Developing needs led child and adolescent mental health services: issues and prospects

For many years mental health services for children have been developed incrementally with little attention to the needs of the local population. However, over the past decade there have been attempts to develop more rational ways of planning child mental health services. This paper describes the information required to develop a needs-led child mental health service and, within that context, discusses how priorities should be set. It will be suggested that although the assessment of needs for child and adolescent mental health services is still very haphazard, there is now a clear trend for the evaluation of clinical practice to become more systematic. At an individual level we know quite a lot about the efficacy of treatment and the measurement of outcomes. At the service level, several models of good practice are being specified and evaluated. Accepted: 16 September 1998     

Editorial Commentary: An agenda for global child mental health

Even as mental health has become increasingly recognized as a key issue in global health, child mental health has largely remained in its shadows. This is possibly because many interventions for child mental health lie outside the realm of narrowly defined biomedical interventions and platforms, with the majority of interventions targeting psychological and social mechanisms and a strong emphasis on prevention. This situation must change, however, as child mental health interventions have potentially the greatest impact on the burden of mental disorders, and other health and social outcomes, than at any other time in the life course. There is now a growing body of evidence that indicates which interventions are ready for scale‐up or show sufficient promise for further research and refinement. These are primarily delivered in community or school platforms through nonspecialist workers in partnership with parents and teachers. They include interventions to promote early child development, parenting interventions through childhood into adolescence, school interventions aimed at reengineering school environments and strengthening life skills, and interventions for the early detection and management of neurodevelopmental disorders and mental health problems through trans‐diagnostic interventions based on impairments. Above all, what is needed is a population‐based approach, which emphasizes the goal of coverage of evidence‐based interventions for all children; with a particular focus on disadvantaged children; with seamless coordination of preventive and treatment interventions across platforms of care; and utilizing collaborative, stepped‐care delivery paradigms.     

Recent trends in UK child and adolescent mental health

Background Past studies have documented rising levels of conduct problems among UK adolescents in the last quarter of the twentieth century, and increased rates of emotional difficulties between the 1980s and 1990s. Method We used parent, teacher and youth ratings from two large scale, nationally representative studies of 5–15 year-old carried out in 1999 and 2004 to assess whether these increases continued into the early years of the new millennium. Results Ratings on most “problem” sub-scales remained stable or showed small declines over this period, and parent and teacher reports suggested small increases in levels of prosocial behaviours. Conclusions The upward trends in rates of UK child adjustment problems noted since the 1970s and 1980s may have plateaued, and possibly begun to be reversed.     

Consequences of prenatal toxin exposure for mental health in children and adolescents

Drug use during pregnancy is common and the developing foetus may be exposed to a range of environmental toxins that have long-term consequences for neurodevelopment. We conducted a systematic review of the literature to explore the results of longitudinal cohort studies that have examined this question. Out of 2,977 abstracts identified, 7 previous systematic reviews and 95 original articles met further selection criteria. These mostly addressed the neurodevelopmental effects of exposure to lead, polychlorinated biphenyls, mercury, cocaine, alcohol, marijuana, cigarettes and antidepressants. Radiation, opiates, steroids, amphetamines and caffeine have received much less attention. Findings are difficult to interpret because risk factors tend to cluster together and interact. However, some findings are consistent. Lead and PCB’s have a general effect on brain development, whilst marijuana and alcohol appear to have long-term effects specifically on attentional skills. The effects of alcohol increase with maternal age and binge drinking is more important than average intake. The effects of cocaine diminish with age and are largely mediated through psychosocial factors, whilst the relation between smoking and later delinquency is largely mediated by genetically inherited factors. Exposure to toxins during pregnancy may constitute an important but relatively unacknowledged cause of child psychiatric morbidity. Electronic Supplementary Material Supplementary Table 1 for this article is available at (doi:) and is accessible for authorised users only     

Russian child mental health A cross-sectional study of prevalence and risk factors

