Lies, Damned Lies and Child Mental Health Statistics
April 30, 2016For as long as I’ve been teaching there has been significant frustration about the availability of CAMHS – Child and Adolescent Mental Health Services – for those children and young people who urgently need help with mental health problems. In recent years the concerns have been magnified as people worried that the services were being cut even further as the population of young people tended to rise and I have no reason to doubt those claiming the services are inadequate.
However, in the last few months children’s mental health has been cited more and more in other contexts in the education debate. Want children to behave in school? That’s unfair, they probably have mental health problems. Want schools to be held to account for whether their students’ learn? That’s cruel, testing causes mental health problems. Think children are in school to learn? That’s selfish, schools should be dealing with their emotional well-being in order to prevent mental health problems. And that last point leads to calls to teach happiness, mindfulness and emotional literacy that schools buy into from time to time despite the huge questions over the ethics and efficacy of such lessons.
Worse, there have been claims that there is some kind of children’s mental health epidemic in schools. Not just a crisis caused by the lack of services, but actually a massive increase in mental health problems. Here are claims from some recent media reports (I have deliberately tried to avoid including stats that are based on subjective questions about whether problems are worse, or ones that are only about recent increases in specific conditions, so please be aware of the selectivity of my quotations).
Teenage mental-health crisis: Rates of depression have soared in past 25 years
How has society managed to produce a generation of teenagers in which mental-health problems are so prevalent?
…there is growing evidence that teens are in the grip of a mental-health crisis. It is as if, rather than acting out, young people are turning in on themselves.
Rates of depression and anxiety among teenagers have increased by 70 per cent in the past 25 years. The number of children and young people turning up in A&E with a psychiatric condition has more than doubled since 2009…
From The Independent February 2016.
Child mental health crisis ‘worse than suspected’
Natasha Devon, the government’s mental health champion in England and Wales, warns of ‘medicalising childhood’…The crisis in children’s mental health is far worse than most people suspect and we are in danger of “medicalising childhood” by focussing on symptoms rather than causes, the government’s mental health champion for schools has warned.
Natasha Devon, who has been working in schools for almost a decade delivering mental health and wellbeing classes, said an average of three children in a class were diagnosed with a mental illness, but many more slipped under the radar.
…rates of depression and anxiety have increased by 70% in a generation,
From The Guardian, April 2016.
As children face a mental health crisis, should schools take the lead in fighting it?
There is a crisis affecting the mental health of England’s young people.
….Three children in every classroom have a diagnosable mental health condition. Half of these are conduct (behavioural) disorders, while one third are emotional disorders such as stress, anxiety and depression, which often becomes outwardly apparent through self-harm.
From The New Statesman, February 2016
Natasha Devon: ‘Britain’s child mental health crisis is spiralling out of control’
…It’s no coincidence that this generation of young people have seen a 70 per cent increase in mental illnesses, such as anxiety and depression
… a 2014 survey by mental health charity Young Minds found that children as young as 12 are concerned that they will be unemployed and cited this as a reason for their anxiety.
From the Telegraph, 29th April
Three children in every classroom have a diagnosable mental health condition. …There has been a staggering 106 per cent increase in the number of children and young people presenting at A & E with a psychiatric condition since 2009. This much is clear: we are in the midst of a crisis regarding the mental health of our children.
From The Independent, February 2016
A closer look at these stories and others like seems to indicate that overwhelmingly the stories reference only a small number of sources. Usually there is a reference to Natasha Devon (and often to her charity the Self-Esteem team) or the charity Young Minds. Occasionally stories like this mention the charity Place2B set up by Camila Batmanghelidjh in the days before Kids Company. The statistics generally seem to be the ones on the Young Minds website. Of these, two seem to be repeated the most:
Among teenagers, rates of depression and anxiety have increased by 70% in the past 25 years, particularly since the mid 1980’s.
and:
The number of children and young people who have presented to A&E with a psychiatric condition have more than doubled since 2009. (8,358 in 10/11; 17,278 in 13/14)
The claim that about 3 children in every classroom having mental health problems (also made on the Young Minds website) is repeatedly mentioned.
None of these statements are false, when used in the correct context, but all three are misleading when used to describe a mental health crisis that is happening right now.
Dealing with each one in turn:
The figure about the 70% increase in depression and anxiety over 25 years has been widely quoted. The source appears to be a 2004 study based on a comparison of data from 1974, 1986 and 1999. Yes, that’s right, 17 years ago. It may or may not have changed since then, but it is clearly not evidence for a crisis now.
