Exploring the Complexities of Self-Harm among Teenagers in Northamptonshire
Added on 2019-09-20
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Priority Grid Criterion Table: Children and Young people among 11-16yrsin Kettering, NorthamptonshireCriterionHealth Need 1Reduction of mental health admissions among 11-16yrsHealth Need 2Reduction of self-harmadmissions among 11-16yrsHealth Need 3Reduction of teenagepregnancy among 11-16yrsSizeIn 2011/2012 the rate of admissions per 100,000 among the under 17s in Northamptonshire rose very sharply to 287 per 100,000, more than double the England average of 91 per 100,000 (Schiller, 2014).In 2012/13, there were 260.4 per 100,000 hospital admissions for Mental Health Conditions in children aged 0-17(includes the target population of 11-16yrs). This is significantly higher than England, where thefigure stands at 87.6(NCC JSNA Northamptonshire, 2015). Kettering has a relatively high number of 12to 16 year olds among its admissions which was 18 per 201 admissions than any other regions between 2010-2013 in Northamptonshire (Schiller, 2014).The Northamptonshire with an average total children and young people (C&YP) population of 1, 03,453 in which 13,949 is estimated in Kettering. About 1,478/13,949 children with mental disorder is prevalent in Kettering (NCC JSNA Northamptonshire, 2015).Prevalence estimates for mental disorder in children aged 11-16yrs is higher in boys (11.4%) rather than girls (7.8%) in Northamptonshire (ChiMat, 2014).The estimated prevalence of mentaldisorders in Northamptonshire among 11-16yrs is 5,625(ONS, 2014). The prevalence isfurther broken down by prevalence ofconduct, emotional and hyperkineticdisorders (Green, 2004).Estimated children (11-16yrs) with conduct disorders in Northamptonshire is 3,245 in which 767(5-16yrs) is estimated in Kettering. Estimated children (11-16yrs) with emotional disorders in Northamptonshire is 2,480 in which 502 (5-16yrs) is in Kettering. The number of estimated children (11-16yrs) with hyperkinetic disorders in Northamptonshireis 725 in which 209 (5-16yrs) in Kettering (NCC JSNA Northamptonshire JSNA, 2015; ChiMat, 2013)According to CAMHS, 3600 referrals were made to CAMHS in 2013.2300 active cases with CAMHS (19.8%) was reported. Admission rates for Northamptonshire were286.6 compared to England 91.3 (Campion, 2014).NCC conducted a survey to address the gap in service provisions and statistical analysis for future found that the modelling team at Public Health Action Support Team (PHAST) projected a 16% increase on average in the numbers of mentally ill children by 2021.(NCC Children’s JSNA, 2016)In 2011/12 hospital admissions as a result of self-harm (rate per 100,000 aged 0-17 years) in Northamptonshire (154.9) was above that of England (115.5), the East Midlands (124.4)and statistical neighbours (125.1). The rate of hospital admissions as a result of self-harm (rate per 100,000 aged 10-24 years) in Northamptonshire has risen from 419.3 in 2012/13 to 510.9 in 2013/14 and both years were considered significantly worse than England for the same time periods( NCC Children’s JSNA, 2016) In Northamptonshire, between 2010/11 and 2012/13, there were 442.84 children and young people (aged between 10 and 24) admitted to hospital per 100,000 populationsas a result of self-harm. This compares with 357.45 children and young people across the East Midlands and 352.26 children and young people across England (NCC Northamptonshire Children’s JSNA 2015).The majority of people who self-harm are aged between 11 and 25 years (Hagell, 2015). According to National CAHMS support Network 2011self-harming seems to be moreprevalent in older groups: a 2001 study based on parental reports, suggests that the rate among 13-15 year-olds is one and a half times that of 11-12 year-olds. Similarly, in a later study sample of 710 under 15 year olds seen at a general hospital, most were aged between 12 and 14(Nixon B, 2011). While an estimate of 3590 people aged 11-16 years previously self-harmed, there were 2940 admissions for self-harm in under 18 year olds in Northamptonshire(Campion,2014) However it is possible that some younger children self-harm without presenting to any services(Nixon B, 2011). In 2012 in secondaryschools anecdotal evidence suggested deliberate self-harm