BSc Healthcare: Enhancing Depression Services for Young People

This report addresses the critical issue of depression among young people, focusing on its definition, prevalence, and impact. It analyzes the existing Child and Adolescent Mental Health Services (CAMHS) in Newham, UK, evaluating their effectiveness in addressing the specific needs of this vulnerable population. The report delves into the four-tier model of CAMHS, examining the roles and responsibilities at each level. Drawing upon research, policy guidelines, and practical experience, the author proposes enhancements to current services, emphasizing the importance of early intervention and community-based approaches. Furthermore, the report critically analyzes the crucial role of the children’s nurse in supporting young people experiencing depression, advocating for a more integrated and proactive approach to mental healthcare within the community. This report is available on Desklib, a platform offering a wealth of study resources for students.

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MEETING THE SPECIFIC HEALTH CARE NEEDS OF YOUNG PEOPLE
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Introduction
This essay aims to discuss the meaning and prevalence of depression as a health aspect among
young people and children, to describe the challenges and issues that a young person with
depression may experience, to analyze current services available for this problem and their
appropriateness in Newham. After which, drawing upon personal experience, research policy,
and practice guidelines, a proposal for enhancement of such services will be composed. Finally,
the children’s nurse’s role in looking after young people undergoing depression shall be outlined.
Definition of Depression
The behavioral definition of depression highlights how the problem manifests itself in a person.
This definition will be unique and specific to different people (Jongsma & Bruce, 2010).
However, depression can generally be defined as a medical condition that negatively affects an
individual’s way of thinking, actions, and feelings. Depression is characterized by feelings of
sadness, loss of interest in whatever the person enjoyed earlier and self-isolation from other
people. These behaviors have to last for at least two weeks to be considered as depression. To
better understand the meaning of depression, Gotlib & Hammen provides a causal cycle of
depression. This cycle entails vulnerability, the onset of depression, maintenance, response,
remission and recovery from depression, (Gotlib & Hammen, 2014).
Prevalence
The most frequently diagnosed mood disorder among the young people is the major depressive
disorder. Overall prevalence rates of mood disorder are estimated to be about 12%, with children
depression rates ranging from 0.4 to 2.5% and adolescent’s depression rates between 0.4 and
8.3%, (Wicks-Nelson & Israel, 2015). It is estimated that an approximate of 25% of adolescents

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will have experienced major depressive disorder by age 19. This means that about 1 out of 4
young people randomly picked from the general population has experienced a depressive
disorder, maybe during their childhood or adolescence stages.
Causes of depression
Gotlib & Hammen provide a causal cycle of depression. This cycle entails vulnerability-
vulnerability disorder is one cause of depression. It is more of a trait to state that characterizes
depression. The vulnerability could originate from genetic factors, biological sub-states or
psychological condition of a person. Second in the cycle is the onset of depression. This is
defined as the appearance of a depressive symptom which must include sad moods and lack of
pleasure persisting for two weeks. Next is the maintenance of depression. Depression symptoms
could last for months necessitating maintenance of the condition. The factors that perpetuate
depression could also be considered to be causal factors of depression. Finally, the causal stage
ends with the response, remission, and recovery. This is the stage at which the symptoms are
dealt with to ensure their disappearance or reduction, (Gotlib &Hammen, 2014).
Various reasons can make a depression to occur in young children. First, personal experiences or
events such as bereavement, bullying at school, neglect or physical illness could act as triggers to
depression. Secondly, the occurrence of too many changes in a young person’s life too quickly or
within a very short span of time whereas there is no person to share these worries with or there is
no practical support, (Davies & Davies, 2011). Harrold further adds that a reaction to a difficult
and stressful life event such as family breakdown, conflict within the family, harassment, break-
up of a relationship, school pressures, and sexual abuse could also lead to depression. Moreover,
another cause of depression among the young people is as a result of a chemical imbalance in the

