Children's hearings training resource manual: volume 2

9 Children's Health

MENTAL HEALTH AND WELL-BEING

Everyone has mental health - just like physical health. Good mental health is about having a basic sense of self-worth, and effective ways of coping with life.

Mental health problems are:

Common - they affect one in four people every year.

Hidden - many people suffer in silence, or don't get help - often because they're afraid of what other people might think.

Real - people don't imagine them. They're not being moody, they're not being weak and they can't just 'snap out of it'.

No one's fault - would you blame someone for having a physical illness? People with mental health problems can't help what is happening. They are not to blame.

Treatable - with the right support and treatment, most people get better and get on with their lives.

Misunderstood - fear and ignorance mean that people with mental health problems have to deal with a lot of prejudice from people around them.

Given that mental health problems are common and that families who attend hearings are often under extreme stress and pressures it is inevitable that mental health will be an issue in some cases. The purpose of this section is to define some of the more common mental health illnesses that may be mentioned in hearing papers. It is not intended that panel members should be able to spot or diagnose mental illness but rather to understand terms used in reports.

Depression

The word 'depression' is used in many different ways. Everyone can feel sad or blue when bad things happen. However, everyday 'blues' or sadness is not depression. 'Clinical depression' lasts for at least two weeks and affects the person's ability to carry out their work or to have satisfying personal relationships.

Depression has no single cause and often involves the interaction of many diverse biological, psychological and social factors. People may become depressed when something very distressing has happened to them about which they have no control.

Depression can also result from some medical conditions, side effects of medication, pre-menstrual (or post natal) changes in hormone levels or lack of exposure to bright light in the winter months.

Psychosis

Psychosis is a general term to describe a mental health problem in which a person has lost contact with reality. There are severe disturbances in thinking, emotion and behaviour. Psychosis severely disrupts a person's life. Relationships, work and self-care are difficult to initiate and/or maintain.

The main psychotic illnesses are schizophrenia, bipolar disorder (manic depressive disorder), psychotic depression and drug-induced psychosis.

Psychosis often begins in late adolescence or early adulthood and the early symptoms involve behaviours and emotions which are common in this age group. Many young people will have some of these symptoms without developing a psychosis.

Schizophrenia

This is nothing to do with 'split personality'. The term means 'fractured mind' and refers to changes in mental function where thoughts and perceptions become disordered. The major symptoms of schizophrenia include:

• delusions; false beliefs of persecution, guilt, special mission etc.
• hallucinations; most commonly hearing voices - these are perceived as very real to the sufferer
• thinking difficulties; difficulties in concentration, memory or the ability to plan
• loss of drive; even motivation for self care
• blunted emotions
• social withdrawal.

Bipolar Disorder

People suffering from bipolar disorder (manic-depressive illness) have extreme mood swings fluctuating between periods of depression, mania and normal mood. During episodes of depression the person has all the symptoms listed above under depression. Common symptoms in mania include:

• increased energy and over-activity
• elated mood
• need for less sleep than usual
• irritability
• rapid thinking and speech
• lack of inhibitions
• lack of insight; the person is so convinced that their manic delusions are real that they do not realise that they are ill.

Drug Induced Psychosis

Brought on by the use of drugs and can be short lived. Drugs that can cause psychosis are marijuana, cocaine, ecstasy, amphetamines (speed) and magic mushrooms.

EATING DISORDERS

The most common eating disorders are anorexia (anorexia nervosa) and bulimia (bulimia nervosa). In both these conditions people control their food and eating as a way of trying to cope with their feelings and anxieties. It is important to remember that people with such disorders sometimes have normal body weight and the condition can go unnoticed for a long time.

Anorexia

People with anorexia don't eat enough. They think that all their problems are caused by how they look and believe they are fat even though others can see they are not.

Anorexia can also cause specific health problems like brittle bones, hair loss, poor circulation, infertility and kidney disease.

Bulimia

This is more common than anorexia. Sufferers binge on large amounts of sugary or fatty foods. These binges are often followed by panic which means that people then go on to starve themselves, make themselves sick, take laxatives or over exercise. Physical problems can include tooth decay, constipation and damage to the intestines.

SELF HARM

Also known as self-wounding, self-damaging behaviour, self-injury, self-mutilation, self-poisoning and para-suicide.

It is important to realise that people do not self-harm to:

• seek attention
• cry for help
• attempt suicide
• nor is it a 'phase' or a horrific prank.

Whilst self-harm is not attempted suicide, there is definitely a link. Between 40-60% of people who commit suicide have previously self-harmed.