The figures about A&E come from a parliamentary answer which is worth quoting in full:
Luciana Berger Shadow Minister (Public Health): To ask the Secretary of State for Health, how many children and young people were diagnosed with a mental health problem in A&E in each year since 2009-10.
Norman Lamb The Minister of State, Department of Health: The information is in the table:
Year 2009-10 2010-11 2011-12 2012-13 2013-14 A&E Attendances 8,358 9,328 11,614 13,655 17,278 FAEs 11,909 12,417 12,361 11,994 12,126 The table shows both the number of attendances in accident and emergency (A&E) in which the A&E diagnosis was ‘psychiatric conditions’ and the number of Finished Admission Episodes (FAEs) in which the primary diagnosis was ‘mental and behavioural disorders’.
This is a remarkable increase in attendances, but the FAEs, which as I understand it are the diagnoses that doctors gave show a completely different story. No significant change. Unless I’ve misunderstood the statistics, to quote only the first row without the second is, in my view, highly misleading. It shows young people attending A&E are more likely to be booked in as having mental and behavioural disorders, but the number being given that as a primary diagnosis is almost the same. Hardly evidence that the conditions are more common.
Finally, the three children in every classroom figure seems to date back to surveys from 2004. So once again the study seems less than up to date. Moreover, while I haven’t compared the methodology, I do recall reports that the rate for adults in surveys of mental health was 23%. Mental health is a very broad category, and half of people will have some kind of mental health problem in their lives, 3 children in every classroom is not that many, and without some indicator that their conditions are severe, that isn’t that many and is not a crisis.
As far as I can tell, there has been a long-term increase in the diagnosis of mental health problems over the last 50 years in young people (although I haven’t compared this with adult rates). Whether this is down to changes in diagnosis or in mental health I could not answer. But I can say that the idea that there is a “mental health crisis” in schools that has happened in the last few years seems to be lacking in good evidence from those who are claiming it is happening. By all means, let’s discuss the issue. Mental health is important. But let’s not be panicked by talk of “crisis” and let’s be very wary of the various vested interests who tell us they have answers to the problem. At the very least, let’s argue for long term investment in CAMHS, not gimmicks like happiness lessons or attempts to dumb down education to make it less stressful. Nor should we forget that, when asked, “Most children report high or very high personal well-being”.
Scenes From The Battleground 
According to today’s Times, this Devon woman is also behind a boycott of KS1 SATs, on similarly spurious ‘mental health’ grounds. A nasty piece of work all round.
There is a wide call for boycotting SATs; how on earth does this make Ms Devon a ‘nasty piece of work’? No need for personal attacks here at all.
Not to mention the additional stress on the health service-
‘…It shows young people attending A&E are more likely to be booked in as having mental and behavioural disorders, but the number being given that as a primary diagnosis is almost the same. Hardly evidence that the conditions are more common.’
I agree that we “see what we want to see” and hyping up these issues helps no -one.
But in the useful link you share at the end, one in ten children aged 10 to 15 report low levels of happiness (2014). That correlates well with the “three in every classroom” statistic (if one assumes 30 in a classroom).
As I say, I didn’t doubt the statistic, just what it means. It actually seems low.
Interesting post. However, I think the term FAE actually refers to admissions to the hospital as an inpatient. People who come to A&E are “attending” but are only “admitted” if they are going to occupy a hospital bed. The FAEs in that table wouldn’t all stem from A&E visits, either, as evidenced from the fact that the number of FAEs is actually higher than the A&E visits in the first 3 columns. Some would come from GPs, etc.
I suspect the increased A&E visit rate reflects the undoubted decreased provision of services in the community, services which of course aren’t shown in that table. Thus it is impossible to tell how much of the increase is due to increased illness rates, as opposed to visits from children who would previously have accessed services in the community.
Another point worth making is that those figures don’t show how many of the A&E visits are from the same children making repeat visits for the same condition. So a child who might previously be counted just once as a community mental health services user, would via A&E be counted multiple times, once for each visit.
Just to add: multiple attendances would help explain why the rise is so very sharp.
It also means that the claim on the Young Minds website is either ignorant or dishonest, that “the number of children” has doubled rather than “the number of visits”.
