Mental health problems in children and young people are on the rise. Here’s how pharmacists can intervene, writes Kathy Oxtoby
KEY LEARNING POINTS
• Mental health problems in this age group can be caused by bullying and neglect
• Pharmacists offering advice about medication and side-effects can be very reassuring
• Pharmacists can also encourage patients to talk about how they’re feeling
Mental health care for children and young people is in a sorry state. Less than 1% of the total NHS budget is spent on Child and Adolescent Mental Health services (CAMHS), and only 8.7% of the total mental health budget goes on under-18s, according to the charity YoungMinds.
But mental health problems affect one in eight children and young people. ‘That’s around three in every classroom – and many more go through times when they struggle to cope,’ says Tom Madders, campaigns director at the charity YoungMinds. An NHS Digital survey published in November 2018 found emotional disorders had become increasingly common in five to 15-year-olds, rising from 4.3% in 1999 to 5.8% in 2017.
This rise ‘reflects what we see in practice’, says Bernadka Dubicka, chair of the child adolescent faculty of the Royal College of Psychiatrists and a consultant child and adolescent psychiatrist at the Pennine Care NHS Foundation Trust. ‘We know from hospital data and our services that demand has increased significantly over the last decade,’ she says.
Reasons for this rise are varied and complex, and include financial strains in families, neglect and bullying at school. And new pressures have emerged in recent years. ‘Our education system puts more emphasis on exam results than wellbeing. Too many children are growing up in poverty. And the rise of social media makes problems like bullying or body image issues more intense than ever,’ says Mr Madders.
But children’s mental health services are under pressure. In November 2018, the Royal College of General Practitioners (RCGP) called for children and young people to have better access to mental health services in the community.
In Scotland, in response to the publication of the Scottish Government’s plan for mental health in 2018, Professor Steve Turner, officer for Scotland for the Royal College of Paediatrics and Child Health (RCPCH), called for more resource for ‘professionals in mental health to ensure every child has the healthiest and happiest possible start in life’.
Working in the front line of care, pharmacists have an opportunity to support this patient group. So what can they do?
Range of conditions
It is important to be aware of the kinds of issues this patient group experiences. These include depression, anxiety and conduct disorder, eating disorders, bipolar disorder, post-traumatic stress disorder and attention deficit hyperactivity disorder (ADHD).
Long-term and chronic conditions such as asthma, diabetes and cancer can also have an impact on mental health. Identifying those with mental health issues requires sensitivity as the conditions still carry a stigma. It can be hard to know when to be worried about a young person’s mental health. ‘But if you’re concerned, it’s a good idea to talk to the young person or their family,’ advises Mr Madders.
Dr Max Davie, officer for health improvement at the RCPCH, says the best way to identify problems is ‘simply to listen to people’s concerns… in an explicitly non-stigmatising environment, with professionals who are interested in the patient, not in speeding them through a process,’ he says.
Prescriptions for mental health conditions are an obvious way to identify children and young people – as well as parents and carers – who need support. Offering advice about medication and side-effects can help to reassure them, particularly as GPs and consultants are often pressed for time during consultations. Medicines use reviews can boost compliance and help patients, carers and families to discuss their concerns.
Lindsey Fairbrother, owner and superintendent pharmacist of Goodlife Pharmacy in Hatton, Derbyshire, finds medication for children is commonly for ADHD, and says she ‘talks to parents a lot to reassure them about side-effects’.
She says the pharmacy also sees ‘exasperated parents with extreme problems awaiting diagnosis. It can be very difficult to help when the parent has seen GPs and specialists but still has no resolution. We are there to support them and watch out for the impact on their mental health.’
She says that the pharmacy sees people from teenagers upwards starting on antidepressants. ‘Our role is to help them to benefit from medical intervention, but also encourage all forms of support, from counselling to simply talking,’ she says.
What pharmacists can do to help
Children, young people, their families and carers should already have support from health and care professionals but if not, the pharmacist can ‘point them in the right direction, such as their GP or psychiatrist’, says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow, north London.
Knowing ‘it’s all right to talk about things like self-harm and suicide with a young person is important for pharmacy’, says Rachel Brown, clinical lead pharmacist for CAMHS, medicines advice and clinical effectiveness at Oxford Health NHS Foundation Trust. She stresses the need to encourage these patients to talk about their thoughts. If those thoughts change, they must get help immediately from their psychiatrist, GP, families and carers.
Pharmacists can signpost to sources of information (see box, below left) such as the Royal College of Psychiatrists, and HeadMeds, a website about mental health medication for young people created by YoungMinds and the College of Mental Health Pharmacy. The website includes advice about feelings, conditions and how to get help, and a helpline for parents. P
harmacists can also print out information from these sources to let patients know they are approachable, as can taking part in Mental Health Awareness Week. Pharmacists can also keep up to date with research. For example, the Royal College of Psychiatrists has guidelines on when children and young people should be seen by a psychiatrist and YoungMinds offers training courses.
Taking on a bigger role
But this bigger role requires training. ‘We are approachable, but we’re not trained to counsel vulnerable people,’ says Ms Thakerar. She believes this training needs to be mandatory, because of the number of suicides among young people. Collaboration between health professionals is crucial to keep up to speed with developments.
Ms Brown would like to see ‘stronger links between community pharmacists and specialist secondary care pharmacists’ for the care of this patient group. And she believes: ‘We need to look at how health professionals can all work together, and to find out from patients what support they want from their community pharmacist.’