What is positive mental health?
How is mental health promoted?
Good practice in schools
Potential causes of mental health problems
What are Risk and Resilience factors and how do they influence each other?
What are the developmental aspects of resilience?
What are typical responses to developments in childhood and adolescence?
Typical childhood development
What are the signs and risk factors of mental health difficulties?
Signs of Mental Health Difficulties
How are mental health difficulties defined?
What are the consequences of mental health difficulties?
Who can intervene and how to promote positive mental health?
What is positive mental health? Children who are mentally healthy have the ability to: • • • • • • •
Develop psychologically, emotionally, socially, intellectually and spiritually; Initiate, develop and sustain mutually satisfying personal relationships; Use and enjoy solitude; Become aware of others and empathise with them; Play and learn; Develop a sense of right and wrong; and Resolve (face) problems and learn from them.
Positive emotions broaden and build cognitive capabilities, pro-social behaviour and coping resources. Studies have shown that people in a positive mood: • • • •
Have a broader focus of attention; Generate more ideas; Are more generous and tolerant of others; and Are more resilient in stressful situations.
How is mental health promoted? Research suggests that as the number of stressful life events accumulates for children or young people more protective factors are needed to act as a counterbalance. Those features that serve to reduce the impact of risk or promote resilience can be within the child, family, or wider community. Being resilient means that, overall; individuals remain stable and maintain healthy levels of psychological and physical functioning in the face of disruption or chaos. At the level of the individual, children who are able to establish a secure attachment to their parents or caregivers in the first year of life are better able to manage stressful events later in life. Also, those children who have effective communication skills, can problem-solve and have the ability to reflect tend to be more resilient. Within the family, an authoritative and supportive parenting style and support for education are important factor in promoting resilience. Alongside this, schools with a positive ethos, high morale and which support pupils’ academic and nonacademic achievement play an important role in promoting resilience.
What is important is that protective processes are put in place for all children and young people.
These may include: • • •
Reducing the likelihood of negative chain reactions arising from risk; Promoting self-esteem and self-efficacy through the availability of secure and supportive personal relationships, or success in achieving tasks; and Opening up new and positive opportunities and offering turning points, where a risk path may be rerouted.
Good practice in schools The importance of work in schools that is positively aimed at promoting the mental health of all children, rather than an approach which is solely focused on work with those children already displaying difficulties, has been shown to have very real pay-offs for those children who are most at risk of developing problems. Much of the work around emotional wellbeing in Britain focused on: empathy, self-awareness, managing feelings, motivation and social skills (Goleman1995). Research indicates that explicit social and emotional learning not only enhances children’s mental health, but also improves their academic achievement scores and school performance. In addition, the following key characteristics within schools promote students mental health:
A committed senior management team, creating a culture within the school in which the importance of trust, integrity, democracy, equality of opportunity and each child being valued regardless of their ability is seen as being vital;
A culture within the school which values teachers, lunchtime supervisors and all those engaged in the care and supervision of children;
Clear policies regarding such vital issues as behaviour and bullying
‘Whole school behaviour’ policies which set out what and what is not acceptable; and the range of sanctions that will result and the acceptance and implementation of the policies throughout the school;
High professional standards (efficient planning, setting, marking, punctuality)
Skilful teaching which arouses pupil interest and motivates; and
Proactive work with parents. In particular attention needs to focus on micro-level processes (e.g. interaction between parent and child)
Potential causes of mental health problems: What are the causes of mental health problems in young people and how can their well being be enhanced? Evidence has shown that it is possible to identify the factors that have an impact on children’s mental health. Certain individuals and groups are more at risk of developing mental health problems than others and these risks are located in a number of areas – risks specific to the child, to their family, their environment and life events. •
Loss or separation – resulting from: o death o parental separation o divorce o hospitalisation o loss of friendships especially in adolescence, o family breakdowns that results in the child having to live elsewhere
Life changes e.g. birth of a sibling, moving house, changing schools and;
Traumatic events – such as: o Abuse o Violence o Accidents o Injuries o War/children from service families or; o natural disaster
What are Risk and Resilience factors and how do they influence each other? Risk Factors: Risk refers to a childâ€™s vulnerabilities. These vulnerabilities may be counterbalanced by their assets or resilience
Risk refers to a childâ€™s vulnerabilities. These vulnerabilities may be counterbalanced by their assets or resilience
Risk factors increase the probability of a child developing a mental health problem. Risk factors are cumulative. If the child has only one risk factor in their life, their probability of developing a mental health has been defined as 1-2%.
However with three risk factors the likelihood increases to around 8%; and with four or more factors in their life this increases to 20%. This set of qualities fosters a process of successful adaptation and transformation despite risk and adversity.
Resilience is… ‘The capacity to manage, process and come through setbacks and to continue to develop despite them’.
‘Resilience seems to involve 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; and thirdly, a repertoire of social problem solving approaches’.
In the table below are the known child, family and community factors which give rise to vulnerability. The positive characteristics and external factors which bolster the child are also listed.
