Children’s Mental Health

1. Children’s Mental Health Rachel Jenkins

2. Children The future 35-50% of the population in LAMIC Only 6% of research literature on LAMIC is devoted to them

3. Does mental health matter? In its own right Impact on human, social and economic capital Impact on MDGs

4. Child 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

5. Both 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.

6. Mental 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

7. 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

8. Characteristics of children looked after by 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.

9. Why young people are looked after by local authorities

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

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

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

13. Physical complaints of children by location

14. Been in trouble with the police in past 12 months by location

15. Ever been in trouble with the police by type of disorder

16. Special educational needs by type of placement

17. Other 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

18. Epilepsy in LAMIC

19. 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%

20. Risk factors for child mental ill health in LAMIC Poverty Maternal psychiatric illness Family violence

22. Vulnerable 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

24. Consequences of child mental ill health Educational failure Employment failure Adult illness (50% adult disorders start in childhood) Suicide is 3rd leading cause of death in adolescents

25. Child 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

27. Global gaps Policy Data gathering capacity Services Training resources

28. Comprehensive 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

30. Primary care training in Upper Egypt

31. A high school in Quito

32. IDPs 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

33. Refugees 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

35. Child 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.

36. Hotel door, Kurdistan

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