Child and adolescent mental health
Last Modified 15/06/2017 17:11:48
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This Government has committed to make children and young people's mental health and emotional well-being a priority. The consequences of untreated mental health problems early in life can be long lasting and far reaching, thus effective early intervention is essential. An independent review of Tier 4 Child and Adolescent Mental Health Services (CAMHS)1 commissioned by NHS England and evidence presented at the House of Commons Health Committee's inquiry (2014)2 into children and young people's mental health have shown that many children and young people with mental health and emotional difficulties do not receive timely, high quality, accessible or evidence-based support.
The Children and Young People's Mental Health and Wellbeing Taskforce was established in September 2014 to consider ways to make it easier for children, young people, parents and carers to access help and support when needed and to improve how children and young people's mental health services are organised, commissioned and provided. The Taskforce published its report Future in Mind: promoting, protecting and improving our children and young people's mental health and wellbeing in March 2015, and the report made key recommendations to schools, commissioners, and early years staff. It emphasised the need to improve services for children and young people from vulnerable backgrounds, to improve access to services and to improve data and standards.
This JSNA report is an aggregation of the Child and Maternal Health (ChiMat) Child and Adolescent Mental Health Service (CAMHS) Snapshot and CAMHS needs assessment reports3 produced by Public Health England. It contains a broad range of indicators which describe levels of provision and need for child and adolescent mental health services (CAMHS) in Blackpool.
- In Blackpool there are an estimated 31,976 young people aged under 20. Approximately 51% are aged under 10 year and 49% aged 10 to 19 years.
An estimated 1,920 of Blackpool's 5-16 year olds have mental health disorders.
An estimated 1,160 of boys and 760 girls aged 5-16 have a mental health disorder, approximately 50% more boys than girls.
There are an estimated 1,190 5-16 year olds in Blackpool with conduct disorders, a higher number of boys than girls.
There are an estimated 745 5-16 year olds in Blackpool with emotional disorders; a higher number of girls than boys.
There are an estimated 585 16-19 year olds with mixed anxiety and depressive disorder, 70% of whom are female.
925 16-19 year olds are estimated to have a neurotic disorder in Blackpool.
There are an estimated 125 children aged 5-9 in Blackpool with an autism spectrum disorder.
In Blackpool, an estimated 4,325 children/young people may experience mental health problems appropriate to a response from CAMHS Tier 1.
An estimated 2,020 children/young people may experience mental health problems appropriate to a response from CAMHS Tier 2.
- Blackpool's rate of primary school pupils with specific, moderate or severe learning difficulty is lower than the North West and England average.
Blackpool's rate of primary school pupils with speech, language or communication needs is higher than the national average.
In Blackpool, 20 in every 1,000 secondary school pupils have a moderate learning difficulty and 20 in every 1,000 have behaviour, emotional or social difficulties.
An estimated 475 of Blackpool's 5-19 year olds has a learning difficulty, approximately 47% are aged 15-19 years.
An estimated 195 of Blackpool's 5-19 year olds have a learning disability with mental health problems.
An estimated 10 young people with mental health problems are sleeping rough in Blackpool.
Hospital admissions with mental health disorders for young people aged under 18 years from Blackpool are significantly higher than the national average.
Hospital admission rates for self-harm in young people aged 10-24 years are two and a half times higher than the national average in Blackpool.
This service snapshot uses research to estimate the prevalence of certain conditions in Blackpool. For this reason it is useful to understand the size of the population and how it is expected to change in the future. Figure 1 shows the 0 to 19 years population for Blackpool. As prevalence varies by sex as well as age the population of boys and girls has been separated. Figure 2 shows how the population is forcast to change between 2012 and 2022.
Figure 1: Children and young people population, 2014
Source: ONS local authority mid-year resident population estimates for 2014
| ||0-4 years ||5-9 years ||10-14 years ||15-19 years |
Figure 2: How the resident child population in Blackpool is forecast to change between 2012 and 2022
Source: Office for National Statistics
Please note, where prevalence has been used to calculate an estimate of the approximate numbers affected, these estimates have been rounded up to the nearest five.
