© who collaborating centre children’s mental health rachel jenkins

© WHO Collaborating Centre

Children’s Mental Health Children’s Mental Health

Rachel JenkinsRachel Jenkins


ChildrenChildren

• The future

• 35-50% of the population in LAMIC

• Only 6% of research literature on LAMIC is devoted to them


Does mental health matter? Does mental health matter?

• In its own right

• Impact on human, social and economic capital

• Impact on MDGs


Child and adolescent mental healthChild and adolescent mental health

• Capacity to achieve and maintain optimal psychological functioning and wellbeing.

• Ability to think, perceive, comprehend and interpret our surroundings , to adapt them and change them if necessary, to communicate with each other and to have successful social interactions.

• Mental capital-the bank account of the brain• Mental ill health-inability to achieve optimal

functioning through difficulties in mood, perceptions, comprehension, capacity to adapt etc


Both health and illness matterBoth health and illness matter

• We know more about illness than health

• Mental illness has difficulties reaching attention because of focus on communicable diseases.

• Even with increased attention to NCDs, mental health is still not properly attended to.


Mental ill health in children in GBMental ill health in children in GB

• 9.5% children 5-15 have disorder– 5.5% conduct disorder– 3.9% emotional disorder (anxiety, depression)– 1.5% hyperkinetic disorder


Mental ill-health in children Mental ill-health in children

• Risk factors– Child-Physical illness, special educational needs– Parents-Lone parents, reconstituted families, low

education, unemployment, low income – Family functioning-distressed mothers, discord– Life events-parental separation, parents in trouble

with police– Neighbourhood-deprivation, lack of social cohesion


Characteristics of children looked after Characteristics of children looked after by local authoritiesby local authorities

Characteristics of children looked after Characteristics of children looked after by local authoritiesby local authorities

Number About 1 in 200 young people in England aged

5 - 15 are looked after by local authorities (44,215 in 2001)

Placements• 70% with foster carers.• 11% living with own parents under the

supervision of local authorities.• 18 % in residential placements.


Why young people are looked after Why young people are looked after by local authoritiesby local authorities

62%10%

7%

6%6% 4% 4% 1%

Abuse/neglect Family dysfunction Acute stressParent illness Absent parent Child disabledSocially unacceptable Low income


Prevalence of mental disorders among 5 -10 year olds: Prevalence of mental disorders among 5 -10 year olds: private household and CLA in Englandprivate household and CLA in England

11%

3%

36%

5%

11%

2%

42%

8%

0

10

20

30

40

50

Emotionaldisorders

Conductdisorders

Hyperkineticdisorders

Any disorder

Children looked after Private household children


Prevalence of mental disorders among 11 -15 year Prevalence of mental disorders among 11 -15 year olds: private household and CLA in Englandolds: private household and CLA in England

12%

6%

40%

6%2% 1%

49%

11%

0

10

20

30

40

50

Emotionaldisorders

Conductdisorders

Hyperkineticdisorders

Any disorder

Children looked after Private household children


Presence of any mental disorder among Presence of any mental disorder among children looked after by placement typechildren looked after by placement type

39%42%

68%

45%

10%

0

10

20

30

40

50

60

70

Fostercarers

Birthparents

Residentialcare

All LAC Privatehouseholdpopulation

Any mental disorder


Physical complaints of children by Physical complaints of children by locationlocation

7%12%

8%16%

10%2%

13%5%

14%4%

16%11%

0 2 4 6 8 10 12 14 16 18 20

Percentage

Eczema

Asthma

Co-ord probs

Bed wetting

Speech probs

Eyesight probs

Looked After Children Private household population


Been in trouble with the police in past Been in trouble with the police in past 12 months by location12 months by location

10%8%

30%

14%

2%0

10

20

30

40

50

All LAC Birthparents

Residentialcare


In trouble with the police in past 12 months


Ever been in trouble with the police by Ever been in trouble with the police by type of disordertype of disorder

22%

29%

17%

5%

0

5

10

15

20

25

30

Emotionaldisorder

Conductdisorder

Hyperkineticdisorder

No disorder

Ever been in trouble with the police


Special educational needs by type of Special educational needs by type of placementplacement

