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Emotional health and wellbeing, also referred to as mental health, affects an individual’s ability to cope and manage with change, transition and life events. Being emotionally resilient and having positive mental health will assist children and young people with their transition into adulthood. The majority of adult mental health disorders have their beginnings in childhood; 50% of adult mental health disorders (excluding dementia) start before the age of 14, and 75% (excluding dementia) start before the mid-twenties, so tackling problems when they first emerge is both morally right and cost effective.
It’s estimated that at least 9.6% of young people suffer from a diagnosable mental health problem, with many more experiencing issues around anxiety, stress and body image. This can lead to poor emotional wellbeing and low levels of resilience, resulting in young people being less able to cope with the challenges of life. Left unchecked, this can spiral into acute, long-term illness. Poor mental health in childhood is associated with a broad range of outcomes including poor educational achievement, a greater risk of suicide, substance misuse, antisocial behaviour, offending and early pregnancy. There are inequalities in good emotional health and wellbeing in children, with children from the most disadvantaged backgrounds being three times as likely to develop a mental health disorder.
Data and intelligence to support the understanding of emotional health and wellbeing in children and young people is recognised nationally as being problematic. Comparative data is limited to children and young people who have been admitted to hospital for certain conditions, whilst data relating to the larger number of children who may be experiencing mental health difficulties is limited to national research and local surveys.
Hospital admissions for mental health disorders
Wakefield has lower rates of hospital admission rates for mental health disorders in those aged under 18 than the national average. In 2017/18, the rate of admissions to hospital because of a mental health disorder in Wakefield was 61.4 per 100,000 population aged under 18, compared to 84.7 in England. This is an increase locally from the previous couple of years, however it is much lower than in earlier periods (2012/13, 2013/14 and 2014/15).
Hospital admissions for self-harm
The rate of hospital admissions as a result of self-harm is higher in Wakefield compared to both the national and regional averages. Local analysis has shown that the majority of self-harm admissions are due to self-poisoning by aminophenol derivatives (pain killers), and that around 60% of admissions are female.
Estimates of mental health disorders and emotional difficulties
A national survey of mental health disorders in young people, completed in 2004 by the Office for National Statistics, is the most authoritative source for estimating the numbers of children and young people with mental health difficulties. The study found that the persistence and onset of childhood mental health disorders were linked to child, family, household (including whether or not accommodation was rented as opposed to owned) and social characteristics.
By applying the findings from this national research to the local population of Wakefield it is estimated that there are around 4,260 children with clinically diagnosable mental health disorders, 9.6% of children. The follow-up of the survey found that 30% of the children and young people who had a clinically-rated, emotional disorder were also assessed as having an emotional disorder three years later. This indicates that, without treatment, emotional disorders and mental health issues are highly likely to persist into early adulthood and beyond.
There will be many more children with lower-level or transient emotional, behavioural or social problems which will nevertheless have a significant impact on their educational, social and family functioning and will require intervention. For example, some children may be struggling to cope with the effects of family breakdown, illness or bereavement, or they may be experiencing bullying. They may not go on to be diagnosed with a mental health problem, but their emotional wellbeing, functioning and ultimately adult mental health is likely to be impaired if they aren’t offered timely support. Research suggests that, in addition to the 9.6% of children with diagnosable disorders, there are a further 15-20% that are likely to be experiencing severe emotional or mental health difficulties at any time. This would equate to a further 6,655 to 8,870 children in Wakefield.
These figures need to be regarded with some caution, they are based on national research which may not reflect the population of Wakefield, they can however be used to give a tentative estimate of the likely numbers. The two estimates indicate that there may be between 11,000-13,000 children with some level of emotional or mental difficulty living in Wakefield.
Evidence suggests that age, gender and socio-economic status also have an impact on the mental health and wellbeing of children. Some specific disorders, particularly eating disorders, are more common in girls than boys and more common in teenagers and older children; however some may still show signs from an early age. The 2004 national survey of mental health disorders in young people showed that mental wellbeing in children was also significantly linked to socio-economic status; children who were identified as living in a household with a lower socio-economic status were significantly more likely to experience emotional disorders.
A Children and Young People’s survey was completed in 2017; a total of 3,161 pupils took part in 46 primary and 13 secondary schools in Wakefield district. The survey asked several questions that give an indication of emotional wellbeing. The Short Warwick-Edinburgh Wellbeing Scale (SWEMWBS) uses responses from a number of questions to give an overall score of wellbeing, the higher the score the higher the indication of positive wellbeing, the lower the score, the poorer the level of wellbeing. In Year 5 (9-10 year olds), only 28.4% of pupils recorded high or maximum wellbeing scores, and only 17.8% of Year 9 pupils (13-14 years olds). Both of these figures are much lower than the figure reported after the previous survey (2015).
Pupils were also asked how much they worried about a list of issues; these included school work/exams, problems with friends, family problems, money problems and the way you look. The proportion of pupils who stated that they worry quite a lot or a lot about any of the issues listed increases with age. According to the survey, 25% of primary pupils and 37% of secondary pupils stated that they worry about school work/exams, and the proportion worrying about money problems were 12% and 13% respectively.
Emotional and behavioural health of Looked After Children
Research shows that 45% of looked after children (LAC) have a diagnosable mental health condition ; since 2008 local authorities have had a duty to administer a screening questionnaire (for mental disorders); to the primary carers of any child that has been LAC for at least a year. The strength and difficulties questionnaire (SDQ) is the screening tool that is used; the questionnaire has 20 questions relating to emotional symptoms, conduct problems, hyperactivity and peer problems. A score of less than 14 is considered normal; 14-16 is borderline cause for concern and 17 or over is cause for concern . LAC in Wakefield in 2017/18 had a higher average score (15.5) than national (14.2) and regional averages (14.9). The average score of LAC has fluctuated since 2013/14, when it was 13.7. Around 47% of LAC in Wakefield have scores where there is cause for concern, higher than the national (38.6%) and regional averages (42.7%).
There has been some recent good work in Wakefield, which we hope to build upon. In 2018/19 Wakefield ensured nearly 3,000 children – 42% of young people – were able to access NHS-funded community mental health services for treatment on at least two occasions. This was against a national target, known as the Children and Young People Mental Health Access Standard, of 32% and was above the national (36.1%) and West Yorkshire (29.5%) averages. This has also impacted on reduced referrals for core CAMHs services, and a 5.9% reduction in all CAMHs referrals during 2018-19 as young people’s emotional wellbeing needs are supported by early intervention services such as Kooth.
Further information about the services available can be found in the Local Transformation Plan 2019-2022; local services are mapped against the domains in the THRIVE model which is an evidence based model to promote needs based care.
Further information on emotional health and wellbeing can be found in the mental health needs assessment and on the JSNA website, in the Children and Young People’s Survey reports: