The prevention and early intervention of mental illness in infants, children and adolescents

Position statement Last updated: Oct 2010 Published in Australia Reference: PS#63

Mental illness in infancy, childhood or adolescence can have enduring consequences if left unresolved.

Definition

Prevention and early intervention is any activity which is aimed at identifying and / or treating risk factors for, or early symptoms of, emotional and behavioural disturbance that may lead to mental illness in childhood or adolescence.

Background

A significant number of infants, children and adolescents experience some form of mental illness. Mental illness in infancy, childhood or adolescence can have enduring consequences if left unresolved. Those affected bear a major burden in suffering, lost opportunities and reduced social and economic outcomes in adulthood, including reduced workforce participation. Among the many adverse outcomes are reduced self-esteem or confidence, reduced educational and occupational opportunity, increased risk of substance abuse and other mental disorders, as well as increased family conflict, breakdown and homelessness.

The RANZCP Faculty of Child and Adolescent Psychiatrists (FCAP) believes that development and implementation of early intervention and prevention strategies for mental illness in infants, children and adolescents is imperative to addressing these adverse outcomes and to prevent or reduce mental disorders in adulthood. To this end, FCAP developed a report (ref) outlining strategies to promote and develop cohesive and evidence-based prevention and early intervention strategies, with the aim of decreasing the prevalence and harmful impact of mental illness in infants, childhood and adolescents. This position statement aims to set out key recommendations necessary to further promote and develop early intervention strategies to prevent mental illness in infants, children and adolescents. FCAP will continue to develop strategy and policy in this area.

Evidence

Early experiences determine whether a child’s developing brain architecture provides a strong or weak foundation for all future learning, behaviour, and health (Center on the Developing Child, 2007). Mental health problems during early years can have enduring consequences if left unresolved (Raphael, 2000) not only by placing individuals at increased risk of difficulties in adult life, but also by placing increased pressure on limited community service resources Sawyer et al, 2000). Suffering and negative outcomes can also cause intergenerational cycles which become larger problems to address (Austin, 2003). There is robust evidence that the onset of many adult psychological problems have their origins in childhood and adolescence (Dadds et al, 2000). Families affected by parental mental illness are at particularly high risk (RANZCP, 2009).

There is a critical need for strategies to be developed in Australia and New Zealand to improve children and young people’s mental health. Research demonstrates that first symptoms of behavioural problems typically precede a mental, emotional or behavioural disorder by two to four years (O'Connell et al, 2009) and that early therapeutic intervention can be highly effective at limiting the severity and/or progression of problems (Hazell, 2000) Prevention and early intervention strategies have been accepted as legitimate actions to address physical health issues for many years, however, they are a relatively recent area of interest in the field of mental health (Mrazek, 1994). Despite this, evidence-based research continues to expand and strengthen the argument in favour of these strategies as having the potential to be both beneficial and cost-effective.

In recognition of this need, the governments of Australia (both Commonwealth and State) and New Zealand have begun, to various degrees, to incorporate the concepts of promotion, prevention and early intervention into their policy frameworks (GermAnn K and Ardiles, 2009). In Australian the National Health and Hospital Reform Committee report (National Health and Hospitals Reform Commission, 2009) and the Fourth National Mental Health Plan (Commonwealth of Australia, 2009) brings a necessary emphasis back on prevention and, in New Zealand, the Second National Mental Health and Addiction Plan published in 2005 Te Tahuhu – Improving Mental Health 2005-2015 has recognised promotion and prevention as the first of ten challenges to be addressed (Ministry of Health New Zealand, 2005).

Critical to the success of the prevention and early intervention of mental illness in childhood, is broadening the roles and priorities of child and adolescent psychiatrists and general psychiatrists to include the provision of leadership to multidisciplinary teams, training of other professionals, and advocating for improvements in service delivery.

