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Many long-term conditions, including most mental health problems, emerge in adolescence. At the same time, health behaviours such as alcohol and nicotine use, overeating leading to obesity and physical activity become established. Early intervention from healthcare professionals can lead to more effective management and prevention of lifelong issues.
Dr Beryl Navti is consultant pharmacist for child and adolescent mental health services (CAMHS) at North East London NHS Foundation Trust. She has this advice for creating a supportive environment in pharmacies for young people:
“Pharmacists should have a quiet area where young people can speak privately with them. They should communicate in a way that resonates with a younger audience, avoiding jargon, keeping information simple and encouraging staff to listen without judgement.
Be aware of your limitations and work closely with local mental health services for children and young people, so you can obtain guidance when needed, as well as escalate serious mental health concerns.”
President of the Royal Pharmaceutical Society, Professor Claire Anderson, adds: “Community pharmacies can collaborate with schools and youth services by supporting health campaigns, delivering talks, and linking with GPs and school nurses to provide joined-up care tailored to young people’s needs.”
Mental health issues
One in five children and young people in England have a mental health problem – alarmingly, that’s 50 per cent more than in 2017. Yet only a third have been able to access treatment, says MIND’s Big Mental Health Report 2024.
Olly Parker, head of external affairs and research at YoungMinds, says: “Many young people are experiencing multiple pressures which impact their mental health, including poverty, inequality, intense academic pressure and the online world, so it is no wonder so many are struggling.
The mental health support available is a postcode lottery, and many young people face long waits, often becoming more unwell before they can access help, which can lead to needing more urgent care.”
The good news is that more young people now have access to a mental health support team in school. Around half of pupils in England have such access and this number is set to increase by 900,000 this year. The Government plans to ensure access for all pupils by 2029/30.
Early intervention is important here, since at least half of lifetime mental health problems are established by age 14 and 75 per cent by age 25. “Early intervention can help prevent escalation of mental health problems into adulthood,” says Beryl Navti.
“Young people often do not understand what is happening to them and can be ostracised by their peers. Addressing these issues early helps them understand better, normalises conversations about issues and reduces stigma.”
Alexa Knight, director of England at the Mental Health Foundation, says: “There are things we can do to protect our mental health – moving our bodies with sport or gentle exercise, doing things we enjoy, getting out in nature, connecting with people socially, and speaking to someone we trust.
Pharmacists can help by getting to know activities and clubs in the local community they can signpost young people to, and keeping leaflets for community groups and leisure facilities in store.”
Pharmacies can also collaborate with local services and schools, Knight suggests; for example by supporting awareness campaigns such as Mental Health Awareness week. “They could host information sessions or workshops,” she adds.
Medication support
Claire Anderson says that while pharmacists don’t replace specialist services, they can offer advice on safe medication use, help to manage side-effects and refer to specialist services where needed.
NICE recommends considering pharmaceutical treatment in combination with psychological intervention for moderate to severe depression in young people. Fluoxetine is the first-line treatment.
There is an increased risk of suicidal thoughts and acts during the first few weeks of treatment, so young people should be closely monitored.
If a patient discloses suicidal thoughts, this needs to be escalated to their GP or CAMHS team immediately. They can get urgent mental health support from NHS111 option 2 or the local A&E.
“Pharmacists can support young people by checking in with them or their parents when they come in to collect medication, and to offer advice on managing side-effects and appropriate storage,” says Navti.
Signposting
- Hub of Hope: a gateway to local support services: hubofhope.co.uk
- Young Minds: youngminds.org.uk
- Mental Health Foundation: mentalhealth.org.uk
- Harmless: harmless.org.uk
- Childline: childline.org.uk; tel: 0800 1111
- BEAT: beateatingdisorders.org.uk
- Samaritans: samaritans.org; tel: 116 123
- Shout: giveusashout.org; text 85258
- Kooth: kooth.com
Self-harm rates rising
The number of recorded self-harm incidents continues to rise, with 24 per cent of 17-year-olds self-harming each year, and 37 per cent of young people having ever self-harmed.
