Posted on: July 7, 2021
What is the difference between mental health and mental illness and how can you differentiate between the two when working with children and young people and undertaking a mental health assessment? Cathy Laver-Bradbury, Co-Editor of Child and Adolescent Mental Health , considers this in light of COVID-19.
Most parents manage their children without difficulty - there may be challenges along the way, but these are viewed as being within the range that are associated with normal development.
However, when parents seek the help of a professional to explain why their child is behaving in a certain way it is generally because they have exhausted all other revenues of help. Or have become confused as friends, family and schools offer many thoughts and ideas on why behaviours are occurring, and as parents they are trying to make sense of the myriad of information they are receiving.
For some parents, their child’s mental health is so much of a concern to them, and they seek support from a CAMH (Child and Adolescent Mental Health) service on how to help their child.
What are the definitions of mental health and mental illness? Have these changed because of the COVID pandemic?
During the COVID pandemic CAMH services have seen a significant increase in referrals for assessment of children’s mental health, as our normal societal expectation of childhood were disrupted by the repeated lockdowns and the change in the structure of the children’s day. Parents were suddenly expected to take on the role of a teacher supporting their child academically, socially, and emotionally. Children were expected to learn online in a virtual world with little social contact with their peers or teachers.
Services that were already underfunded and under resourced are experiencing further strain as the number of referrals increased.
So, for those in CAMHS (Child and Adolescent Mental Health Services), who assess for mental health difficulties, how do we acknowledge that more children might be struggling generally but these do not necessarily mean that their mental health will not recover as ‘normality’ returns? How do we differentiate those who may experience long term difficulties because of the pandemic both physically and mentally, and what support can be seen to be offered to both them and their parents?
How society defines mental health and how it defines mental illness is important and this changes as society gains knowledge and progresses. We already have some considerations that childhood mental health conditions may put a child more at risk of catching COVID because of their impulsivity.
Will the definition of mental illness we have in society change due to COVID?
How do CAMHS professionals consider what has been an exceedingly challenging time for many children and young people? There are many aspects of the Covid pandemic that can affect the mental health of children:
- The grief and loss of loved ones that died because of COVID and the impact it has on the family system.
- The impact of having a parent with ‘long COVID’ who is no longer able to care for them as they had previously. Or a young person even becoming their carer.
- The knowledge that they (the young person) might unwittingly have been or could be the transmitter of the virus to friends and family and the impact this might have on them.
- The increased risk of catching it themselves when attending school or displaying behaviour that could put them more at risk both in terms of social ostracising or the illness or spreading COVID - those children and young people with neurodiversity that struggle to follow social rules in particular - such as the implementation of wearing face masks and/or using them correctly.
- The effects of ‘long COVID’ on children’s physical and mental health will we (as services) need to adapt current treatment regime to find one that helps young people recover or manage their difficulties?
Currently we have more questions than answers about the various aspects of COVID and much further research is needed into its impact and whether it has led to any increase in mental health disorders.
What is apparent is the awareness of the impact of COVID on young people has increased. It is in the forefront of many of the public services minds as they plan how to help children catch up with their academic learning, to individual families seeking help from health, education, and social care.
So, what is the difference between mental health and mental illness when we consider this in the context of a global pandemic. One thing that is certain is that child and adolescent mental health and its definitions will change as the research knowledge increases and it will continue to change over time, as it can never be a static entity as both society and knowledge continually changes.
Use communication and assessment skills
In the meantime, what clinicians can do is to remember our skills of communication and assessment so we can recognise those in need of specialist help and by ‘making every contact count’:
- Parents/carers and children are likely to be anxious-they do not know yet if they can trust you, or if you will judge them or take their concerns seriously.
- They are likely not to remember or recall all the information you might need for our comprehensive assessments and so more than one appointment maybe necessary.
- Adults with long COVID report cognitive decline, we do not yet know how this affects children.
- Telling their story can be painful and bring back memories they are trying to forget, especially if they were close to loved ones that were lost in the pandemic.
- The parents’ ‘story’ may be different to the young persons, and both might need to be heard separately to complete a formulation for the young person.
- You might be the first professional they have encountered or one in a line of many, it is important to make sure that whichever it is you are helpful to them and their child. The experience needs to be kind, considered and thoughtful.
- Parents may be struggling with their own issues that are impacting how available they are to effectively parent their young person.
- Or despite herculean parenting their child is not responding, and they are struggling.
Whatever the ‘story’ or the influence of COVID, being listened too and having the chance to ‘borrow’ a clinician’s brain to make sense of what is happening can be reassuring at a time when life is challenging.
Does your course cover CAMH? Request an inspection copy of Child and Adolescent Mental Health . The text covers all core aspects of the subject, from the importance of knowing why mental health in children is important, to how to assess, formulate and treat a variety of presentations seen in children and young people.