We know that sleep and mental health are closely connected. Mental health problems can affect how well young people sleep, and poor sleep can have a negative impact on their mental health. In our development of Youth Mental Health Services across Norfolk and Suffolk we have become more aware through local data and clinical expertise of the increased prevalence of significant sleep problems in children and young people (CYP) presenting with severe mental health difficulties. To find out more about how common sleep problems are in young people accessing mental health support, we approached the CORC Central Team who analysed specific information from the CORC+ dataset on our behalf.
Analysis of 8,596 young people’s Revised Childhood Anxiety and Depression Scale (RCADS) scores from the CORC+ dataset suggests that over 50% of young people aged 8-18 accessing CAMHS services across the country endorsed ‘often’ or ‘always’ on the ‘I have trouble sleeping’ question. Furthermore, the analyses of this data set conclude that CYP who report higher levels of sleep trouble score significantly higher on all subscales of the RCADS, as well as Total Anxiety and Total Internalizing.
There is a need to consider sleep quality and quantity when treating CYP within our services. Although we are aware that sleep problems may result from a combination of biological, social and psychological factors, less is known about treatments within CYP mental health services. In Suffolk, we have been using and adapting Cognitive Behavioural Therapy for Insomnia (CBTi) principles to develop a brief sleep intervention that could be delivered by non-expert therapists in an engaging way, under the supervision of a clinical psychologist. Our case-series explored the feasibility and effectiveness of this intervention in improving sleep and mental health difficulties in CYP with clinical levels of insomnia accessing our services.
We found that young people generally liked the intervention, found it helpful, non-stigmatising and would recommend it. Recognising the limitations of a small sample size and a case-series design our initial analyses suggest that the intervention significantly reduces insomnia scores and mental health difficulties, supported by large effect sizes. We were pleased to discover that of the 15 CYP seen, 12 no longer met clinical thresholds for insomnia. Goal Based Outcomes scores also suggested the positive impact on quality of life and functioning.
We are hopeful that those CYP accessing this intervention at such a key developmental stage continue to improve their sense of agency and overall wellbeing. We look forward to further evaluating this intervention and liaising with clinicians, managers and commissioners to champion the need to offer sleep interventions to CYP when indicated.
Many thanks to our CORC members Rebecca Rollinson, Tim Clarke, Brioney Gee and Isy Price (Norfolk & Suffolk NHS Foundation Trust)