Really interesting post! I was searching for child mental health figures & went to young minds’ website but noticed the dates were very old – then found your post. There is apparently a new govt. study happening this year – https://www.gov.uk/government/consultations/the-survey-of-the-mental-health-of-children-and-young-people-2016-consultation-on-survey-content – and it’ll be interesting to see the results. Meanwhile, I absolutely agree that more that putting money into genuine psychological services such as CAMHS and Educational Psychologists is vital rather than any ‘quick fixes’ – though perhaps given the current climate, raising awareness in schools (for pupils and also teachers’ mental health) anway is a good thing. The panorama programme this week illustrated why http://www.bbc.co.uk/iplayer/episode/b077r82t/panorama-im-broken-inside-saras-story
A very interesting post. I wrote this a while back in response to an article on mental health and young people: https://lenabellina.wordpress.com/2016/03/20/generation-leisure/
I completely agree that an increase in specialist services like CAMHS is essential to help address mental ill health amongst young people. But I do think that we can all, as educators, help children and young people to develop skills in coping with the ups and downs of life.
There is little value in arguing about the statistics referred to and certainly no positive gain in belittling colleagues whatever one’s position or perspective. I would simply point to the following BBC articles;
http://www.bbc.co.uk/news/education-35502394
http://www.bbc.co.uk/news/education-34733952
http://www.bbc.co.uk/news/education-35113899
Whilst I agree that we should be aware of “vested interests”, “As far as I can tell…..” and “…..I could not answer” reduce your well intentioned remarks to opinions which seems out of character – but maybe that was the intention? A wee bit of devil’s advocacy? Fair enough on a bank holiday weekend!
Having led in PRU, special and mainstream, there is significant evidence from my experience of a rising need for mental health intervention which therefore implies an increase in numbers of children at risk (no, no statistics or research, you will just have to take my word for it). This coincides with a generally poor response from an over-stretched CAMHS service causing a bottleneck – not a crisis – which can be improved through investment, NHS commission review and schools becoming more proactive. The reasons for the rise could come from a variety of life circumstances and social issues and, possibly, the current drive in many schools for results. Who knows, and that’s a huge debate which needs to happen, of course, but not in the context of the intervention discussion.
Schools can definitely have a proactive influence. Many schools suffering from reduced budgets and other financial constraints have cut pastoral staff who would have supported the most vulnerable and filtered the most at risk to referral stage for CAMHS intervention or advice. Many have not and support their children to excellent effect but experience inadequate CAMHS provision for those at severe risk. However, without going down the “gimmicks” route, there is plenty schools can do to create an ethos which is both supportive and effective in addressing mental health (and most of it is free!).
See:
https://www.minded.org.uk/
http://www.cypmhc.org.uk/
http://www.youngminds.org.uk/
http://www.mind.org.uk/
https://www.restorativejustice.org.uk/restorative-practice-schools
There are loads of others but get some training before jumping in at the deep end. And, for those with a lead role in maintaining or monitoring children’s mental health, have a good look at:
Click to access Guide-COOP-Book010414.pdf
Whilst you are at it, consider the same for staff mental health. Workload issues, data driven performance management, unpaid overtime, etc, etc are increasing stress and anxiety to ridiculous levels causing some damn good folk to exit our vocation. Our profession could do with a good old shake up and move away from the deficit driven model of improving teaching to a strength based approach. We work best as collaborators not backside kickers so why do we let this woeful system prevail? Sorry – a wee hobby horse of mine and a nip of devil’s advocacy back at ya.
Happy holiday weekend!
You haven’t pointed to anything new. You are just confirming that there are a lot of claims about a children’s mental health crisis and a lot of organisations who are not run by medical professionals promoting the claims and offering to provide answers.
Honesty and scrutiny is important here if effective action is to be taken. If you can’t see why, then consider the possibility that if you were writing that comment a year or two earlier you’d have been likely to put Kids Company on the list too.
I don’t refer to anyone other than organisations affiliated to or working in tandem with RCPSYCH – run by medical professionals, I believe. Also, I understand the importance of honesty and scrutiny having spent 30+ years working with vulnerable children but thanks for the advice.
My intention was to highlight good practice and signpost for those interested in mature reflection.
One of the websites you linked to was an organisation I’d linked to above as the source of misleading statistics. One of them was a group campaigning against effective discipline in schools. So I think I’ll stick with the conviction that scrutiny is most definitely needed before we turn to charities, rather than mental health professionals, over this issue.
There was no suggestion that we should “turn to charities”. The organisation is referred to for it’s resources, advice and ideas. If one feels they are appropriate and useful, then the signpost is useful. I leave the choice to professionals and I stand advised by mental health professionals from RCPSYCH and CORC.
