Children and young people's mental health and emotional wellbeing (health and wellbeing needs in South Tyneside)

The levels of MHEW need in children and young people is very difficult to measure accurately as many mental health and emotional wellbeing problems go undetected and unrecorded in a format that is useful for needs assessment. Therefore much of the need information below is derived from estimates and bespoke studies.

Population

There are around 32,900 children aged 0 - 19 years in South Tyneside (2014, taken from PHE Child Health Profile, 2016). One in four of the under 20 population is classified as living in poverty. Every year there are around 1,600 births. More information on prevalence rates of mental health and wellbeing indicators in children and young people can be found here.

Maternal and Pre-school

• Maternal mental health is a particular topic of concern because of the effect they can have on the foetus, baby, wider family and mother's physical health and the fact that problems often are not disclosed, recognised or treated during this period. Mental health problems in women can occur during pregnancy (the antenatal period) and the postnatal period, which is defined as up to one year after childbirth. The antenatal and postnatal periods are often called the perinatal period, when referring specifically to mental health. There are a range of mental health problems that can affect women during perinatal periods including depression, anxiety, post-traumatic stress disorder (PTSD), postpartum psychosis and adjustment disorders and distress.
• Based on the number of women giving birth in South Tyneside, the figures below show how many women we would expect to have certain mental health problems in pregnancy and the postnatal period.[1] These estimates are based on national estimates of these conditions and local delivery figures only, and have been rounded up to the nearest five. They do not take into account socioeconomic factors or anything else which is likely to cause local variation. We are not aware of any data or research on exactly how maternal mental health differs by socioeconomic status that would allow us to take this into account in the estimates.

• Adding all these estimates together will not us an overall estimate of the number of women with antenatal or postnatal mental health conditions in South Tyneside, as some women will have more than one of these conditions. It is believed that overall between 10% and 20% of women are affected by mental health problems at some point during pregnancy or the first year after childbirth.
• There are relatively little data about prevalence rates for mental health disorders in pre-school age children. A literature review of four studies looking at 1,021 children aged 2 to 5 years inclusive, found that the average prevalence rate of any mental health disorder was 19.6% (Egger, H et al, 2006). Applying this average prevalence rate to the estimated population within the area, gives a figure of 1,320 children aged 2 to 5 years inclusive living in South Tyneside who have a mental health disorder.

School Age Children

Mental and Behavioural Disorders

• Prevalence estimates for mental health disorders in children aged 5 to 16 years have been estimated in a report by Green et al. (2004). Prevalence rates are based on the ICD-10 Classification of Mental and Behavioural Disorders with strict impairment criteria - the disorder causing distress to the child or having a considerable impact on the child's day to day life.
• Prevalence varies by age and sex, with boys more likely (11.4%) to have experienced or be experiencing a mental health problem than girls (7.8%). Children aged 11 to 16 years olds are also more likely (11.5%) than 5 to 10 year olds (7.7%) to experience mental health problems.
• The estimated number of children in South Tyneside with mental health disorders are:
  • 800 5 - 10 year olds,
  • 1,170 11 - 16 year olds,
  • Out of the estimated total 1,970 5 - 16 year olds with a mental health disorder, around 60% are boys,
• These prevalence rates of mental health disorders have been further broken down by prevalence of conduct, emotional, hyperkinetic and less common disorders (Green, H. et al, 2004). These estimates are
  • 515 5 - 10 year olds and 700 11 - 16 year olds with conduct disorders,
  • 2455 - 10 year olds and 530 11 - 16 year olds with emotion disorders,
  • 1805 - 10 year olds and 150 11 - 16 year olds with hyperkinetic disorders (around 90% of these are estimated to be boys),
  • 1405 - 10 year olds and 125 11 - 16 year olds with less common disorders,

