Young People's Experiences & Mental Health PDF

Young peoples experiences **Conceptualisation and prevalence** Are mental health problems among children and young people becoming more common? Why? Rates of mental illness is growing quickly in young children 2017: 1 in 8 children suffered from mental disorder This rose to 1 in 6 in 2022 (Brit...

Young peoples experiences **Conceptualisation and prevalence** Are mental health problems among children and young people becoming more common? Why? Rates of mental illness is growing quickly in young children 2017: 1 in 8 children suffered from mental disorder This rose to 1 in 6 in 2022 (British medical association) COVID 19: Kauhanen et al 2022: systematic review issued that the pandemic deteriorated young peoples mental health : increased depression, anxiety and psychological distress - Increased loneliness - Social isolation - Health anxiety LBTQ : 2-3 more likely to report a mental health problem 23% of Black/ Black british (\> 17% of white british) report a mental health issue (MIND) How can schools and educational psychologists contribute to promoting and supporting children and young peoples wellbeing and mental health **Mental health: defined?** Acts on a continuum: normal human emotional experience -\> extreme psychological distress and mental ill health Not clearly defined where we move from mental health to mental ill health - Depends on the context and culture - E.g. school exclusions -- but could function well in other contexts (e.g. work) Cultural differences in defining mental health: Patients from different cultures will vary in how they describe their symptoms to practitioners: leading to different diagnoses e.g. Asian patients report somatic symptoms (dizziness) whilst ignoring emotional (Lin and Cheung 1999) Depression varied from 2 -- 19% across countries (Weissman et al 1996) : factors such as poverty and violence play a role in this onset (race/ ethnicity/ socioeconomic status of country increases the likelihood of exposure to these stressors) PTSD: countries of war/ violence are more likely to be exposed to longstanding symptoms (Yehuda 2000) **What is well being?** The quality of peoples life? More of a dynamic state Can be understood using objective measures: household income, educational resources and health status Also subjective indicators: happiness, perceptions of quality of life and life satisfaction Emerging consensus that childhood wellbeing is multi dimensional: physical, emotional and social wellbeing - Focus on immediate but also future lives - Incorporates some subjective as well as objective measures Hard to study wellbeing in children -- impacted by parental influences : may be manipulated by abusive parents to believe that their maltreatment is justified (e.g. Menendez brother case: Lyle Mendez was taught to believe that his sexual abuse was a normal part of father -- son interaction & a bonding experience) Children are also less likely to respond about how they are feeling and will hide their emotions (Theodosiou et al 2020) : feel as if they won't be taken seriously or others won't understand Due to this inability to understand and express how they are feeling : signs of frustration (mood / behavioural changes, poor academic achievement, social withdrawal) may instead be seen as behavioural problems and punished -- exacerbating the problems **Mental health: a special educational need?** Does mental health create an educational need? Sense of wellbeing underpins their social wellbeing and this has a knock on effect on their educational performance Concern that there's a lot of focus on behaviour rather than emotions 6.32 children and young people experience a wide range of social and emotional difficulties; these manifest themselves in a variety of ways \- withdrawn/ isolated + displaying challenging, disruptive or disturbing behaviour \- behaviours can reflect underlying mental health difficulties (anxiety, depression, self harm, substance misuse, eating disorders) or medically unexplained physical symptoms \- may be ADHD, attention deficit disorder or attachment disorder \- 6.33 schools and colleges should have clear processes to support children and young people =\> how to manage the effect of any disruptive behaviour so it doesn't affect other pupils =\> Schools are asked to identify struggling students and have a support plan in affect (to help both the student and not to distract other students around them) **When does mental health become a problem?