There are several factors that determine whether young people receive services for their emotional
and behavioural problems. Firstly, the young person or their parents and carers or another significant
person in their lives must recognise that there is a problem and that the problem requires assistance.
Secondly, they or people close to them need to know that there are effective services to deal with
these problems and these must be accessible. Lastly, parents and carers, and young people
themselves particularly when they are older, must feel able to receive care and be willing to use
services.
This chapter reports on the need for services and barriers to care for young people as perceived by
their parents and carers.
8.1 Perceived need for mental health care
Parents and carers were asked about the help their child or adolescent needed with their emotional
or behavioural problems and whether their needs for these had been met. The help was categorised
into four types:
• Information about emotional or behavioural problems, treatment and available services;
• Prescribed medication for emotional or behavioural problems;
• Counselling or a talking therapy about problems or difficulties (either one-on-one, as a family
or in a group); and
• Courses or other counselling for life skills, self-esteem or motivation.
8.1.1 Perceived need for help for all children and adolescents
Just over a quarter (26.8%) of all parents and carers reported that in the previous 12 months their
child or adolescent had some need for help for emotional or behavioural problems. Seven out of ten
parents and carers (70.2%) who indicated a need for help reported their child’s or adolescent’s needs
were met either fully (42.9%) or partially (27.3%). The remainder (29.8%) indicated their needs were
not met at all (Table 8-1).
The most common type of help parents and carers felt their children needed was counselling or a
talking therapy, with one fifth of all parents (21.6%) reporting a need for such services in the previous
12 months. Of the 4-17 year-olds whose parents indicated a need for counselling or talking therapy,
two thirds (66.8%) reported that their needs were met either fully (42.7%) or partially (24.1%).
One in ten parents and carers of 4-17 year-olds (10.3%) indicated a need for courses or other
counselling for life skills, self-esteem or motivation in the previous 12 months, of which less than half
(43.1%) indicated the need was met either fully (29.0%) or partially (14.1%). Similarly, about one in ten
(12.1%) parents and carers identified a need for information, of which 62.4% reported that the need
was met either fully (44.3%) or partially (18.1%). Relatively few (4.2%) parents and carers identified a
need for medication.
82 The Mental Health of Children and Adolescents
Table 8-1: Perceived need for help in past 12 months for 4-17 year-olds
Level of perceived need
Information
(%)
Medication
(%)
Counselling
(%)
Life skills
(%)
Any type of
help (%) (b)
No need 87.9 95.8 78.4 89.7 73.2
Any need— 12.1 4.2 21.6 10.3 26.8
Needs fully met (a) 44.3 54.4 42.7 29.0 42.9
Needs partially met (a) 18.1 18.7 24.1 14.1 27.3
Needs unmet (a) 37.7 27.0 33.2 56.9 29.8
(a) The proportion of those reporting any need whose needs were fully met, partially met or unmet.
(b) Where need for more than one type of help was identified, level of perceived need for any type of help has been derived
from the level of perceived need for each type of help needed (see glossary for details).
8.1.2 Perceived need for help for young people with mental disorders
Almost four fifths (78.6%) of parents and carers of children and adolescents with mental disorders
identified that their children had a need for some type of help with their emotional and behavioural
problems in the previous 12 months. Almost three quarters (73.8%) of these parents and carers
reported that their children’s need for help in the previous 12 months had been either fully (34.9%) or
partially met (38.9%). However, one quarter (26.2%) reported that they had unmet need (Table 8-2).
Almost double the proportion of parents and carers of 4-11 year-olds with mental disorders than of
12-17 year-olds with mental disorders felt that their children had no need for help (26.8% compared
to 14.6%).
Table 8-2: Perceived need for any type of help in past 12 months for 4-17 year-olds with mental
disorders by age group
Level of perceived need 4-11 years (%) 12-17 years (%) 4-17 years (%)
No need 26.8 14.6 21.4
Any need— 73.2 85.4 78.6
Needs fully met (a) 35.2 34.6 34.9
Needs partially met (a) 33.7 44.7 38.9
Needs unmet (a) 31.2 20.7 26.2
(a) The proportion of those reporting any need whose needs were fully met, partially met or unmet.
Counselling was the type of help most often reported as needed. Two thirds (68.1%) of parents and
carers of children and adolescents with mental disorders reported that their child or adolescent
needed counselling. Of these, just over two thirds (67.7%) indicated that their needs were met either
fully (36.8%) or partially (30.9%) (Table 8-3).
