Child Mental Health Service - Essay Example

Without a doubt, the need for child mental health services is one that has existed for some time and has gained awareness in the late 1990s. The scope and ramifications of mental illness in children was not clearly delineated until the Office of National Statistics (ONS) conducted its first national child mental health survey throughout the United Kingdom. This study revealed as many as ten percent of all children between the ages of five and fifteen years old present with a history of psychiatric disorders. These disorders often serve to emotionally cripple many of these children and the majority of the clinical disorders transcend from childhood to adulthood. In fact children who are looked-after by local authority, homeless adolescents and youthful offenders show the highest propensity for psychiatric disorders. Additionally, the statistics indicate that there is a socio-economic disparity in the incidents of mental illness among children. This disparity is such that children in households wherein the head of the households were unskilled laborers showed a fifteen percent rate of mental illness and their counterparts in households wherein the head of households were professionals showed a five percent rate of mental illness (Office of National Statistics, 2004). In examining mental health and the provision of services to children, one has to focus on the epidemiology of mental disorders. In so doing, there are many epidemiological studies which indicated that there is an association between childhood mental health disorders and economic and social situations. There is no clear and concise causal relationship established, however, the risks for mental health issues seem to be familial, run along peer lines and to be influenced by the neighborhoods in which the sufferers reside. In fact, the ONS survey revealed that children reared in single-parent families are twice as likely to develop mental health issues as children reared in two-parent households. Additionally, the level of dissension within the family has significant implications for disorders in children. An example of this can be seen in the psychological effects of divorce on the children in the household (Office of National Statistics, 2001). Clearly, there are many risk factors in the manifestation of mental health issues in children. Some of factors include psychopathology within the family, problematic attachment with regards to the children and the parents which can result from repeated separation from the parents, inadequate or inappropriate parenting as evident by child abuse/neglect, exposure to violence in the home and undesirable peer group influence (Taylor & Rutter, 2002). In order to conceptualize this, Dunn, Deater-Deckard, Pickering, O'Connor, Golding & the ALSPAC Study Team (1998) delineate a wide variety of mechanisms wherein mental health disorders can be obtained by children. These mechanisms include: Biological factors which are exacerbated by stress on the underlying biological systems The development of aversive coping mechanisms Adverse effects on the underlying psychological correlates of relationship formation Low self-esteem, self-concepts and aversive coping skills with regards to self-image. In addition to the above-mentioned causes, there are several other pertinent issues with regards to the risks for child mental health disorders. First, there is empirical evidence that show that there is a difference in the way in which children respond to stressors. This brings to task the notion of resilience. Resilience according to Rutter (1987) involves individual variation in response to risk such that poor outcomes are reduced or good outcomes are enhanced, often beyond previous levels of adaptation. Essentially, the risk factors are characteristics of the individual or his/her environment which serve to increase the likelihood of the individual succumbing to mental illness as a direct result of poor adaptation to very difficult situations. The net effect of the risk is determined by the vulnerability of the individual as well as his/her resilience (Luthar & Zigler, 1991). Now that we have examined the etiology of the mental health issues faced by children and adolescents through the UK, it is prudent that we turn our examination to the level and scope of serves provided to children at risk. This examination must be framed with the notion that the mental health issues of children and adolescents are complex and the needs of those children often involve a multi-systemic approach. In examining this notion, the ONS survey assessed the number of contacts made between children and adolescents and mental health service providers as well as other health, educational and social services agencies. The results of the survey indicated that approximately fifty percent (50%) of all children who were diagnosed with a mental disorder were in contact with their general practitioner within the past twelve months when compared to a thirty-three percent (33%) contact rate among children and adolescents with no history of psychological/psychiatric disorders. Additionally, the survey indicated that the general practitioner served as the first source of assistance for a great deal of children and adolescents with psychiatric problems which have somatic illnesses associated with them. Additionally, there is a consensus that general practitioners vary in their ability to recognize psychiatric disorders in children and refer only a very small percentage of children to specialist (Garralda, 2001). Kataoka, Zhang & Wells (2002) noted that most of the children in need of mental health services do not have access to those services and the need for specialized care for children and adolescents with mental health issues is often overlooked. This transcends national boundaries and the same statistic applies to children in the UK as well as those in the United States. A 1999 Audit Commission study of Children and Adolescent Mental Health Services (CAMHS) in England and Wales indicated that there are many inherent problems when dealing with children and adolescents with mental health issues. These problems vary in complexity, however, in sixty to eighty percent of the cases examined the issues which render the necessity of mental health services included the following: Coping issues with regards to family and other relationships Emotional problems which manifest themselves in disorders such as eating disorders and substance abuse Problems with peer relationships Behavioral problems such as disruptive and aggressive behaviors When examining those children who sought service, the 1999 Audit Commission reported that approximately thirty-three percent (33%) of those families receiving services were headed by individuals who were unemployed. Additionally, nineteen percent (19%) of those children were living with at least one parent with a prior history of mental illness. Of those children examined, nine percent (9%) were being looked after by the Local Authority. Furthermore, a closer look at the number of contacts made by children and adolescents with health services, indicate that approximately half of the children diagnosed with mental health disorders have been referred for educational services within the past twelve months the and twenty percent (20%) of those children were referred for other social