There are relatively little data about prevalence rates for mental health disorders in pre-school age children. The Report of the Children and Young People's Health Outcomes Forum "recommends a new survey to support measurement of outcomes for children with mental health problems. In particular, we recommend a survey on a three-yearly basis to look at prevalence of mental health problems in children and young people. This could build on the work of the survey, 'Mental health of children and young people in Great Britain, 2004'." A literature review of four studies looking at 1,021 children aged 2 to 5 years, found that the average prevalence rate of any mental health disorder was 19.6%4. Applying this average prevalence rate to the estimated population within the area, gives a figure of 1,305 children aged 2 to 5 years living in Blackpool who have a mental health disorder.
Prevalence estimates for mental health disorders in children aged 5 to 16 years have been estimated 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 life5. 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. Using these rates, figure 3 shows the estimated prevalence of mental health disorder by age group and sex in Blackpool. Note that the numbers in the age groups 5-10 years and 11-16 years do not add up to those in the 5-16 year age group as the rates are different within each age group.
Figure 3: Estimated number of children with mental health disorders in Blackpool by age group and sex
Source: ONS local authority mid-year resident population estimates for 2014, Green, H. et al (2004).
| ||Estimated number of children aged 5-10 years ||Estimated number of children aged 11-16 years ||Estimated number of children aged 5-16 years |
These prevalence rates of mental health disorders have been further broken down by prevalence of conduct, emotional, hyperkinetic and less common disorders5. Figure 4 show the estimated number of children with conduct, emotional, hyperkinetic and less common disorders in Blackpool, by applying these prevalence rates (the numbers in this table do not add up to the numbers in the previous table because some children have more than one disorder).
Figure 4: Estimated number of children with conduct, emotional, hyperkinetic and less common disorders in Blackpool by age group and sex
Source: ONS local authority mid-year resident population estimates for 2014, Green, H. et al (2004)
| || Children ||Boys ||Girls |
| || Age 5-10 yrs|| Age 11-16 yrs|| Age 5-10 yrs||Age 11-16 yrs || Age 5-10 yrs||Age 11-16 yrs |
|Less common disorders
A study has estimated prevalence rates for neurotic disorders in young people aged 16 to 19 inclusive living in private households6. Figure 5 show how many 16 to 19 year olds would be expected to have a neurotic disorder if these prevalence rates were applied to the population of Blackpool.
Figure 5: Estimated number of males and females aged 16 to 19 with neurotic disorders in Blackpool
Source: ONS local authority mid-year resident population estimates for 2014, Green, H. et al (2004)
| ||Males ||Females |
| Mixed anxiety and depressive disorder
| Generalised anxiety disorder
| Depressive episode
| All phobias
| Obsessive compulsive disorder
| Panic disorder
| Any neurotic disorder
Autistic Spectrum Disorder (ASD)
A study of 56,946 children in South East London7 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 survey8 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 Commission9 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. Nevertheless the Commission estimates that according to the existing information, the age-specific prevalence rates for 'classical autism' in the European Union (EU) could be estimated as varying from 3.3 to 16.0 per 10,000. These rates could however increase to a range estimated between 30 and 63 per 10,000 when all forms of autism spectrum disorders are included. Debate remains about the validity and usefulness of a broad definition of autism. The EU definition of rare diseases focuses on those diseases lower than 5 per 10,000. The Commission notes that ASD could be considered as a rare disease using the most restrictive diagnosis criteria but it seems more appropriate to not refer to ASD as a rare disease.
Figure 6 shows the numbers of children with autistic spectrum disorders if the prevalence rates estimated7,8 were applied to the population of Blackpool.