“Pharmacists need to be trained on how to recognise signs of self-harming in young people, and when talking to them, approach conversations with empathy and without judgement,” says consultant pharmacist for child and adolescent mental health services, Dr Beryl Navti.
Samaritans has these tips on how to have a conversation about self-harm to help young people open up and get support:
- Show that you care and are happy to talk about it if they want to. There is no need to ask questions about why they do it
- Let them know you won’t judge and they don’t need to apologise. Listen to what they say
- Ask about how they are feeling now. Focus on what might be causing the self-harm.
Encouraging teens to talk
When communicating with teenagers, the most important thing is to listen actively and show genuine interest in what they are saying about their feelings and experiences, then provide reassurance that seeking help is a positive step, says Beryl Navti.
Alexa Knight, director of England at the Mental Health Foundation, adds: “Pharmacies should actively communicate that they are a safe space for discussing mental health, through posters, signage and friendly interactions with staff. Making consultation areas more welcoming, by adding artwork, plants, colourful advice leaflets and comfortable furniture, can help to create a less clinical, more reassuring environment.
“When speaking to a young person about their mental health, create a safe and non-judgemental space where they feel comfortable sharing their feelings.
Using open-ended questions such as ‘How have you been feeling lately?’ rather than ‘Are you okay?’ can encourage more meaningful conversations. Acknowledging their emotions and reassuring them that they are not alone can help them feel supported.”
Parents of teens might come to the pharmacy seeking advice too. Stevie Goulding, interim head of services at the charity YoungMinds, says it can be hard for parents to know when to be worried about their child’s mental health.
“If a child is consistently struggling, a parent might see a sustained change in their behaviour, sleeping or eating patterns or they might seem upset over a long period of time,” he says.
“Parents know their child better than anybody else, so it’s important to act on the warning signs if they feel concerned.”
CPPE has a programme that can help pharmacy teams support teenagers living with anxiety:
cppe.ac.uk/programmes/l/anxiety-e-01
Childhood obesity
Obesity now affects one in four children in the UK and the numbers double from the start to the end of primary school. Some 2.5 million children are carrying excess weight, with 1.2 million significantly obese.
“Children living with obesity are at higher risk of health conditions including heart disease, diabetes and asthma. Some 80 per cent of obese adolescents continue living with it into adulthood,” says Bridget Benelam, a nutritionist at the British Nutrition Foundation (BNF).
“Body weight can be a sensitive issue. It is important to acknowledge that living with excess weight doesn’t mean a failure of parenting or that children don’t have enough self-control. Framing conversations in relation to food-related health rather than body weight may help avoid stigma.”
Portion control is one way for parents to prevent and manage obesity in children. Research by the BNF found that 57 per cent of parents relied on visual estimates to decide on portion sizes for themselves, 32 per cent only sometimes felt confident about choosing the right portion size for their child and 48 per cent said their child has second helpings at least once a week.
Benelam says: “Portion size is important and should be adapted to suit children’s age and size. Using smaller plates can help, and a good approach is to start small and allow children to have more if they’re still hungry. It is particularly important to watch portion size of calorie dense foods such as chocolate, biscuits and crisps.”
Signposting
- British Nutrition Foundation: nutrition.org.uk
- NHS Eatwell guide: nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide
Alcohol and substance abuse
“The biggest rise we’ve seen is in teen nicotine dependency and lack of support or services to help them quit – most seem to be for over-18s, and GPs don’t know who to refer them to,” says Helena Conibear, chief executive and founder of Talk About Trust.
“The most problematic substance by far among teens remains cannabis, especially higher strength skunk, shatter, THC and spice. Some 67 per cent of under-18s receiving support for substance dependency are there for cannabis.
We are also seeing an increase in cheap ketamine availability and use, and pink cocaine,” which is a combination of MDMA, ketamine and 2C-B, she says.