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brain especially during adolescence stage, and finally, depression could be a part of another
illness, for instance, those with bipolar disorder, post-traumatic stress disorder, and
schizophrenia and anxiety disorder, as viewed in Harrold (2009).
Impacts on the young people experiencing depression
Depression negatively affects a young person’s life, academically, socially and personally.
“Depression causes young people to have trouble taking the initiative, developing independence
and self-confidence and establishing their own identity,” as explained in Moragne (n.d. Pg. 62).
In addition, depression can lead to violent behavior that may include suicide or self-harm. The
symptoms of depression in themselves are already negative impacts on the young person.
Depression diminishes the person’s ability to think therefore inability to perform well in
academic work. It may lead to the person feeling lonely and isolating him or herself from other
people, causes bad moods most of the day and lower self-esteem, thereby affecting the ability of
the person to interact with other people (impact on social life). Moreover, depression also affects
the personal and physical life of the young person through such impacts as sleep disturbances,
fatigue and changes in appetite or weight of the person, (Claveirole & Gaughan, 2011).
Considering the numerous negative impacts of depression on adolescents’ health and well-being,
it is important to get assistance as soon as possible to avoid episodes of depression from
recurring and to foster the normal development of this young generation, (Moragne, n.d.).
Analysis of service provision
Child and adolescent mental health services, CAMHS, provide services targeting children and
adolescents experiencing emotional problems or behavioral well-being issues, (Nhs.uk, 2018). In
spite of the effectiveness of early intervention and prevention of depression, many young people

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suspected of experiencing mental health problems are referred to CAMHS, (Steen & Thomas,
2015). A range of health and mental professionals such as nurses, social workers, and
psychologists provide different services, under CAMHS, including assessment and treatment of
mental health illness, and both individual and family counseling towards dealing with depression
in adolescents and children.
CHAMHS services are provided in a four-tier model. Great Britain & Wollaston describes this
model as follows:
Tier 1- consists of universal services delivered by people who are not mental specialists (all
children schools, GPs, health visitors, Children’s centers).
Tier 2-these are those services that are provided by professionals working in primary care. It
involves jointly working with targeted and universal services (children who are at risk of
experiencing mental health difficulties, targeted services in education, social care and health),
(Goldson, 2013).
Tier 3- involves specialist multidisciplinary teams dealing with more severe, complex and
persistent problems (for instance mental health in-reach teams).
Tier 4- deals with severe or highly complex mental health needs through highly specialized
services, for example, inpatient units, including secure forensic units, (Great Britain &
Wollaston, 2014).
According to Goldson, a child who enters tier 1 does not necessarily end up receiving services at
this tier only. Depending on the complexity of his or her problem, he or she may simultaneously
require services from different tiers. “Moreover, workers at tier 1, when there is a need, may be

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supported by professionals at tiers 2 or 3, including youth offending team workers who may be
located at different tiers,” (Goldson, 2013. Pg 112). To understand the community by community
service provision and NHS services in relation to depression, this essay will mainly focus on Tier
3 and Tier 4 stages of CAMHS.
Mild depression is managed best in tier 1 and 2 services. This entails duration of maybe up to
four weeks of observing the patient followed by simple non-directive supportive therapy or
guiding the person to attain self-help. If these become unresponsive or unhelpful, then the young
person is referred to CAMPH specialists in tier 3. For moderate or severe depression, according
to the most current NICE guidance, the patient may be administered with an antidepressant.
Moreover, psychological therapy may be started along with the antidepressant, without first
offering psychological therapy trial (Baldwin, Hjelde, Goumalatsou, Myers & Collier, 2016)
CAMHS tier 3 deals with service provision for children with specific mental health problems
which are complex and persistent. This tire describes outpatient community care. Adolescents
are referred to this stage often by education welfare officers, social workers, school nurses, and
pediatricians. These services are clinic or hospital-based or some outreach work in schools or
homes, (Woolfe, 2009). These specialist mental health teams are responsible for mental health
disorders assessment and treatment in young people up to age 18. Hooper, Thompson, Laver-
Bradbury & Gale explain that Tier 3 consists of multidisciplinary teams working in child
guidance clinics and other specialized units, that is, Specialized Child Mental Health Services
(SCHAMHS). Depression is dealt with in this tier as it is one of the problems seen to be too
complex to be dealt with in Tier 2, (Hooper, Thompson, Laver-Bradbury & Gale, 2012).
Moreover, community CAMHS teams also provide TIER 3 services. Community CAHMS
provide services for the population of a specific geographical region under tier 3 service

