At Risk of Severe Mental Health Pathway (ARMS)


Why is adolescent mental health a public health concern ?

As part of normal development young people aged 12 to 18 years negotiate multiple transitions in most aspects of their life, some of these include; furthering education or employment, moving out of home and becoming independent. These transitions compounded with other psychosocial stressors in their lives make them more vulnerable to particular risks such as mental disorders .They are these transitions that place young people at risk of suffering disproportionately from many different types of disadvantages, including homelessness, lack of training or education and poor health (in particular mental and sexual health).

The adolescent period is considered to be one of high risk. The total UK prevalence of psychiatric disorders increased from a rate of 9.5% in children aged 5 to 15 years (in the British Child and Adolescent Mental Health Survey), to between 20 and 25% in those aged 16 to 24 year age group with 7.2 per cent having two or more mental disorders. Despite the fact that 75% of mental disorders begin before the age of 25 years, less than half of the young people are willing to accept that they are struggling with a mental disorder and less than a third are known to mental health services.  These very facts make adolescent mental health a public health concern.

A world wide systematic review reported a step increase in burden of disease of 2.5 times from the 10 to 14 year age bracket to the age group 15 to 19 years. The main disorders contributing to the burden of disease (which was measured in DALYs), for both genders were (most prevalent listed first); unipolar depression, schizophrenia, road traffic accidents, bipolar disorder, alcohol use, violence and self-harm. The commonest DSM-IV mental disorders reported in the British Child and Adolescent Mental Health Survey were; anxiety disorders, depressive disorders and disruptive disorders; these included; attention deficit hyperactivity disorder (ADHD), Autism Spectrum Disorders (ASD), conduct disorders and oppositional defiant disorder.

Epidemiological studies spanning the last thirty years, in different populations repeatedly have linked childhood and adolescent mental disorders to certain ‘risk factors'. These factors include; poverty, poor general health, family dysfunction, parental psychiatric illness, adverse life events, low socio economic status and ethnicity.

Given that there is strong evidence that adolescence is a risk period for the emergence of serious mental disorders, the UK’s National Health Service (NHS) has an explicit equity-driven policy framework for access to services. Despite this emerging awareness of these additional developmental tasks that young people need to master, there are reports which state that mental health provision for young people with mental health needs are limited, inconsistent in different parts of the country and are not necessarily configured in ways that are ‘supportive’ for young people. There are now a series of publications highlighting the poor provision of most health services for young people with ongoing and long term health care conditions as they attempt the transition  (barriers and facilitators) from child and adolescent services to adult services.

This TAASC pathway aims to delve deeper by offering a holistic and in depth assessment based on the most recent research on the adolescent period. Furthermore to provide individualised tailored management to meet the needs of the young people and offer a platform for the scaffolding thes young person through a most difficult time in their lives.