** - Severity - Complexity - Persistence (is it a temporary response to an event? E.g. divorce/ death)- if only short term it is not a problem) - Impact on development, learning and life - Risk factors - Protective factors (what helps people to cope) - Societal and cultural values and influences Rating of how likely a child is to be vulnerable/ resilient Childhood mental health problems led to detrimental abilities to work economically as an adult, poor marriage stability and declined conscientiousness & agreeableness (Goodman et al 2011) Also more severe physical effects: stress caused from mental health problems can impair the development of the brain and nervous system -- halting children from reaching their full potentials Those who's mental health issues come from complex traumatising incidents suffer from frequent body dysregulations, making them hypersensitive to environmental stimuli but also less able to feel painful sensations. (National child traumatic stress network) **Well being** - Most children + YP are positive about their lives - 2013-14 (UK) : 8/10 YP aged 16-14 reported high/very high life satisfaction - BUT 1/5 reported symptoms of anxiety and depression (2011-12) Tellus4 (2009): - Decline in emotional health and wellbeing: due to the fact children felt as if they couldn't speak to an adult other than their parent when worried - Drop in the measure for participation in positive activities (DCSF 2010) - Index of child wellbeing in Europe: UK is the 21^st^ / 28 for subjective wellbeing May be due to a general increase of difficulties or because more people are becoming identified 8.1% of children aged 5-10 found to have a mental health disorder (46,000) 11% of young people aged 11-15 years (49,000) (Meltzer et al, 1999) Repeated survey 2004 and found very similar prevalence rates (Green et al, 2004) and NHS (2017) Emotional disorders have increased: more common in 5-15 year olds- from 4.3% in 1999 to 3.9% in 2004 to 5.8% in 2017 Other disorders (behavioural, hyperactivity) remain broadly stable : must be a link to mental health problems Sudden increase after 2011 Issues have risen alongside increased technological use: "cultural trends in the last 10 years may have had a larger effect on mood disorders and suicide-related outcomes among younger generations" (Twenge 2019) - Increased digital use has caused a greater stability in children's social life : impacts their ability to sleep, communicate and their attention span - Also increased risk of cyberbullying: anonymous and without the face to face complexities [Rates of mental health disorders increased with age: ] Young people aged 17-19 were x3 more likely to have a disorder (16.9%) compared to pre school children aged 2-4 (5.5%) Emotional disorders were highest for 17-19 year olds But behavioural and hyperactivity 5-16 year olds 1/3 of 5-19 year olds with a disorder were recognised as having special educational needs ½ of these had an education, health and care plan in place Areas of concern: 50% of mental illnesses begin before age 14 10-20% of adolescents experience a mental health problem in any given year Increasing emotional problems in girls but plateau for behavioural difficulties - Girls are more likely to internalise emotions (chaplin and aldao 2012) - Girls were also more likely to use more verbal and indirectional relational bullying: has more of an impact emotionally School influences: - The school environment found to play an important role in children's social, emotional and behavioural wellbeing - Children's learning and enjoyment in primary school found to predict their later wellbeing in secondary school. - For boys, learning in primary school the strongest influence on behavioural aspects of their later wellbeing - For girls it is more predictive of social wellbeing - (Gutman and Feinstein, 2008; Gutman et al., 2010). - Children Society (2015) surveyed happiness in 10-12-year-old children in 15 diverse countries, - Children in England found to be more unhappy with their school experience than children in 11 other countries including Ethiopia and Algeria, but better than children in Germany, South Korea and Estonia. - A third (38%) of 10 and 12 year olds in England reported that they had been physically bullied in the last month, and half (50%) had felt excluded. - Two children in every classroom were said to be dissatisfied with aspects of their school life, with their main concerns being their relationship with their teachers, the things they learn and the other children. (Good Childhood Report, 2015) Factors contributing to mental health: Societal + cultural + environmental + education Psychological + biological + social Accessing support: How is children and young people's mental health and well being promoted in school? - In a study 10,438 children 5-15, just under half (46%) who had a mental health problem had not accessed a service 20 months later. - Of those that did, teachers were most commonly consulted (43.6%), CAMHS workers (22.1%) & social services (11.6%) Comprehensive mental health support: with or without "tiers" - Child and Adolescent Mental Health (CAMH) is 'Everybody's Business' - Tier 1- Frontline Staff - Tier 2 - Network of Professionals (educational psychologists) - Tier 3 - Specialist Outpatient CAMH Team - Tier 4 - Inpatient CAMH provision (HAS, 1995; DoH, 2005) - More recently arguments for developing a system without Tiers? ( Future in Mind, DoH, 2015) - A single point of access or hub. - Triaged and direct access to a service appropriate to your mental health need. EP contributing to supporting mental health - Typically work in a network of professionals; these have a role expected to include : work to promote positive mental health, prevent and provide for short term mental health needs alongside other professionals - Supporting frontline professionals (teachers, GPs, social workers) to meet the mental health needs of children and young people - Consult, involve and seek supervision from CAMHS when appropriate **How can mental health and educational psychology by accessed?