Highlights in child mental health research: February 2023

This month’s highlights include:

• Experiences with mental health crisis services for children and young people
  

This systematic review examined 138 reports on mental health crisis services for children and young people. The study highlights challenges, facilitators, experiences, and perceptions of crisis support, including from the perspectives of children and young people. Findings indicate that there is a lack of early intervention mental health support for children and young people, and crisis services tend to be inaccessible and unsuitable to the needs of children and young people.

• Parent and teacher knowledge and recognition of mental health difficulties in children

This systematic review focused on parent and teacher recognition of mental health difficulties in children. The study found that teachers generally have good recognition of childhood ADHD, but less knowledge of internalising disorders. Few studies addressed parent knowledge or recognition of mental health difficulties in children.

• How parents influence their children’s mental health service use

This study examined, through interviews with adolescents, how parents supported or inhibited their children’s access to and use of mental health services. The study found that parents can be both a help and a hindrance. Some adolescents are reliant on parents for problem recognition, help-seeking and access to mental health services. A lack of support or poor facilitation by parents can obstruct service use.

• Associations between mental health-related hospitalisation, child protection and youth justice

Using data from 14,972 children and young people in the Northern Territory, this study investigated the relationships between mental health-related hospitalisation and involvement in child protection and/ or youth justice. Children and young people with a mental health-related hospitalisation were more likely to have been involved with child protection and youth justice, than those without. Children and young people who had involvement with child protection were also more likely to be in detention than those with no child protection involvement.

Why is this important?

• Rising demand and increasing healthcare waiting times mean more children and young people (CYP) are presenting at mental health (MH) services at crisis point.
• This study investigated MH crisis services in hospital and community settings for CYP, including the experiences and perceptions of CYP and families, and the effectiveness of these approaches.

What did they do?

• This systematic review analysed 138 English-language reports on the provision and reception of crisis support for CYP aged 5-25 years, published between 1995-2020.

What did they find?

• Crisis services included: triage/assessment-only; digitally mediated support approaches; and intervention approaches and models.
• From thematic analysis of qualitative data on CYP experiences, four themes emerged: (a) barriers and facilitators to seeking and accessing appropriate support; (b) what children and young people want from crisis services; (c) experiences of crisis services among children, young people and families (d) the challenges of service provision.
• The findings indicate that CYP want the following from crisis services:
  • Immediate and 24/7 access to services that cater to their age
  • Peer support and CYP participation.
  • Different forms of support, including telephone, text, and email. CYP like the immediacy and anonymity of text and the ability to refer to messages later.
  • For health professionals in crisis services to have good listening skills, be understanding, compassionate, and skilled in MH issues specific to CYP.
• Key barriers and concerns for CYP accessing support included:
  • A general lack of support before crisis is reached, including long wait times and various thresholds to access specialist services.
  • A lack of available and accessible information for CYP on how to seek support when experiencing a MH crisis.
  • Geographical and transport issues (e.g., travel and financial barriers).
  • A lack of safe spaces for CYP in MH crisis. Assessment, management, and level of follow-up care for CYP who present to emergency departments in crisis is limited. They can also be stigmatising and noisy environments, with a lack of privacy.
  • Hospital admission processes can be lengthy, overcomplicated, and frustrating.
  • CYP think crisis plans lack sufficient detail and follow-up support is lacking.

What does this mean for practice?

• Practitioners should consider how best to provide information to CYP and their families about available MH services and early intervention supports, and how to access
• MH services could better support CYP by addressing key barriers and incorporating the specific needs or CYP.
• CYP should be involved in the development of services and public information.

Read the full text

Why is this important?

• This study reviewed the literature on mental health (MH) literacy for supporting children among parents and teachers of children 5-13 years.

What did they do?

• This systematic review analysed and assessed 39 qualitative studies, published between 2000-2021 that explored mental health knowledge or recognition in children.

What did they find?

• The included studies reported knowledge or recognition of ADHD, general knowledge of mental health in children, diagnosis-specific knowledge, recognition of internalising and externalising disorders and autism spectrum disorders (ASD).
• Almost half of the studies (n=19) focused on teacher awareness of ADHD. Few reported on parent knowledge or recognition (n=5).
• The literature was classified most often as low or moderate quality (using the Appraisal of Cross-Sectional Studies guidelines). There was also no consistent measure of MH literacy used across the included studies.
• Teachers have some difficulty in distinguishing between the severity of symptoms and in recognising disorders with moderate or low levels of symptoms.
• In several studies, teachers reported having brief or inadequate training in child MH literacy.
• Although there were limited parent studies in the review, there was some evidence to suggest that parents may under-recognise MH difficulties especially internalising difficulties, and less severe presentations.
• There is some evidence that teachers are better able to identify ADHD and ASD in boys than in girls, and more accurate at identifying anxiety in girls than in boys.