Two fifths of parents and carers (41.7%) of children and adolescents with mental disorders reported a
need for information, and this need was met fully (39.4%) or partially (25.0%) in about two thirds of
cases. Just over one fifth (22.3%) of parents and carers reported a need for medication for their child
or adolescent in the previous 12 months and this need was met in 76.5% of cases, either fully (54.5%)
or partially (22.0%).
The Mental Health of Children and Adolescents 83
One third (36.0%) of parents and carers of children and adolescents with mental disorders reported
that the young person needed life skills training. A relatively low proportion (39.1%) reported that this
need was met either fully (20.6%) or partially (18.5%). The majority (60.9%) of parents reporting a
need for life skills training indicated the need was not met.
Table 8-3: Perceived need for help in past 12 months for 4-17 year-olds with mental disorders by type
of help
Level of perceived need
Information
(%)
Medication
(%)
Counselling
(%)
Life skills
(%)
Any type of
help (%) (b)
No need 58.3 77.7 31.9 64.0 21.4
Any need— 41.7 22.3 68.1 36.0 78.6
Needs fully met (a) 39.4 54.5 36.8 20.6 34.9
Needs partially met (a) 25.0 22.0 30.9 18.5 38.9
Needs unmet (a) 35.5 23.5 32.3 60.9 26.2
(a) The proportion of those reporting any need whose needs were fully met, partially met or unmet.
(b) Where need for more than one type of help was identified, level of perceived need for any type of help has been derived
from the level of perceived need for each type of help needed (see glossary for details).
The extent to which parents perceived a need for help varied with the severity of the young person’s
disorder (Table 8-4). Two thirds (68.3%) of parents and carers of 4-17 year-olds with mild mental
disorders felt that their child or adolescent needed help, and in 65.6% of cases these needs were met
either fully (40.2%) or partially (25.4%). By contrast, all or nearly all parents of children or adolescents
with a moderate or severe mental disorder (91.8% and 100.0% respectively) reported that they
needed some form of help. A higher proportion of parents of children and adolescents with moderate
and severe disorders (81.8% and 84.2% respectively) reported that their needs were met fully or
partially than did those parents of 4-17 year-olds with mild mental disorders (65.6%).
Parents and carers of three quarters (73.6%) of those with severe disorders, one half (51.6%) of those
with moderate disorders and less than one third (29.6%) of those with mild disorders identified a need
for information. The need for information was unmet in about one third of cases (34.6% in those with
severe disorders, 31.5% for moderate disorders, and 39.1% for mild disorders).
Parents and carers reported that half (52.4%) of children and adolescents with severe disorders, one
third (36.7%) of those with moderate disorders and less than one in ten (8.7%) of those with mild
disorders had a need for prescribed medication. This need was unmet for around one quarter of those
with severe disorders (23.3%) and moderate disorders (28.4%).
Counselling or talking therapies were the type of help most often reported by parents and carers as
being needed, with 87.0% of those with severe disorders, 85.8% of those with moderate disorders and
55.9% of those with mild disorders identifying a need for this type of help. According to parents and
carers, four fifths (84.9%) of children and adolescents with severe disorders needing counselling had
their needs met either fully (30.9%) or partially (54.0%) with the remainder (15.1%) reporting their
needs were unmet. Unlike other types of help, unmet need for counselling was strongly associated
with severity, increasing for those with moderate disorders and again for those with mild disorders
(28.7% and 41.3% respectively).
84 The Mental Health of Children and Adolescents
Two thirds (66.0%) of parents and carers of children and adolescents with severe disorders identified
a need for courses or other counselling for life skills, self-esteem or motivation as did 38.3% of those
with moderate disorders and 27.6% of those with mild disorders. Need for courses or other
counselling for life skills, self-esteem or motivation was unmet in three fifths of cases with 58.5% of
those with severe disorders, 64.9% of those with moderate disorders and 60.0% of those with mild
disorders having unmet need.