** Specialising in the mental health of young people, a *child psychologist* may provide help and support to those experiencing difficulties. A CAMHS team will include a child psychologist, but it may also be possible for schools to use the services of an LA educational psychologist or to commission one directly themselves, depending on local arrangements (DfE, 2015). Mental health and wellbeing task force DOH 2014 Requires the want of the school to include these promotions (e.g. headteachers to spend their money on these sectors) - Promote resilience, prevention and early intervention - Improve access to effective support (system without tiers) - Care for the most vulnerable - Accountability and transparency - Developing the workforce UK governments three pillars - To incentivize and support all schools and colleges to identify and train a Designated Senior Lead for Mental Health - To fund new Mental Health Support Teams, which will be supervised by NHS children and young people's mental health staff. - To pilot a four-week waiting time for access to specialist NHS children and young people's mental health services. (DfE, 2017) Strong message that mental health support teams should work with a wide range of professionals and services Mental health support teams can be strengthened when working closely with other services (e.g. school nurses, counsellors, local authorities) - Each role plays a crucial part in supporting young people - Schools increasingly being looked to for intervention and support (Patalay et al 2016) - Children are there for the majority of their day: makes sense that this is the most noticeable location : important for early intervention M - Need for an improved evidence-base for interventions; implementation and outcomes in educational settings rather than clinical ones (Murphy & Fonagy, 2013). - Emphasis on integrated working and early intervention (Future in mind, DoH 2015) - But....Issues of collaboration between education and health and access remain (Independent CAMHS review, 2008; DfE/DoH, 2017) - Challenges of increased diversity in education marketplace and commissioning of educational psychology services (BPS, 2024) - EP role with Social, Emotional and Mental Health (SEMH) in state of flux linked to its statutory function and pressures in SEN identification and assessment. Ellins et al 2022: schools can implement mental health support teams (MHSTs) - These work in education settings to deliver evidence based interventions - Interventions showed modest improvements (Pilling et al 2020) **What role for the EP?** Paradigms for understanding mental health: - Medical-diagnostic model - Social model - Educational model - Psychological model Medical model -\> understand the complexity of human condition and develop treatments best suited to their conditions - Problematic in the sense that it over emphasises the diagnosing and treatment pathology Mental health problems are more likely to occur as a result of their circumstance EPs work with and alongside , other professionals such as Community Paediatricians and may contribute to: - Diagnostic processes ( e.g. ADHD, ASC pathways). - Supporting others to understand diagnostic processes and the impact of labelling - Support the implementation of evidence-base treatments or interventions for particular conditions ( (e.g. Behavioural for ADHC). - Attempting to bridge the gap in understanding between health, social care and educational settings. - Evaluating impact and implementation of evidence-based/informed interventions in educational settings Social model: younger people have negative views and use pejorative terms in every day language Young people with mental health problems are more likely to experience higher levels of stigma than adults -- this causes them to be secretive about their problems and avoid seeking help We need to reduce this stigma- those with training about mental health show improvement - young people with information about mental health issues has been shown to improve attitudes to mental health and help seeking behaviour. - Training 1. teachers in mental health issues has also been shown to improve understanding of mental health (Gale, 2010) Social model promotes the voice on young people: important that they're able to express their distress Typically frameworks are imposed which deny individuals their own knowledge and expertise -- instead we need to make links between thoughts, feelings and behaviours helping people realise the realities of social and personal experiences What can schools do?? - Teaching about good mental