatal obsessive-compulsive disorder (OCD), postpartum psychosis, and post-traumatic stress disorder (PTSD) following childbirth.  For those who may be diagnosed and require treatment, this typically involves psychological therapies, medication, or a combination of both. 

Perinatal mental health problems affect between 10 to 20% of women during pregnancy and the first year after having a baby. [4. Perinatal mental health - GOV.UK (www.gov.uk)].

Across England, smoking at time of delivery has reduced significantly in recent years and continues to fall, however, South Tyneside remains higher than the England average at 12.1% compared to England score of 9.1% (2021/22).

Health inequalities data tells us that, males living in the most deprived areas were living around 10 years less than those living in more affluent areas; the gap being around 8 years for females. 

Children in Need

Children in the most deprived 10% of small neighbourhoods in the UK are over 10 times more likely to be in foster or residential care or on protection plans than children in the least deprived 10% a study by the Child Welfare Inequalities Project Team has found in South Tyneside a quarter of the population live in the 10% most deprived areas in England.  The Child Welfare Inequalities Project concludes deprivation is the largest single factor in families becoming involved in child protection.

Although each child or young person will have a unique journey into care, the most common reason for becoming looked after was abuse or neglect. These are considered to be major adverse childhood events (ACEs). These can cause trauma and can lead to long-term damaging effects on children and young people's physical and mental health. Other adverse childhood events experienced by looked-after children and young people include physical abuse, emotional abuse, and sexual abuse. Trauma can also include domestic abuse, serious harm, exposure in the home or community to alcohol, drug misuse or violence. All looked-after children and young people will have experienced trauma in some way.

In 2023, there was an increase of 2% in children looked after on the previous year (number of children looked after totalled 83,840 across England). [GOV.UK: Children looked after in England including adoptions, Reporting year 2023]

There was a 6% increase on 2022 in the number of children who began to be looked after (33,000), of which there was a 29% increase in unaccompanied asylum-seeking children (UASC).

In South Tyneside there have been 6,707 contacts and 1,067 to Children's Social Care in the period September 2023-February 2024 in the last six months.  Of those, 21% were children with previous referrals (within the last 12 months).

Locally collected data (September 23-February 24) tells us in South Tyneside there are 106.1 (per 10,000) 315 children looked after, with 70 cases beginning in the last 6 months.  There are currently 823 children open to the Early Help Service.

Access to Mental Health Services

Performance data from local statutory mental health services, and the digital offer with Kooth, to the end of the fiscal year 2022/23 show the number of children and young people accessing those services as:

The number of referrals to statutory services in 2023/24 has slightly decreased from 2022, (2,977 referrals received via the Single Point of Access), however, access to digital support via Kooth has slightly increased from 2021/22 when there were 510 new registrations and 3,498 logins.

Schools are consistently the highest referrers into services, and the main point from which young people hear about Kooth.

Children and Young People with Special Education Needs and Disabilities

Data taken from the School Census 2022/23 tells us that; nationally, there are 1,183,384 pupils in schools who have identified SEN needs without an Education Health Care Plan (EHCP) - this is an increase of 4.7% from 2022.  There are 389,171 pupils who do have an Education Health Care Plan (EHCP) - increase of 9.5% from 2022.

This gives the total number of children and young people who have special educational needs (SEN) as 1,572,555.

Using the same data (School Census 22/23) the published South Tyneside Figures are:

• 3,960 - SEN Support/SEN without an EHC Plan
• 1,105 - EHC Plans
• Total SEN = 5,065

The table below demonstrates the South Tyneside picture against statistical neighbours, the north east as a region and England and tells us that South Tyneside currently has a higher rate of children and young people requiring SEN support. This trend has been consistent over the last four years.

Youth Justice

In 22/23 there were 21 First Time Entrants (FTE) in service an increase from the 12 in 2021/22.

From Ministry of Justice data return (unpublished), in 22/23 there were 21 First Time Entrants (FTE) in service, an increase from the 12 in 2021/22. However, these numbers are comparably low which is reflective of the continued use of Outcome 22s [Deferred prosecution - Outcome 22 (yjlc.uk)], joint working work between YJS and Northumbria Police, and an indication that data for 2020/2021/2022 was anomalous due to the Covid 19 pandemic. South Tyneside's FTE figures are substantially less than the region and national comparators.

Custody rates remain at 0 for young people, as they have done since 2019. This reflects positive working relationships between YJS and the court in identifying and using bail support, ISS and Intensive Referral Orders as an alternative to custody.