Table 8-4: Perceived need for help in past 12 months for 4-17 year-olds with mental disorders by
severity of disorder and type of help
Severity Level of perceived need
Information
(%)
Medication
(%)
Counselling
(%)
Life skills
(%)
Any type of
help (%) (b)
Mild No need 70.4 91.3 44.1 72.4 31.7
Any need— 29.6 8.7 55.9 27.6 68.3
Needs fully met (a) 41.8 71.2 39.7 23.3 40.2
Needs partially met (a) 19.1 np 19.0 16.6 25.4
Needs unmet (a) 39.1 np 41.3 60.0 34.4
Moderate No need 48.4 63.3 14.2 61.7 8.2
Any need— 51.6 36.7 85.8 38.3 91.8
Needs fully met (a) 44.8 51.3 35.9 17.2 31.3
Needs partially met (a) 23.7 20.4 35.4 17.9 50.5
Needs unmet (a) 31.5 28.4 28.7 64.9 18.2
Severe No need 26.4 47.6 13.0 34.0 0.0
Any need— 73.6 52.4 87.0 66.0 100.0
Needs fully met (a) 29.2 47.1 30.9 19.3 25.6
Needs partially met (a) 36.2 29.6 54.0 22.2 58.6
Needs unmet (a) 34.6 23.3 15.1 58.5 15.8
(a) The proportion of those reporting any need whose needs were fully met, partially met or unmet.
(b) Where need for more than one type of help was identified, level of perceived need for any type of help has been derived
from the level of perceived need for each type of help needed (see glossary for details).
np Not available for publication because of small cell size, but included in totals where applicable.
8.1.3 Differences in perceived need between those using and not using services
As reported in Chapter 7, just over half (56.0%) of children and adolescents with mental disorders had
used services for emotional and behavioural problems in the previous 12 months. Conversely, 44.0%
had not used any services.
Virtually all (97.1%) parents and carers of children and adolescents with mental disorders who had
used services in the previous 12 months reported that their child or adolescent had a need for some
type of help (Table 8-5). Of these, only a small proportion (6.2%) reported that these needs were
unmet. In terms of the particular types of help needed by those who had used services in the previous
12 months, the greatest area of need reported by parents was for counselling (87.0%).
The Mental Health of Children and Adolescents 85
By contrast, just over half (54.9%) of parents and carers of children and adolescents with mental
disorders who had not used services in the previous 12 months reported that their child or adolescent
had a need for some type of help (Table 8-5). Almost three quarters (71.1%) of those with needs
reported that their child’s or adolescent’s needs were not met. In terms of the particular types of help
needed by those who had not used services in the previous 12 months, the greatest area of need
reported by parents and carers was for counselling (44.1%).
Table 8-5: Perceived need for help in past 12 months for 4-17 year-olds with mental disorders by
service use and type of help
Service use Level of perceived need
Information
(%)
Medication
(%)
Counselling
(%)
Life skills
(%)
Any type of
help (%) (b)
Used
services
No need 43.7 63.7 13.0 53.9 2.9
Any need— 56.3 36.3 87.0 46.1 97.1
Needs fully met (a) 46.4 59.7 47.2 24.9 44.5
Needs partially met (a) 29.7 24.1 39.2 21.2 49.3
Needs unmet (a) 23.9 16.2 13.6 53.8 6.2
No service
use
No need 76.9 95.6 55.9 76.9 45.1
Any need— 23.1 4.4 44.1 23.1 54.9
Needs fully met (a) 17.8 0.0 10.6 9.5 13.2
Needs partially met (a) 10.7 0.0 10.0 11.5 15.7
Needs unmet (a) 71.6 100.0 79.4 79.1 71.1
(a) The proportion of those reporting any need whose needs were fully met, partially met or unmet.
(b) Where need for more than one type of help was identified, level of perceived need for any type of help has been derived
from the level of perceived need for each type of help needed (see glossary for details).
8.2 Barriers to seeking and receiving help
Table 8-6 shows all the reasons given by parents and carers of children and adolescents with mental
disorders for not seeking help or receiving more help when needs were not fully met. The most
commonly identified reasons were not being sure where to get help (39.6%), not being able to afford
help (37.0%) and preferring to handle the problem by themselves or with help from family or friends
(31.1%). Being concerned with what other people might think was identified as a barrier by only 5.3%
of parents and carers.