rates could be as high as50%(Schiller, 2014)The greater prevalence of self-harm among females was demonstrated in a studyconducted on 10-19 year-olds over a period of 10 years, in which the majority of cases (73.1%) were women. This is echoed in national figures which show that 6.5% of girlsand 5.0% of boys reported that they had tried to harm themselves (Nixon B, 2011). According to national CAHMS the proportionof self-harm among 11-16yrs with no mental illness is below 2% while those with mental problems are higher which is more than 18%,but those with anxiety problems accounts to 10% (Nixon B, 2011)As per National levels among 11-16 year olds7% have tried to harm, hurt or kill themselves (Campion, 2014). But higher withemotional (28%) and conduct disorders (21%) (Schiller, 2014). In Northamptonshirethe rates of self-harm in young women averaged 302 per 100,000 in 10 to 14 year olds and among menaveraged 67 per 100,000 in 10-14 year old (Hawton, K, 2012)In 2012 teenage conceptions by those aged 13-15 and deliveries to mothers under 18, Northamptonshire performs about30.8per 1000 population worse than both the national average (27.7)and regional average(28.3) (NCC JSNA Northamptonshire, 2015). In 2012 there were 30.4 conceptions per 1,000 of females aged 15-17 in Kettering. Though below the Northamptonshire average of 30.8, Kettering is aboveboth the East Midlands (28.29) and England (27.75) rates (NCC JSNA Kettering, 2015).The overall rate of teenage conceptions in Northamptonshire has shown a downward trend in past years (2008-1010) from 524 in 2008 to 450 in 2010. The county’s teenage pregnancy rate in 2010 was 35.1 per 1,000 females aged 15 to 17, which was similar to the national average of 35.4 (NCC, 2014). Even though it shows a downward trend in under 18 conception ratesthan England rates, but the reducing trend in rates over the past decade has reversed in Corby,Kettering and South Northamptonshire (JSNA report, 2013)The young women vulnerable to become teenage parents are thosein care or leaving care, those not attending school, those involved inyouth offending system, those who already have children and those who underperform at school(NHS Northamptonshire, 2009).In 2010 the UK statistics reveals that there are seven pregnancies per 1,000 girls aged under 16(NHSCHOICES, 2012). The forecasted conception rates per 1000 femalesaged 15-17yrs in 2020 and 2015 in Northamptonshire will be 36.6 which will be higher than England and East Midlands average of 32.1 and 31.5 respectively (JSNA report 2013)Most people become sexually active and start forming relationships before 16yrs. Young people in these age groups have significantly higher rates of poor sexual health ; figures indicate thatyoung people aged 16-24 account for over half of the sexually transmitted infections (STIs) diagnosed and, despite progress made in tackling teenage pregnancy, 80% of under 18 conceptions were 16 and 17 year olds (PHE, 2013)
Priority Grid Criterion Table: Children and Young people among 11-16yrsin Kettering, NorthamptonshireSCORE: 5 As per NHS, Kettering have a higher rate of deliberate self-harm admissions including poisoning with 199 per 100,000 C &YP population which is high than local average of 165/100,000 population (Schiller, 2014) .SCORE-5SCORE-3SeverityChildren with mentaldisorders are more likely to absent in schools(Green, H, 2004). About 14% of young peoplewho committed suicide were in contact withmental health services (ChiMat, 2016). Approximately 50% of lifetime mental health starts at the age of 14 (ChiMat, 2016). Young people with mental health problems result in low educational attainment and leave school with no qualification which is evident from county profiles that significantly less YP attain five GCSEs A* to C than the England average (PHE,2015). Thus are strongly associated with behaviours that pose a risk to their health, such as smoking drug and alcohol abuse and risky sexual behaviours (Green, H, etal, 2004)Conduct disorder is the most common mental disorder in childhood and adolescence affecting 5299 per 100,000 child population aged 11-16 year olds in Northamptonshire. Conduct disorder is the cause of a 34% of school exclusions.Lifetime costs of each one year cohort of 11-16 year olds with conduct disorder in Northamptonshire