Can Sport improve Mental Health and Wellbeing of young people?Stephen McLeodHead of Specialist Children’s ServicesNHS Greater Glasgow and Clyde

Definitions & DeterminantsGlasgow’s School Children – active and healthy? Young People’s development – what is normal?Distress V DisorderResilienceActions

Contents

Definition of health

“A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (WHO 1948)

We need to reframe a definition for our time to reflect the population age and the pattern of illness changes

“The ability to adapt and self manage” in the face of social, physical and emotional challenges. (Huber et al BMJ 2011)

Positive mental health can be promoted through

Physical activity-incorporating exercise into everyday activities

Labour market activity-having meaningful work and a daily routine

Social activity-being connected to family, friends and our communities

The social determinants of mental healthSociety Community Family Individual

Equality of opportunity

Safety and social order

Family structures and networks

Lifestyle (e.g. food, exercise, alcohol intake)

Employment opportunities

Housing and amenities

Family dynamics (e.g. high/low expressed emotion)

Attributional style (i.e. how events are understood) and self efficacy

Social cohesion Quality of physical environment and green space

Genetic characteristics

Financial security

Educational opportunities

Social connections and networks

Intergenerational relationships

Physical health

Health care provision

External influence and control

Parenting skills and resources

Individual relationships

• ‘Recovery capital.’… the things, the people, their resources, their understanding and concern for the individual which can help them have a sense of belonging and connection which helps them to firstly help them consider, and then initiate change in their lives. Sometimes this change is slow, but it can be sustainable change, change that’s supported by others in a meaningful and very personal way.

• My vision for a healthy Glasgow is one where people have a common sense of hope and purpose in their lives”

Neil Hunter, Chief Reporter to the Children’s Panel

“Many folk in Glasgow spend five or more hours a day watching television – particularly commercial channels. My vision for a mentally flourishing Greater Glasgow and Clyde is one where

people spend less time watching television and more on activities, which support them socially and emotionally.

Carol Craig,Director, Centre for Confidence and Wellbeing.

Screen time – computer games, surfing the net, social networking, smart phone and TV

25% of secondary school pupils 12 or more hours of screen time

• One in four (25% 1,166 pupils) spent more than 12 hours a day on screen-based activities on school days

Arts, culture and mental health

Contribute to effective health educationContribute to therapeutic and relaxed environments in

health servicesDevelop creativityImprove quality of lifeRaise expectations of what is possible and desirable…plausible link to mental health outcomes but more

research required

Physical & mental• Improves quality of life• Manages weight• Reduces risk of chronic diseases• Improves sleep• Reduces stress, depression• Develops motor skills• Improves concentration, memory

& learning

Economic• Creates employment• Draws tourism• Means of transport • Supports local businesses• Reduces absenteeism • Reduces crime• Reduces health savings

Social• Encourages family/community

connectedness• Improves social skills/networks• Prolongs independent living for

older people• Reduces isolation, loneliness• Enhances self-esteem,

confidence

Environmental• Reduces traffic congestion• Reduces air pollution• Reduces greenhouse emissions• Reduces noise pollution• Creates safer places with

people out and about

Benefits of Physical Activity

Physical Activity Benefits

Glasgow Schools Survey

Sport, exercise and travel

• 4/5 report taking part in a sports club out of school

• Swimming, football, dance are most popular

• 51% used active travel methods to journey to school

• ¾ report owning a bicycle

Level of walking remains high but trend towards greater car use and less walking over past 20 years

Some examples of schools with high levels of active travel despite pupils travelling longer that average distances

No difference by whether or not school has a travel plan

Cycling levels low – just over 2%- but ten times as many secondary pupils would like to cycle than do currently

Travel to School

Best practice in planning for physical activity (NICE)

Identify groups of children and young people least likely to exercise at least 1 hour a day

Understand the factors that help or prevent them getting involved

Involve them in design, planning and delivery

Mental health is important too

Widen awareness of mental health issuesMental health promotion considered in all

plans and service designsPromote value of positive environments and

activitiesStronger focus and leadership on physical

activity even in these times of austerity

The challenges to mental health and wellbeing

High levels of child and family povertyMore likely to be admitted to hospital through assaultMore likely to be reported to the Children’s Panel through

violenceHigher rates of looked after and accommodated childrenLower rates of referral to social services as a result of concerns

(public or professionals)Worse school attendance Higher proportion of 16-19s not in education, employment or

training

Psychosocial Crisis Stage Life Stage Virtue age range, other descriptions

4. Industry v Inferiority School Age Competency 5-12 yrs, early school

5. Identity v Role Confusion Adolescence Fidelity 13-18 yrs, puberty, teens*

6. Intimacy v Isolation Young Adult Love18-40, courting,

early parenthood

7. Generativity v Stagnation Adulthood Care 30-65, middle age, parenting

8. Integrity v Despair Mature Age Wisdom 50+, old age, grandparents

Erik Erickson’s Stages of Psychosocial Development

Developmental Goals (6 to 12)

