Mental health for children

Article 1:

Children and Mental Health Challenges

In recent years, there's been an increasing emphasis on the significance of mental health and wellbeing. Just as we suffer from physical pain and illness, we may suffer from mental distress and illness. Estimates indicate that one billion people (13%) worldwide are suffering from mental disorders, depression and anxiety being the most common.[1] About 29% report having suffered from a mental disorder during their lifetime.[2] So, mental disorders are common, and mental distress is something most people will experience sooner or later in life.

During the disruptions, stress, worries, and social isolation of the pandemic, many suffered mentally, and it became particularly clear that children's and adolescents' mental health was hit especially hard. Reports from around the world told us of staggering increases in depression, anxiety, eating disorders, stress and trauma-related disorders, substance abuse, and suicidal ideations. However, mental distress and disorders were nothing new in children and adolescents. "Over the past 30 years, there had been a huge increase in the number of individuals [children and adolescents] suffering from anxiety disorders, major depressive disorders, and conduct disorders including an alarming increase in the rate of eating disorders."[3] "Globally, it is estimated that 1 in 7 (14%) 10–19 year-olds experience mental health conditions, yet these remain largely unrecognized and untreated. Depression, anxiety and behavioral disorders are among the leading causes of illness and disability among adolescents.

Suicide is the fourth leading cause of death among 15-29 year-olds."[4] Such challenges in the formative years of childhood and early adulthood have a significant impact on the quality of life, functioning, and the trajectory for future life. All children need support and care, and those who struggle are in critical need of it.

The World Health Organization (WHO) has defined mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. With respect to children, an emphasis is placed on the developmental aspects, for instance, having a positive sense of identity, the ability to manage thoughts, emotions, as well as to build social relationships, and the aptitude to learn and to acquire an education, ultimately enabling their full active participation in society.”[5] The WHO states that there is "no health without mental health."[6]

Article 2:

Determinants of mental health in children

The causes of mental illness are complex. Often not we cannot fully understand or explain why one individual suffers, while another doesn't. As is the case with physical illness, someone who does everything "right" may still get sick. This may partially be explained by genetic predispositions and environmental factors beyond our control. People also have varying tolerance and resilience for stress and adversities. Still, there are some factors that are well-recognized.

In childhood and adolescence, the patterns for lifestyle, intellectual, emotional, social, and spiritual habits and skills are formed. Getting sufficient quantity and quality of sleep; daily physical activity; healthy eating; developing coping, problem-solving, and interpersonal skills; learning to manage emotions; and connecting with God and people are essential for optimal growth and development. Protective and supportive environments in the family, at school, in church, and in the wider community are important.

Many factors affect mental health. The more risk factors children and adolescents are exposed to, the greater the risk of adverse effects on their mental health. The quality of parental and family relationships is one of the most significant. Beyond that, the relationship with friends and peers. Violence, especially sexual violence and bullying, harsh parenting, and socioeconomic problems are major risks to mental health. Societal pressures, including social media influences, may cause significant distress. Stigma, discrimination, war, conflicts, and humanitarian crises increase risk. Lack of sleep, physical activity, and appropriate nutritious food, often lead to emotional and behavioral problems.[1]

Whenever the physical, mental, social, or spiritual environment is not supportive and safe, it will cause mental distress that may lead to long-term struggles with mental health.

[1] WHO. Mental health of adolescents. Accessed September 12, 2023. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health 

Article 3

Signs and symptoms of mental health issues in children

It may be difficult to distinguish between behavior in a child that is just part of growing up and a mental health problem. But if there are behavioral signs and symptoms that last for weeks or months, and when these issues interfere with the child’s daily life at home, at school, or with friends, further assessment and help are recommended.

Young children may benefit from an evaluation and treatment if they:

• Have frequent tantrums or are intensely irritable much of the time

• Often talk about fears or worries

• Complain about frequent stomachaches or headaches with no known medical cause

• Are in constant motion and cannot sit quietly

• Sleep too much or too little, have frequent nightmares, or seem sleepy during the day

• Are not interested in playing with other children or have difficulty making friends

• Struggle academically or have experienced a recent decline in grades

• Repeat actions or check things many times out of fear that something bad may happen

Older children and adolescents may benefit from an evaluation and treatment if they:

• Have lost interest in things that they used to enjoy

• Lack energy

• Sleep too much or too little, or seem sleepy throughout the day

• Spend more and more time alone, and avoid social activities with friends or family

• Diet or exercise excessively, or fear gaining weight

• Engage in self-harm behaviors (such as cutting or burning their skin)

• Smoke, drink alcohol, or use drugs

• Engage in risky or destructive behavior alone or with friends

• Have thoughts of suicide

• Have periods of highly elevated energy and activity, and require much less sleep than usual

• Say that they think someone is trying to control their mind or that they hear things that other people cannot hear [1]

When such signs and symptoms are evident, then appropriate evaluation and help should be sought without delay.

