Mental health difficulties can pose daily challenges to children and adolescents, negatively affecting their physical health, relationships with others and academic performance. The consequences may be long-term, impacting not only the affected child or adolescent, but also their family and friends.

In a community sample of primary school-aged children in Singapore, published in 2007, 12.5 per cent experienced emotional and behavioural problems. Among these children, internalising problems, such as anxiety and sadness, occurred more than twice as often as externalising problems, such as aggressive and delinquent behaviour¹.

A 2009 report showed that among under-14 year olds, autism spectrum disorder is the leading cause of disease burden, with attention-deficit hyperactivity disorder (ADHD) and anxiety/ depressive disorders ranking third and fifth respectively².

Additionally, emotional support helplines, such as Samaritans of Singapore (SOS) and Tinkle Friend have reported 50 to 70 per cent increases in the number of calls from children and adolescents in the last five years.

More than a list of clinical symptoms to be elicited and treated, mental health difficulties in children and adolescents can be greatly debilitating, and benefit from multidisciplinary, team-based care for the patient and family. The earlier these difficulties are recognised and addressed, the better the child’s response to treatment and prognosis.

A strong network of support

The Child and Adolescent Mental Wellness Service (CAMWS) comprises a team of psychiatrists, case managers and psychologists, operating within the Department of Psychological Medicine in KK Women’s and Children’s Hospital (KKH).

The service receives over 450 new referrals yearly, and utilises a consultation liaison model – working jointly with paediatricians, medical social workers, occupational therapists, speech therapists and art therapists – to identify psychosocial and psychiatric issues in children and adolescents that may accompany physical illness, and to offer a comprehensive assessment and multidisciplinary management plan.

Among paediatric patients who are referred within KKH, 25 per cent are patients who have self-harmed or attempted suicide. Nearly 40 per cent are found to have a stress-related disorder, usually precipitated by psychosocial and family difficulties. Other presenting problems include anxiety, low mood and medically unexplained physical symptoms.

Among paediatric patients who are referred to KKH, common presentations include hyperactivity, concentration and learning difficulties, anxiety, academic stress and behavioural problems. ADHD (24%), stress-related disorders (16%) and anxiety disorders (11%) are the most common outpatient diagnoses³.

During treatment and intervention, psychoeducation is provided to the patient and their parents. Further assessment and management may involve liaising with a school counsellor, with parental consent.

Depending on the presenting problem, individual counselling, psychological therapy, family therapy and/or medication may also be offered.

Helping the child be heard

To build community awareness and support for children and adolescents with mental health difficulties, in 2017, the CAMWS team produced an anthology of real-life accounts written by paediatric patients aged eight to 16 years, receiving psychiatric care at KKH, titled ‘I Don’t Want To’.

During the writing process, the children and adolescents were guided to reflect on their experiences and to gain fresh perspectives on their problems, resulting in stories of difficult realities that are also full of hope.

Since its release earlier this year, complimentary copies of ‘I Don’t Want To’ have been distributed to school counsellors under the Ministry of Education, to encourage conversations with students experiencing similar difficulties as the book authors, and to promote healthy help-seeking behaviours.

The team also conducted book readings at several National Library Board public libraries to help caregivers – such as parents and teachers – to understand, accept and support children and adolescents with mental health difficulties.

Ultimately, the book aims to inspire compassion in the community by dispelling the stigma and fear associated with mental health conditions, and bring hope to children and adolescents with mental health difficulties, empowering them to seek help.

	​Dr Shirley Pat Fong, Associate Consultant, Child and Adolescent Mental Wellness Service, Department of Psychological Medicine, KK Women’s and Children’s Hospital A child and adolescent psychiatrist, Dr Shirley Pat Fong completed her training in the United Kingdom and her special interests include neurodevelopmental child psychiatry and paediatric liaison.
	​Ms Estelle Lim, Senior Medical Social Worker, Department of Psychological Medicine, KK Women’s and Children’s Hospital Ms Estelle Lim passionately works in collaboration with community partners, such as schools and voluntary welfare organisations, to provide early assessment and intervention for mental health difficulties in students aged seven to 18 years, and to enhance and promote their recovery and the functioning of their families.
	Dr Chua Tze-Ern, Senior Consultant, Women’s Mental Wellness Service, Department of Psychological Medicine, KK Women’s and Children’s Hospital Dr Chua Tze-Ern is a locally-trained psychiatrist with special interests in perinatal psychiatry and mood disorders. In addition to clinical work, she is actively involved in research, teaching and patient safety.