A difficult baby who screamed constantly, Ricky became more uncontrollable as he got older. When he was two, a health visitor referred him to a social worker, who sent him to a community paediatrician, who passed him on to a child psychiatrist.
His mother, Juliet Jarrett, a 36-year-old divorcee struggling to bring up two other children - partially sighted Emma, now 11, and Timothy, 14 - often blamed herself. "You think it must be something you've done," she says, despite assurances from Ricky's psychiatrist that one in 100 children is simply sent to try their parents' patience. "I just cut myself off, never went out. I literally couldn't take Ricky anywhere."
A danger to himself as well as others, he was diagnosed as a child with "severe behavioural problems". His state also makes him insecure, as he is frightened by his violent outbursts. His temper tantrums last for up to two hours, after which he falls into a trance and then sleeps. He has a very active brain at the limits of normality. After trying different drugs, diets and role-playing therapies with Ricky, his psychiatrist referred him to the Maudsley Hospital, London, when he was six. The family saw a child psychiatrist and family therapist there once a week for nine months.
The hospital taught Mrs Jarrett how to control him. How to talk to him, pin him down on the floor, hold him against a wall so he couldn't move. They made videos of the way he attacked his mother and examined how the family interacted. "For six months I was covered in bruises and bites. Then he slowly started to improve. Ricky is much, much better than he was, but he will always be overactive and very hard work."
He still wets himself, has a 10-minute attention span, is three years behind his classmates and is on the verge of being assessed as a special needs child.
Ricky is unusual. Two million other children and adolescents in England and Wales have a mental health problem, reflecting a massive increase in the number of young people with behavioural and emotional difficulties.
A study in 1992 for the South-West Thames Regional Health Authority estimated that one in 14 pre-school children had moderate to severe mental health problems. One in four of six- to 12-year-olds in urban areas and one in 10 in rural areas have moderate to severe problems; as many as 20 per cent of adolescents may suffer from a psychiatric disorder.
Depression, anxiety states or phobias, and behavioural disorders, are found on average in 10 per cent of children. Twice as many boys as girls are seen by child psychiatric services.
The under-10s, according to Peter Wilson, director of the campaigning organisation Young Minds, suffer mainly from behavioural problems. "Children's anxieties can manifest themselves in disruptive behaviour or they may become withdrawn," he says. Children also suffer from obsessions, eating disorders, problems of sexual identity and school phobia, but serious psychotic disorders such as schizophrenia are rare until early adolescence.
According to the Department of Health, while admissions to adult psychiatric wards fell by 9 per cent from 1985 to 1990, there was a 65 per cent rise in admissions for children aged between 10 and 14. The number of 15- to 19-year-olds admitted to psychiatric hospitals rose by 21 per cent and of under-10s by 42 per cent. There has also been a 75 per cent increase in suicide rates in young men aged 15-24 since 1982.
But parents are often not sufficiently aware of children's mental health problems. Many know the symptoms of meningitis, but might not pick up on signs of depression. "There's a myth that children don't get depressed, and that being moody is just part of growing up," says Professor Philip Graham, the recently retired professor of Child Psychiatry at Great Ormond Street.
Most parents would sense if their children were preoccupied, distressed or not fitting in well at school. "But they might not be sure how to understand it, whether to be embarrassed or ashamed about it, or indeed know if there's anything that can be done," Peter Wilson says. "I don't think they've quite cottoned on that they have a right to be worried and something can be done."
GPs don't fare much better. Studies show that 23 per cent of children attending GPs' surgeries have some form of psychological or emotional problem. Only 2 per cent are identified by GPs.
While the rise has nothing particularly to do with poverty, those most prone to these disorders are more likely to be poor. It's tempting to put the increase down to the fact that people are more aware of and better at diagnosing these conditions, but Professor Graham says this is not the case. The weight of evidence is too great and the rise is undoubtedly real. "Since the Second World War, I think there has been a loosening of social control and family bonds, and a prolonging of the dependence period for adolescents as well as earlier maturity. The combination of these factors probably explains the rise over time," he says.
Many families now find it a struggle to provide the security and stability children need. There's often a lack of support, with no extended family nearby, financial insecurity and the high rate of marital breakdown. Peter Wilson believes the rise in mental health problems is largely to do with changes in the way in which families live. "I think everybody is finding this a challenging time," he says. "This climate of tension and change we're all living in percolates through to kids in different ways."
Despite the increase, there is a decline in services for young people. There has been a gradual loss of beds in adolescent psychiatric units. At least seven units have closed all beds; others are threatened with closure. Waiting times for clinics for young people have also lengthened in 66 per cent of units to up to six months in 10 per cent of cases. Those working in the field say many child guidance units are overstretched, with a dwindling number of part-time sessional workers trying to meet a huge need.
"It's one of the major scandals of our time," says Peter Wilson. "The services that do exist don't seem to relate to what the needs are and there seems to be no co-ordination. Of the total mental health budget, not more than five per cent is spent on the under-21s, although they constitute 20-25 per cent of the population.
"We need a comprehensive child mental health service, with child psychiatrists at the top and a whole range of primary care workers at the bottom. There is concern at the Department of Health and there are some good initiatives coming out, but at the moment, the provision of services is extremely patchy."
"I know difficult choices have to be made, but if I had to choose, I know where I'd put my money," Peter Wilson says. "It's ludicrous to give such a small amount to children's services. There is nothing more important than the mental health of children."Reuse content