health and emotional resilience - Whole school approach which build understanding about mental health, tackle stigma and develop emotional resilience - Successful evidence-based models that increase access to mental health support and services see for example, the TAMHS (Targeted Mental Health in schools (DfE, 2009). Should foster the development of resilience and provide opportunities for the delivery of interventions aimed at improving mental health ELSAS (emotional literacy support assistance)- emotion coaching EP role within the social model: Draw attention to the fact that children and young people's school experiences can impact their mental health, distress and wellbeing - Promote systemic responses to mental health, distress and wellbeing - Help address issues of stigma and inclusion - Help young people to understand and cope with their experiences of mental distress Educational model: concerned with the development of social and emotional competence Emphasises the teaching and learning of emotional awareness and social skills - Emotional literacy, social and emotional aspects of learning 5 key social and emotional skills - Self Awareness - Self Regulation (Managing feelings) - Motivation - Empathy - Social skills EP work within the educational model - Training on the Social and Emotional Aspects of Learning - Offer support to help the theory underpinning the approaches ( e.g. concepts of Emotional Intelligence (Goleman) and Emotional Literacy (Gardiner) - Work with schools to develop whole school approaches. - Offer training key staff in the knowledge and skills around how to support emotional literacy, peer mentoring and use of cooperative group work - Provide training on Strengths Based Approaches such as Solution Focused and Orientated Practice ( deShazer, 1990; O'Hanlon, 2000) and Positive Psychology (Seligman et al, 2009). - Working with schools to provide targeted group work to those children identified as at risk of social emotional and behavioural problems (see Squires, 2002). - Working with schools to support the identification, assessment and provision of support of children with social, emotional and behavioural needs (DfE, 2015) Psychological model: Recognises: the importance of the interaction between the person and environment and vice versa Considers: the impact of the individual on the system and system on the individual Impact of behaviour, cognition, emotion and interpersonal interactions Typically adopts: an eco systemic approach and research practicioner mindset using a case formulation, hypothesis and problem solving Different forms of consultation, assessment, evaluated intervention and systems work Individualist vs system approach +-----------------------------------+-----------------------------------+ | [Individualist] | [Whole system] | +-----------------------------------+-----------------------------------+ | Pipe-end | systemic | +-----------------------------------+-----------------------------------+ | pathogenic | salutogenic | +-----------------------------------+-----------------------------------+ | mandatory | participatory | +-----------------------------------+-----------------------------------+ | dependency | sustainable | +-----------------------------------+-----------------------------------+ | inequitable | equitable | +-----------------------------------+-----------------------------------+ | additive | integrative | +-----------------------------------+-----------------------------------+ | maintains status quo | population health gain builds | | | social systems | | (Harrison & MacDonald, 1997) | | +-----------------------------------+-----------------------------------+ Educational psychologists are a key therapeutic resource for young people - Many young people do not adequately respond to treatments \] Limitations: not all treatments work for all and sometimes they can have negative consequences - Need evidence and context based circumstances Interactive factors framework: Monsen and Fredrickson 2008  Mental health: the ecosystem - Draws on the principles of ecology and systems theory - Looks to understand the interacions within and between Micro system: exo system, macro system, meso system Evidence based practise: EPs role advising appropriate support and interventions Considerations: The case, the evidence, the context Not what is the best evidence but what is relevant A range of meta analytic studies and systematic reviews of interventions - e.g.Drawing on the Evidence (Wolpert et al, 2006) EBPU - Choosing what is best for you (2007) EBPU - Knowing where to look (2008) EBPU - Fonagy, P et al (2002) What Works for Whom? - NICE Guidance for Health and Care Professionals - EPs are a statutorily regulated profession have a case- reflect on this and what are our hypotheses are (evidence, values...), In the future innovative methods of service delivery (the internet, social media) should be developed \+ improving mental health literacy in the wider community \+ EP work in the support of emotional literacy support assistance