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provision, (National Collaborating Centre for Mental Health (Great Britain), 2013). Professionals
in this Tier further provide 24-hour emergency services as well as managing the full range of
mental health difficulties in young people.
CAMHS Tier 4 level consists of specialized day and inpatient units such as adolescent units,
specialized social services therapeutic homes, for assessment and treatment of patients with more
severe mental illnesses (Hooper, Thompson, Laver-Bradbury & Gale, 2012). These services
under tier 4 do not operate independently from other CAMHS system parts. As Great Britain
(2014) indicates, they are linked to specialist outpatient services, targeted early intervention
services and universal services such as schools and general practitioners’ services.
To improve the effectiveness of their services, CAMHS in the United Kingdom, have undergone
significant changes from the time of its formation. With emphasis placed on CAMHS, by
Children Act 2004 and The National Service Framework for Children, Young People and
Maternity Services, in 2004, aiming to decrease social exclusion, to take account of user
perspectives and to encourage all children services to work together (Afuape & Krause, 2016),
CAMHS has devolved to include several changes that would allow for effective and efficient
services provision to the adolescents. Further, “These expectations have placed pressure on
CAMHS professionals to increasingly work outside the clinic or the health facility, in schools,
general practices, nurseries and children’s centers, which was not the case in the past,” (Afuape
& Krause, 2016. Pg. 4).
The health of children and young people depend on the ease of accessing services and the
possibility of delivering interventions early. This has further emphasized the need for CAMHS to
ensure that its professionals bring their services close to the populations and the communities

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who may be in need of these services, necessitating the changes. However, due to the additional
costs and expenses associated with bringing the services closer to the communities, CAMHS, in
providing early intervention services, is often precarious and suffer from reduced, insecure and
short-term funding, thus affecting the effectiveness of the programs.
House of Commons report, (2014, pg.3) confirms that the whole system of CAMHS has not been
effective in commissioning and providing mental health services for children and adolescents.
Afuape and Krause highlight that the whole CAMHS system has experienced problems right
from prevention and early intervention through to inpatient services delivery for the most
vulnerable adolescents, (Afuape& Krause, 2016).
To deal with these problems, CAMHS established developments within its system to further
emphasize local partnerships. This led to bringing together organizations that have the
responsibility to provide adolescent and children’s services and their families, including schools,
nurses, health visitors, social workers and the police among others, with a shared aim to improve
the lives of young people. However, despite the abolishment of many of these developments in
2012 by the NHS reforms, CAMHS still embrace the principles of working in the community
and joining partnerships with other professionals and community organizations in providing its
services.
Young Minds, a charity organization dealing in adolescents’ mental health, also promotes
nationwide projects that provide information on dealing with trauma, which helps mental health
professionals to support those children and young people experiencing distressing or depressing
situations (Youngminds.org, 2018). In responding to an independent review of CAMHS to
determine its appropriateness, Young Minds outlined that there was a serious lack of skilled

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personnel to treat the few children suffering from severe mental health problems. According to
them, CAMHS delivered inadequate services especially to children with learning problems and
older teenagers, (Walkers, 2011).
Planned Proposal
Majority adolescent’s mental health problems, such as depression, often seek for primary care
first, with general practitioners, (GPs), being the first people approached by the families of these
young people, as the initial course of action, while training in adolescent mental health is not part
of the compulsory GP training program. This may affect the expertise of family door mental
health intervention program, (Midgley, Hayes & Cooper, 2017) since they are more often than
not provided by GPs.
In addition, the onward referral options available for GPs are also fairly limited. Due to the
statutory CAMHS limited capacity and high thresholds, only adolescents in crisis will meet the
assessment and treatment criteria. Only one thousand four hundred out of one hundred thousand
young people aged below 20 years are referred to CAMHS annually for mental health services.
Furthermore, there is also an extreme limitation of specialized inpatient beds, with an
approximation of 1,400 across the whole of England. With at least 10 percent of the adolescents
and about 5 percent of the younger population suggested to experience mental health symptoms
that require treatment, there is a treatment gap.
Midgley, Hayes & Cooper highlight that, from the findings of a national survey, over half of the
young people between the ages 12-15 with mental health problems, including depression, do not
have access to services for these problems. This gap is wider for adolescents as well as young
adults compared to other age groups. A survey conducted in the United Kingdom secondary