Conibear says the biggest risk to teen health is early use and poly use – few are aware of the dangers of combining drugs or mixing drugs with alcohol.
The UK has the worst rate of child alcohol abuse worldwide, with more than 50 per cent of children having drunk alcohol by 13 years of age, according to WHO.
“It is important to focus on personal safety and the increase in vulnerability – from excessive drinking to accidents, personal or sexual assault and increased risk of using other substances – as inhibitions go. Using the advice to eat, hydrate and pace is helpful, as well as sticking together and planning how to get home,” says Conibear.
“If someone is drinking to self-medicate to reduce anxiety or stress, highlighting that alcohol actually disrupts sleep and increases anxiety at higher doses is helpful.”
She has this advice for pharmacists: “Firstly, being prepared to listen and understand can be a huge first step. Try to find out the underlying reason for their use. Do they have someone trusted to talk to?
Is there an underlying mental health issue? It is really important for pharmacy staff to know the locally commissioned services for under-18s. These can be more welcoming than going to a GP.”
Conibear agrees pharmacies could collaborate more with schools and other services. “This has to be done at local level, via the school nursing network for example, or the head of safeguarding or pastoral care. Listening and understanding what the local issues are and then looking to address them with advice and expertise would be helpful.”
Signposting
- Talk About Trust: talkabouttrust.org
- The Mix: themix.org.uk
- Talk to Frank: talktofrank.com; tel: 0300 1236600
- We are with you: wearewithyou.org.uk
Sexual health
There has been a drop in the number of 16 to 24-year-olds using sexual and reproductive health services for contraception – but the rate of provision of emergency contraception has risen.
“We see more young people expressing concerns about side-effects and the potential impact on fertility,” says Clare Matthews, clinical manager at the charity Brook.
“At the same time, we are seeing a decline in condom use, which in turn has led to an increase in STI diagnoses. In part, negative perceptions of hormonal contraception are being driven by what young people see on social media.
“We know from our own research that many young people are turning to online sources of information because they aren’t always satisfied with what they learn in school or the information they receive from health professionals.”
Matthews says pharmacists can help: “If someone expresses concerns about hormonal contraception, try to engage them in a conversation about why they feel that way.
A young person is more likely to trust you and take on board advice if they feel their concerns have been heard.
“It is also important to be honest about side-effects. Advise that hormonal side-effects can be common but may also settle after a few months. Also encourage young people to consider what the consequences might be of not taking contraception. Signpost them to reliable information about contraception.”
Young people can also be signposted to local free condom provision and pharmacies may be able to sign up to provide these. “Form close links with your local sexual health services and actively support any initiatives to engage young people,” says Matthews.
“Get involved with national campaigns like Sexual Health Week. Find out what STI services are available in your area and sign up to free STI test distribution if it is available.”
Signposting
- Brook: brook.org.uk
- British Pregnancy Advisory Service: bpas.org
- Family Planning Association: fpa.org.uk
It’s Pharmacy First for kids
Children can be treated via the Pharmacy First service, although condition eligibility varies depending on the age of the child. Here is a quick reminder of the key facts…
Infected insect bites: 1 year and over
- Most insect bites and stings are uncomplicated and can be managed with symptomatic treatment
- Antibiotic treatment for secondary infection of insect bites should only be offered when there is clear evidence of infection
- Infected insect bites provide opportunities to educate patients, parents and guardians about appropriate antibiotic use.
Self-care advice
- Oral analgesics – paracetamol or ibuprofen in a dose appropriate for the age of the child can be given for pain
- Oral antihistamines or topical corticosteroids can help to reduce itching and the temptation to scratch and further damage the skin
- Topical treatments such as antihistamines and local anaesthetics should be avoided as they can cause allergic skin reactions.
