Editorial Perspective: A call to collective action – improving the implementation of evidence in children and young people's mental health

With growing mental health needs of children and young people and the increasing demand on children and young people’s mental health services, narrowing the evidence to practice implementation gap has never been more important. Implementation science and research provides useful theory, identification of barriers and facilitators as well as suggested strategies for improved uptake of evidence-based treatments, but the application of these is often limited. Supporting optimal learning and implementation cultures based on collaborative, relational and pragmatic action planning is likely key. We propose suggested next steps and recommendations to move this agenda forward within the children and young people’s mental health field with a ‘call to action’. With the need for specific roles and clear accountability, we emphasise that between clinicians, researchers, consumers and policy makers this is everyone’s business.     

Editorial Perspective: The digital divide – inequalities in remote therapy for children and adolescents

COVID-19 has triggered a shift towards remote delivery of therapy and, despite a number of benefits, it risks discriminating against young people already marginalised due to adverse early life experiences, poverty or ethnicity. This editorial perspective considers challenges for remote therapy, focusing on: the financial burden of telehealth; the necessity of safety to speak; and, how telehealth may exacerbate difficulties in therapeutic alliance formation by interfering with epistemic trust and mentalising. As well as compounding the inaccessibility for children who are subject to abuse, the implicit assumptions behind telehealth risk disproportionately excluding from therapy those from a low socioeconomic status, and who are from ethnic minorities. Suggestions are made for how these challenges may be addressed. It is argued that service design and delivery should seek to proceed with the practicalities and principles of engagement in mind and use this as an opportunity to improve parity of access, rather than risk further entrenching inequalities.     

Editorial: Social media use in children and adolescents – on the good or the bad side of the force?

Children and adolescents spend increasingly large parts of their social life connecting with each other via social networks sites. While this is clearly an achievement and may have helped many of them during difficult COVID-19 lock downs, there is an ongoing political and scientific debate around the potential harm that (excessive) social media use may pose on young individuals. This editorial highlights a systematic review that was published on the topic of social media use and child and adolescent mental health, and sets the results of this review into a current research and public health perspective.     

Editorial Perspective: Mental health needs of children and young people of Black ethnicity.1 Is it time to reconceptualise racism as a traumatic experience?

We explore racial inequality in relation to Black children and young people (CYP) and Child and Adolescent Mental Health Services (CAMHS). We argue that the experience of racism should be universally considered an Adverse Childhood Experience (ACE). We argue that racism and the vicarious trauma arising from exposure to frequent media reports of racially motivated violence against persons of Black ethnicity can all predispose Black CYP to increased risk of mental health problems. We make recommendations to improve Black CYP’s early access to CAMHS, and to reduce their overrepresentation in psychiatric in-patient settings in the UK. This would require making CAMHS more welcoming to Black CYP and consideration of the impact of racism and trauma in the diagnostic and treatment formulation for Black CYP. This should include: the impact of racism in staff training, improving the cultural competence of CAMHS staff, and supporting Black CYP to articulate their experiences of racism and related traumas whilst facilitating their development of coping strategies to manage these experiences.     

Editorial: New insights into self-harm among children and young people – renewed links with inequality,new opportunities for recognition and new treatment option

Supporting children and young people (CYP) who self-harm (SH) is an important work of Child and Adolescent Mental Health Services (CAMHS). This theme is reflected in three papers in this issue. Starting with risk factors, Marraccini and colleagues found that compared with adolescents, preadolescent children with suicidal behavior were more likely to be male, from a Black ethnic background, or to have a neurodevelopmental disorder such as autism spectrum condition (ASC) or ADHD. These authors’ finding of increased school-related stressors emphasizes the importance of educational adjustments in reducing the risk of SH among CYP with ASC and ADHD. Ward and Curran’s study suggests that screening for ADHD symptoms among CYP who present with SH may improve early identification of those affected by ADHD—especially among females. Finally, Ramsey and colleagues found that coupling dialectical behavioral therapy (DBT) with a specific intervention targeting self-criticism reduced episodes of SH more than standard DBT alone. Given the link between SH and suicide, improving understanding of the risk factors, early identification, and new treatment options for SH remain important.     

Living with ‘Hwa-byung’: the psycho-social impact of elder mistreatment on the health and well-being of older people

Objectives: Elder abuse and neglect is an increasing concern that adversely affects the health and well-being of older people in most societies. The purpose of this paper is to describe the psycho-social impact of elder mistreatment on the health and well-being of older Korean people living in New Zealand.

Method: Data were collected from in-depth interviews. The lived experiences of elder abuse and neglect were studied with 10 older people who were, or who had been, mistreated in their family context. To analyse the data collected, a combined analysis approach was employed using traditional code-based techniques and a concept-mapping method.

Results: The findings of the study show that the effects of elder mistreatment were complex and multidimensional. The older persons who were mistreated in family settings experienced a range of emotional, psychological distress and physical symptoms. Many of them identified ‘Hwa-byung’ (literally anger disease) as a health issue associated with suppressed emotions of anger, demoralisation, heat sensation and other somatised symptoms.

Conclusion: Elder abuse and neglect is a traumatic life event that has considerable psycho-social impacts on older people experiencing the problem. It is important to recognise the power of multidimensional challenges caused by elder mistreatment in health and well-being.     

Magnetic resonance imaging of the brain in children and young people with cerebral palsy: who reports matters?