Figure 6: Estimated number of children with autistic spectrum disorders in Blackpool
Source: ONS local authority mid-year resident population estimates for 2014, Green, H. et al (2004)
| ||Children |
| Autism in children aged 9-10 years
| Other ASDs in children aged 9-10 years
| Total of all ASDs in children aged 9-10 years
| Autism spectrum condition disorders in children aged 5-9 years
Special education need by type of need
Information about the number of school children accessing specialist CAMHS is not collected in a way which would make it possible to identify the actual incidence of mental health disorders in each school in an area. Information is however available for certain disorders with reference to statements of special educational need or School Action Plus (extra help for children with difficulties). Figure 7 shows these data for primary and secondary schools in Blackpool. Approximately 40% of young people who have a learning disability may also have a mental health disorder10.
Figure 7: Pupils in primary and secondary schools in Blackpool at School Action Plus or with a statement of special education need: rate per 1,000 pupils: 2014
Source: Department for Education (2014)
| ||Primary schools ||Secondary schools |
| ||Blackpool||North West||England ||Blackpool ||North West ||England |
|Specific learning difficulty
| Moderate learning difficulty
| Severe learning difficulty
| Profound and multiple learning difficulties
| Behaviour, emotional, social difficulties
| Speech, language, communication needs
| Hearing impairment
| Visual impairment
| Multi-sensory impairment
| Physical disability
| Autistic Spectrum Disorder
| Other difficulty/disability
Psychological and physical wellbeing
Promoting positive emotional wellbeing is a core component of a local area's psychological wellbeing and mental health strategy for children and young people. Psychological wellbeing is also associated with many aspects of physical wellbeing.
The TellUs surveys assessed both physical and psychological wellbeing. They were conducted across a sample of schools of all main types in every local authority in England between 2005 and 2009. TellUs 4 took place in autumn 2009. The TellUs series of surveys have now ended but the results of TellUs 4 are still topical and relevant. Although not directly related to mental health issues and widely influenced by the norms of society and peer group pressures, negative health behaviours, especially in the extreme may be indicative of poor mental health and a failure to cope with the stresses and strains of everyday life. Conversely, the TellUs4 survey found for example, that young people who had participated in positive activities in the previous four weeks were less likely to have been drunk within the same four week period or to have ever taken drugs.
Evidence from some previous studies suggests that looked after children are nearly five times more likely to have a mental health disorder than all children. This clearly indicates a need to improve the mental health of children and young people who are looked after. Since April 2008 all local authorities in England have been required to provide information on the emotional and behavioural health of the children they look after.
Data is collected by local authorities through a strengths and difficulties questionnaire (SDQ) and a summary figure for each child (the total difficulties score) is submitted to the Department for Education through the SSDA903 data return. Scores may range from 0 to 40. A higher score on the SDQ indicates more emotional difficulties. A score of 0 to 13 is considered normal, a score of 14 to 16 is considered borderline cause for concern and a score of 17 and over is a cause for concern.
Figure 8 shows information relating to the emotional health of all children in care in Blackpool compared with England and the North West.
Figure 8: Emotional health
Source: Department for Education
| ||Blackpool ||North West ||England |
|Emotional and behavioural health of looked after children - Average score per child 2011/12
|Emotional and behavioural health of looked after children - Average score per child 2012/13
|Emotional and behavioural health of looked after children - Average score per child 2013/14
The reasons why a child or young person experiences mental health problems are likely to be complex. However, certain factors are known to influence the likelihood of someone experiencing problems. The information below describes some of these factors.
Many services are targeted, at least partially, at the needs of vulnerable groups of children. These include children and young people with learning disabilities, looked after children and young offenders. The following provides an insight into the number of children in these categories and, where possible, historical trends.
Children and young people with learning disabilities
People with learning disabilities are more likely to experience mental health problems11. The Foundation for People with Learning Disabilities10 estimates an upper estimate of 40% prevalence for mental health problems associated with learning disability, with higher rates for those with severe learning disabilities. Figure 10 shows how many children with learning disabilities who also experience mental health problems might be expected in Blackpool.
