Posted 2nd February 2021
Children’s mental health week highlights the damage the pandemic has brought but we need to put funding behind interventions that work to really make a difference.
It’s children’s mental health week, and two recently published reports both shed some light in differing ways on the current situation for children’s mental and emotional health. The first, a report by the Children’s Commissioner, The state of children’s mental health services 2020/21, draws attention to the increased prevalence of mental health problems in children and young people, and the continued lack of adequate service provision. The second report offers some hope in the increasingly robust evidence base for the effectiveness of psychotherapeutic interventions with children and young people experiencing mental health difficulties. The evidence-base for psychoanalytic and psychodynamic psychotherapy with children and adolescents
The Children’s Commissioner Report
Anne Longfield, in her fourth annual report, pulls no punches and opens with the observation that, “The sad truth is that, in spite of progress, services are still nowhere near meeting the level of need and hundreds of thousands of children are being left without help as a result”.
Mental Health difficulties in children are on the increase, and she refers to a large-scale study, undertaken by the NHS in July 2020, Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey – NHS Digital, which found that clinically significant mental health conditions amongst children had risen by 50% compared to three years earlier. “One in six children (16%) of children aged 5 to 16 were identified as having a probable mental health disorder, increasing from one in nine (10.8%) in 2017. The increase was evident in both boys and girls”
This is in line with our own local data, taken from our work in schools, using nationally validated clinical measures, which show year on year increases in the complexity and severity of the problems children are referred with, an emerging data that suggests a further spike during this academic year.
Longfield argues forcefully that, although access is improving, it is not keeping pace with the problem, and access to children’s mental health services is still not adequate. She has also called for more collaboration with existing voluntary sector provision to help roll out a more comprehensive provision of mental health support in schools which would give greater capacity and flexibility given pressures on the NHS – something the Bridge Foundation has also been arguing for.
Psychoanalytic psychotherapy with children and young people is effective
On a more optimistic note, we can be increasingly confident that effective and cost-effective interventions for child and adolescent mental health are available. A new review of the evidence base recently published [Midgely et al 2020] The evidence-base for psychoanalytic and psychodynamic psychotherapy with children and adolescents shows psychodynamic psychotherapies for children and young people are effective with a wide range of presentations, and gives us a clearer picture about who is most likely to benefit from such interventions, and how best to tailor those interventions for maximum effectiveness, in terms of variables such as intensity and length of treatment.
Why is this important?
We know many long term mental health problems begin early, and, as illustrated in the Children’s Commissioner’s report, more services are desperately needed, particularly to address the longer term impacts of the pandemic. But it is also important that services are informed by the best available evidence and are effective and cost-effective.
“75% of mental illnesses start before a child reaches their 18th birthday, while 50% of mental health problems in adult life (excluding dementia) first appear before the age of 15 (MQ, 2017). These widely quoted figures highlight the urgent need for interventions that are effective in childhood to limit the impact of mental health problems that may persist into adulthood, at considerable individual, social, and economic cost.”
What kinds of problems can psychoanalytic therapy help with?
The good news is that psychotherapy can help with a broad range of difficulties. Psychotherapy can help with emotional difficulties, and specifically with anxiety and depression. A number of studies including random control trials (RCTs) show that emotional disorders respond well to psychodynamic therapy. Child psychotherapy for depression can result in good outcomes across a range of domains, with those outcomes maintained beyond the end of treatment. Children with disruptive behaviours can be difficult to engage, but those who do often do well and can see significant symptom reduction. There is also evidence to suggest that young people who self-harm respond well to contemporary psychodynamic therapies such as mentalisation based treatment (MBT)
What have we found at the Bridge Foundation?
Again, this picture fits with our own local Bridge in Schools service outcomes that we have accumulated over a period of four years. We work with children and young people referred with a wide range of presenting difficulties, often with high levels of complexity. Our data shows that children who receive psychotherapy do well and show significant improvement with emotional and behavioural difficulties, peer relationship difficulties, problems with hyperactivity, and in overall functioning.
We are likely to see continued raised levels of mental health problems in the longer term as we come out of the immediate impact of the pandemic, and its longer term consequences are felt. If we are to address this adequately, and give the next generation the best chance of fulfilling their potential, we desperately need more investment in children’s mental health, and in interventions that are effective in mitigating the damaging toll on child mental health.
If you are a school and would like support around mental health and emotional wellbeing in schools, you can get in touch. We are currently offering free emotional wellbeing health checks for schools, which is a free consultation with one of our mental health specialists. Contact Matthew Jenkins on 0117 9424510 or firstname.lastname@example.org
If you are a parent, and need more help & support with your child’s mental health, at The Bridge Foundation we also offer parent consultations in our fee-paying service, where you can talk through your concerns about your child’s behaviour and mental health with a specialist. Contact us on 0117 9424510 or email@example.com