Neurotic Disorders

• A study conducted by Singleton et al (2001) has estimated prevalence rates for neurotic disorders in young people aged 16 to 19 inclusive living in private households.
  • Males aged 16 - 19 years;
    • Mixed anxiety and depressive disorder 190
    • Generalised anxiety disorder 60
    • Depressive episode 35
    • All phobias 25
    • Obsessive compulsive disorder 35
    • Panic disorder 20
    • Any neurotic disorder 320
  • Females aged 16 - 19 years;
    • Mixed anxiety and depressive disorder 435
    • Generalised anxiety disorder 40
    • Depressive episode 95
    • All phobias 75
    • Obsessive compulsive disorder 35
    • Panic disorder 25
    • Any neurotic disorder 670

Autistic Spectrum Disorder (ASD)

• A study of 56,946 children in South East London by Baird et al (2006) estimated the prevalence of autism in children aged 9 to 10 years at 38.9 per 10,000 and that of other ASDs at 77.2 per 10,000, making the total prevalence of all ASDs 116.1 per 10,000.
• A survey by Baron-Cohen et al (2009) of autism-spectrum conditions using the Special Educational Needs (SEN) register alongside a survey of children in schools aged 5 to 9 years produced prevalence estimates of autism-spectrum conditions of 94 per 10,000 and 99 per 10,000 respectively. The ratio of known to unknown cases is about 3:2. Taken together, a prevalence of 157 per 10,000 has been estimated, including previously undiagnosed cases.
• The European Commission (2005) highlights the problems associated with establishing prevalence rates for Autistic Spectrum Disorders. These include the absence of long-term studies of psychiatric case registers and inconsistencies of definition over time and between locations.
• The numbers of children with autistic spectrum disorders if the prevalence rates found by Baird et al (2006) and by Baron-Cohen et al (2009) were applied to the population of South Tyneside are:
  • Autism in children aged 9 - 10 years old 15,
  • Other ASDs (9 - 10 year olds) 25,
  • ASDs in children aged 5 - 9 years 130.

Suicide and Self Harm

• Looking at suicides in the UK between 1997 and 2003, one study has made the following observations (Windfuhr, K., 2008):
  • Three times as many young men as young women aged between 15 and 19 committed suicide
  • Only 14% of young people who committed suicide were in contact with mental health services in the year prior to their death, compared with 26% in adults.
  • Looking at the difference between sexes, 20% of young women were in contact with mental health services compared to only 12% of young men
• Levels of self-harm are higher among young women than young men. The rates of self-harm in young women averaged 302 per 100,000 in 10 to 14 year olds and 1,423 per 100,000 in 15 to 18 year olds. Whereas for young men the rates of self-harm averaged 67 per 100,000 in 10 - 14 year olds and 466 per 100,000 in 15 to 18 year olds (Hawton, K., 2012). Self-poisoning was the most common method, involving paracetamol in 58.2 % of episodes (Hawton, K., 2012).
• In comparison with the 2009 / 10 - 2011 / 12 period, the rate of young people aged 10 to 24 years who are admitted to hospital as a result of self-harm in South Tyneside is higher in the 2012/13-2014/15 period. The admission rate in the 2012 / 13 - 2014 / 15 period is higher than the England average. Nationally, levels of self-harm are higher among young women than young men.

(Data source: Hospital Episode Statistics, Health and Social Care Information Centre).

• In 2014 / 15, this meant that there were 134 admissions as a result of self-harm in the 10 - 24 year old age group. It's important to note that these admissions may represent the tip-of-the-iceberg with regards to self-harm as much may go unreported/ undetected.

Estimated need for services at each tier

• Estimates of the number of children and young people who may experience mental health problems appropriate to a response from CAMHS at Tiers 1, 2, 3 and 4 have been provided by Kurtz (1996).
• Estimated number of children / young people who may experience mental health problems appropriate to a response are;
  • Tier 1 4,400
  • Tier 2 2,055
  • Tier 3 545
  • Tier 4 25

[1] Definitions of the conditions can be found in the glossary at the end of this report.