The growth in mental health problems in young people is a serious cause for concern. Pharmacists have an important role to play in tackling the issue

According to a 2017 NHS report into the mental health of children and young people in England, over 12 per cent of five to 19-year-olds – or around one in eight – are currently dealing with at least one mental health disorder. This equates to one in every eight young people having a recognised mental health issue, the commonest of which are emotional disorders.

The report also revealed that the prevalence of mental health disorders appears to be growing – fast.

Emotional disorders in particular are becoming commoner in five to 15-year-olds – up from 3.9 per cent in 2004 to 5.8 per cent in 2017. This category of mental health problems encompasses anxiety disorders characterised by fear and worry, depressive disorders associated with sadness, loss of interest and energy, and low self-esteem, as well as more severe conditions such as mania and bipolar disorder.

Rates of all other types of mental health disorder, such as behavioural, hyperactivity and other less common disorders, remained steady. Among young people, mental health disorders were also shown to increase with age, rising from rates of just over 5 per cent in two-four year-olds to around 17 per cent in 17-19 year-olds.¹

“The growth in emotional disorders in children between 2004 and 2017 is a serious cause for concern,” says Mark Rowland, chief executive of the Mental Health Foundation. “The findings in new categories such as the prevalence of mental disorders in two to four year-olds as well as 17-19 year-olds show new areas of risk and evidence of distress, which are important to understand and to track.

“Today’s prevalence figures show what many have been saying for some time: some groups in society are more likely to be affected by mental health disorders. Those most at risk are children from low-income households, children whose parents have poor mental health or are in receipt of a disability payment, and 14-19 year-olds who identify as LGBTQ.”²

Safeguarding and supporting mental health

In May 2018, the Royal Pharmaceutical Society hosted a roundtable to discuss the potential role that pharmacy can play in supporting patients with mental health problems.³ Several of the key recommendations from this report provide valuable tools to facilitate supporting young people’s mental health.

Indeed, the RPS concluded that the community pharmacy setting offers some of the greatest untapped potential for using the skills of pharmacists and their teams in aiding people of all ages with their mental health. Important steps that pharmacy can take to adopt a more active role in safeguarding the mental health of young people include:

Acting as advocates for young people with mental health problems
The pharmacy is an accessible, comfortable and familiar setting for people of all ages, making pharmacy staff perfectly positioned to take on the role of confidant or adviser for young customers with mental health issues, particularly emotional disorders such as anxiety or depression.

Identifying mental health problems early
Pharmacists and their teams need to be aware of common trigger points for emotional disorders in young people such as bullying, abuse, family problems, social deprivation, low self-esteem and sexuality. If suspected, these should prompt simple but engaging questions such as: ‘How does this make you feel?’. Pharmacists should also be alert to potential mental health problems when talking to any young patient with a newly diagnosed or longer-term medical condition.

Suicide is always an important risk to be aware of in young people, with recent data from the Office for National Statistics showing that suicide rates among 15-19 year-old girls are growing at record rates. In 2017, the incidence of suicide among 15-19 year-olds stood at 3.5 and 7.6 per 100,000 members of the population for males and females, respectively.⁴

Providing ongoing medication monitoring
Children prescribed pharmacotherapy for attention deficit hyperactivity disorder (ADHD), for example, require regular monitoring of key metrics such as blood pressure and pulse. Pharmacies provide a convenient and accessible location to carry out this physical screening, which young people may prefer to the more clinical setting of their GP surgery.

Promoting adherence and optimal use of medicines
Adherence levels can be particularly poor in patients taking medicines for mental health conditions and pharmacists can play a key role in promoting better compliance by targeting adolescents in charge of their own medication directly or the parents of younger children. Pharmacy also has an important responsibility to help reduce the adverse events and potential harm from medications used to treat mental health conditions.

Linking up with mental health initiatives and campaigns
A key national programme relevant to young people’s mental health that pharmacy is well-placed to support is STOMP, which stands for ‘Stopping over-medication of people’ with a learning disability, autism or both.

Signposting to other sources of support
With mental health currently high on the public health agenda, a huge raft of supportive services are now available for a broad range of mental health disorders. Mental Health UK and Mind are good places to start.

Promoting physical health

Pharmacy teams can work collaboratively with young people to support not only their mental health, but also physical well-being. Giving children with mental health problems the tools they need to safeguard their physical health over the long-term may be a key step towards closing the 15-20-year mortality gap that currently exists in people with severe mental illness. However, healthy living advice is equally important for all young people – particularly given today’s sedentary, online lifestyles and ready access to high calorie foods.

Research indicates that there has been a 10-fold increase in the number of children and adolescents with obesity since 1975, highlighting the urgent need for early and proactive intervention to tackle one of the biggest health threats currently facing the UK.⁵

As Dr Max Davie, officer for health promotion for the Royal College of Paediatrics and Child Health (RCPCH) points out, “twenty per cent of children are already obese by the time they leave primary school and this is totally unacceptable. Access and funding of high quality weight management services are urgently needed now if we are to ensure no child slips through the net and all children, no matter where they live, are given the same opportunity to good health.”⁶

By 2020, the RCPCH estimates that half of all children in the UK will be overweight or obese. This in turn makes them much more likely to become obese adults and carries significant health risks such as type 2 diabetes and cancer, as well as impacting negatively on self-esteem and body image.⁵

Practical advice and education from pharmacists for young people should centre on diet and physical activity. Key steps for success include:

• Keeping meals and snacks to age-appropriate portion sizes and featuring nutritious foods and drinks
Young people should aim to eat the recommended five portions of fruit and vegetables per day and intake of sugary or high-fat foods should be discouraged or kept to a minimum. Consider signposting to Change4Life, which provides practical tips on diet and exercise and simple everyday steps to keep children physically healthy

• Increasing activity levels
Children require at least 60 minutes of physical activity per day. For young people, choosing an activity or sport they enjoy is key to establishing long-term patterns of regular physical exercise. Group activities and team sports also offer the additional mental health benefit of socialising, while exercise such as yoga or tai chi can help promote relaxation and overall well-being

• Cut down on screen time and get more sleep
Limiting time spent on inactive, sedentary activities such as playing on electronic devices or watching television boosts overall activity levels and also improves sleep (which is independently linked to obesity risk). Children should be limited to a maximum of two hours of screen time per day.

Whenever possible, advice on healthy living for young people should extend to and include parents, who are the major role models and drivers of good health habits in their children. Recent research by NHS Digital has confirmed the link between obese parents and obese children.

Children with obese parents are three times more likely to be obese themselves compared to their peers with healthy weight parents. Notably, around half of parents of obese children believe their child is of the correct weight.⁷

References

1. NHS Digital. Mental health of children and young people in England. 
2. Mental Health Foundation. Our response to new children’s mental health data. 
3. The Royal Pharmaceutical Society England. No health without mental health: How can pharmacy support people with mental health problems? June 2018
4. Office for National Statistics. Suicides in the UK: 2017 registrations
5. RCPCH: About childhood obesity. 
6. RCPCH: Latest obesity statistics published.
7. Health Survey for England 2017. 
8. British Skin Foundation. Acne. 
9. Clinical Knowledge Summaries (CKS). Dysmenorrhoea. Last revised May 2014