Access Evidence No. 3, March 2018 YOUTH MENTAL HEALTH in Ireland and Northern Ireland Access Evidence is a series of evidence reviews for frontline practitioners working with children and young people. AC Produced by CES S EVIDENCE 1 Youth Mental Health in Ireland and Northern Ireland Youth Mental Health in Ireland and Northern Ireland An AcCESs Evidence Report By: Sarah Rochford, Professor Mark Morgan, Dearbhla Quinn and Niamh Farren March 2018 Acknowledgements The authors would like to thank the following people who made important contributions to this publication: members of the AcCESs Evidence Practice Advisory Group (Anne En- glish, Beth Cooney, Michelle Harris, Eimear Gilchrist, Carmel Brennan, Sarah Kelleher, Paul Mardsen and Teresa Bennett). The authors would also like to extend special thanks to Dr. Eve Griffin (National Suicide Research Foundation) and Professor Siobhán O’Neill (Ulster University), for contributing to, and reviewing, earlier versions of this report and offering valuable expert feedback and guidance. In addition, they would like to thank other mem- bers of the CES AcCESs Evidence team: Nuala Doherty, Melanie Stone, Mary Rafferty and Aisling Sheehan. The Centre for Effective Services (CES) is a not-for-profit company limited by guarantee (Company Number 451580 and Charity Number 19438 in Ireland). The work of the Centre is supported by The Atlantic Philanthropies. Published by the Centre for Effective Services, Dublin ISBN: 978-0-9957189-3-7 This report should be cited in the following way: Rochford, S., Morgan, M., Quinn, D. and Farren, N. (2018) Youth Mental Health in Ireland and Northern Ireland: An AcCESs Evidence Report. Dublin: Centre for Effective Services. All rights reserved. No part of this publication may be reproduced, stored in a retrieval sys- tem, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the copyright holder. For rights of translation or reproduction, applications should be made to: Centre for Effective Services, 9 Harcourt Street, Dublin 2, D02 HH48, Ireland The Centre for Effective Services www.effectiveservices.org 9 Harcourt Street Dublin 2 Forestview, Purdy’s Lane D02 HH48 Belfast BT8 7AR Ireland Northern Ireland Tel: +353 (0) 1 416 0500 Tel: +44 (0) 28 90 438 433 Email: [email protected] Email: [email protected] 3 Youth Mental Health in Ireland and Northern Ireland Contents 1. Introduction ..............................................................................................................6 1.1 About this report and how to use it ..........................................................................8 1.2 About the AcCESs Evidence series ..........................................................................9 1.3 Key messages from research about youth mental health .......................................9 2. Youth mental health– background ........................................................................12 2.1 What do we mean by youth mental health? ..........................................................12 2.2 Adolescence – a time of transition .........................................................................13 2.3 The cost of youth mental health .............................................................................14 2.4 What can data tell us? ..............................................................................................15 3. Youth mental health – facts, figures and disorders ..............................................17 3.1 Mental health problems are on the increase .........................................................17 3.2 Mental health difficulties and disorders .................................................................18 3.3 Does gender make a difference? ............................................................................19 3.4 Self-harm – a hidden issue ......................................................................................20 3.5 Mental illness and in-patient admissions ...............................................................23 3.6 Suicide rates – a global concern .............................................................................25 3.6.1 The rate of youth suicide ...................................................................................27 3.7 Suicide clustering .....................................................................................................30 4. What influences youth mental health? .................................................................33 4.1 Social and cultural influences ..................................................................................34 4.1.1 The impact of stigma .........................................................................................35 4.1.2 Self-image ...........................................................................................................36 4.1.3 At-risk groups .....................................................................................................37 4.2 Demographic factors ...............................................................................................40 4.2.1 Gender ................................................................................................................40 4.2.2 Socioeconomic position ....................................................................................43 Socioeconomic position in Ireland ...........................................................................44 Socioeconomic position in Northern Ireland ..........................................................45 4 AcCESs Evidence 4.3 The immediate environment ...................................................................................46 4.3.1 Family structure and parenting .........................................................................46 4.3.2 Peer influences ...................................................................................................49 4.3.3 The school environment ....................................................................................52 4.3.4 Use of the Internet .............................................................................................53 4.4 Individual factors ......................................................................................................54 4.4.1 Lifestyle behaviours ...........................................................................................54 4.4.2 Lifeskills/psychosocial competencies ...............................................................55 5. What supports youth mental health? ....................................................................58 5.1 The role of services ..................................................................................................58 5.2 The importance of prevention ................................................................................59 5.3 Challenging stigma ..................................................................................................60 5.4 Targeting ‘at risk’groups ..........................................................................................61 6. Resources ................................................................................................................64 7. References ...............................................................................................................68 5 Youth Mental Health in Ireland and Northern Ireland INTRODUCTION 6 AcCESs Evidence 1. 1.Introduction Adolescence is a critical time for the development of positive mental health. Most young people across the island of Ireland are doing well and are generally happy with their lives. As they grow up, young people may experience short-term changes in their mental health – temporary dips where they need more support and care from the adults in their lives, from their families and from their friends. Some young people experience changes in their men- tal health which are acute and can cause them, and their friends and families, considerable pain, distress and harm. Research shows that 75% of all mental health illnesses emerge between the ages of 15 and 25 years.1 Mental health difficulties may include behavioural or developmental disorders, pe- riods of anxiety or depression, eating disorders, substance abuse, self-harm, or more acute disorders such as psychiatric illness. They can involve single episodes or more prolonged pe- riods of difficulty. Some young people may struggle with mental health difficulties throughout their lives. Difficulties may emerge Research shows during times of physical or emotional stress, or for no apparent that 75% of all men- reason. There is a strong link between poor mental health and tal health illnesses suicide. When mental health problems deteriorate and young emerge between people experience considerable distress and suffering, there is a the ages of 15 and significant risk of self-harm and suicide. 25 years. Statutory and community services aim to support young people experiencing mental health difficulties. As is the case with other public health challenges, prevention and early intervention approaches are key to recognising and tackling problems early on. Front-line practitioners, such as teachers, social workers, youth workers and other professionals who come into regular contact with young people, play an important role in recognising the signs and symptoms of distress among young