Retrospective case note audits were undertaken of children with clinically diagnosed cerebral palsy known to paediatricians and physiotherapists in Sunderland (UK). Evidence of brain magnetic resonance imaging (MRI) was recorded, including expert opinions requested, in order to quantify the perceived mismatch between local, general radiological and regional, specialist neuroradiological reporting, towards ensuring the best possible yield to inform clinical practice and accurate information-sharing with families. One hundred and ninety-seven out of 214 (92%) had documented neuroimaging; 111 out of 197 (56.3%) were dual reported. Only 34 out of 111 reports were concordant overall. Sixty per cent of brain MRI reported as normal locally, were found not to be normal on specialist review. Clinicians requesting brain MRI in children with disordered development must be mindful of the expertise of those reporting. Those based in district settings must network closely with specialists in expert centres, if disabled children and young people are to receive equitable care of the highest standard.     

The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: A case–control study

PurposeThe present study aimed to assess the impact of the ketogenic diet on arterial morphology and endothelial function of the big vessels of the neck and on cardiac diastolic function, in a cohort of epileptic children and young adults treated with the ketogenic diet.MethodsPatients were recruited based on the following inclusion criteria: (1) patients who were or had been on the ketogenic diet for a time period of at least six months. Each patient underwent measurement of carotid intima media thickness, carotid artery stiffness, echocardiography, and diastolic function assessment. Patients with drug resistant epilepsy, matched for number, age and sex and never treated with ketogenic diet, were recruited as controls.ResultsThe population study was composed by 43 epilepsy patients (23 males), aged between 19 months and 31 years (mean 11 years). Twenty-three patients were or had been treated with ketogenic diet, and 20 had never been on it (control group). Subjects treated with the ketogenic diet had higher arterial stiffness parameters, including AIx and β-index and higher serum levels of cholesterol or triglycerides compared to those who had never been on the diet (control group) (p < 0.001).ConclusionsArterial stiffness is increased in children and young adults treated with the ketogenic diet, before the increase of the intima media thickness. This supports that arterial stiffness is an early marker of vascular damage.     

Debate: Is there a true global children and young people mental health crisis? Fact or Fiction: A South African Perspective

The article seeks to discuss the complexities that prevail in South Africa in attempting to understand the debate about whether there is a true global children and young people mental health crisis in the country. In the absence of reliable and current epidemiological data and prevalence studies, assumptions can only be made about the extent of the crisis when considering the prevailing social determinants of mental disorders. The lack of investment, limited child and adolescent mental health resources, and inadequate access to treatment complicate this crisis as many children and young people go untreated. The author argues that the debate should be focused on the need to address the risk factors that perpetuate the ever-increasing mental health concerns of children and youth in South Africa.     

Eco-crisis and mental health of children and young people: Do child mental health professionals have a role?

Child mental health professionals have an extremely important role to play in their distinct roles as clinicians, therapists, researchers, policy makers, advocates, preventative public health professionals and service developers pertaining to eco-crisis in the child and adolescent populations. This article provides examples of how this can be done.     

Editorial Perspective: Missing the forest for the trees – how the focus on digital addiction and gaming diverted attention away from wider online risks

Despite the many ways in which Internet-related technologies can affect psychology, research into the Internet’s mental health consequences has disproportionately focussed on the narrow topics of online addiction and the closely related Internet gaming disorder. Over two decades into the online revolution, the Internet is being blamed for dramatic transformations, including a rise in extremism, social polarization and weakened democracies. In trying to understand how these shifts could have happened, or how they might be contained, society looks to mental health experts – after all, it is the interaction between technology and human psychology that is encouraging certain behaviours online and discouraging others. The field, however, has precious little to offer by way of explanations. To no small degree, this is due to the tendency to approach online psychological problems primarily through the addiction framework. The result has been to blind us to other important traits and phenomena that are playing out online and on social media, including impulsivity, aggression, inattention, narcissism and the psychological meaning of living in a postprivacy world. The article covers historical aspects of how the addiction model came to dominate the field; some insufficiently heeded early warning signals about other online ills and the big price society is paying today for this approach. We end with a call for a significant broadening of the focus of research when it comes to online psychopathology.     

Debate: The greater the needs the lesser the evidence – therapeutic residential care for young people

In this debate article, we provide our thoughts and reflections on the issues and uses of Therapeutic Residential Care (TRC) in child welfare systems in the US and England. We highlight the issues associated with the lack of clarity of how TRC is defined and when and how it is used. The premise for the article is that some of our most vulnerable young people are living in residential homes without there being a sufficient evidence base to understand whether their needs are being adequately met, or the best outcomes are being achieved. We set out some suggested elements to try to progress debates and decisions that will ultimately improve the services and placements that are provided.     

What do children and young people want from mental health services?

PURPOSE OF REVIEW: The purpose of this paper is to review the literature reporting on children and young people's views on child and adolescent mental health services. RECENT FINDINGS: The review demonstrates that there is limited research exploring the views of children and young people regarding mental health services. Despite its limitations, the research available shows that young people, their parents and healthcare providers often have different expectations of services. Young people want accessible services staffed by those they are able to trust and who demonstrate an ability to listen; above all, young people want to be involved in the decisions made about them. SUMMARY: To date, children and young people have not been actively engaged or involved in service development. This is an evolving field and we need to ensure that existing evidence is taken into account as well as investigating further the views of young people. Child and adolescent mental health services need to consider how we serve young people, particularly children, whose perspectives may differ from those of their parents.     

The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help

Purpose  

In this study, we examined whether young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help are influenced by their own, and their parents’ stigmatising attitudes towards young people with mental disorders.     

Debate: Should academics collaborate with social media and gaming companies to identify and reduce mental health impacts on children and young people?

Should academics collaborate with social media and games companies to reduce harms or might there be an alternative approach that would ensure young people's well-being is considered during the design-and-build process for platforms, games and services.