Impetigo: 1 year and over
- There are two forms of impetigo – bullous and non-bullous. Pharmacy First PGDs deal with the more common non-bullous form, which is caused by Staphylococcus aureus
- The condition usually clears up spontaneously and heals without scarring within two to three weeks. However, antibacterial treatment is recommended to minimise the risk of spreading and complications
- Impetigo is highly contagious and good hygiene measures are required to reduce the risk of spreading it to other areas of the body or other people. This includes keeping children away from school until lesions are healed or crusted over, or 48 hours after antibacterials are started.
Self-care advice
- Avoid touching patches of impetigo as this may spread the infection to other areas
- Always wash hands with soap after accidentally touching the area
- Wash hands before and after putting cream or ointment on the impetigo
- Do not share towels, flannels or other items until the infection has cleared. Always use a clean cloth on each occasion to dry the affected area
- The child’s towels and bedlinen should be washed on the hottest available setting (at least 60ºC) with the addition of laundry bleach.
Acute otitis media: 1-17 years
Under the Pharmacy First clinical pathway, two main groups are eligible for pharmacist antibiotic provision:
- Patients under 18 years who have otorrhoea (discharge after eardrum perforation) or eardrum perforation (suspected or confirmed)
- Children under two years with infection in both ears diagnosed via otoscopy with severe symptoms and symptoms that have lasted for three or more days
- Any patient with three or more episodes in six months or four or more episodes in 12 months should be referred.
Self-care advice
- Whether an antibiotic is supplied or not,
parents should be advised to give regular doses of paracetamol or ibuprofen at the right dose for the age/weight of the child and maximum doses for severe pain - NICE does not advise using decongestants and antihistamines as the evidence suggests they do not help with symptoms.
Sore throat: 5 years and over
- Around 90 per cent of sore throats that present in pharmacy will be viral in origin
- It can be difficult to differentiate between viral and bacterial infections, but the majority of both are self-limiting
- If the sore throat has lasted seven days or longer and shows no signs of settling, the patient should be referred
- An important part of assessing young patients is to see if there are signs of them appearing unwell or having a respiratory tract infection, with an accompanying cough or a runny nose. It is also good practice to check for a raised temperature
- The child’s throat and neck will also need to be examined in order to use the clinical scoring system
- Antibiotics need careful targeting and may have a limited effect on outcome (on average, they reduce the duration of symptoms only by about 16 hours).
Self-care advice
- NICE recommends paracetamol for pain or fever or, if preferred and suitable, ibuprofen
- OTC sore throat preparations such as lozenges, pastilles and throat sprays may help to ease pain, but many are not suitable for young children.
Acute sinusitis: 12 years and over
- Anyone under 16 years of age who is pregnant or could be pregnant should be referred
- Most cases of acute sinusitis take two to three weeks to resolve and do not need treatment with antibiotics
- 98 per cent of cases are caused by viruses. Symptoms indicating bacterial infection are a marked deterioration after an initial milder phase, fever (above 38˚C), unremitting purulent nasal discharge and severe unilateral pain (especially tooth and/or jaw pain)
- NICE advises that even bacterial sinusitis is usually self-limiting and does not routinely need antibiotics
- A high dose nasal corticosteroid for 14 days (off label) can be recommended in those who have had persistent unremitting symptoms for 10 days or longer
- Antibiotics can be provided where there are persistent symptoms despite the use of a high dose nasal corticosteroid, or if high dose nasal corticosteroids are unsuitable.
Self-care advice
- NICE advises considering paracetamol or ibuprofen for pain or fever. It adds that patients “may wish to try self-care with nasal saline or nasal decongestants… but it should be explained that there is not enough evidence to recommend these
- It should be explained that no evidence has been found for using oral decongestants, antihistamines, mucolytics, steam inhalation or warm face packs in sinusitis.
Clinical pathways, service specifications and PGDs for all Pharmacy First services can be found on the NHS England website: england.nhs.uk
Red flags
Pharmacists and all other members of the pharmacy team should know the red flags associated with all of the Pharmacy First pathways. You can find these on Pharmacy Magazine’s Pharmacy First Hub online at pharmacymagazine.co.uk/pharmacy-first
In Clinical