Conduct Disorder

Ken McLaughlin writes:

In an article for spiked last month, I warned about the likely rise in ‘advocacy research’, that is, studies purporting to show unacknowledged levels of prevalence of various social problems. Such reports are usually published by organisations with vested interests in keeping their services at the forefront of social policy concern in order to maintain or improve government funding. Given the scale of government cuts, which are likely to severely affect funding to public, charitable and voluntary sectors, it is perhaps understandable that various groups will seek to protect their interests and services.

Such tactics appear to have had some success, with the government apparently taking heed of those who claim that the nation’s mental health is in crisis. Yesterday, the Department of Health announced plans to invest £400million in mental-health care, with the aim of ensuring that mental health awareness and treatment are given as much prominence as physical health issues. The No Health Without Mental Health strategy informs us that one in four people will suffer a mental-health problem at some time in their lives, one in six people are currently suffering from such conditions, and that 10 per cent of children aged between five and 16 are afflicted.

While the new strategy covers all age groups, its long-term success is seen as being built upon its focus on children’s mental health. Unsurprisingly, mental-health charities have praised the initiative, in particular the focus on young people and the need for early intervention, which they would hope to be paid to provide. They have also taken the opportunity to remind the government that the challenge of making the strategy a reality could be compromised by economic cuts in other related areas.

It is still not clear how much of the promised £400million is new money or, as is perhaps more likely, whether it will come from currently existing primary care trust budgets. Nevertheless, the announcement represents a clear statement of intent on behalf of the Lib-Con coalition as to its view of a major problem facing the country. According to the health secretary, Andrew Lansley, this new cross-government strategy ‘will finally place good mental health at the heart of everything we do… The NHS will also no longer focus its attention on treatment alone, but will move towards early intervention and prevention to deliver outcomes for patients which are among the best in the world.’

Maybe charities and health authorities have a point with regard to early intervention. In 2005, a study by Adrian Angold, an associate professor of psychiatry, claimed that one in ten pre-school children was mentally ill, a claim that, at the time, I said was madness. Six years, later, these ‘really sick’ toddlers are now older, and would appear to have graduated into the pathological ranks of the school playground. So, it would seem that there is a problem and that it is getting worse. However, in the realm of mental health, nothing is as it appears.

The first problem is in getting a precise, agreeable definition of the problem, with terms such as ‘mental illness’, ‘mental disorder’ and ‘mental-health problems’ often used interchangeably to the extent that almost any social, behavioural or emotional state can be redefined as indicative of mental disorder. For example, in relation to children, the most common ‘mental disorder’ is ‘conduct disorder’ which includes such deeds and actions as being defiant, aggressive and/or exhibiting other forms of ‘anti-social’ behaviour. What the report terms the ‘less common disorders’, or what others would call the more serious ones, affected only 0.7 per cent of the children.

Neither does the evidence indicate that the situation is getting worse. The government’s ‘one in ten’ figure is no different from a prevalence study of psychiatric disorders from 1999, and which suffered from similar problems of definition. Given the subjective nature of mental distress, it is difficult to gauge the extent of the problem. However, if we look at more ‘hard’ facts, such as rates of compulsory hospital detention and suicide figures, rather than the elastic, ever-expanding indicators of mental disorder, it is possible to argue that the situation is better than is being portrayed.

The Office for National Statistics was unable to point me in the direction of any recent information regarding the number of children detained under the Mental Health Act 1983/2007, which would at least have allowed a comparison over time of the numbers at the more severe end of the mental-health spectrum. However, a Mental Health Act Commission report states that between April 2002 and September 2003, only 270 children, most of them aged 16 to 17, were detained on adult psychiatric wards. The National In-Patient Child and Adolescent Psychiatry Study (NICAPS) received figures from 71 out of 80 (89 per cent) of adolescent units in England and Wales, which showed only 663 young people were in-patients on the day of the census.

In Scotland, the number of children subject to emergency psychiatric detention from January to June 2003 was just 29. Figures from the World Health Organisation show that the rate of suicide in the UK is at its lowest level since 1950, and has decreased in each recorded five-year period since 1985. In 2007, there were 14 suicides amongst the five-to-14 age group, and 379 in the 15-to-24 age group. Suicide rates in those aged 10-19 declined by 28 per cent in the period 1997-2003. Interestingly, the NICAPS study also found that the least in-patient improvement was found for conduct disorder, which may indicate the futility of treating a social problem as one of individual pathology.

Childhood mental distress that results in the need for in-patient care or, more extremely, in a young person taking his or her life, is undoubtedly a tragedy. Nevertheless, out of an under-18 population of approximately 13 million, the figures above are not indicative of significant and dangerous levels of severe distress in the whole of the adolescent population.

The real tragedy is that the government’s strategy is unlikely to do anything to help those children who do need professional intervention. It is more concerned with the micro-management of behaviour, extolling both platitudes and condescension towards us all. We are given the ‘Fiveways to wellbeing’ which suggests that people: ‘connect – with the people around them, family, friends and neighbours; be active – go for a walk or a run, do the gardening, play a game; take notice – be curious and aware of the world around them; keep learning – learn a new recipe or a new language, set themselves a challenge; and give – do something nice for someone else, volunteer, join a community group’, and that ‘we can get more directly involved in local decision-making, volunteering and local action, including in schools and colleges, at work and in our local communities.’

Leaving aside the fact that to connect with our neighbours, or get involved in local action, can only lead to ‘wellbeing’ once the state has sanctioned us via the criminal records vetting process, it is hard to see how such ‘advice’ helps any of those young people who are indeed suffering emotional crises. Is it really wise to spend £400million to tell us to talk to our families, to go for a walk, to learn a recipe and to volunteer? Perhaps the time has come to sack our anger-management counsellors and direct our anger towards the coalition government and the patronising direction of its mental-health strategy.

If there is a problem with childhood behaviour today, its roots lie more in a crisis of adult authority rather than children’s pathology. The irony is that the more the government treats us like children, the more our ability to socialise and mould the next generation is further eroded.

Perhaps above all, Attention Deficit Hyperactivity Disorder does not exist. Mostly for being born boys rather than the girls wanted and expected by their mothers (more and more of whom in any case know little or nothing about men or boys), half a million British children are now drugged up to their eyeballs with Ritalin and such like as "treatment" for ADHD and various other nonexistent conditions.

Having long since decided that femaleness, simply in itself, was a medicable condition requiring the pumping of women's and girls' bodies full of highly poisonous substances in order to stop those bodies from doing what they do naturally, we now seem to have decided to treat maleness in the same way, and to get in even younger than we did with femaleness.

Meanwhile, prisoners are to be tested routinely for ADHD, if that is not already happening. Criminal behaviour is to be, or is being, defined as a manifestation of ADHD. Why else bother testing prisoners, in particular and as such, for it? So they will all be found to have it. But they don't have it. No one has it. It does not exist.