Wellbeing, resilience and mental health: language and evidence based practice

What do we mean by…….

• Mental health definitions and terms • Prevalence of problems • Early intervention • Evidence based interventions

Mental health definitions Mental health

An umbrella term embracing concepts of mental well-being, mental health problems, mental disorder and mental illness.

Mental well-being

The positive capacities and qualities that enable young people to deal with the ups and downs of life.

Mental health problems

Broad range of emotional and behavioural difficulties that may cause concern to parents and carers and/or distress to the young person. Can be short or long term and will disrupt the young person’s life even though they may not be diagnosable as a mental disorder.

Mental health definitions Mental disorder

Problems that meet ICD-10, an internationally recognised classification system for mental and behavioural disorders. Associated with considerable distress and substantial interference in young person’s daily life

Mental illness

Refers to the most severe types of mental disorder

Prevalence in 2004

10% of 5-16 yr olds were found to have a clinically diagnosed mental disorder. Of these…..

• 6% had a conduct disorder • 4% had an emotional disorder (anxiety or depression) • 2% had a hyperkinetic disorder • 1% had a less common disorder e.g. autism, eating disorders

*ONS (2005)

Prevalences in 11-16 yr olds*

13% of boys had a mental disorder • 10% of girls had a mental disorder • Boys were more likely (8.1%) to have a conduct disorder • Girls were more likely (6.1%) to have an emotional disorder

ONS (2005)

Children in Care

A study in one local authority showed that mental disorders were prevalent in; • • 57% of adolescents in foster care 96% of adolescents (13-17) in residential care (compared with 15% in a comparison group) Of those adolescents with disorders; • • 26% had over-anxious disorders 28% had conduct disorders

McCann

(1996)

Different labels same children

Children at risk; in need; vulnerable Children with emotional and behavioural difficulties; special needs Children with mental illnesses; psychiatric disorders Social Care Education Health

YoungMinds

We are passionate about mental health and believe there are core attributes seen in mentally healthy children and young people: • The capacity to enter into and sustain mutually satisfying personal relationships • A continuing progression of psychological development • An ability to play and to learn appropriately for their age and intellectual level • A developing moral sense of right and wrong • The capacity to cope with a degree of psychological distress • A clear sense of identity and self worth

The mental health spectrum

From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being

Flourishing Moderate mental health Languishing Mental disorder Number of symptoms or risk factors

The effect of shifting the mean of the mental health spectrum

From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being

Flourishing Moderate mental health Languishing Mental disorder Number of symptoms or risk factors

Early intervention… By early we mean any (or all) of the following;

• Early in a child’s life (pre-conception, ante-natal, post natal support and early years services) • Early in the life cycle of the child’s difficulties (as soon as these are detected) • Early in the presentation of the child’s difficulties (very swiftly after the child is first seen for a difficulty at a health or social care service).

Early interventions in mental health might include…

• • • • • • • • • • • • Maternity and post natal depression interventions Parenting support and training Individual and group therapy work Information, advice and guidance services Family support, mediation, relationship support Issue specific support (e.g. bereavement, young carer, domestic violence, substance misuse etc) Youth services – activity based, generic support School based activity such as anti bullying, anger management, nurture groups Social care interventions e.g. children in need, vulnerable CYP in families Targeted support e.g. LAC, YOs, travellers, BME, disability, SEND Education support e.g. Behaviour support, Educational psychology CAMHS eg. Primary mental health work

Why early intervention in CYP’s mental health?

50% adults with lifetime mental health problems experience symptoms before 14 years of age.

75% adults with lifetime mental health problems experience symptoms before their mid 20s.

Less than 50% were treated appropriately at the time.

(Taken from Mental Health Strategy 2011 DH)

Cost benefit ? Investment decisions… Cost of intervention

Levels of evidence for intervention studies (from National Iinstitute of Clinical Excellence) Level of evidence

1++ 1+ 1 – 2++ 2+

Type of evidence

High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias* High-quality systematic reviews of case –control or cohort studies High-quality case relationship is –control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the causal Well-conducted case –control or cohort studies with a low risk of 2 3 – confounding, bias or chance and a moderate probability that the relationship is causal Case –control or cohort studies with a high risk of confounding bias, or chance and a significant risk that the relationship is not causal* Non-analytic studies (for example, case reports, case series) 4 Expert opinion, formal consensus *Studies with a level of evidence ‘–‘ should not be used as a basis for making a recommendation

School based interventions

• Evidence from research literature is that work on emotional and social competence and wellbeing in schools can achieve the following outcomes (Weare & Gray. 2003): – Greater educational and work success – Improvements in behaviour – Increased inclusion – Improved learning – Greater social cohesion – Improvements to mental health – School improvement

Types of mental health work in schools

(from TaMHS national evaluation 2012)

Category Types of work included 1. Social and emotional skills development of pupils 2. Creative and physical activity for pupils 3. Information for pupils

Social and Emotional Aspects of Learning (SEAL) programmes, Nurture groups and Circle time drama, music, art, yoga, outward bound activities advice lines, leaflets, texting services, internet based information

4. Peer support for pupils 5. Behaviour for learning and structural support for pupils 6. Individual therapy for pupils 7. Group therapy for pupils 8. Information for parents

buddy schemes, peer mentoring behaviour support, behaviour management, celebrating success, lunchtime clubs, calm rooms counselling, cognitive and/or behavioural therapy interpersonal group therapy, cognitive and/or behavioural therapy groups leaflets, advice lines, texting services, internet based information

9. Training for parents 10. Counselling/ support for parents

parenting programmes such as Webster Stratton and Triple P programmes individual work for parents, family therapy, family SEAL – can include children and parents or just parents, or a combination

11. Training for staff 12. Supervision and consultation for staff 13. Counselling/ support for staff

specific training from a mental health professional on-going supervision or advice from a mental health professional provision to help staff deal with stress and emotional difficulties

Whole school approaches

Including the following which have been found to be effective; • Social and emotional learning programmes (integrated into all aspects of the curriculum with staff trained to deliver) • Targeted help and support available, including involving specialist services (and parents in primary).

• Staff being able to identify emerging problems. • Provision of a safe environment - nurtures and encourages sense of self-worth and promotes positive behaviour.

• Generic approaches more effective in primary • Anger management/social development type interventions can be effective, particularly targeted to emerging problems • Anti bullying interventions • Parent support advisors (or links between home and school)

Counselling in schools

• School counselling is an example of MH service in school • Effective in improving social behaviour and emotional difficulties • Some evidence in relation to improved concentration and attendance • Most effective in secondary • Quality issues - counsellor training and supervision important • Links to specialist services essential • Less evidence of impact on disadvantaged groups

Cost effective… Increased Access to Psychological Therapies (IAPT)

• Cognitive behavioural therapies and parenting programmes. • Aimed at conduct disorder, and anxiety and depressive disorders.

Early Intervention in Psychosis

• For adolescent and early adulthood.

Multi Systemic Therapy

• For young people who are at risk of out of home placement in either care or custody, due to delinquent and aggressive behaviour, and anti-social attitudes.

• Impact on range of outcomes.

Treatment Foster Care

• Impact on range of outcomes including stability.

GETTING IN TOUCH Website: www.youngminds.org.uk/bond Email: [email protected]

Telephone: 020 7089 5050