If you suspect a child, or even a young teenager of having a mental health problem, then it is usually possible to drag them along to the doctor. But getting older teenagers and young adults to recognise that the have a problem, and making sure they get help can be far more difficult.
The most common teenage and children’s mental health problems I see are depression, eating and obsessive compulsive disorders and phobias. Both depression and eating disorders can become serious, life threatening illnesses but early treatment can prevent a young life spirally out of control
All teenagers have ups and downs so knowing when a seemingly normal reaction has turned into a genuine mental illness can be very difficult. As a general rule, if someone is behaving out of character for more than a month, then start considering whether they need help. Many young people fear being ‘shoved on drugs’ so reassurance that ‘talking therapy’ is used first line can be helpful.
Depression can cause obvious sadness but other signs can be loss of interest in activities, excessive tiredness, change in appetite and poor concentration. There may be a clear trigger, such as a relationship break-up, but it can come on out of blue, for no obvious reason. Suicide is a particular risk in young men, who can suddenly feel that life just isn’t worth living any more.
Eating disorders are more common in women but young men are affected too. Signs of anorexia include meal avoidance, an obsession with food including cooking for others and exercising to excess. Bulimia can be much more difficult to spot but erratic eating habits, disappearing to the toilet after meals ( to vomit ) and frequent episodes of diarrhoea ( due to laxative abuse ) along with wildly fluctuating weight can be clues.
Obsessive compulsive disorders ( OCD ), such as endlessly washing hands for fear of contamination with germs, or checking doors are locked, and phobias, such as fear of lifts, may not seem to serious, but they too can thwart a young life. Again, the sooner they are spotted and treated, the more likely they are to be cured.
Psychosis isn’t a condition, but a symptoms of another underlying mental health problem. Psychotic episodes can be triggered by illegal drugs and also by binge drinking. It can also occur in bipolar disorder, sometimes in people who are severely depressed and more rarely it is a sign of schizophrenia. Commonest symptoms are hallucinations, seeing or hearing things, and delusions, for example believing they are about to be poisoned by their best friend. Anyone exhibiting psychotic symptoms needs to see a doctor as soon as possible. If they refuse then phone their GP, and explain what is going on ( for advice on children over 18 se below) The GP should then be able to help, if nececessary by compulsorily admitting the patient to hospital, though this is avoided if at all possible.
Illegal drugs can trigger irrational behaviour and mental illness and conditions such as depression can also make a person more prone to experimenting with drugs. The drug problem has to be tackled first and clinics for people with drug problems are aware that many of their clients have mental health issues, and have skilled staff who can deal with this as well as helping with addiction problems.
Confidentiality and helping a young adult
One of the biggest obstacles for parents trying to get help if their offspring is over 18 is the rules of confidentiality. Doctors cannot disclose any medical information without their consent which means that if a clearly worried mother rings me about her son, I cannot let her know if I’ve seen him, or not, and whether he is getting the help she needs. It’s infuriating for parents, and often for doctors, but it’s the law. What I can do though, is listen, and record the conversation on his notes which can be very helpful if he then comes into the surgery. I can also explain how to access local mental health services (see below). It is also important that I know whether the young person is aware that a parent has spoken to me – not surprisingly some young people get really angry if they find out things have been said about them behind their back. The message here is to always try and talk to the young person first.
What if they really won’t see a doctor?
Mental health services vary from region to region and there has been worrying publicity about the shortage of mental health beds for children and adolescents but in many places it is possible to access NHS psychological treatments without a doctors referral. Ask your GP’s reception for information, and Google IAPTS ( short for improving access for psychological treatments ) to see what is available locally.
Two Charities that can help with children’s mental health
MIND has a huge amount of helpful information. Visit mind.org.uk or the helpline 0300 123 3393 (9 am – 6 pm weekdays ).
The charity Rethink also offers expert accredited advice and support to anyone affected by mental health problems. Visit rethink.org or the helpline 0300 5000 927 (10 am – 2 pm weekdays)