1 in 10 Children Has A Mental Health Problem That Needs Treatment: At Least It's Not An Epidemic

What-E-ver. Attitude before platitudes.

I was initially quite cheered that this story about children's mental health wasn't described as an epidemic. However, when so many health issues are blared with brass trumpets and the sound of the falling walls of civilization as we know it, it is a little surprising to see almost a complete absence of hyperbole in a summary of a report that headlines One in ten youngsters suffers mental problems as behavioural disorders double in 30 years. The British Medical Association's Board of Science has published a report that finds:

• 1 in 10 children between the ages of 1-15 has a mental health disorder - ranging from sleep problems to excessive temper tantrums and depression
• more than one million children are suffering from mental disorders severe enough to require treatment
• more than 700,000 children are affected severely enough by behavioural disorders to require treatment, which disrupts school classes and family life
• the proportion of boys with conduct disorders has risen from 7.6 per cent in 1974 to 16 per cent in 2004. Among girls, the proportion has risen from 6 per cent in 1974 to 7.9 per cent in 2004, it's suggested that they may be under-diagnosed
• ADD affects a further 5.1 per cent of boys and 0.8 per cent of girls
• 16 per cent of children from families with a weekly household income of less than £100 suffered from mental health disorders. Only 5 per cent are affected in families with a weekly income above £600 a week.

Vivienne Nathanson, head of science at the BMA is quoted as saying:

There is a huge need for robust measures to ensure children and adolescents are able to cope. Children from deprived backgrounds have a poorer start in life on many levels but without good mental health they may not have a chance to develop emotionally and reach their full potential...Healthcare professionals are realising just how important diet and exercise are in preventing mental health problems and it is vital more research is carried out. Anecdotal evidence suggests behaviour and concentration deteriorate with processed sugary food.

Now, I'm all in favour of research that tests whether received wisdom is true, but in with the stuff that my granny could have told me, I also like to see findings that might have elicited a, "Who'd have thought?": the latter is distinctly lacking in this summary. Vivian Nathanson's follow-up comment piece, No single cause: no easy answers to help youngsters is no more illuminating.

The stresses and complexities of modern-day life also play a part. Just because a child is brought up in a deprived environment or is a victim of a family break-up does not necessarily mean they will develop a mental health disorder but those life events may trigger a pre-disposition to developing a problem or just reduce the ability of the child to cope. We can say for certain that deprivation, family and financial instability and poor environmental surroundings do not help children flourish.

I agree but for heaven's sake! This is the 21st century and this is sounding like the founding document for a Workhouse.

The care and training of children are matters which should receive the anxious attention of Guardians. Pauperism is in the blood, and there is no more effectual means of checking its hereditary nature than by doing all in our power to bring up our pauper children in such a manner as to make them God-fearing, useful and healthy members of society. From the Poor Law Handbook of the Poor Law Officers' Journal in 1901.

I don't think that any of us were in any doubt that this is a wicked problem. (Wicked problems were first identified in the area of public policy and are described as "a set of problems that cannot be resolved with traditional analytical approaches". It is the nature of wicked problems that unanswered questions and chronic issues can take years to work out or never be satisfactorily resolved.) However, I'd have liked some exploration of other countries where divorce, single parenthood, family breakdown and reconstitution don't seem to lead to the same disastrous consequences as are reported in the UK. As for the observations about healthy eating and lifestyle, I think we are beyond anecdotal evidence: Tony Plant offers a good overview of the research in Fish v. Drugs for Children and Criminals and (courtesy of Gladwell) explores some of the more complex issues that influence food choices.

There is an unhelpful side-bar by Caron Kemp in the main article that gives an insight into a single mother's difficulties when caring for an autistic child. Fair enough. What was completely unhelpful was the mother's concluding declaration:

The main thing is that the children don't need to change, but society needs to.

What? What do you think that the specialist interventions, treatments and 'lack of help' that the mother criticises are intended to do? They are intended to change the children's behaviour and responses. Since when have they not contributed to who we are?

The sidebar is shoddy reporting, poor editing or the regurgitations of a generic complaint with no need to explain the thinking behind the comment (in some ways, this is related to what Dr. Crippen has dubbed the Vera Lynn Syndrome:something so self-evidently 'good' that it requires no explanation). But I'm going to ask the question, in what ways does society need to change? To indulge in shoddy writing and strawmen, I wanted to run the Pinker-esque exercise of using thought experiments from Robert Nozick. But I'm hampered because I don't know what the mother is complaining about beyond 'lack of help when they have incidents'. What does the mother want? Social change that supports more generous attendance allowances or carers' benefits that might actually pay for additional help? A specialist day-school with home-helps? Respite care? More child mental health staff beyond the reported 40% increase since 2002? What? I can't believe that I'm about to say that the Daily Mail published We don't need to wipe out autism...we need to care more: an article that was much better written and contained a straightforward statement of needs.

...the 'problem' lies not with autism itself but with the way in which our society responds to it. As just one example there needs to be far more Government provision for the respite care that is so pitifully inadequate at present.

...we can afford to pay carers so we can spend some time getting on with other things and I believe that all parents of children with autism should be entitled to do the same.

There are an estimated 90,000 children with autism in the UK, but only 7,500 special places available for them in the education system.

I still have a problem with 'society' and 'government spending priorities' being used as if they are synonyms but I like the explicit recommendations although I am disappointed by the lack of any costings.

As summarised, the account in the Independent is disappointing: it's possible the full report is both more nuanced and interesting. In which case, the Independent's Health Editor's summary and Vivienne Nathanson's comment deserve a "Should try harder. Could do better". This is a wicked problem but we deserve some sensible proposals: something beyond, "We need more investment and more research" and the injunction that society should change. The poverty of imagination is one of the true scandals here. A different scandal is the complete lack of any attempt to cost this treatment for a million children: I shall have to apply a lot of ice to my temples and think about this.