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If you suspect all is not well with your child’s mental health, when should you step in? Dr Fiona Pienaar offers some pointers

It doesn’t always take a multitude of stressors to throw children and young people ‘off their life course’. Just one normative stressor (one that most children experience in life) such as transitioning to a new school can prove overwhelming and, coupled with the changes that occur as children develop into adolescence, parents can find themselves worrying that all is not as it should be.

Of course as children move through childhood and enter adolescence, they do change. As they become more independent, their behaviour, their emotions, their thinking, their beliefs, the culture/s that they align themselves with, are all aspects of a child or young person that can change as they get older.

What’s normal

For this reason, it can be helpful if parents are aware of what is generally understood as ‘normal’ child and adolescent development so that they may have an informed sense of what changes are expected and those that are perhaps unexpected and worrying.

A good place to start if concerned is the family doctor. Another source of potential support or advice are schools where, if there is not a resident school counsellor, there should be an experienced staff member tasked with supporting students’ mental wellbeing who can advise and refer. 

Speaking to professionals such as teachers, psychologists, counsellors and GPs, who should have a clear understanding of ‘normal’ child and adolescent development, will help parents in deciding whether they should seek further professional advice.

When to call for help

While parents can expect changes as part of normal development, it is vitally important to be alert to behaviours that are impacting on your child’s life, and probably the family’s as well.

We could describe behaviours as externalising (acting out) or internalizing (withdrawing). While all children and young people, like adults, can have days where they feel less energetic, less optimistic and less communicative than they usually are, if these changes appear to sustain and/or worsen over time and are impacting on your child’s ability to function in their daily life, then it is wise to seek support from professionals, either in-school professionals (if available) or your GP.

Where to go for help

If children and young people are showing signs of meeting the criteria of, for example, anxiety or depression, a GP or a professional within the school should be able to assist with the process of referral to the Child and Adolescent Mental Health Services (CAMHS).

With the pressure on statutory services such as CAMHS leading to long waiting times, parents might want to seek private professional support. The British Psychological Society has a ‘find a psychologist’ section; the Royal College of Psychiatrists suggests that, in order to find a child psychiatrist, parents should ask their local GP or local hospital. The majority of psychiatrists work within the NHS but some also work privately. You can search the Royal College of Psychiatrists’ online membership list to confirm whether or not a psychiatrist is a member of the Royal College of Psychiatrists. Not all psychiatrists are members of the College.

The NHS Choices website also provides information, and the MindEd website (funded by the Department of Health and Department for Education) has a dedicated section for families which outlines how to identify a child at risk of a mental health condition, and where to seek help

The charity YoungMinds offers information about the symptoms, diagnosis and treatment of common mental health and behaviour concerns; information about the mental health services available for children; and free, confidential telephone and email advice.

What happens at a mental health consultation?

When meeting a mental health professional for the first time, they will spend some time talking to a child or young person and accompanying adult/s, to try to understand what difficulties are being experienced, the duration of the problem and what impact this is having on their life. It is also an opportunity to get to know the child or young person - what they enjoy, what school is like, their relationships with their friends, their life in general. The child or young person can ask any questions that they might have. There are also comprehensive questionnaires that will assist the mental health professionals in their assessment.

For an example of what can be expected at a first appointment at CAMHS check out the Central and North West London NHS description:

The foundations for lifelong mental health are established in childhood and adolescence. If you are at all concerned about the wellbeing of your child or adolescent, seek professional advice and support.

Dr Fiona Pienaar is director of clinical services for children’s mental health charity Place2Be

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