63%56%

78%

64%

19%

0

20

40

60

80

100

Fostercarers

Birthparents

Residentialcare



Other disabilities in LAMICOther disabilities in LAMIC

• Severe mental retardation 5-22 per 1000

• Child blindness 15 per 1000 in Nigeria, – 7x that in UK

• Epilepsy 5-20 per 1000


Epilepsy in LAMICEpilepsy in LAMIC


Mental disorder in LAMIC children Mental disorder in LAMIC children

• Bangladesh 5-10 years olds 15% – 15% rural area– 10% urban area (relatively prosperous)– 20% slum

• Yemen 7-10 year olds 16%• Sudan 3-15 year olds 8%• Saudi Arabia 8-15 year olds 13%• Brazil 7-14 year olds 13% • Goa 12-16 year olds 2%• Bangalore 0-16 year olds 12.5%


Risk factors for child mental ill Risk factors for child mental ill health in LAMIChealth in LAMIC

• Poverty

• Maternal psychiatric illness

• Family violence


Vulnerable groupsVulnerable groups

• Refugees, IDPs, asylum seekers• Child soldiers • Prostitution• HIV /AIDs orphans• Substance abuse• Violence and abuse, bullying, sexual abuse• Epilepsy common in LAMIC and carries

increased risk of mental ill-health


Consequences of child mental ill Consequences of child mental ill health health

• Educational failure

• Employment failure

• Adult illness (50% adult disorders start in childhood)

• Suicide is 3rd leading cause of death in adolescents


Child Mental health and the MDGsChild Mental health and the MDGs

• MDG 2 universal primary education by 2015– Learning and emotional problems contribute to

underachievement and drop out

• Improving adolescent mental health will improve maternal mental health which will improve– MDG 1 child mortality– MDG 4 child under-nutrition– MDG 5 maternal health– MDG 6 HIV prevention


Global gapsGlobal gaps

• Policy

• Data gathering capacity

• Services

• Training

• resources


Comprehensive approachComprehensive approach

• Mental health promotion• Prevention of disorder• Early assessment and treatment• Rehabilitation• Prevention of mortality• Intersectoral approach• Strengthen communities and systems• Integrate child mental health into all systems


Primary care training in Upper Primary care training in Upper EgyptEgypt


A high school in Quito A high school in Quito


IDPsIDPs

• 24.5 million IDPs in 52 countries in 2006, of which 12 million are in Africa .

• Sudan has over 5 million IDPs. • According to UNHCR estimates,

over 4.2 million Iraqis have been displaced since 2003, with 2 million within Iraq


RefugeesRefugees

• 12-15 M

• World’s refugee burden is carried overwhelmingly by the poorest countries of world

• 20 countries with the highest ratios of refugees have an average annual per capita income of 700 dollars


Child soldiersChild soldiers• Child soldiers are still actively being recruited in at least 13 countries.

– Afghanistan, Burundi, Chad, Colombia, Democratic Republic of Congo, Ivory Coast, Myanmar, Nepal, Philippines, Sri Lanka, Somalia, Sudan and Uganda.

• In Uganda – 1,500 children are still held by the Lords Resistance Army. – Another 10,000 children associated with the LRA are still unaccounted for.

• In Sri Lanka,– at least 5,000 children have been recruited since 2001.– Despite the ceasefire signed in 2002, the threat of re-recruitment is once again so strong

that parents are afraid to let children leave the house.

• An estimated 11,000 children are currently involved with militias in DRC.

• Children as young as eight are being recruited by the government army of Southern Sudan.

• In 2005 over 8,000 children were still fighting in West Africa, with another 20,000 in the process of or waiting to be released.


Hotel door, KurdistanHotel door, Kurdistan


• Address wider causes of – Unplanned rapid urbanisation– Breakdown of social networks– Rising economic inequality– Conflict– Bullying and abuse

© who collaborating centre children’s mental health rachel jenkins

Documents

centre mental disorder

lamic slide

centre mental illhealth

england slide

centre mental ill health

location slide

centre epilepsy

mdgs slide