86 The Mental Health of Children and Adolescents
Table 8-6: Barriers to seeking help or receiving more help in past 12 months for 4-17 year-olds with
mental disorders by age group
Barrier 4-11 years (%) 12-17 years (%) 4-17 years (%)
Preferred to handle by self or with family/friends 36.5 24.5 31.1
Concerned about what people might think 5.2 5.4 5.3
Not sure if child or adolescent needed help 33.5 19.8 27.3
Not sure where to get help 39.9 39.3 39.6
Thought problem would get better by itself 30.1 21.9 26.4
Problem getting to a service that could help 31.8 25.3 28.9
Couldn’t afford it 40.5 32.9 37.0
Couldn’t get an appointment 29.5 28.8 29.2
Child or adolescent refused help, didn’t turn up for
appointment or didn’t think they had a problem 6.2 48.4 25.4
Some reasons for not seeking help or receiving more help were more common among children than
adolescents with mental disorders (Table 8-6). These included parents and carers preferring to handle
the problem by themselves or with the help of family or friends (36.5% for 4-11 year-olds compared
with 24.5% for 12-17 year-olds), and not being sure if help was needed (33.5% for 4-11 year-olds
compared with 19.8% for 12-17 year-olds). In comparison, the most commonly identified reasons for
not seeking help or receiving more help for 12-17 year-olds were related to the adolescent
themselves, including the young person refusing help, not turning up for an appointment or thinking
that they did not have a problem (48.4% compared with 6.2% of 4-11 year-olds).
If parents and carers reported more than one reason, they were also asked about the main reason
for not seeking help or receiving more help. About one third (30.9%) of parents and carers identified
issues to do with the accessibility of services, specifically problems in getting to a service, not being
able to afford it, or not being able to get an appointment. For about another third of parents and
carers (36.4%), the most common main reasons for not seeking help or not receiving more help
were being unsure if their child or adolescent needed help, where to get help, or thinking the
problem would get better by itself, issues that could be broadly considered as mental health
literacy (Table 8-7).
Just under one fifth (17.3%) reported that the main reason was related to the child or adolescent not
wanting to seek help, and 15.4% of parents and carers reported that the main reason was related to
them wanting to manage the problems themselves.
The main barriers to seeking help or receiving more help differed between the age groups. The
reasons most commonly identified as the main barriers for 4-11 year-olds were issues primarily
related to mental health literacy (43.6%) or accessibility (36.2%). In contrast, the main barrier to
adolescents seeking help or receiving more help was identified by about one third (34.8%) of parents
as the young person refusing help, not turning up for appointments or because they did not think they
had a problem.
The Mental Health of Children and Adolescents 87
Table 8-7: Main barrier to seeking help or receiving more help in past 12 months for 4-17 year-olds
with mental disorders by age group
Main barrier 4-11 years (%) 12-17 years (%) 4-17 years (%)
Self-management/stigma 18.3 12.1 15.4
Mental health literacy 43.6 28.2 36.4
Accessibility 36.2 24.9 30.9
Child-related np 34.8 17.3
np Not available for publication because of small cell size, but included in totals where applicable.
8.3 Perceived need for help for parents and carers of children and
adolescents with mental disorders
Parents and carers of children and adolescents with emotional and behavioural problems were also
asked about whether they themselves or another family member had received any help to deal with
their children’s problems, whether their own needs had been met and, if not, what types of help they
felt that they needed. Two fifths (39.0%) of parents and carers reported that they had no need for any
type of help (Table 8-8).
Of those who reported a need for any type of help (61.0%), four fifths (78.1%) indicated their needs
were met either fully (37.3%) or in part (40.8%) (Table 8-9). Conversely, around one fifth (21.9%)
reported unmet need.
The type of help for which there was greatest need was counselling, not only on how to manage the
child’s problems, but also to help family relationships and to deal with parents’ and carers’ own
problems, worries or stresses as a result of their child’s problems. Counselling was identified by 86.5%
of parents and carer’s who indicated some need for help. While this need was either fully or partially
met for nearly two thirds of parents and carers (64.4%), 45.6% of parents and carers reported their
needs for counselling on how to manage their children’s problems were not being met at all, 44.8%
had unmet need for counselling to help family relationships, and 38.7% had unmet need for
counselling for their own problems, worries or stresses as a result of their child’s problems.
In terms of information about their child’s problems, treatments and services, 41.0% had any need of
which one third (32.6%) had unmet need. About one fifth (18.4%) of parents and carers reported some
need for a parenting skills course of which over half (52.4%) did not have these needs met.
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