Abstract Background The fall of communism and subsequent economic crises have been followed by major social and health problems. High rates of child mental health problems are frequently cited by the Russian media, though there is little relevant evidence. Aims The aim of this study was to investigate the prevalence and associations of child mental health problems in Russia using internationally recognised measures and diagnostic systems. Method A two-stage, two-phase cross-sectional survey of the mental health of 7- to 14-year-olds involved random sampling of schools, followed by random sampling of pupils from school lists. A sample of 448 children was obtained, representing an 83% participation rate. In the first phase, screening measures of psychopathology and risk were administered to parents, teachers and 11- to 14-year-olds. In the second phase, more detailed psychiatric assessments were carried out for subgroups of screen-positive and screen-negative children (N=172). Results The prevalence of psychiatric disorder was about 70% higher than that recently found in Britain with comparable measures, but there were few differences between Britain and Russia in type of disorder or key risk factors. Conclusion There is a pressing need for evidence-based mental health treatments to be made widely available to Russian children and adolescents.     

Transitioning from child and adolescent mental health services with attention‐deficit hyperactivity disorder in Ireland: Case note review

In a context of international concern about early adult mental health service provision, this study identifies characteristics and service outcomes of young people with attention‐deficit hyperactivity disorder (ADHD) reaching the child and adolescent mental health service (CAMHS) transition boundary (TB) in Ireland. The iTRACK study invited all 60 CAMHS teams in Ireland to participate; 8 teams retrospectively identified clinical case files for 62 eligible young people reaching the CAMHS TB in all 4 Health Service Executive Regions. A secondary case note analysis identified characteristics, co‐morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). Two‐thirds of young people with ADHD were on psychotropic medication and half had mental health co‐morbidities, yet none was directly transferred to public adult mental health services (AMHS) at the TB. Nearly half were retained in CAMHS, for an average of over a year; most either disengaged from services (40%) and/or actively refused transfer to AMHS (35%) at or after the TB. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. Despite high rates of medication use and co‐morbid mental health difficulties, there appears to be a complete absence of referral to publicly available AMHS for ADHD youth transitioning from CAMHS in Ireland. More understanding of obstacles and optimum service configuration is essential to ensure that care is both available and accessible to young people with ADHD.     

Parental involvement and mental health among Thai adolescents

The objective of this analysis was to examine the associations between parental involvement and mental health in Thai middle school students. Data from the 2671 school-going adolescents aged 12–15 y who participated in the nationally representative Global School-based Student Health Survey in Thailand in 2008 were analysed. About 16.5% of students reported symptoms of depression, and about 8.6% reported having seriously considered suicide in the past year. High levels of parental involvement – homework checks, monitoring of free time and seeking to understand children's problems – were associated with significantly lower odds of symptoms of depression and suicidal thoughts for both boys and girls. Skipping school without permission was associated with significantly increased odds of poor mental health, including loneliness and anxiety. Active parenting and effective communication between schools and parents about truancy may contribute to the promotion of adolescent mental health and early detection of psychological problems.     

Changing pattern of mental health utilization in Hachijojima

Abstract We have reviewed retrospectively 229 patients interviewed by the mental health team in the Hachijojima since the establishment of our services in 1987. The 6 year observation period was classified into three chronological stages for the purposes of identifying any change in the utilization pattern of the mental health services of the island. The rate of schizophrenia was observed to have decreased from 48% in the first 2 years of the study period to 28% in the last 2 years; while that of other mental disorders increased yearly. Interestingly, an increasing number of patients were referred to our services by professionals in areas other than mental health (from 42 to 77%), and patients without any history of psychiatric treatment were more frequently seen (from 36 to 75%) in the later part of the study period. These changes suggest the importance of access to mental health services.     

新兵积极心理品质和父母教养方式与抑郁情绪的关系

目的：探讨新兵积极心理品质和父母教养方式与抑郁情绪的关系。方法采用新兵积极心理品质评估问卷（PMCS －R）、父母教养方式评价量表（EMBU）及抑郁自评量表（SDS）对某部2013年和2014年秋季入伍的6830名新兵进行测试。结果（1）抑郁情绪与积极心理品质以及EMBU中的父母情感温暖理解、父亲过分干涉和过分保护均呈负相关（r ＝－0．585～－0．057,P＜0．05）,与EMBU中的其他各因子均呈正相关（ r＝0．035～0．288,P＜0．05）;除父母偏爱被试外,积极心理品质与父母惩罚严厉、拒绝否认均呈负相关（r＝－0．179～－0．133,P＜0．05）,与EMBU中的其他各因子均呈正相关（r ＝0．015～0．917,P ＜0．05）。（2）PMCS －R中除正义维度外的其余5个维度,以及EMBU中的父亲情感温暖理解、拒绝否认、过分干涉和母亲情感温暖理解、惩罚严厉、过分干涉保护对抑郁情绪均具有预测作用（ F＝293．685,P＜0．05）,可解释总变异的42．3％。结论积极心理品质和父母情感温暖理解是新兵抑郁情绪重要的保护性因素。     

Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization

The widely-used Kessler K6 non-specific distress scale screens for severe mental illness defined as a K6 score ≥ 13, estimated to afflict about 6% of US adults. The K6, as currently used, fails to capture individuals struggling with more moderate mental distress that nonetheless warrants mental health intervention. The current study determined a cutoff criterion on the K6 scale indicative of moderate mental distress based on mental health treatment need and assessed the validity of this criterion by comparing participants with identified moderate and severe mental distress on relevant clinical, impairment, and risk behavior measures. Data were analyzed from 50,880 adult participants in the 2007 California Health Interview Survey. Receiver operating characteristic curve analysis identified K6 ≥ 5 as the optimal lower threshold cut-point indicative of moderate mental distress. Based on the K6, 8.6% of California adults had serious mental distress and another 27.9% had moderate mental distress. Correlates of moderate and serious mental distress were similar. Respondents with moderate mental distress had rates of mental health care utilization, impairment, substance use and other risks lower than respondents with serious mental distress and greater than respondents with none/low mental distress. The findings support expanded use and analysis of the K6 scale in quantifying and examining correlates of mental distress at a moderate, yet still clinically relevant, level.     

Recommendations of mental health professionals and the general population on how to treat mental disorders

Objective The objectives of the study are (1) to assess the mental health literacy of mental health professionals, (2) to determine whether there is agreement between different professional groups with respect to different psychopathological conditions and (3) to compare the professionals' knowledge with that of the general population. Methods Two representative samples of mental health professionals and laypersons were presented with a vignette depicting either a person with schizophrenia, major depression or without any psychiatric symptoms (‘non-case’). Out of 18 treatment proposals, the respondents were asked to indicate the proposals regarded as helpful and those considered as being harmful, respectively, for the person depicted. Results Mental health professionals view their profession and less often their treatment methods as helpful. Dealing with the situation alone, electroconvulsive therapy, hypnotics and sedatives are consistently regarded as harmful. For the individual with schizophrenia, mental health professionals agree about helpful treatments. Regarding depression, a lack of consensus is found about treatment proposals such as psychiatric hospitalisation, antidepressants and complementary and alternative medicine. An important part of mental health professionals suggests medical help (psychologists and general practitioners) for the non-case vignette. Fewer nurses, social workers, vocational workers and occupational therapists (‘other therapists’) as compared to psychiatrists and psychologists recommend standard treatment methods. Professionals and the general population significantly differ in their attitudes towards the treatment suggestions, especially regarding medication and alternative medicine. Conclusions To improve the treatment of mental disorders, various strategies must be considered. These include permanent education of all mental health professionals, especially nurses and other therapists. A special focus must be given to affective disorders and a potential (over-) treatment of normal behaviour.     

驻舰艇军人心理状况与人格特征的相关研究

目的:探讨驻舰艇军人心理健康状态及相关因素。方法:采用症状自评量表(SCL-90)、艾森克人格问卷(EPQ)评估海军某水面舰艇200名驻舰航行(长航)前后的心理健康状况。结果:长航前,除人际关系因子外,驻舰军人SCL-90总分及其他因子分均较男性军人常模显著低(P<0.01)。长航后SCL-90总分及各因子分均有所提高,其中总分、躯体化、焦虑、恐惧及精神病性因子分变化有统计学意义(P<0.05或P<0.01)。驻舰军人EPQ各分量表得分与男性常模比较差异均无显著性(P均>0.05)。SCL-90各因子分与EPQ精神质、神经质呈显著正相关(P<0.01),与掩饰性呈显著负相关(P<0.01);而人际关系、抑郁、恐惧因子分与内外向呈负相关(P<0.05或P<0.01)。结论:驻舰军人心理健康水平较好。人格特征与应激状态下心理健康水平关系密切。