Ages 6 to 12To develop industry

Begins to learn the capacity to workDevelops imagination and creativityLearns self-care skillsDevelops a conscienceLearns to cooperate, play fairly, and follow social

rules

Normal Difficult Behavior Ages 6 to 12

Arguments/Fights with Siblings and/or PeersCuriosity about Body Parts of males and femalesTesting LimitsLimited Attention SpanWorries about being acceptedLyingNot Taking Responsibility for Behaviour

Cries for Help/More Serious IssuesAges 6-12

Excessive AggressivenessSerious Injury to Self or OthersExcessive FearsSchool Refusal/PhobiaFire Fixation/SettingFrequent Excessive or Extended Emotional

ReactionsInability to Focus on Activity even for Five MinutesPatterns of Problem behaviors eg property damage

Adolescence

Developmental Goals

Developing Identity-the child develops self-identity and the capacity for intimacyContinue mastery of skills

Accepting responsibility for behaviorAble to develop friendshipsAble to follow social rules

Normal Difficult Behavior

Moodiness!Less attention and affection towards parentsExtremely self involvedPeer conflictsWorries and stress about relationshipsTesting limitsIdentity Searching/ExploringSubstance use experimentationPreoccupation with sex

Cries for Help- Ages 13-18

Sexual promiscuitySuicidal/homicidal ideationSelf-mutilationFrequent displays of temperWithdrawal from usual activitiesSignificant change in grades, attitude, hygiene, functioning,

sleeping, and/or eating habitsDelinquencyExcessive fighting and/or aggression (physical/verbal)Inability to cope with day to day activitiesLots of somatic complaints (frequent flyers)

Discussion

How do you make the distinction between the Concerning versus the Unconcerning?

Prevalence Quiz…..

Prevalence Quiz

One in ten children between the ages of one and 15 has a mental health disorder.

(The Office for National Statistics Mental health in children and young people in Great Britain, 2005)

Estimates vary, but research suggests that 20% of children have a mental health problem in any given year, and about 10% at any one time.

(Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding The Lifetime Impacts, Mental Health Foundation, 2005)

Rates of mental health problems among children increase as they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged 11-15.

(Mental Disorder More Common In Boys, National Statistics Online, 2004)

Prevalence Quiz

One in two LAC children between the ages of one and 15 has a mental health disorder.

(The Office for National Statistics Mental health in children and young people in Great Britain, 2005)

Distress V Disorder

Mental Health Distress

Mental Health Disorder

Mental Health Distress

Sadness

Anger

Worry

Common Mental Health Disorders

Behavioural Problems (e.g. ADHD)

Anxiety and/or Phobias

Depression

Suicidal Thoughts and/or Self Harm

Everything else (Psychosis, Eating Disorders etc)

Mental Health Distress

Distress is a normal human emotion and

reaction to sadness or suffering

Distress tends to disappear when the situation

is relieved or the stressor goes away

Mental Health Distress can lead to a Disorder when:

The child has significant trouble with a stressful situation and his/her response is not appropriate

Problems do not go away when the stressful situation is resolved

The child cannot adapt to the stressful situation

Resilience

A child with a mental health disorder does not necessarily have poor mental health.

When a child has strong character traits, they are able to build resiliency.

Resiliency is the ability to overcome challenges and stress in a way that promotes health and wellness.

Community Sources of Resilience

One Good Adult –dependable, mentoring, guiding, befriending

Whole Team approach to mental health – ethos, curriculum, positive behaviour, anti-bullying

Network of Youth Services – confident, skilled and able to intervene

Community Sources of Resilience

Guide to the ‘Service Maze’ – a range of supports and able to find quickly

Distress, Self Harm and Suicide Prevention –staff are confident, able to help those in distress, including self harm and risk of suicide

Peer Help and Social Media – young people who share their problems enjoy better mental health; use opportunities to use peer support and social media.

Building Resilience

Focus on strengthsIdentify what they are good at, recognise it,

value it, celebrate it and build on it. Promote connectednessPositive impact of one supportive adult or one

adult who a child knows is thinking about them even when they are not there. For most children that will be a parent or carer but for some it may be a coach or volunteer.

Become better observersObservation is about noticing and reflecting on

behaviour (the visible spectrum) in order to understand what is going on in the areas of our experience that are hidden from others. This includes, but is not confined to, observing children’s behaviour.

Model emotional regulationThe last thing you need if you are a young

person who feels out of control and distressed is an adult who reacts to your high display of emotion with an equal level of anxiety and distress.

Remember…You are not there to be the mental ‘disorder’ expertYour job is to support young people, not find labelsYou are a young person expertYou can be a witness to fact – listen, observe, be the

dependable adult, advocateEncourage help and support seeking

“Comparative studies have demonstratedthat exercise can be as effectiveas medication or psychotherapy.”

Mental Health Foundation on depression (2010)

“Miracles are being achieved every day…Football groups are saving lives.”

Participant in Time to Change focus group, for football

and mental health project attendees (2011)

"Working in football isn't always good for your mental health, but being physically active definitely is: that's why we're pleased to get behind SAMH's Get Active campaign".

Danny Lennon, manager at St Mirren

“I worked in mental health for ten years… Out of all thethings that I did as a mental health worker, I found that thebenefits from football far outweighed anything else that I did.I could see the progress that people made by being involvedin a physical activity.”

Rob Thomas, Mental Health Lead, Everton in the Community