Strength based assessments are undertaken with all young people which includes a mental health needs assessment. Where there are indicators of neurodiversity, staff are also able to complete the Do-It Profiler [Neurodiversity in Youth Justice - Do-IT Profiler (doitprofiler.com)]

with input from young people. A partnership approach is key to ensuring the needs of young people is considered and addressed with monthly peer support from colleagues in Lifecycle and CYPS for consultation.

Substance Misuse

Data from the Matrix (young people's drug and alcohol service) tells us there were 107 young people (60 boys and 45 girls) in treatment over 2022/23. 2022/23 also saw an increase in young people presenting with anxiety and mental health needs, this is consistent with the increase in need following the Covid pandemic and the impact on young people.

The main source of referrals received were from Children's Social Care at 30% higher than the National average of 21%. There were 27% of referrals were received from young people themselves, or friends and family on their behalf. This is higher than the national average of 18%. Referrals from the Youth Justice Service is lower than the national average at 4%, however this has resulted in the development of a more suitable screening tool to further identify young people's substance related need and more collaborative working. 

In 2021/22 there was an increase across all age groups accessing the Matrix Drug & Alcohol Service.  The average age of young people referred to the service is 13-14 years. Cannabis is the primary substance used by young people, with a constant rise since 2019/20.  Alcohol consumption in young people, whilst always slightly higher than England, has decreased to 48% in 2022/23 from 55% in 2021/22. [Alcohol and drug misuse and treatment statistics - GOV.UK (www.gov.uk)]

Domestic Abuse

Domestic abuse is defined as, any incident or pattern of incidents of controlling, coercive or threatening behaviour,  violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse:

• Psychological
• physical
• sexual
• financial
• emotional
• online or digital abuse

Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim."

This definition, which is not a legal definition, includes 'honour' based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.

Long-term effects of domestic abuse on children and young people can include; mental health problems, such as becoming anxious or depressed. Low mental health can also lead to impact on physical health, including self-harm, developing an eating disorder, having a lowered sense of self-worth, using alcohol and other drugs as unhealthy coping mechanisms, repeating behaviours seen in their domestic setting

Since the Domestic Abuse Act 2021, children that have been exposed to domestic abuse are now recognised as victims of domestic abuse in their own right, rather than just witnesses.

The police recorded 1,500,369 domestic abuse-related incidents and crimes in England and Wales in the year ending March 2022 [https://www.ncdv.org.uk/domestic-abuse-statistics-uk/]. In 2020/21 the number of domestic abuse-related crimes increased to almost 8% compared to the previous year [https://www.nspcc.org.uk/about-us/news-opinion/2022/record-number-children-affected-domestic-abuse/. 

An estimated 1.4 million women and 751,000 men aged 16 years and over experienced domestic abuse in the last year (2022); a prevalence rate of approximately 5.7% of women and 3.2% of men. [Domestic abuse victim characteristics, England and Wales - Office for National Statistics (ons.gov.uk)]

Young Carers

The standard definition of a carer is "anyone who cares for a friend or family member who, due to illness, disability, a mental health problem or an addiction, cannot cope without their support. The care they provide is unpaid".

The 2021 Census tells us that there are approximately 15,000 carers in South Tyneside, with 8% in the 5-24-year-old category; approximately 1,200 young and young adult carers who are likely to be juggling their caring role alongside education and other interests. This can make it hugely challenging for young carers to enjoy the same opportunities as their peers.

Young Carers have been identified as a priority within the South Tyneside Carer's Strategy 2022-2027 [CARERS_STRATEGY_2022-2027.pdf (southtyneside.gov.uk), to support young carers to achieve their full potential.

Self Harm

Self harm amongst pre and early teens has increased in recent years, and appears to following an upward trajectory following the COVID-19 pandemic, please refer to Health Related Behaviour Questionnaire below, which contains some data from children and young people on this topic.

In 2022/23 [Public health profiles - OHID (phe.org.uk) the rate of hospital admissions as a result of self harm in 10-24 years was 319/100,000.  A breakdown of the age groups are as follows:

Eating Disorders

Service providers are reporting that they are seeing younger children (pre-teen/upper primary age) through their service.  They report that social media is an influence on body image and how they perceive themselves. 

Data from the service provider (Cumbria, Northumberland, Tyne and Wear - CNTW) reflects that the number of acute admissions were as follows:

• 2021 - 2022 - 11 admissions into SRH
• 2022 - 2023 - 11 admission into SRH
• 2023 - non at present

The community team have reported an vast increase in referrals to the team between 2019 and 2023 (performance data indicates that referral numbers have almost quadropuled, however, this data is not accessible for publishing).

Health Related Behaviour Questionnaire

The Health-Related Behaviour Questionnaire (HRBQ) is a digital survey which collects self-reported data from children and young people in academic years 4, 5 and 6 in primary school (ages 8-11yrs) and academic years 8 and 10 in secondary schools (ages 12-15yrs) about various health topics. 

Areas of interest include age-appropriate questions about citizenship, healthy eating, physical activity, dental care, drugs, alcohol & tobacco, emotional health & wellbeing, safety, puberty & growing up, school & career and relationships & sexual health.  The questions are age-appropriate and ask children and young people about their experience in the days and weeks before the survey. 

The 2022 data is heavily COVID-19 affected, and considerable fewer participants completed the survey, for this reason, results have been compared to the previous South Tyneside survey in 2017, rather than the wider area data which was not available.  The outcomes from the survey are not publicly accessible, however, if required, can be requested by contacting: public.health@southtyneside.gov.uk

Key headline results from the questionnaire in relation to mental health and emotional wellbeing are as follows:

Primary

1. Self-esteem* is lower in children this year than in 2017, with 26% of pupils rating their self-esteem as high this year compared to 31% in the last survey.  33% of boys said their self-esteem was high, compared to only 20% of girls.

*This measurement is derived from the responses to a set of ten statements taken from a standard self-esteem enquiry method developed by Denis Lawrence (Lawrence, 1981) [The development of a self-esteem questionnaire. (apa.org)]. The scale is based on social confidence and relationships with friends.

2. Overall, children are more worried about things than they were in the previous survey.  80% of children said they were worried about at least one of the items listed in the questionnaire this year, compared to 75% in 2017. 

Top worries for our children include:

• 37% (40%) SATS/tests
• 33% (27%) problems with friends
• 32% (30%) family problems
• 30% (21%) how they look - girls were more worried about this (39% of those questioned) than the boys (21%)
• 30% (31%) crime - this figure is lower than the previous survey
•  27% worried about COVID-19
• 18% (17%) body changes while growing up

3. Most children have one, or a group of, close friends. This figure of 84% has not changed.

4. Resilience in year 6 children has given mixed results, with 65% pupils responding that when something goes wrong, they 'usually' or 'always' learn from it for next time, compared to 63% in 2017.  In contrast, this year 30% said they get upset and feel bad for ages when something goes wrong, compared to only 20% in the previous survey.

Secondary

5. Student's self-esteem* is falling.  Only 25% of students reported high self-esteem, compared to 37% in the previous survey.  Only half (50%) of young people said they were happy with their life at the moment, compared to 65% in 2017.

*This measurement is derived from the responses to a set of ten statements taken from a standard self-esteem enquiry method developed by Denis Lawrence (Lawrence, 1981).  The scale is based on social confidence and relationships with friends.

6. Students are slightly more worried about things this year, with 86% (83%) of young people reporting they were worried about at least one thing listed in the survey.  Girls are significantly more worried about the listed topics than the students in the previous survey, particularly around the way they look.

Top worries for boys:

• 44% the future (44%)
• 40% exams and tests (41%)
• 35% mental health of a family member (25%)
• 31% the way they look (24%)
• 26% family problems (25%)

Top worries for girls

• 70% the way they look (54%)
• 70% exams and tests (51%)
• 61% the future (45%)
• 54% their own mental health (33%)
• 52% schoolwork (27%)

42% of pupils reported that they think they have been picked on or bullied because of the way they look, compared to 32% in 2017. 

7. 36% of pupils responded that they feel afraid of going to school because of bullying at least 'sometimes', an increase from 27% in the previous survey. 44% of pupils responded that they think their school takes bullying seriously, fewer than the 54% in the previous survey, despite more students (25%) reporting bullying, compared to only 17% in 2017.

8. Self-harm has risen significantly in secondary-aged boys, and slightly in girls.  13% of boys this year said they had self-harmed, compared to 7% in the last survey.  19%, around a fifth, of girls said the same this year, compared to 17% in the last survey.  8% (5%) of boys and 16% (11%) of girls did not want to say if they had self-harmed.   49% of boys and 64% of girls who self-harmed did not receive any support, compared to 38% and 44% in 2017, however only 15% of those who reported to have self-harmed had shared this information with someone else, the most common being a friend at 10%.

9. Our young people have good coping strategies when feeling worried or stressed, with listening to music, socialising with friends and thinking carefully about how to problem solve themselves being the top 3 activities for both boys and girls.

Top activities to combat stress for boys:

• 72% listening to music (73%)
• 69% going out to socialise with friends (71%)
•  69% thinking carefully about the problem themselves (71%)

Top activities to combat stress for girls:

• 92% listening to music (85%)
• 75% going out to socialise with friends (77%)
• 72% thinking carefully about the problem themselves (72%)

50% of boys, and 57% of girls will do nothing when they are feeling stressed or worried, compared to 34% and 40% respectively in the last survey.