Mental health report set to confirm fears

Nicholas Pyke

An increase in psychological disorders in children and adolescents is expected to be revealed in a major study of young people's mental health across Europe and North America.

The study, which is to be published next week, has been written by Professor Sir Michael Rutter from the London Institute of Psychiatry and Professor David Smith, a criminologist at the University of Edinburgh.

Such a finding will go some way to validating the firmly-held view of many teachers that, year by year, their pupils are harder to deal with as their families and communities disintegrate. Despite a dry title, Psychosocial Disorders in Young People - Time Trends and their Causes has been eagerly awaited.

There is increasing statistical evidence to support the study's finding, although none of it is so far conclusive. In schools, for example, the rate of permanent exclusions - pupils expelled - has risen enormously in the past five years and is thought to be rising still.

The expulsion of primary pupils is a new and disturbing phenomenon. The Office for Standards in Education found that nearly 900 pupils were expelled from a sample of only 428 primary and secondary schools in 19923, a rate which suggests that there are 8,000 permanent exclusions nationally. There is also much to suggest that the true number of expulsions outstrips official statistics. Interim findings from a new study at the University of Portsmouth indicate that there were at least 1,300 permanent exclusions of primary children alone in 19923.

The rate at which children are found to have emotional and behavioural difficulties is also rising. Although far from perfect as an indicator, the number of statements of special need for emotional disorder has risen sharply. A recent study by Barnado's suggested a clear link with exclusion.

The Department of Health meanwhile identifies a steadily increasing number of children requiring psychiatric help. Figures released in spring last year showed a rise of some 25 per cent between 1986 and 1991. Many of the children are under 10: the proportion aged nine or under doubled from 707 to 1,400 over the same period.

The situation has been exacerbated by two factors in particular. The first, identified by the Association of Metropolitan Authorities, is the apparent decline in the extent to which schools are able to soak up additional strain. The burden of implementing new educational legislation and the pressure of academic league tables are touted as possible contributors. It is also harder to persuade autonomous grant-maintained schools to accept troublesome pupils.

The second factor is the national reduction in the number of joint health-education facilities offering early intervention and therapy. The child mental health group Young Minds has identified 17 local authorities where such collaborative services are facing cuts: education authorities appear disproportionately to blame. This last trend has been partly held responsible for the increasing number of children placed in unsuitable adult psychiatric wards .

With this sort of development in mind the Department of Health has recently published two books urging co-operation between education, health and social services. These are Child and Adolescent Mental Health Services and the Handbook on Child and Adolescent Mental Health.

The first document has won praise from educationists for its emphasis on collaboration between the services: "The establishment of a multi-disciplinary specialist service," it says, "is critical."

The handbook provides a new four-part framework for establishing such a service, with education playing a crucial part. Suggesting that between 10 and 20 per cent of children will need help at some time, it recommends: * primary care including interventions by GPs, teachers and health visitors; * uni-professional care from groups such as educational psychologists, or community paediatricians; * specialist multi-disciplinary teams; * specialist care in day units or hospitals.

It calls for Children's Service Plans and for liaison between chief education officers, chief officers of district health authorities and social services departments. And, at a local level, for GPs, schools, social services officers and the child and adolescent mental health services to work together.

Some authorities such as Cornwall have already started trying to implement this advice. "These documents are excellent," says Steve Colwill, chief educational psychologist and president of the Association of Educational Psychologists. "We hope the DFE will follow the health service and see fit to put some money into the initiative. It seems a golden opportunity."

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