What does this mean for practice?

• More training for teachers and parents on MH difficulties in children is warranted, especially for internalising disorders.
• There is limited evidence about parent MH literacy for children without a mental health diagnosis. This makes it challenging to design early intervention approaches involving parents that are evidence-based.
• The authors encourage use of the framework for conceptualising mental health outlined in the Australia’s National Children’s Mental Health and Wellbeing Strategy 2021, as it focuses on functional impairment and distress (rather than symptom categories) and could aid better assessment and early intervention.

Read the full article

Why is this important?

• This study explores how young people view their parent’s influence on their mental health service (MHS) access and use.

What did they do?

• Semi-structured interviews were conducted with 22 young people aged 14-18 years old in Perth, WA. All were current or recent users of MHSs, most were female and about half were LGBTIQA+.

What did they find?

• Descriptions of positive parental involvement by participants included the following:
  • Some participants felt that without their parents they would not have known how to access MHSs or had the motivation to reach out for help.
  • Some young people felt their parents initiated their decision to start accessing MHS and were advocates to ensure their needs were met.
  • Young people saw parents as necessary for practical support such as transport to appointments or arranging appointments.
  • Some participants believed their parents were the ones who supported, understood, and addressed their MH issues the most. This was attributed to their parents’ past experience with MH or work in health professions.
  • Some young people found their relationship with their parents was improved through MHS, through, e.g., learning to communicate with each other better.
• Barriers to MHS use and access, as identified by participants, included:
  • Reluctance to communicate with their parents about MH difficulties, including not wanting to burden or worry their parents (especially parents with their own MH issues), feeling discouraged to initiate MH-related discussions because they had not been well received in the past, or hiding MHS use.
  • A lack of emotional awareness and MH stigmatisation from parents, including feeling that their MH was not fully understood or dismissed by their parents.
  • Parents acting as gatekeepers to MHS access, resulting in young people feeling unaware of, or unable to access, support they needed.
  • Parents being unavailable or unmotivated to help their child to attend appointments or intervening only when their child had reached a crisis point.
  • Unstable family environments that made expressing emotions unsafe. This was also perceived as a contributing factor to the development of MH issues.

What does this mean for practice?

• Young people are often reliant on their parents for help-seeking and MHS access.
• MHSs need to be aware of the potential barriers created by parents and consider how they could be addressed. This could include creating pathways for young people to access MHSs independently, or ensuring effective lines of communication for adolescents whose parents are not supportive.
• Stronger problem recognition and MH literacy support for parents could support young people with help-seeking and with having their MH taken more seriously.

Read the full abstract

Why is this important?

• This study explored patterns of child protection and youth justice involvement among children admitted to hospital for mental health related reasons in the Northern Territory (NT), Australia.

What did they do?

• This study analysed linked administrative data from human service agencies for all children in the NT who turned 10 years old between 2004 and 2009, inclusive (total of 14,972 children and young people).
• The authors studied relationships between mental health-related hospitalisation (MHRH) and involvement with child protection or youth justice.

What did they find?

• Children and young people with any MHRH were more likely to have been involved with child protection and youth justice than young people without an MHRH.
• The prevalence of MHRHs increased as levels of child protection and youth justice involvement increased. Those who experienced both out-of-home care (OOHC) and youth detention had the highest prevalence for MHRHs.
• Compared to non-Aboriginal children and young people, a higher proportion of Aboriginal children and young people experienced child protection involvement (47% compared with 21%), youth justice involvement (21% compared with 5%), and one or more MHRH (5.5% compared with 2.3%).
• Of children and young people with two or more MHRHs and experience in OOHC, 77% had been in youth detention while only 27% had never been charged with an offence.
• Substance use disorder was the most likely diagnosis among young people with MHRH with any level of involvement in child protection and/or youth justice.

What does this mean for practice?

• Children and young people with child protection and youth justice involvement are at greater risk for mental health hospitalisation.
• Closer and more effective collaboration between child and adolescent mental health services, child protection, and youth justice systems in the NT could support better understanding and management of the psychiatric needs of children.
• Culturally safe trauma-informed responses in youth services may be beneficial.

Read the full abstract