Figure 10: Estimated total number of children with learning disabilities with mental health problems
Source: Office for National Statistics mid year population estimates for 2014. The Foundation for People with Learning Disabilities (2002)
| || Children aged 5-9 yrs||Children aged 10-14 yrs ||Children aged 15-19 yrs |
Looked-after children are more likely to experience mental health problems14. It has been found that among children aged 5 to 17 years who are looked after by local authorities in England, 45% had a mental health disorder, 37% had clinically significant conduct disorders, 12% had emotional disorders, such as anxiety or depression, and 7% were hyperkinetic15. Variation was shown depending on the type of placement with two-thirds of children living in residential care found to have a mental health disorder compared with four in ten of those place with foster-carers or their birth parents.
Figures 14 and 15 shows the trend in the number and rate of looked after children in Blackpool.
Figure 14: Number of looked after children in Blackpool
Source: Department for Education
| ||2005||2006||2007||2008 ||2009 ||2010 ||2011 ||2012 ||2013 ||2014 |
Figure 15: Looked after children: rate per 10,000 population aged 0-18 years
Source: Department for Education
Homelessness and sleeping rough
Homeless adolescents and street youth are likely to present with depression and attempted suicide, alcohol and drug misuse, and are vulnerable to sexually transmitted diseases, including acquired immune deficiency syndrome (AIDS)16. Two major studies of this group in London17 and Edinburgh18 found significant histories of residential care, family breakdown, poor educational attainment and instability of accommodation. These were associated with sexually risky behaviours, substance misuse and comorbid psychiatric disorders, particularly depression. The estimated number of young people aged 16 to 24 sleeping rough in England in 2008/9 was 3,200, giving a rate of 51.3 per 100,00019. In a study of 16 to 25 year olds who were sleeping rough in London20, it was found that 67% had mental health problems. Applying these rates to the population in Blackpool provides an estimate of 10 young people with mental health problems who are sleeping rough.
Suicide and self-harm
Suicide is a complex issue and one which requires further research to understand better the specific risk factors associated with it. Looking at suicides in the UK between 1997 and 2003, one study21 has made the following observations:
According to the Office for National Statistics (ONS), in 2014 there were 476 deaths of 15 to 24 year olds from intentional self-harm or undetermined intent in England and Wales. This is a rate of 6.6 deaths per 100,000 population aged 15 to 24 years.
- There were less than 5 deaths over the same period in young people aged under 18 in Blackpool.
Self-harm is a related issue:
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 olds22. Self-poisoning was the most common method, involving paracetamol in 58.2 % of episodes.
Presentations, especially those involving alcohol, peaked at night. Repetition of self-harm was frequent (53.3 % had a history of prior self-harm and 17.7 % repeated within a year)22, characteristics of adolescents who self-harm are similar to the characteristics of those who commit suicide23.
Young South Asian women in the United Kingdom seem to have a raised risk of self-harm. Intercultural stresses and consequent family conflicts may be relevant factors23.
As many as 30% of adolescents who self-harm report previous episodes, many of which have not come to medical attention. At least 10% repeat self-harm during the following year, with repeats being especially likely in the first two or three months23.
The risk of suicide after deliberate self-harm varies between 0.24% and 4.30%. Our knowledge of risk factors is limited and can be used only as an adjunct to careful clinical assessment when making decisions about after care. However, the following factors seem to indicate a risk: being an older teenage boy; violent method of self-harm; multiple previous episodes of self-harm; apathy, hopelessness, and insomnia; substance misuse; and previous admission to a psychiatric hospital23.
Children and young people who have formally entered the Youth Justice System
Figure 16 compares rate of children and young people who have formally entered the Youth Justice System. Figure 17 shows the actual counts of children and young people in these age groups. Please note, data are shown for the Blackpool Youth Offending Team.
