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  • 1. David Wall-Jones Senior Mental Health Promotion Specialist Education Bradford & Bradford & Airedale PCT Mental Health and Emotional Wellbeing

2. Exercise Talk to person sitting next to you and briefly describe a child who you know or who you believe is leading a emotionally, mentally and healthy life. What are the key characteristics of this child? Please display these as thoughts or behaviours on the sheet provided. 3. Learning Together Understand and respect others Maintain confidentiality Taking equality and diversity seriously Commitment to learning Time out 4. n In 2004 one in ten children in Great Britain aged 5-16 had a clinically recognisable mental disorder. This is the same proportion recorded in 1999. Mental illness disproportionately affects children in low income households, large families, step families or single parent families. Expenditure on children's mental healthcare varies dramatically by health authority. 5. Definition of Mental HealthMental health is having the capacities of: The ability to develop psychologically, emotionally, intellectually and spiritually The ability to initiate, develop and sustain mutually satisfying personal relationships The ability to become aware of others and empathise with them The ability to use psychological distress as a developmental process.(HAS, 1995) 6. Another Definition of Mental HealthWhen looking at mental health we need to take into account emotional well-being; happiness; integrity & creativity; the capacity to cope with stress and difficulty. Mental health, in effect refers to the capacity to live a full, productive life as well as the flexibility to deal with its ups and downs. In children and young people it is especially about the capacity to learn, enjoy friendships, to meet challenges, to develop talents and capabilities. (YoungMinds, 1996) 7. Young Peoples View of Mental HealthThe young people identified four main factors as contributing to mental health: Family and friends Having people to talk to Personal achievement, and Feeling good about yourself Pets, presents and having fun were also mentioned. Friends and family were seen as making young people feel secure, supported and wanted and conversely as preventing feelings of isolation. 8. Prevalence of mental health problems in children and young people Distinction needs to be made between mental health problems and disorders The former are seen to encompass a very broad range of emotional and behavioural difficulties which may cause concern or distress. They are relatively common. The latter however are more severe and persistent and usually defined using fairly clear diagnostic criteria. 9. Classification of mental disorders Emotional disorders phobias, anxiety states and depression Conduct disorders stealing, defiance, fire setting, aggression, & anti social behaviour Hyperkinetic disorders disturbance of activity and attention Developmental disorders (general, pervasive or specific) For example; learning disability, ASD, delay in acquiring certain skills e.g. speech and language 10. Classification of mental disorders Eating disorders pre-school eating problems, anorexia nervosa, bulimia nervosa Habit disorders tics, sleeping problems, soiling Post traumatic syndromes Effects of witnessing or experiencing traumatic event(s) e.g. disaster or abuse Somatic disorders chronic fatigue syndrome Psychotic disorders schizophrenia, bi-polar disorder, psychoses including drug induced psychoses 11. Prevalence One child in five (around 20%) display a mental health problem. 10% of children have diagnosable disorder Greater in the upper age group Level increasing over time (for some disorders) Differences across ethnic groups Differences between family types Variations with household income 12. Prevalence of any mental disorder by age and sex 0 2 4 6 8 10 12 14 Percentage of children with a mental disorder 5 - 10 yrs 11 -15 yrs All Age Boys Girls All 13. Prevalence of emotional disorders by age and sex 0 1 2 3 4 5 6 Percentage of children with emotional disorders 5 - 10 yrs 11 -15 yrs All Age Boys Girls All 14. Prevalence of conduct disorders by age and sex 0 1 2 3 4 5 6 7 8 9 Percentage of children with conduct disorders 5 -10yrs 11 - 15yrs All Age Boys Girls All 15. Prevalence of hyperkinetic disorders by age and sex 0 0.5 1 1.5 2 2.5 Percentage of children with hyperkinetic disorder 5 - 10yrs 11 - 15yrs All Age Boys Girls All 16. Prevalence of any Disorder by Ethnicity White 9.75% Black 12% Indian 4% Pakistani & Bangladeshi 8% Other groups 10% All C&YP 9.75% 17. Prevalence of any mental disorder by gross weekly household income 0 2 4 6 8 10 12 14 16 18 U nder 100 1 00- 199 2 00- 299 3 00- 399 4 00-4 99 5 00-5 99 6 00-7 70 O ver 7 70 Gross weekly household income Percentageofchildrenwithamental disorder 18. Bradford Up to 6,800 (5%) requiring specialist helpUp to 6,800 (5%) requiring specialist help Source: Dr. Julia Raines July 2004Source: Dr. Julia Raines July 2004 Between 13,600 and 27,200 (10-20%) with disorderBetween 13,600 and 27,200 (10-20%) with disorder Up to 54,400 (40%) with a mental healthUp to 54,400 (40%) with a mental health problemproblem July 2003 total number of children & young people aged 0-18 registered with a BradfordJuly 2003 total number of children & young people aged 0-18 registered with a Bradford GP 135,596.GP 135,596. Source: Bradford Health Informatics ServicesSource: Bradford Health Informatics Services 19. Exercise Case Studies1) What do you think are the issues in this case study? 