services and did in fact receive those services. Another interesting finding of this survey was the fact that forty-three percent (43%) of the children between 11 and 15 years old have had some contact with the police and had varying degrees of legal issues. This is very alarming in that this figure is more than twice that of children within the same age group who are not diagnosed with mental health issues. The implications of this are such that the costs associated with treating mentally ill children and adolescents are exorbitant when compared with the costs associated with treating the children and adolescents without mental health disorders (Scott, Knapp, Henderson & Maughan, 2001). When examining the costs of providing mental health services to children, it is prudent to examine the funding sources. In an attempt to ensure that adequate funding is allotted for each and every child, the government in England has instituted the Children Act. This reform focuses on all aspects of the lives of children as well as their mental wellbeing and encompasses programs administered by the Department of Health. Within the realm of children mental health services, CAMHS operates as the governmental body responsible for the administration of mental health services to children and adolescents. CAMHS receives grants from the government in order to provide for the mental health services of children and adolescents. An example of the funding provided for the treatment of mental illness in children can be seen in the budgetary allotment of 93.539 million to CAMHS during the 2004 fiscal year. Of the 93.539 million allotted to CAMHS by the Department of Health, 90.539 million were allocate to the provision of services to children in the general sector while 3 million was allocated for treatment of children within the foster care system (Department of Health, 2006). In examining the services provided by CAMHS, it is prudent to note that there is a great disparity in the level of services provided based on geographic area and other unknown determinants. Livesey (2000) noted that an examination of the way in which the services rendered by CAMHS are allotted is such that there is an equal division of services between child health services and child mental health services. Within this division ninety-four percent (94%) of the mental health services are community based. As such, there is a disparity between the services within the communities with services based on socio-economic status, race/ethnicity and the individual community where services are provided. Finally, after having examined the etiology of mental health problems in children and adolescents, it is prudent to indicate that there are many mental health problems faced by children and adolescents. At any one point in time at least ten percent (10%) of all children within the UK face behavioral as well as emotional problems which adversely affect their ability to function within as well as outside of the context of the family. This inability to function places a great burden on both the families and the mental health system charged with the responsibility of taking care of the mentally ill child. As illustrated in this paper, the mental health problems are pervasive and have a tendency to transcend from childhood to adulthood. In establishing the etiology of these mental health problems, one can clearly see that biological, psychological and social factors contribute to the manifestation of psychological and psychiatric disorders in children. The extent to which each factor contributes is unattainable as these factors are inextricably linked. At some point in time, the children with psychiatric disorders are connected with the necessary services. Some of these children receive minimal services while others receive specialized service. The children who do not receive specialized services undoubtedly place a great burden on the mental health system. This burden can be relieved through an assessment system geared at identifying the need for prompt and specialized services. In providing specialized services, there is a need for: Active governmental involvement in addressing the issue of a shortage in mental health professionals, inadequate funding for employee training and easy access to services for children and adolescents. Multidisciplinary teams to address the biopsychosocial needs of children and adolescents Adequate mental health services to address the needs of children in a manner that is free of bias. References Audit Commission, 1999, 'Children in mind: child and adolescent mental health services', Audit Commission: London, Available at: http://www.audit-commission.gov.uk/reports/AC-REPORT.aspCatID=&ProdID=5C9F4553-27E2-413D-A379-4AA5BF388159 Department of Health, 2006, 'Children's services: Child & adolescent mental health services grant allocations for 2007-08', Department of Health, Available at: http://www.dh.gov.uk/assetRoot/04/14/08/50/04140850.pdf Dunn, J., Deater-Deckard, K., Pickering, K., O'Connor, T. G., Golding, J. & the ALSPAC Study Team. 1998, 'Children's adjustment and prosocial behaviour in step-, single, and non-stepfamily settings: findings from a community study', Journal of Child Psychology and Psychiatry, Vol. 39, pp 1083-1095. Garralda, E., 2001, 'Child and adolescent psychiatry in general practice', Australian and New Zealand Journal of Psychiatry, Vol. 35, pp 308-314. Kataoka, S. H., Zhang, L & Wells, K. B., 2002, 'Unmet need for mental health care among US children: variation by ethnicity and insurance status', American Journal of Psychiatry, Vol. 159, pp. 1548-1555. Livesey, A.E., 2000, 'W(h)ither child psychiatry: The impact of primary care groups and trusts on the future of child and adolescent mental health services', Psychiatric Bulletin, Vol. 24, pp. 370-371. Luthar, S. & Zigler, E. 1991, 'Vulnerability and competence: A review of research on resilience in childhood', American Journal of Orthopsychiatry, Vol. 61, pp 6-22. Maughan, B. 2000, The influence of family, school, and the environment, in Gelder M. G., Lopez-Ilbor Jr., J. J. & Andreasen N. C. (eds) New Oxford Textbook of Psychiatry volume 2, Oxford University Press, Oxford. Office of National Statistics. 2001, 'Children and adolescents who try to harm, hurt or kill themselves: A report of further analysis from the national survey of the mental health of children and adolescents in Great Britain in 1999', National Statistics, Available at: http://www.statistics.gov.uk/downloads/theme_health/Childselfabuse_v1.pdf Office of National Statistics. 2004, 'News Release: The Health of Children and Young People', National Statistics, Available at: http://www.statistics.gov.uk/pdfdir/health0304.pdf Rutter, M. 1987, 'Psychosocial resilience and protective mechanisms', American Journal of Orthopsychiatry, Vol. 57, pp 316-331. Rutter, M. & Silberg, J. 1999, 'Genetics and Child Psychiatry: II Empirical Research Findings', Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol. 40, no. 1, pp 19-55. Scott, S., Knapp, M., Henderson, J. & Maughan, B. 2001, 'The cost of social exclusion: Antisocial children grown up', British Medical Journal, Vol. 323, pp 191-195. Taylor, E. & Rutter, M. 2002, Classification: conceptual issues and substantive findings, in Rutter M and Taylor E (eds), Child and adolescent psychiatry, Fourth Edition (pp 3-17), Blackwell Science, Oxford Read More