Shocking revelations about the scale of mental disorder among British children...

2nd June 2000 at 01:00
...should have set alarm bells ringing. So why are policy-makers failing to heed the warning? Victoria Neumark reports

One in 10 children aged five to 15 suffers from a mental disorder, according to official figures released in March. And if that seems shocking, even more disturbing is the UK authorities' apparent unwillingness to act on the findings.

So impressive is the Office for National Statistics report, The Mental Health of Children and Adolescents in Great Britain, that governments in Brazil, Spain,Bangladesh and Switzerland are planning similar surveys. But in this country the results seem to have been shuffled quietly aside. Why?

The ONS team of 300 psychologists and statisticians was headed by Robert Goodman, professor of brain and behavioural medicine at Londonuniversity's Institute of Psychiatry, and Howard Meltzer, principal survey officer at the ONS. Their aim was to identify "marked personal distress or substantial interference in everyday life". Surveying 10,500 parents of children aged five to 15 and 4,500 11 to 15-year-olds in person, as well as teachers by post, they came up with the most authoritative national database yet on child mental health.

Professor Goodman says the findings provide important information for teachers and education policy-makers. They show that emotional and behavioural problems are so clearly linked to social factors - specifically social class and family functioning - that channelling children with emotional and behavioural difficulties into medical, rather than educational or social, care, makes little sense. He says future generations may look on our labelling of disruptive behaviour as a psychiatric "disorder" in the same way that we now view those who in years gone by insisted that homosexuality was a psychiatric problem.

Of the children surveyed, 5 per cent had conduct disorders (defined as defiant or oppositional behaviour at home andor school), 4 per cent suffered anxiety and depression and 1 per cent were assessed as hyperactive, measured by inattention and overactivity. An additional 0.5 per cent had rarer disorders such as autism, anorexia nervosa or serious tics.

According to Professor Goodman, boys "are enormously more likely to have developmental disorders such as autism and tics". He is convinced there is a biological basis for this. But the discrepancy between genders in conduct disorder - 7.4 per cent of boys against 3.2 per cent of girls - can also be blamed, he feels, on social factors. "It's what society expects and allows."

While you are more likely to suffer mental distress if you are a boy, you are also more likely to suffer if you are poor and your family has split. More specifically, the risk of suffering mental health problems is higher for those who:

* live in single-parent households (16 per cent, against 8 per cent for those living with two parents);

* live in reconstituted families (15 per cent against 9 per cent);

* have four or more siblings compared with one (18 per cent against 8 per cent);

* have both parents unemployed (20 per cent, against 8 per cent where both parents are working);

* come from a poor family (16 per cent for those with gross weekly income of less than pound;200, and 6 per cent for those on pound;500 or more);

* have parents in the bottom social class (14 per cent for social class V - unskilled - against 5 per cent for social class I - professional);

* live in rented accommodation (17 per cent for social sector tenants, against 6 per cent for owner-occupiers).

Money doesn't make you happy, but it helps. That perhaps is no surprise. Nor is the correlation between physical ill-health and mental problems, nor that parents of children with mental disorders are more likely than others to have sought help from educational services. What is startling is the high correspondence between special educational needs and mental disorder.

This correspondence goes both ways. One in five of the children surveyed had SEN, but those with a disorder were three times more likely than those without to have special needs (49 per cent compared with 15 per cent). Conversely, 6 per cent of children with no SEN had a mental disorder, but 43 per cent of those statemented with SEN had one. Although learning difficulties were not isolated by the study, Professor Goodman points out that teachers believed that "the lower your IQ, the higher the rate of problems". (Other studies have shown a strong link between low IQ and hyperactivity.) Furthermore, 15 per cent of children whose parents lacked educational qualifications had a mental illness, against 6 per cent of those whose parents were educated to degree level or equivalent. As Professor Goodman says: "Those who've stayed in the educational system longest have the best-adjusted children."

School absence rates yielded striking evidence. The report found that 25 per cent of children with anxiety or depression had missed 11 or more days of school in the previous term, as had 21 per cent of children with conduct disorders and 14 per cent of those with hyperkinetic disorders. School absence, then, is a strong indicator of serious problems, whether the children are at home with vague ailments and the permission of their parents, or bunking off for fun - or out of anger and defiance.