Figure 16: Children and young people who have formally entered the Youth Justice System: rate per 1,000 population
Source: Ministry of Justice, Office for National Statistics
Figure 17: Number of children in Blackpool who have formally entered the youth justice system, by age group: 2013/14
| ||Blackpool |
| Children aged 10 to 14 years who have formally entered the youth justice system
| Children aged 15 years who have formally entered the youth justice system
| Children aged 16 years who have formally entered the youth justice system
| Children aged 17 years who have formally entered the youth justice system
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 the Mental Health Foundation24. Figure 18 shows these estimates for the population aged 17 and under in Blackpool.
Figure 18: Estimated number of children who may experience mental health problems appropriate to a response from CAMHS
Source: Office for National Statistics mid-year population estimates for 2014. Kurtz, Z. (1996)
| ||Tier 1 ||Tier 2 ||Tier 3 ||Tier 4 |
'The Department initiated the national programme budget project in 2002 to develop a source of information, which shows 'where the money is going' and 'what we are getting for the money we invest in the NHS'. Programme budgeting data has been collected since 2003-04. The annual programme budgeting data collection requires primary care trusts to analyse their expenditure by specific healthcare conditions, such as cancer and mental health. There are currently 23 programme budgeting categories, which are based on the World Health Organisation (WHO) International Classification of Disease (ICD10)" 25
Figure 19 shows the CAMHS budgetary information relevant to Blackpool.
Figure 19: CAMHS programme budget
Source: Department of Health/Office for National Statistics
| ||Programme budget per head 2011/12 ||Programme budget per head 2012/13 |
|| £ 30.87
| North West
|| £ 60.8
|| £ 64.66
Hospital admissions relating to mental health and wellbeing of children and young people in Blackpool
Selected outcomes and indicators from Public Health England help illustrate the mental health needs of children and young people in Blackpool.
One in ten children aged 5-16 years has a clinically diagnosable mental health problem and, of adults with long-term mental health problems, half will have experienced their first symptoms before the age of 14. Self-harming and substance abuse are known to be much more common in children and young people with mental health disorders - with ten per cent of 15-16 year olds having self-harmed. Failure to treat mental health disorders in children can have a devastating impact on their future, resulting in reduced job and life expectations. In 2013/14 45 children aged under 18 years from Blackpool were admitted to hospital with a mental health disorder, a rate of 155 per 100,000, significantly higher than the England average of 87 per 100,000.
Hospital admissions for self-harm in children have increased in recent years, with admissions for young women being much higher than admissions for young men. With links to other mental health conditions such as depression, the emotional causes of self-harm may require psychological assessment and treatment. In Blackpool there were 700 hospital admissions in young people aged 10-24 in the three year period 2010/11 to 2012/13. This was a rate of 918 per 100,000, more than two and half time the national average of 352 per 100,000.
Alcohol misuse at any age has health and social consequences. Alcohol misuse in young people is a major contributor to criminal and antisocial behaviour. Although evidence suggests that the number of teenagers who drink has decreased in recent years, the amount drunk by young people who do drink has increased. Across Blackpool 81 children aged under 18 were admitted to hospital for alcohol specific conditions in the three year period 2010/11 to 2012/13.
There is evidence to suggest that young people who use recreational drugs run the risk of damage to mental health including suicide, depression and disruptive behaviour disorders. Regular use of cannabis or other drugs may also lead to dependence. Among 10 to 15 year olds, an increased likelihood of drug use is linked to a range of adverse experiences and behaviour, including truancy, exclusion from school, homelessness, time in care, and serious or frequent offending. In Blackpool 135 young people aged 15-24 were admitted to hospital due to substance misuse in the three years 2011/12-2013/14. The rate of 264 per 100,000 is more than three times the national average of 81 per 100,000.
Injuries are a leading cause of hospitalisation and represent a major cause of premature mortality for children and young people. They are also a source of long-term health issues, including mental health related to experience(s).
Figure 20 and 21 shows the rates (and numbers in Blackpool) of hospital admissions compared to the North West and England average.
