David Wall-JonesSenior Mental Health Promotion Specialist

Education Bradford & Bradford & Airedale PCT

Mental Health and Emotional Wellbeing

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.

Learning Together –

•Understand and respect others

•Maintain confidentiality

•Taking equality and diversity seriously

•Commitment to learning

•Time out

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.

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)

Another Definition of Mental Health

When 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)

Young People’s 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.

(Armstrong, Hill &Secker, 1998)

Prevalence of mental health problems in children and young

peopleDistinction 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.

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

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

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

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

BoysGirlsAll

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

BoysGirlsAll

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

BoysGirlsAll

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

BoysGirlsAll

Prevalence of any Disorder by EthnicityWhite 9.75%

Black 12%

Indian 4%

Pakistani & Bangladeshi 8%

Other groups 10%

All C&YP 9.75%

Prevalence of any mental disorder by gross weekly

household income

0

2

4

6

8

10

12

14

16

18

Gross weekly household income

Perc

enta

ge o

f ch

ildre

n w

ith a

menta

l dis

ord

er

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 Bradford July 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

Exercise Case Studies

1) 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?

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

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

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)

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)

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

What else helps children’s and young people’s 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

What else helps children’s and young people’s 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

What else helps children’s and young

people’s mental health?•Boundaries

•Knowing what they can and can’t do

•Be consistent

•Expect challenge

•Skill Development

•Enabling children and young people to improve their mastery of stressful situations

What else helps children’s and young

people’s mental health?•Being there

•Links with attachment

•Even if they don’t talk to you, the main thing is not to put them off talking to someone in the future

•Doing what you promise – don’t let them down!

Beginnings

• Where do you begin?

Resilience

Resilience involves several related elements.

Firstly, a sense of self-esteem and confidence;

Secondly a belief in one’s own self-efficacy and ability to deal with change and adaptation;

Thirdly, a repertoire of social problem solving approaches’ (Rutter 1985)

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

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

Resilience Factors - Community

•Wider supportive network

•Good housing

•High standard of living

•High morale school with positive policies for behaviour, attitude and anti-bullying

•Schools with strong academic and non-academic opportunities

•Range of sport/leisure opportunities

Promoting resilience in relationships

• Increase warmth and pleasure parent feels for the child

•Foster concern/interest as this helps to develop self-esteem

•Foster ability to predict child’s needs

•Use activities which foster connectedness

•Help parents and children to do funny things together

•Build parental confidence and skills

Outcome •Be healthy

•Stay safe

•Enjoy and achieve

•Make a positive contribution

•Achieve economic well being

Emotional Presupposing

Thinking about how we use language of emotion

Relational

Autonomous

Emotional Posture of aChild

Do they want to meet?

How will they feel when they meet you?

Will they be relaxed/

reflective?

Will they be focussed on listening or protesting?

What will they want you to appreciate about them?

Emotional Posture of the Teacher

Are you looking forward to

meeting them?

What might you experience in your body or notice about their body/

What feelings will you carry from the

earlier?

How might your posture affect how you can be with these people?

Which posture is likely to invite respect,

safety and collaboration?

How would you like to be with this child?

Presuppose the postion of the child, family, school, community and ourselves

Who might they ask you to be?

How might they invite you to

act?

What might you need to do?

What position do you prefer to offer?

What is your

storyline?

Extend your repertoire of postions

If you did something

different what would happen?

What other postions might you invite?