is £795 million (Campion, 2014)The children from 11-16yrs with conduct disorders are 30% likely to indulge in risk behaviours like smoking and 28% in drug use as well as 21% had tried to suicide (Campion, 2014; Green ,H, 2004).Among young people of 11-16yrs with an emotional disorder, 23% were smokers and 20% had taken drugs at some time and 28% said that they had tried to harm or kill themselves (Green, H 2004).Poor mental health in childhood and adolescence also leads to a broad range of poor adult health outcomes which leads to higher rates of adult mental disorder like;1.Depression2.Schizophrenia and mania3. Substance misuse4.Suicidal behaviour5.Personality disorder: 40–70% of children with conduct disorder develop antisocial personality disorder as adults(Campion, 2014)Mental health problem National Institute for Clinical Excellence (NICE) indicates that those who have self-harmed are 100 times more likely die by suicide in the following year (Nixon, B, 2011) Recent statistics conclude that rates have increased in the UK and are now among the highest in Europe. According to the National Institute for Care and Excellence, the riskof suicide has also increased (NICE 2013). Self-harm also include deliberate self-harm, self-mutilation, self-injury, self-poisoning, self-cutting, overdosing and attempted suicide. (Mitchell, J 2015). A national survey of more than 10,000 children of 11-15 year-olds, with the prevalence of self-harm at 1.2% among were children without any mental health issues, but 9.4% among those diagnosed with an anxiety disorder, and 18.8% if the diagnosis is depression or kind of mental disorder (Nixon B, 2011).About 14 % of children and young people who deliberately attempt self-harm are with mental problems(ChiMat, 2013).There was 36,423 admissions of 10-24 year olds for self-poisoning in 2014 and a total of 41,921 hospitalisations for self-harm among 10-24 year olds in England in 2014. In 2013 the rates for young women who committed suicide were 1.6 per 100,000 for 15-19year olds (Hagell ,2015).Repetition of self-harm was frequent and about 17.7 % repeated within a year (Hawton, K, 2012).The characteristics of adolescents who self-harm are similar to the characteristics of those who commit suicide. After a deliberate self-harm “Childbirth is the number one killer of teenagers’. Worldwide around 50,000 teenage girls and young women die during pregnancy and childbirth every year (NHS CHOICES, 2012). Babies born to young mothers are also at greater rise and about 1 million babies born to adolescent girls die before their first birthday (NHS CHOICES, 2012). One third of the young women are less likely to breast feed, and are 3 times at higher risk of smoking leading to 13% of still birth, 21% high risk for prematurity and low birthweight babies and 56% of infant mortality (PHE, 2013)Teenage pregnancy is a serious social problem. Having children at a young age can damage young women’s health and well-being and severely limit their education and career prospects.Teenage mothers have 3 times the rate of post-natal depression (DES, 2013).The cost of teenage pregnancy to the NHS alone is estimated to be £63m a year which places significant burdens on the NHS and wider public services (DES,2013).Along with the teenage pregnancy the young women riskier sexual practises lead to other sexually transmitted diseases like chlamydia gonorrhoea and other STIs at 131.6, 29, 680 per 1000 population in Northamptonshire (JSNA report, 2013)Young women with a child often leads to low educational attainment which pave way to bringing up a child incredible difficult situation and often results in poor outcomes for both the teenage parent and the child, in the interim leading to long-term poverty in both child and teenage mother ( DH, 2010). Children born to teenage mothers have a 63% higher risk of living in poverty