Implication for panel members

There is little the panel member can do in a hearing to address a child's or young person's mental illness, but the information above gives some insight into the symptoms experienced by them. There are however some procedural matters that should be considered in cases where mental health is an issue:

• at the start of the hearing, emphasise that it is important to get everyone's view and that if at any time people are finding things difficult or confusing to let the panel know
• be prepared to take a short break, or consider other ways to help everyone take a full part in the hearing
• careful consideration should be given to the need for a safeguarder to safeguard the child's interest if they are unable to do so because of their own illness or if a carer's illness creates any doubt of what is in the child's best interest
• if the criteria are met, careful consideration should also be given to the need to authorise legal aid, particularly if the child's illness limits their capacity to understand the proceedings
• if you feel the child and/or parents are confused by the hearing then consider deferring the hearing and advise them to bring a representative to the next hearing. In this instance good practice would be to consider if the child needs the protection of an interim compulsory supervision order
• if you suspect that a child or relevant person doesn't have the mental capacity (on the day) to accept the section 67 ground then these should be discharged or referred for proof
• in the case of a child who is caring for a parent with a mental illness the parent may need to be 'handled with care' during the hearing and issues about the effect of caring on the child's welfare will need to be carefully addressed.

Remember it is not the role of the hearing to treat young people's problems, but to decide if compulsory supervision needs to be in place in order for professionals to do so.

Useful Contacts

Further information is obtainable from the following:

• www.penumbra.org.uk (general information on mental health)
• www.readthesigns.org.uk (information on mental illnesses)
• www.nshn.co.uk (information on self harm)

Information contained within this section is reproduced from; Mental Health First Aid Manual, Penumbra training materials, Mind's read the signs web site. Its use is gratefully acknowledged.

NEONATAL ABSTINENCE SYNDROME

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome ( NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics.

What Causes Neonatal Abstinence Syndrome?

Almost every drug passes from the mother's blood stream through the placenta to the foetus. Illicit substances that cause drug dependence and addiction in the mother also cause the foetus to become addicted. At birth, the baby's dependence on the substance continues. However, since the drug is no longer available, the baby's central nervous system becomes over-stimulated causing symptoms of withdrawal.

Why is Neonatal Abstinence Syndrome a concern?

When a mother uses illicit substances, she exposes her baby to many risks. A mother using drugs may be likely to use more than one drug, which can complicate the treatment. The risk of contracting HIV and AIDS is also greater among intravenous drug users.

In addition to the specific difficulties of withdrawal after birth, problems in the baby may include - but are not limited to - the following:

• Poor intrauterine growth.
• Premature birth.
• Seizures.
• Birth defects.

FOETAL ALCOHOL SYNDROME OR FOETAL ALCOHOL SPECTRUM DISORDER

The prevalence of FAS / FASD is not accurately known in the United Kingdom, given the lack of routine monitoring.

Foetal Alcohol Spectrum Disorder refers to :

• Pre and post natal growth deficiency. Babies are known to be short in length, light in weight, with smaller than normal head circumferences. They are also known not to catch up with healthy children as they grow older.
• Physical anomalies - a particular cluster of facial features include upturned nose, receding forehead and chin, asymmetrical ears and short palpebral fissures (the measurement between the inner corner of the eye and the outer corner of the eye). Other anomalies include heart and kidney problems.
• Central nervous system dysfunction including severe learning difficulties.

Such a diagnostic categorisation has been superseded by the term Foetal Alcohol Spectrum Disorder, which more accurately takes into account a wider range of associated disorders.

The effects of Foetal Alcohol Spectrum may include:

Young children

• Continuing lack of concentration and impulsivity.
• Their ability to relate to children of their own age may be limited.

Primary school age

• Short attention span.

• Inability to learn from past mistakes.
• Difficulty in adapting to new experiences.
• Inability to transfer what has been learned from one situation to another.
• Some may have poor impulse control and do not understand social rules.
• Difficulty in understanding the link between cause and effect, so if they do something wrong, they genuinely do not understand that it will result in some form of punishment.

Secondary school age

• Slower at reaching developmental milestones.
• Due to growth deficiency they will not stand out as older.
• Highly vulnerable, easily manipulated, wanting friends so desperately. They also have no sense of risk or danger.

Adolescent to adult

• Difficulty in understanding or working out the value of money. Problems in grasping concepts of time.
• Increased risk of mood and anxiety disorders in adolescence.
  (Ref: Professor Moira Plant. 'Paternal alcohol misuse, implications for child placement' in Children Exposed to Parental Substance Misuse. BAAF 2004.)