KEY CONCEPTS

• Mental illness can occur across the life span.
  
• Early intervention and prevention are key for early detection of mental ill health.
  
• Undetected illness can lead to further problems into adulthood.
  
• Everyone who works with children and young people and his or her families and care givers have key roles and are responsible for the care they deliver.

INTRODUCTION

One in seven 10–19-year-olds experience a mental illness, which accounts for 13% of the global burden of disease within this age population (WHO 2022a). Individuals who suffer from mental illness have an increased likelihood of premature death. The World Health Organisation’s (WHO 2022a) Comprehensive Mental Health Action Plan 2013–2030 states when compared to the general population, those who have a diagnosis of major depression and schizophrenia have a 40–60% greater chance of dying prematurely. Parity of both physical and mental health is crucial and an integrated approach to care is essential for this to be addressed. Factors which contribute to poorer health outcomes such as social, cultural, environmental, and exposure to adversities in childhood, all play a key role in this. Early intervention and prevention is key to reducing the risk of developing mental illness, this takes into account the entirety of and child and young person (CYP), their family environment, educational opportunities and contributing factors such as poverty, ethnic group or homelessness.

Significant gaps are evident for those who present with mental illness and receive care. For example, between 76–85% of people who have a severe mental illness receive no treatment in low-income countries compared to 35–50% for high-income countries (WHO 2022a). CYP have been significantly affected by the pandemic due to public health measures imposed through ‘lock down’ resulting in major mental health concerns. It has been reported that there has been a significant increase in crisis presentations to general CYP healthcare settings, which is placing further demands on services and staff. The exact cause of this is unknown however, it can be hypothesised that isolation, which is closely linked with depression, has been one of the main causing factors (Loades et al. 2020). Eating disorders are a common presentation in this age range with it being reported that in 2019, 6% of CYP inpatient beds are due to CYP with a mental illness (Hudson et al. 2021).

With increased demands and complex presentations of CYP, this indicates the need for all health, social and educational sectors to have further knowledge and understanding of potential mental health conditions, which are commonly presented in this population. Further understanding will therefore increase the likelihood that early intervention and prevention will allow for CYP to reach their full potential throughout the life span. It is also important to consider the health equalities for CYP and that social inequalities vary according to their social condition where they live and economic status (Rajmil et al. 2014). It has also been identified that socioeconomic environment and family environment are associated with mental health in childhood.

Given the gravity of mental illness within this population, it is crucially important to widen the conversations and address issues such as ‘stigma’ and the importance of allowing CYP to have ‘a voice’ (UNCRC 1989), which is heard, and more importantly validated. Compassionate nursing should be at the core of every nursing intervention and compassionate conversations are required to help aid assessments and develop a plan of care, which is individualised to meet the needs of the child, young person, their family, and support system. Along with physical health, parity of esteem is required and a comprehensive approach with the understanding that across the life span there will be periods whereby people may be unwell, and that recovery is achievable so that individuals are able to function in a healthy, positive way.

EARLY INTERVENTION AND PREVENTION

The development of mental health issues can start in early childhood with 75% of all mental health problems becoming evident by the age of 18 years (Department of Health 2015). Untreated mental health problems in childhood can lead to further long-term problems in adulthood such as an increase in unemployment and poorer physical health outcomes. For that reason, individuals are prevented from reaching their full potential.

Early intervention and prevention of mental health issues are key to reduce the risk of further problems developing in adulthood (UNICEF 2021, WHO 2022b). Mental health issues can present in numerous ways with some of the most common being depression, anxiety, and early symptoms of first onset of psychosis. Healey (2017) postulate that societal expectations and the need to succeed educationally can put added pressure on a young person, which can increase vulnerability and add stress, which may exacerbate or increase the likelihood of becoming unwell. Self-harm and suicide are also major public health concerns amongst adolescents with suicide being the second most common cause of death in young people world-wide (Hawton et al. 2012). Females are more likely to engage with self-harm behaviour. Alcohol and drug misuse during adolescence can increase suicidal thoughts and impulsivity, which are all of concern. Table 12.1 identifies the risk factors for self-harm and suicidal behaviour – this information should be communicated to all professionals who work with CYP.

MENTAL HEALTH IN THE CONTEXT OF COVID 19

There is considerable evidence to support the rise in mental health issues for CYP during the COVID-19 crisis in which the epidemic has led to further disparity between socioeconomic populations. The most vulnerable groups have had further increase in risk factors with families been negativity impacted and an increase in poverty. Rosen et al. (2021) postulate that risk factors for mental health are increased during times of hardship and crisis and the impact on school closures and lock down has intensified the risk further.