2) Do you think there is a mental health problem? 3) What are the key factors that you feel need to be considered? 4) What further information would you like to have to be clearer about what to do next? 5) Suggest a specific intervention. 6) Do you think this case requires specialist? 20. What helps - Anxiety Prevention - A number of causes of general anxiety in childhood can be prevented by sensible handling For illogical fears that are not quite phobias, simple explanations and reassurance will help many children gradually get over them Detailed interview with child and family Look to other agencies for interventions eg Educational Psychologists or Education Socal Workers if anxiety is about school, social workers if about home life 21. What helps - Anxiety Talking to or helping children and parents to understand how the problem has developed Specific fears are usually treated by helping children confront their fear in a way and at a pace that they can manage eg carefully planning a gradual return to school if the anxiety is school based Teaching relaxation Help children talk through their anxieties using drawing or play 22. What helps - Depression About 10% of children and young people with depression recover spontaneously within 3 months Be able to determine, recognise and assess those with depression Ensure timely information is available on the nature, cause and treatment in all local languages (NICE, 2005) Ask sympathetically how they are and listen to the response Encourage them to remain active Praise all efforts (Royal College of Psychiatrists, 1999; YoungMinds) 23. What helps - Hyperactivity Learn about hyperactivity and what it means Give structure and encourage regular routine Give clear instructions, sufficient time to complete tasks Provide a variety of physical activity Reward any achievements (HASCAS, 2004) 24. What helps conduct disorder All approaches are grounded in respect for the child Empathy, attention and involvement, play, problem-solving, listening, talking. Praise any achievements and reward them Encouragement Clear limits and consistent rules with consistent follow-through Ignore negative behaviour, distract from negative behaviour (positive verbal redirection) and use re-engagement strategies Remind of expected behaviour and warn of consequences Use consequences 25. What else helps childrens and young peoples mental health? Adults being self-aware Feeling helpless/angry/rejected Learn from your experiences Respect their view even if an alternative adult view is presented Understanding Them Their peer group Their developmental stage/age Their life circumstances 26. What else helps childrens and young peoples mental health? Listening Actively Open questions Warmth and empathy Take account of cultural issues Never promise to keep a secret Child protection procedures Emotional language 27. What else helps childrens and young peoples mental health? Boundaries Knowing what they can and cant do Be consistent Expect challenge Skill Development Enabling children and young people to improve their mastery of stressful situations 28. What else helps childrens and young peoples mental health? Being there Links with attachment Even if they dont talk to you, the main thing is not to put them off talking to someone in the future Doing what you promise dont let them down! 29. Beginnings Where do you begin? 30. Resilience Resilience involves several related elements. Firstly, a sense of self-esteem and confidence; Secondly a belief in ones own self-efficacy and ability to deal with change and adaptation; Thirdly, a repertoire of social problem solving approaches (Rutter 1985) 31. Resilience Factors -Child Secure early relationships Being female Higher intelligence Easy temperament when an infant Positive attitude, problem-solving approach Good communication skills Planner, belief in control Humour Religious faith Capacity to reflect 32. Resilience Factors - Family At least one good parent-child relationship Affection Clear, firm and consistent discipline Support for education Supportive long-term relationship/absence of severe discord 33. Resilience Factors - Community Wider supportive network Good housing High