Exploring harms experienced by children aged 7 to 11 using ambulance attendance data: A six-year comparison with adolescents aged 12–17

Acknowledging younger children have different needs

Over the past two decades, there has been significant investment in youth mental health services worldwide, including headspace in Australia, Youthspace in England and Jigsaw in Ireland. These programs provide youth-targeted services and research to promote mental health and wellbeing. headspace also provides physical health, work and study support, as well as alcohol and other drug services.

Given that adolescence is a high-risk time for the development of mental health and substance use disorders, with half of all lifetime mental disorders commencing by the age of 14 years, such initiatives are to be applauded. What has been less well researched and understood is the mental health and service needs of younger children, particularly those aged under 12 years.

The difference in mental health symptomology

The focus of youth services has typically centred on young people aged 12–25 years, with studies examining the immediate and long-term outcomes and trajectories of these affected youth. However, mental health*, substance ingestion**, and self-harm related behaviours*** and thoughts in children aged under 12 is less well-described and understood. Many population data sources do not routinely collect data of children under 12, despite research showing that mental health, self-harm related behaviours and thoughts and substance ingestion can have severe consequences in this age group.

To address this knowledge gap, we used six years of ambulance attendance data (Jan 2012 to Dec 2017) from Victoria to characterise mental health, self-harm related behaviours and thoughts, and substance ingestion in children aged 7–11. We compared this group to older children aged 12–17. We found that in comparison to those aged 12–17 (n=26,778), a smaller number of children aged 7–11 years (n=1,558) were experiencing serious harms, with mental health symptomology the most common harmful outcome.

Self-harm related behaviours and thoughts significantly increased in both age groups throughout the study period with an increase in suicidal behaviours of 138% between 2012 and 2017. For mental health, self-harm related behaviours and thoughts, and substance ingestion in the 7–11 age group, males were significantly over-represented. Those aged 7–11 were more likely than those aged 12–17 years to ingest pharmaceuticals, rather than alcohol or illicit substances, and suicidal ideation was the most common self-harm related behaviour and thoughts in this age group, compared with suicide attempt in the older group.

The need for a specific focus

The issue of youth mental health has grown in prominence, with a corresponding increase in tailored interventions and service provision. These efforts have been supported by population level data collection in this age group, which has provided information on the harms experienced and risk factors for those harms. However, children and adolescents under 12 have not had the same level of attention, and data coverage in this age group is limited, which leaves this age group vulnerable to undetected harms.

Our research shows that a group of children and young adolescents are experiencing serious and increasing harms related to mental health, self-harm and substance ingestion. Importantly, the characteristics of harms in this age group is distinct from older adolescents.

We suggest that data collection needs to occur specifically in this age group, without aggregation into older adolescents, and furthermore, that services and interventions to improve mental health and wellbeing will need to be specifically designed and targeted at the 7–11 age group. Examples of these may include services such as Kids Helpline that provides counselling services to children for any reason, and services designed to support children within the context of their family (e.g. Intensive family support services), but should be guided by future research on harms in children and the underlying causes of those harms. Early onset of these harms is associated with poor outcomes in affected children; therefore, it is imperative that when children and young adolescents experience these harms, that they are detected and acted upon in a timely and effective manner.

A link to the full research paper upon which this article is based is available at: www.mdpi.com/1660-4601/15/7/1385/pdf

Author details

Debbie Scott

• Eastern Health Clinical School, Monash University, Box Hill, VIC 3128
• Turning Point, Eastern Health, Richmond, VIC 3121

Rose Crossin

• Eastern Health Clinical School, Monash University, Box Hill, VIC 3128
• Turning Point, Eastern Health, Richmond, VIC 3121

Rowan Ogeil

• Eastern Health Clinical School, Monash University, Box Hill, VIC 3128
• Turning Point, Eastern Health, Richmond, VIC 3121

Karen Smith

• Ambulance Victoria, Doncaster, VIC 3108
• Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, VIC 3199
• Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004

Dan I. Lubman

• Eastern Health Clinical School, Monash University, Box Hill, VIC 3128
• Turning Point, Eastern Health, Richmond, VIC 3121

Glossary

* Mental health – includes symptoms of mental health issues, including anxiety, depression, psychosis, social or emotional distress, other mental health symptoms, and mental health symptoms associated with physical disease or illness (e.g. hallucinations in delirium).

** Substance ingestion – relates to the ingestion of any alcohol, illicit drugs or other poisons (e.g. household cleaners) or pharmaceutical substances in an inappropriate way (e.g. taking medications prescribed for someone else or exceeding their prescribed therapeutic dose.

*** Self-harm related behaviours – includes threat of self-injury, self-injury (that may not have an intent to die), suicidal ideation, and suicide attempt.