Children and adolescents Flashcards
Why is mental health in childhood and adolescence important?
Most important periods for ensuring mental wellbeing
- dynamic brain development
- critical period to acquire: economic, social, emotional and cognitive resources
What is the prevalence of mental health problems in young people?
1 in 5 young people will experience a mental health problem
Which disorders are typically found in children and adolescents?
> Anxiety disorders
> Mood disorders
> Disruptive behavioural disorders
- ADHD
- conduct disorder
- oppositional defiant disorder
> Stress-related disorders
What is the percentage of adult mental health problems that originate before the age of 24?
75%
What are the consequences of childhood and adolescent mental health problems?
Negative outcomes during childhood and adolescence, that continue into adulthood
-> poorer education, economic, health and social outcomes as adults
What does the United Nations’ data (2015) say about young people in the global population?
In the global population:
- 1 in 3 people is aged 0-19
- 90% of children and adolescents live in a LMIC
What causes an increase of the vulnerability to mental health problems in children and adolescents?
Personal and environmental threats:
- conflict
- natural disasters
- violence
- poverty
- poor nutrition
- poor physical health
- gender discrimination
What are the societal and economic consequences of mental health problems?
- Lost productivity
- Community destabilisation
- Greater healthcare use
What is the current issue with mental health policies, plans and services?
Despite the significant burden of poor adolescent mental health and its associations with mental health in adulthood, youth are systematically underserved by existing mental health policies, plans and services
What is the state of the current evidence in certain geographical areas of child and adolescent intervention?
Underrepresentation of mental health research from LMICs
- LMICs concern 6.8% of mental health research between 2005-2009
- low and yet, it’s almost double the LMICs percentage between 1966-2004
What is the issue with current mental health research in LMICs?
- Majority of mental health research in LMICs is conducted in East Asia and Pacific region
- AND mostly focused on schizophrenia
What are the ramifications (consequences) of the currently limited mental health research in LMICs?
> It is difficult to improve outcomes with limited research and publication of findings
> Particularly important for children and adolescents
-> a neglected area
How did Petersen and colleagues (2016) categorise child, adolescent and adult interventions in LMICs?
- Best evidence -> Interventions that should be applied
2. Good evidence -> Interventions that show promise
Which community-based interventions for children and adolescents were shown to improve mental health outcomes (Barry et al., 2013)?
- Social and emotional learning interventions
- Parenting interventions
- behavioural and emotional outcomes in infants and young children - Community parenting interventions
- improvement for preschool and school-going children - Child protection laws
- reduction of child maltreatment (risk factor for MH problems) - Interventions to improve mental health literacy and tackle stigma
- effective for adolescents - Interventions focused on gender and/or economic empowerment
- Targeted interventions
- e.g. children/adolescents with HIV, or living in areas of conflict - Child enrichment and preschool educational programmes
What could be used to engage adolescents in interventions to improve mental health literacy and stigma?
Technology and social media
When are economic interventions most effective?
When integrated with gender empowerment, health and education components
What can hinder the impact of targeted interventions?
Environmental characteristics of individuals
Which type of interventions have no effect on mental health outcomes in children and adolescents?
Short-term interventions (e.g. 3-12 days)
What are the impacts of interventions focusing on child enrichment and preschool educational programmes?
Significant positive impact on:
- child social and emotional outcomes
- school readiness
- behavioural problems
- cognitive skills
Which areas outside of mental health should interventions for children and adolescents also improve?
> Improved relationships with peers and teachers
> Increased academic performance
> Reduced risky sexual behaviour and substance misuse
What is the limit of delivering interventions for children and adolescents within schools?
Nearly half of more than half of adolescents aged 15-17 are not attending school in Africa and much of Asia
What is the mental health Gap Action Programme (mhGAP) developed by the World Health Organisation in 2016?
A programme destined to improve the detection and treatment of mental health problems in LMICs
What is the purpose of the mhGAP Intervention Guide (WHO, 2016)?
To improve access to mental healthcare in LMICs by going training to providers with non-mental health specialties
- including community health workers and teachers
- 8 sections of mental health problems addressed
How is the mhGAP child and adolescent module composed (WHO, 2016)?
Flowchart with:
- Assessment
- Management
- Follow-up
-> train providers to deliver relevant interventions
What is the mental healthcare provided by non-specialists for behavioural disorders as recommended by WHO in the mhGAP (2016)?
- Behavioural interventions (conditional)
- Parent education/training for ADHD (conditional)
What is the mental healthcare provided by non-specialists for emotional disorders as recommended by WHO in the mhGAP (2016)?
- Psychological interventions (conditional)
- Caregiver skills training (conditional)
What is the mental healthcare provided by non-specialists for developmental disorders as recommended by WHO in the mhGAP (2016)?
Caregiver skills training (strong)
What is the mental healthcare provided by non-specialists for somatoform disorders as recommended by WHO in the mhGAP (2016)?
Brief psychological interventions (conditional)
What are the WHO recommendations for medication treatment by non-specialists in mhGAP (2016)?
> Medication treatment largely discouraged to be delivered by non-specialists
> Excepting: pharmacological interventions for ADHD and depression among adolescents only AFTER specialist consultation AND adequate supervision throughout treatment
What is the SWOT analysis?
Strengths, Weaknesses, Opportunities, Threats
What are the four strengths in the field of child and adolescent mental health?
- Good foundation
- Strong evidence for what works and what doesn’t
- Experience from other areas within health
(e. g. sexual and reproductive health) - Availability of quick and easy implementation of evaluation tools
What is the consequence of the availability of quick and easy implementation of evaluation tools in child and adolescent mental health?
It will make it easier to assess the potential of new and existing interventions
AND help in argument for their scale-up
What are the five weaknesses in the field of child and adolescent mental health?
- Scale-up often fails
- Poor detection of mental health problems among children and adolescents
- > many won’t get the help they need - Poor engagement of children and adolescents and their parents, and family
- > interventions aren’t given the best chance of succeeding -> poor demand for services - Limited evidence for the delivery of effective interventions
- Sometimes, majority of target population won’t be reached
- it’s likely children and adolescents with mental health problems are even more vulnerable and in need of interventions
Why do scale-up often fail in the field of child and adolescent mental health?
The best ways to deliver interventions which increase demand, acceptability and accessibility, are still unknown
Why is there a poor detection of mental health problems among children and adolescents in LMICs?
Lack of mental health literacy and detection training for health and non-health professionals, teachers and community members
What are the six opportunities for the field of child and adolescent mental health?
- Good collaboration exists between LMICs and HICs
- Multidisciplinary research
- integrating mental health outcomes into other areas of child and adolescent research - Adolescent health (including mental health) has become a ‘hot topic’ among governments and investors
- Adoption of the WHO Comprehensive Mental Health Action Plan in 2013
- Multidisciplinary thinking, methods and approaches in mental health research and service delivery
(e. g. business, design, marketing)
- > potential major advances - Our ability to harness the use of tech and social media among adolescents in LMICs
- > significant opportunities for mental health promotion, prevention and treatment
What do we need in order to be successful in the field of child and adolescent mental health?
To increase demand for mental health services
What are the threats to the field of child and adolescent mental health?
- Stigma needs to be dealt with before interventions to prevent and treat mental health problems
- Very few individuals in LMICs are trained in child and adolescent mental health
- Funding priorities could change at any time
- Greater communication is needed by researchers and service providers to learn from each other
- e.g. Mental Innovation Network
What is the purpose of the Mental Innovation Network?
To advertise and link individuals and organisations working to improve mental health outcomes in LMICs