Priority Grid Criterion Table: Children and Young people among 11-16yrsin Kettering, Northamptonshirethat go untreated result in distress in childrenand their families, carers and communities.Within NHS its accounts for more than 12%oftotal budget. It is estimated that in 2007, thecost of mental health care across services was22.5 billion pound, taking into account loss ofemployment and other associated costs thisrises to 48.6 billion pound, which is 3.6%GDP. By 2026 it is estimated that thesecombined costs will have risen to 88.5 billionpound which is 6.6%of GDP (NHS, 2013).SCORE-5thereis 30-66% increased chance of suicide (Hawton, K, 2005).Challenging behaviour can take many forms from self-harm, aggression, sleeplessness, risk taking behaviours, anti-social behaviour and may lead to poor outcomes such as school and social exclusion.(YHMP, 2011).SCORE-4(PHE, 2013).Women who were teenage mothers are 22% more likely to be living in poverty at age 30 (PHE, 2013)SCORE-3EffectiveinterventionsLocal level :According to Dr.Schiller, 2014Northamptonshire have array of interventions , some of theearly interventions which are found to be effective are:1. Prevention and Early help, which includes the key projects *Talk Out Loud Anti Stigma Programme(Talk Out Loud Young Person’s: is designed to improve awareness of emotional wellbeing and mental health isues in secondary schools, enabling young people to talk openly about their concerns.(YHMP, 2014) *Ask Normen Service Gateway: This website www.asknormen.co.uk had a £30k investment in 2013/14 and the input of over 40 stakeholders to transition it from a service directory to an information, advice and guidance website. This website supports the professionals and families understand: Behaviours and Concerns, Conditions, Emotional Wellbeing themes, National and Local Policies, Child Development & Parenting Support, Links to services, Training Directory, News stories and newsletters, Referral pathways. The utilisation of site has dramatically increased with a peak of 632 users in March 2014 and an average of 433 users a month for the lastquarter of 2013/14 (YHMP, 2014).*Building emotional resilience through common language : “five to thrive”: Which aims to give families a better start which include preparing teens to become parents, In order to prevent self-harm the main focusis on schools to train teachers in identify, intervene and refer for further support for child. The programme also provided guidance for schools to undertake an in-school meeting with the young person as well as carers and parents (Halls 2011).Toolkit has been developed by Northamptonshire Multi-agency pathway development team. The tool kit introduced in schools and other health sectors, help in introducing school best practice policy and toprovide guidance in dealing with self-harm children (Sturgeon, S, 2016).The Talk Out Loud Anti Stigma programme/TaMHS work in schools to promote mindfulness is effective in Northamptonshire(Grinham, 2015).Those with some problems can be referred to NCC targeted services for counselling, specialist services like CAMHS required for those with moderate impairment. But those with severe suicidal ideation or attempts can be referred to hospital services (Grinham, 2015).The new self- harm toolkits for Northamptonshire on Asknormen to share there questionnaires for acute self-harmers, helps to identify the specific self-harm behaviour of the peer (Grinham, E, 2015).An emerging qualitative evidence that more access to robust treatment of mental health disorders in adolescents who self-harm actively contributes in suicide rates of young In order to reduce the teenage conceptions the target should include males and females, educating them on safer sex, and giving young people the aspiration to grow and achieve (NHS Northamptonshire, 2009).One programme to reduce teenage pregnancy is Time2Talk. The project aims to identify, train and support young people (16-24) to become peer educators and promoters of safe sex with local populations of ‘vulnerable’ young people aged 13-19 years. These peer educators are to educate andsupport young people on issues relating to safe sex, prevention of unwanted pregnancies and sexually transmitted diseases (NHSNorthamptonshire, 2009). This ‘Time2Talk’ team which serves theyoung people aged 13-15 includingcounselling, information on drugs, sexual health, pregnancy and sexually transmitted infections. It also encourages teenagers to talk to parents for support (Daventry Express, 2015)Team working in partnership with young people under19yrs to reduce the rates of pregnancy through sex education in schools, free advice and contraception (Daventry Express, 2015)
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