B730 : Meeting The Specific Health Care Needs Of Young People

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B730 : Meeting The Specific Health Care Needs Of Young People

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B730 : Meeting The Specific Health Care Needs Of Young People

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Course Code: B730
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Specifically pertinent to young people:for example: Any long term health condition, acute condition, sexual health problem or mental health problem?Analyse the services currently available in relation to chosen aspect of health?Drawing on practice experience and with reference to research policy and practice guidelines, compile a written proposal for how this service could be further developed and why.?Critically analyse the role of the children’s nurse within this proposed development

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).
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 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 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 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 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 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 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 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 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 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).
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).
Depression is a serious mental illness that affects many young people especially as they develop into puberty and adolescence. This can be attributed to the various emotional changes associated with childhood development at this stage. The NHS has provided guidelines towards the treatment of depression in the young population. Through the CAMHS program and the Young Minds charity organization, young people experiencing mental health problems can get assistance. However, due to lack of enough resources and skilled personnel, the CAMHS program has not been very effective in addressing depression needs of children and adolescents. Finally, the young people’s nurses also play an important role towards ensuring that young people experience good mental health free of depression related disorders.  Mental health services towards young people should thus be accessible, flexible, designed in accordance with the stages of development in the life of the young people and their needs as well as attain the objectives for which they are designed and delivered.
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.
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Baldwin A., Hjelde N., Goumalatsou C., Myers G. & Collier J.A.B. (2016). Oxford handbook of clinical specialties. Oxford University Press.
Claveirole A. & Gaughan M. (2011). Understanding Children and Young People’s Mental Health. New York, NY, John Wiley & Sons. Available at https://nbn-resolving.de/urn:nbn:de:101:1-201412308087. (Accessed on 31st May 2018)
Davies R. & Davies A. (2011). Children and Young people’s Nursing: Principles of Practice. CRC Press.
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Great Britain & Wollaston S. (2014). HC 342-Children’s and Adolescents’ Mental Health and CAMHS. Great Britain, The Stationery Office.
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Jongsma A.E. & Bruce T.J. (2010). Evidence-based treatment planning for depression workbook. Hoboken, N.J., Wiley.
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Midgley N., Hayes J. & Cooper M. (2017), Essential Research Findings in Child and Adolescent Counseling and Psychotherapy. SAGE Pubns.
Moragne W. (n.d.). Depression. New York, Lerner Digital.
National Collaborating Centre for Mental Health (GREAT BRITAIN), (2013), Psychosis and Schizophrenia in children and young people: recognition and, management. RCPsych Publications.
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Norma, I.J. & Ryrie, I. (2013), The art and science of mental health nursing: principles and practice. Available at https://www.dawsonera.com/depp/reader/protected/external/AbstractView/S9780335245628 (Accessed on 31st May 2018).
Steen, M. & Thomas M. (2015), Mental Health across the Lifespan: A Handbook. Routledge.
Valentine F., & Lowes L. (2007), Nursing care of children and young people with chronic illness. Oxford, Blackwell Pub. Available at https://public.eblib.com/choice/publicfullrecord.aspx?p=351312. (Accessed on 31st May 2018).
Walker, S. (2011), The Social Worker’s Guide to Child and Adolescent Mental Health. London, Jessica Kingsley Publishers.
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Youngminds.org. (2018). Available at https://youngminds.org.uk/. (Accessed on 31st May 2018).

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