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schools on 3750 young people between ages 12-16 revealed that only 5 percent of those at high
risk of depression had gotten in contact with specialist CAMHS in the past six months. While 79
percent of those with probable depressions contacted their GP and 5 percent found to have
sought specialist mental health, depression, services in the previous year, (Midgley, Hayes &
Cooper, 2017).
To bridge this gap in providing mental health services, with regards to depression, for the young
people, it would be appropriate to link up NHS provision with others, for example, counseling
services and voluntary sector youth information. However, doing this can be very challenging.
Therefore, interventions towards meeting mental health services needs among children and
young people should consider this wider gap of services provision and also include voluntary and
independent sectors, to ensure e larger proportion of young people that do not meet the CAMHS
threshold.
As suggested in Walker, (2011), training should be provided to all professionals dealing with
young people to equip them with the necessary skills and expertise to asses and identify
problems as they arise. Moreover, training would enable them to know how to support
adolescents in distress, understand the normal developmental stages of the young people and
know when and how to make referrals to specialist practitioners. From recent research, Walker
further notes that it was founded out that 80 percent of young people between the ages of 7 to 13
years prefer to seek for help from their teachers in case of problems than a mental health
professional (Young Minds 2003), (Walker, 2011).
Walker also suggests paying attention to the many developmental stages incorporated between
the ages from childhood to adolescence in designing of developmentally appropriate intervention

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methods. Failure to consider these stages and considering children as miniature adults has often
led to providing mental health services for young people based on adult concepts, models, and
practices.
To better understand and design appropriate mental health care services to the young people, it
would be important to understand what young people, their parents, and caregivers want in
relation to mental health services provision. McDougall & Cotgrove (2013) outlines the
expectations of young people in relation to intensive crisis services in CAMHS to include:
receiving intensive support and continuity of care after discharge from inpatient treatment to
other services; understanding what is happening and receiving information in the most suitable
way to them; being reassured that there is help, and that help is accessible immediately, by the
right professional at the right time; and avoiding admission where possible as well as receiving
intensive support in the community or at home. This proposal aims to address how to bridge the
existing treatment gap in mental health services provision and how to ensure that these services
are appropriate, flexible and accessible.
Role of the young people’s nurse
School nurses have been found to be the first point of professional contact for young school
going people with mental health problems. McDougall indicates that these nurses are in a
position to identify mental health issues and challenges and provide effective support for pupils
and students. School nurses work across the field of education, health and social care putting
them in key positions for leadership and influence with multi-agency colleagues, (McDougall,
2016).

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To ensure that they provide effective mental health services, McDougall suggests that school
nurses should form good networks and working relationships with other health and social care
professionals such as health visitors, speech, and language therapists and adolescent specialist
nurses as well as practice nurses, psychologists and mental health workers. The fact that school-
based nurses spend the most time with these young people in school than even their parents
during the school term enables them to form professional relationships with children and young
people thus helping in reducing health inequalities. The school nurses are further identified to be
very important in terms of helping young people choose healthy lifestyles, emotional health as
well as well-being. School nurses’ services are universal, and most young people tend to see
them be less stigmatizing compared to specialist CAMHS. The school nursing practice is guided
by several Nursing Institute for Health and Care Excellence, NICE, guidelines on physical and
mental health, (McDougall, 2016).
Mental health nurses and community nurses are also engaged in the care, support, and treatment
of the young people with depression-related mental health problems are causing. It is important
for young people’s nurses to recognize the limitations of their knowledge and skills and where
possible make referrals to the specialists (Valentine & Lowes, 2007).
Moreover, community nurses for young people provide depression-related mental health services
to adolescents in their homes and give valuable assistance to families. Finally, children’s nurses
contribute towards the treatment of children experiencing depression with an aim to reduce
depression, promote social and emotional functioning and assisting the family in understanding
and dealing with their children’s illnesses, (Norman & Ryrie, 2013).
Conclusion