I read your post with interest as I am training as an Educational Psychologist and I am very aware of the government’s renewed focus on tackling mental health in schools. In March 2016 they published a guide to school staff on Mental Health and Behaviour in Schools: “This non-statutory advice clarifies the responsibility of the school, outlines what they can do and how to support a child or young person whose behaviour – whether it is disruptive, withdrawn, anxious, depressed or otherwise – may be related to an unmet mental health” need. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/508847/Mental_Health_and_Behaviour_-_advice_for_Schools_160316.pdf
As for whether there is a crisis; there is no doubt that many young people are in need of mental health services – when I run exam anxiety sessions at schools, the young people who attend often have anxiety far beyond just worries about passing exams, which actually interferes with their daily lives. Sadly, I know when I suggest they seek help through their GP that they are unlikely to be seen by CAMHS because these services have increased their threshold to Tier 3 (severe, persistent problem). Tier 2 services, which may prevent a child or young person ending up with a severe, persistent problem, are now mainly delivered by voluntary organisations and charities. This means the service is patchy and in some areas practically non-existent. So yes, access to mental health services maybe contributing to the ‘crisis’ because children and young people without early support will get sicker and then need more intensive support. This is why, of course, the government are now focused on mental health in schools because they need schools to offer more Tier 1 e.g. PSHE lessons for all children, and Tier 2 e.g. targeted group sessions to build esteem, services. In some ways this is good news because whole school approaches to mental health have a growing evidence base and, more importantly, we want all children and young people to not only be free of mental ill health, but to be in the best mental health they can be. However, schools do need access to appropriate mental health professionals such as clinical and educational psychologist to ensure that the whole school approaches they adopt have a sound evidence base, as well as to offer more intensive support as required. There is a chronic shortage of Educational Psychologists, although the government have recently increased the annual training number to 150 from 132.
In terms of why there may be an increase in mental ill health in children and young people, research shows a link to adverse life events and societal factors. Since 2010 many more families have found themselves struggling to make ends meet. Poverty significantly increases the likelihood of mental ill health. For example there has been an increase in children and young people self-harming over the past decade (evidenced by hospital admissions and calls to helplines). https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/252660/33571_2901304_CMO_Chapter_10.pdf
Certainly the unrelenting focus on standards, assessments and exam results has also contributed to school level factors and there are many parents who have seen first-hand the pressure now on teenagers to get C grades in the ‘right subjects’ – throw in demoralised teachers and ever decreasing budgets – it is no wonder pupils are struggling with positive mental health.
You are right the statistics on the apparent ‘crisis’ are twelve years old, so we can’t be certain that rates overall are up, nor if the profile of the problems have changed. However, a more recent survey conducted in Scotland in 2007 (Twenty-07 study), seems to corroborate the 2004 survey, in terms of an increase in mental health cases in children and young people. And from the wellbeing survey you quoted from there seems to be a worrying amount of bullying in UK schools when compared with other countries, which we know increases the likelihood of mental ill health four fold.
Where I disagree is that schools should only be concerned with teaching and learning because in order to learn you need to be psychologically healthy. Learning is near impossible if you are suffering from anxiety or depression or other mental health issues.
Thanks for raising this issue, it is important that we scrutinise the figures, but we mustn’t ignore hard real word evidence such as the impact of austerity on mental health. Recent evidence for adult mental health shows a significant increase between 2009 – 2013 http://www.sciencedirect.com/science/article/pii/S0277953615302173. And where parents have poor mental health then often so do their children.
For more evidence of impact see https://psychagainstausterity.wordpress.com/
I read this article a while ago..
http://www.frankfuredi.com/article/stop_medicalising_pupils_normal_tensions_and_anxieties_as_mental_health_con
As an A level teacher, I have witnessed increasing students diagnosed with different disorders- anxiety, depression, bi polar etc.
I think some of it is indeed very real. However. growing up has always been a difficult time, I remember my own teenage years as a time of angst.
The difference? – And I think this article has it spot on- is we had resilience to deal with the stress and anxiety. This should be a key focus in schools and families.
I am not trivialising mental illness, I think it is awful that funding is being cut, but I do think we should also look at responses to anxiety, depression etc.
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Reblogged this on The Echo Chamber.
[…] In Lies, Damned Lies and Child Mental Health Statistics I observed that a number of interested parties (particularly the charity Young Minds and the now sacked “mental health champion” Natasha Devon) were claiming that children’s mental health problems had massively increased, by misusing and misinterpreting statistics. […]
We must move beyond the limitations of the DSM and labels and raise our collective emotional intelligence instead. People, young and old, live with adversity and a spectrum of differences. If we learn this and create communities which acknowledge and honor this we will transform, not just our systems of education but the very fabric of our societies. My two cents. ;)
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