When it comes to families, the survey teased out unnervingly close connections on maternal anxiety and depression - a staggering 36 per cent of children whose mothers were severely affected with anxiety or depression suffered those disorders themselves, as opposed to 5 per cent of children whose mothers showed no such symptoms.

Furthermore, only 7 per cent of children from families with a healthy level of communication and interaction (tested by levels of agreement to statements such as: "planning family activities is difficult because we misunderstand each other" or "in times of crisis we can turn to each other for support") had a mental disorder, whereas 32 per cent of those with the least healthy level of interaction did.

As yet unprinted figures also reveal a map of mental misery "much higher in specific areas", closely related to the map of social deprivation, which in turn could be mapped over low educational attainment figures.

Geography, social class, family function, educational attainment - what is the best route to help so many troubled children?

A high incidence of mental problems should, believes Professor Goodman, attract funding just as educational needs do. "Emotional and behavioural difficulties have an impact in a school setting, which increases the justification for providing help in schools," he says. It is less stigmatising, too, for children and their families to get the help they need on school premises.

Specifically, he would like to see more learning support assistants to encourage those who find concentrating difficult; more training for teachers to recognise signs of mental distress; more training in classroom management and behaviour control; and more educational psychologists to provide appropriate advice in managing children with problems within the classroom. He agrees that such measures would be costly, but no more so than the present "shuffling off of social problems on to the health service".

Above all, says Professor Goodman, whose book, Child and Adolescent Mental Health Services: reasoned advice to commissioners and providers, attacks the medicalisation of social problems in the child and adolescent mental health services, teachers need training in distinguishing the 1 to 2 per cent of children whose problems are organic (such as hyperactivity and autism) and who can be helped medically, and those who have pressing emotional-social problems (from shyness to anxiety, depression and impulses towards self-harm and suicide).

But this raises much bigger questions. Do we really help children who have difficult, even terrible, lives by giving their problems a medical label such as "mental illness" or "conduct disorder"? How can agencies help them? And do we really want to change things for the better? Because if we do, the report unequivocally points out the scale of the problem. Now all we need is the political will.

The Mental Health of Children and Adolescents in Great Britain (Stationery Office pound;35) is available from the government website: www.ukstate.comThe Office of National Statistics website is at:


Scott is 10. His family, fleeing Scott's abusive stepfather, have been rehoused in an upmarket suburb, but without an income to match. Scott does not look right. His trainers are from Woolworths, not a named brand. His haircut is not shiny and glossy. His sisters are said by their little classmates to have nits. And however much the school nurse says that nits love clean hair, Scott's sisters still cry, So Scott (not his real name) gets teased, The teasing is mostly verbalythis is a nice area, after all y but it is relentless.

Scott's mum doesn't feel able to put Scott's case to the teachers, so the teasing does not stop. Scott, who has already fallen behind with several changes of school, falls further behind in Year 5. To mask his own sense of inadequacy y he really does find reading and writing very hard y he plays up and drives his newly qualified class teacherto distraction. He is often in trouble, kept in at break or lunchtime, which adds to his social isolation.

His teacher has not built up the skills to contain his disruption and focus in on his specific learning difficulties. He is "a pain".

Scott, who is finding it all too much, begins to truant. It is easier for his mother to keep him at home, where he is calm, than to force him into the school environment. Education welfare officers and educational psychologists talk of "challenging behaviour"; but resources are stretched and they cannot offer any help within the year.

So Scott and his mother are sent on to the GP, who arranges an appointment with the local child and family mental health service. A diagnosis of conduct disorder is made and family therapy begins. The family do not like the "talking cure" and make little progress. Scott's mum, particularly, feels blamed for circumstances which she feels are beyond her control, such as the behavioui of her ex-partner. Scott, in turn, feels ashamed, especially when his classmates find out that "weirdo" is also "psycho" and visits the "funny clinic According to Professor Goodman, from whose files this story has been adapted, the root causes of the problem have not been tackled. An approach which looked at the social and educational aspects first would have identif ied and dealt with teasing, at both the personal and the whole-class level, recognised and speedily addressed the learning difficulties, and invested in training to build up the teacher's behaviour management skills y at initial and in-service training. Professor Goodman says the money spent on intervention by expensively trai ned professionals would have done more good if it had been invested in bettertraining and support for the teacher, on in school assessment and remediation services nvolving educational psychology.

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