© WHO Collaborating Centre
Children’s Mental Health Children’s Mental Health
Rachel JenkinsRachel Jenkins
© WHO Collaborating Centre
ChildrenChildren
• The future
• 35-50% of the population in LAMIC
• Only 6% of research literature on LAMIC is devoted to them
© WHO Collaborating Centre
Does mental health matter? Does mental health matter?
• In its own right
• Impact on human, social and economic capital
• Impact on MDGs
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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.
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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.
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
All LAC Privatehouseholdpopulation
In trouble with the police in past 12 months
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
All LAC Privatehouseholdpopulation
© WHO Collaborating Centre
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
© WHO Collaborating Centre
Epilepsy in LAMICEpilepsy in LAMIC
© WHO Collaborating Centre
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%
© WHO Collaborating Centre
Risk factors for child mental ill Risk factors for child mental ill health in LAMIChealth in LAMIC
• Poverty
• Maternal psychiatric illness
• Family violence
© WHO Collaborating Centre
© WHO Collaborating Centre
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
© WHO Collaborating Centre
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
© WHO Collaborating Centre
© WHO Collaborating Centre
Global gapsGlobal gaps
• Policy
• Data gathering capacity
• Services
• Training
• resources
© WHO Collaborating Centre
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
© WHO Collaborating Centre
© WHO Collaborating Centre
Primary care training in Upper Primary care training in Upper EgyptEgypt
© WHO Collaborating Centre
A high school in Quito A high school in Quito
© WHO Collaborating Centre
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
© WHO Collaborating Centre
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
© WHO Collaborating Centre
© WHO Collaborating Centre
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.
© WHO Collaborating Centre
Hotel door, KurdistanHotel door, Kurdistan
© WHO Collaborating Centre
© WHO Collaborating Centre
• Address wider causes of – Unplanned rapid urbanisation– Breakdown of social networks– Rising economic inequality– Conflict– Bullying and abuse