Recommendations

Effective development and implementation of prevention and early intervention strategies requires:

adequate funding for Child and Adolescent Mental Health Services to provide early intervention services relative to the proportion of the population experiencing disorders
increased capacity and competence of the workforce to engage in prevention and early intervention work
coordinated and integrated care between health and other sectors to identify high-risk children and deliver prevention and early intervention programmes
continued strategies to reduce stigma associated with mental illness in children and adolescents
introduction and maintenance of rigorously evaluated prevention and early intervention programmes across all age-groups from 0 – 18 years
focus on specific prevention and early intervention programmes to address these key target groups: children with conduct disorders, anxiety disorders, depressive disorders, children who self harm or who are at risk of suicide, children of parents with a mental illness, and Indigenous children
further research into acceptability and effectiveness of prevention and early intervention programmes for infants, childhood and adolescents.

To assist in achieving progress in relation to these principles, RANZCP, through its bi-national and regional structures, will work to engage collaboratively with State and Territory Health Departments in Australia and District Health Boards in New Zealand in their efforts to establish or enhance strategies that focus on the prevention and early intervention of mental illness in infants, children, and adolescence and further develop policy in this area.

Further specific recommendations can be found in the full report: Prevention and early intervention of mental illness in infants, childhood and adolescents: Planning strategies for Australia and New Zealand.

References

Austin M (2003) Perinatal mental health: opportunities and challenges for psychiatry. Australasian Psychiatry 2003, 11:399–403.

Center on the Developing Child (2007) A Science-Based Framework for Early Childhood Policy: Using Evidence to Improve Outcomes in Learning, Behaviour, and Health for Vulnerable Children. Cambridge: Harvard University.

Commonwealth of Australia (2009) Fourth National Mental Health Plan: An agenda for collaborative government action in mental health 2009-2014. Canberra, Australia: Commonwealth of Australia.

Dadds M, Seinen A, Roth J, Harnett P (2000) Early intervention for anxiety disorders in children and adolescents, In: Kosky R, O'Hanlon A, Martin G, and Davies C (eds) Clinical approaches to early intervention in child and adolescent mental health. Adelaide: Australian Early Intervention Network for Mental Health in Young People.

GermAnn K, Ardiles P (2009) Toward Flourishing for All: Companion document - Mental health promotion and mental illness prevention policy in international jurisdictions. Toronto, Canada: Centre for Health Promotion, University of Toronto.

Hazell P (2000) Attention deficit hyperactivity disorder in preschool aged children, In: Kosky R, O'Hanlon A, Martin G, and Davies C (eds) Clinical approaches to early intervention in child and adolescent mental health. Adelaide: Australian Early Intervention Network for Mental Health in Young People.

Mrazek P, Haggerty R (1994) Reducing the risks for mental disorders: frontiers for preventive intervention research. Washington, DC: National Academy Press.

National Health and Hospitals Reform Commission (2009) A Healthier Future for All Australians - Final Report of the National Health and Hospitals Reform Commission. Canberra, Australia: Commonwealth of Australia.

New Zealand Ministry of Health (2005) Te Tahuhu - Improving Mental Health 2005-2015: The Second National Mental Health and Addication Plan. Wellington, New Zealand: Ministry of Health.

O'Connell M, Boat T, Warner K (2009) Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: Board on Children Youth and Families, Institute of Medicine.

Raphael B (2000) Promoting the mental health and wellbeing of children and young people. Discussion paper: Key principles and directions. Canberra: National Mental Health Working Group, Commonwealth Department of Health and Ageing.

Royal Australian and New Zealand College of Psychiatrists (2009) Position Statement 56: Children of Parents with mental illness. Melbourne, Available at: www.ranzcp.org/News-policy/Policy-submissions-reports/Children-of-parents-with-mental-illness.aspx

Sawyer M, Arney F, Baghurst P, Clark J, Graetz B, Kosky R, Nurcombe B, Patton G, Prior M, Raphael B, Rey J, Whaites L, Zubrick S (2000) The mental health of young people in Australia: The child and adolescent component of the national survey of mental health and wellbeing. Canberra: Mental Health and Special Programs Branch, Commonwealth Department of Health and Ageing.