Figure 20: Mental health related hospital admissions for children and young people
Source: PHE, Children's and Young People's Mental Health and Wellbeing Profile
| ||England ||North West ||Blackpool |
| ||Rate||Rate ||No. ||Rate |
|Child admissions for mental health: rate per 100,000 aged 0 -17 years: 2013/14
|Child hospital admissions due to alcohol specific conditions: rate per 100,000 aged under 18: 2010/11-2012/13
|Child hospital admissions for unintentional and deliberate injuries: rate per 10,000 children 0-14: 2013/14
|Young people hospital admissions due to substance misuse: rate per 100,000 aged 15 - 24: 2011/12-2013/14
|Young people hospital admissions for self-harm: rate per 100,000 aged 10 - 24: 2010/11-2012/13
|Young people hospital admissions for unintentional and deliberate injuries: rate per 10,000 young people 15-24: 2013/14
Figure 21: Mental health related hospital admissions for children and young people
Source: PHE, Children's and Young People's Mental Health and Wellbeing Profile
Child and adolescent mental health services (CAMHS) cover all types of provision and intervention ranging from mental health promotion and primary prevention to specialist care. Services are often separated into 4 tiers. Whilst some services may have structural and/or functional tiers, others may combine some tiers.
Tier 1 CAMHS is provided by professionals whose main role and training is not in mental health. These include GPs, health visitors, school nurses, social services, voluntary agencies, teachers, residential social workers and juvenile justice workers.
Tier 2 CAMHS is provided by specialist trained mental health professionals. They work primarily on their own but may provide specialist input to multiagency teams. Their role involves helping young people that have not responded to Tier 1 interventions and they usually provide consultation and training to Tier 1 professionals. Roles include clinical child psychologists, paediatricians (especially community), educational psychologists, child psychiatrists and community child psychiatric nurses/ nurse specialists
Tier 3 CAMHS is aimed at young people with more complex mental health problems than those seen at Tier 2. Many of the professionals working at Tier 2 will work in this area, however the service is provided by a multidisciplinary team. Roles include child and adolescent psychiatrists, social workers, clinical psychologists, community psychiatric nurses, child psychotherapists, occupational therapists and art, music and drama therapists
Tier 4 services are aimed at children and adolescents with severe and/or complex problems. These specialised services may be offered in residential, day patient or out-patient settings. The service requires a combination or intensity of interventions that cannot be provided by Tier 3 CAMHS. These services include adolescent in-patient units, secure forensic adolescent units, eating disorder units, specialist teams for sexual abuse and specialist teams for neuro-psychiatric problems.
Views of the Local Community
Healthwatch Blackpool has produced a Child and Young People's Mental Health Report (October 2015) to gather the views of a group of young people regarding the issues children and young people face.
Healthwatch Blackpool has also produced a Children and Adolescent Mental Health Services (CAMHS) and CONNECT outreach counselling services Report (November 2016) to specifically understand the expereinces of young people who havbe used these services.
National and local guidance
Find out more about mental health and psychological wellbeing from the National Child and Maternal Health Intelligence Network knowledge hub.
Find further information on children and young people's mental health in Blackpool from the Children and Young People's Mental Health and Wellbeing Profile Tool
Future in Mind The report of the children and young people's mental health taskforce includes a number of proposals for improving children and young people's mental health care and support.
NICE advice (LGB12) published in 2013 summarises the recommendations for local authorities and partner organisations on social and emotional wellbeing for children and young people, specifically, vulnerable children aged under 5 years and all children in primary and secondary education. It is particularly relevant to health and wellbeing boards.
Transitions in Mental Health Care is a guide for health and social care professionals on the legal framework for the care, treatment and support of young people with emotional and psychological problems during their transition years.
 CAMHS Tier 4 Report Steering Group (2014) Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report. London: NHS England
 House of Commons Health Committee (2014) Children's and adolescents' mental health and CAMHS: Third Report of Session 2014-15 Third Report of Session 2014-15. London: House of Commons
 PHE, ChiMat, Mental Health and Psychological Wellbeing, Needs assessment reports
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