[1] NIMH. Child and Adolescent Mental Health. National Institute of Mental Health (NIMH). Published July 19, 2023. Accessed September 12, 2023. https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health

Article 4:

Promoting mental health in children

We promote the mental health of children by providing environments that support the growth and development in all dimensions of life; the physical, mental, social, and spiritual. We optimize the conditions for health and well-being when children are kept safe, loved, and healthy, and promptly are provided treatment whenever they are struggling and suffering.

The first condition for mental health is safety. We live in a world where there are threats and dangers all around. Sadly, other people typically represent the greatest threat; people who willfully hurt people. Children should be kept safe from all kinds of violence, abuse, or neglect; at home and outside the home. Children should be protected and defended against anyone who may hurt them. The safety of a child has precedence over any needs or desires of a potentially dangerous person. Whenever safety is threatened by uncontrollable external events, like war, conflict, and natural disasters, one should still strive to create a protective environment of caring people who see and comfort the child.

The second condition for mental health is love. Children need parents, parental figures, and other adults who are caringly available, sensitive, and responsive. They need to be surrounded by love, care, and respect in the family, at school, in church, and in the community. Whenever there is a breach somewhere in the circle of love around a child, whether in the family or elsewhere, the other parts of the circle must step in to shield the child and compensate for what is lacking.

The third condition for mental health is a healthy lifestyle. The health principles promoted by the Seventh-day Adventist Church for more than 150 years still form an excellent basis for a life of optimal growth and development in all dimensions of life:
·      Sufficient sleep and rest; daily physical activity in work and play; a balanced, nutritious, and appealing diet
·      An environment where the child's thoughts, feelings, and behaviors are appreciated, respected, wisely, and lovingly guided
·      Strong, healthy relationships with family, friends, peers, mentors, and leaders; opportunities to serve and contribute
·      The sense of hope, meaning, purpose, and significance is cultivated, and ultimately rooted in the relationship with God

The fourth condition for mental health is appropriate care and treatment when someone is struggling and suffering. When a child or anyone else is suffering, they should be provided with the best available support and treatment as soon as possible. They should be brought to qualified health professionals who can make assessments, recommendations, and provide interventions. Sadly, help often comes late and is insufficient. When there is reason for concern, don't hesitate or delay providing the help that is available.

Article 5:

Providing support to families of children with mental health issues

When a child in a family suffers, the whole family suffers. The family therefore needs support and care from professionals, the extended family, the school, the church, and the community. In providing that, here are some things to be mindful of:

• Shame and guilt: The family of a child who suffers may already be struggling with shame and guilt. Don't add to that. It's the responsibility of the patient, the family, and health professionals to determine the causes, the diagnoses, and the treatments. For the rest of the community, the responsibility is to support, care, and love. Don't blame or shame the child or the family, and do not impose your understanding and advice on them.

• Normalize it: We are all somewhere on the spectrum of mental health and illness. All of us will sooner or later suffer the pains of living and dying. It is as "normal" to suffer from mental health issues as it is to suffer from physical health issues. People who suffer from mental illness are not a different category of people. They are one of us and should be treated as such.

• Talk about it: We need communities that are well-educated and informed about mental health issues. We need to talk about it in general, and when someone specifically is suffering, we should talk about that according to the needs and desires of the child and the family.

• Keep on living: There is more to the lives of the child and the family than the mental illness. Appreciate that. Support the child and each member of the family in engaging in positive activities that may bring joy, meaning, and hope. There's a time and space for focusing on the mental illness, but there should also be time and space for engaging in other things. It may be important for the parents and other children to have opportunities where they for a shorter time may just do "normal" things. When one gets the balance right between the illness of the child and the rest of life, all may be better equipped to provide optimal support, care, and love for the child.

When a child is suffering from mental distress or illness, that's when Jesus' call Jesus to each one of us is: "I tell you the truth, when you did it to one of the least of these my brothers and sisters, you were doing it to me" (Matthew 25:40 NLT). Jesus' warning is: "I tell you the truth, when you refused to help the least of these my brothers and sisters, you were refusing to help me" (Matthew 25:45 NLT). When we are lovingly and caringly available, sensitive, and responsive to those who suffer, we are His children and he will say: "Come, you who are blessed by my Father, inherit the Kingdom prepared for you from the creation of the world (Matthew 25:34 NLT).