Risk factors in the child Learning difficulties Communication difficulties Specific developmental delay Genetic factors Temperamental difficulties Physical illness Academic failure Low self-esteem Social difficulties Risk factors in the family Overt parent conflict Family breakdown Inconsistent/unclear discipline Hostile/rejecting relationships Failure to adapt to childâ€™s changing needs Physical, sexual emotional abuse Parental psychiatric illness
Resilience factors in the child Secure early relationships Being female Social competence Outgoing temperament Problem solving skills Experience of success and achievement Opportunities for participation
Resilience factors in the family At least one good relationship Affection Clear, firm, consistent discipline Support for education Supportive long term relationship Absence of discord Community network support for vulnerable parents
Parental/sibling criminality Alcoholism personality disorder Death and loss, including friendship Risk factors in the Community Socio-economic disadvantage Homelessness Disaster discrimination
Resilience factors in the Community Wider supportive network Good housing High standard of living High morale school with positive policies for behaviour, attitudes and anti-bullying Range of positive sport/leisure activities Rewards
What are the developmental aspects of resilience? Resilience in infancy • Resilient infants tends to have predictable temperamental characteristics which elicit positive responses from other people • Active, affectionate, cuddly, good natured, responsive, easy to deal with and have a capacity for self -expression • Have experienced a secure attachment and learned to trust in availability • Have a supportive family member • Have a pronounced sense of autonomy and social orientation • Are described as alert, cheerful, responsive, self- confident and independent • Are advanced in communication, mobility and self-help skills • Are more advanced in social play than vulnerable toddlers • Have developed a coping pattern that combines autonomy with an ability to ask for support when needed Resilience in middle childhood • Well-liked by peers and adults • Reflective rather impulsive in thinking style • Feel they can influence their environments positively • Are able to use flexible coping strategies, including humour • Are adept at recruiting surrogate parents, even if not blood relatives • Resilient boys emotionally expressive, socially perceptive and nurturant • Resilient girls are autonomous and independent • Resilient children display flexible coping strategies which promote mastery over • adversity rather than reactions in a rigidly sex stereotyped manner • Overall girls are generally more resilient to stress and trauma than boys Resilience in adolescence • Can select what they need from their environment and make good use of it • Change or restructure a situation • Are optimistic and helpful
What are typical responses to developments in childhood and adolescence? Stage 1 - 0 to 18 months: Children are required to develop the ability to trust without eliminating the capacity to mistrust. Thus children are learning that the social world is a safe place in developing an understanding of their own bodies and biological urges. Stage 2 - 18 months to 4 years: Children are learning to develop independence and the confidence to explore their environment. Parents may notice children who appear self-willed and prone to tantrums and stubbornness. This stage is often labelled “the terrible twos” when children are often heard to defiantly shout “no!”. Stage 3 - 4 years to 6 years: At this stage, children aim to further develop a fantasy world and curiosity, imagination and courage. This is the “play age” when children use all forms of play to discover their world. They are beginning to engage in sharing and turntaking. Stage 4 - 6 years to 12 years: At this stage, children aim to positively respond to a school experience, to tone their imagination and begin to embrace rules. They begin to develop attention skills and further develop the prerequisite skills which are necessary to enable them to make and maintain friendships, thus moving away from egocentricity. They are learning to share humour with others and enjoy being successful across a number of spheres, both academic and social. They are beginning to engender the idea that success is often governed by “how hard you try, rather than who you are”. Children are said to develop a sense of industry at this stage, i.e. a desire to work hard which is tinged with an element of humility, thus enabling them to develop competency. Stage 5 – Adolescence: Adolescent young people are aiming to develop an identity i.e. to know who they are and where they fit into society. It is supposed to be a transitory period (between the powerless, irresponsible time of childhood … to the powerful and responsible time of adulthood). A key task for young people at this age is to avoid role confusion which may lead to an identify crisis or an involvement in destructive behaviours. During this time, following an inevitable period of experimentation, adolescents are said to develop a set of ideals which are socially congruent.
Typical childhood development The following relates to pupils who may be seen as responding typically to developments in childhood. Preschool pupils • Active, busy, interested in exploring their environment. • They have a predictable temperament and are able to engage in interactions which elicit a positive response from other people. • They are able to use language, pointing and gesturing to express their needs. • They are alert and cheerful, are confident and strive for independence but are willing to ask for help when needed. • They are able to engage in social play activities • They are developing problem-solving skills which they aim to put to good use. Middle childhood • Have further developed a sustained ability to make and maintain friendships with peers. • Are able to interact with adults. • They feel they can positively influence their environment. • Their thinking style is reflective rather than impulsive. They are aware of the consequences of their actions. • They are able to use humour and a number of coping strategies to deal with adversity and unpredictable events. • They are able to express their emotions. Adolescence • Adolescents are developing the ability to be responsible and show a sense of social maturity. They are becoming achievement orientated. • Have internalised a positive set of values. • Have a more positive self-concept. • Have a belief in their ability to control their own fate. • Have a sense of self-efficacy and confidence. • Are able to select what they need from their environment and make good use of it. • They are optimistic and hopeful.
What are the signs and risk factors of mental health difficulties? Early intervention is key to the prevention of future mental health difficulties. School staff and professionals working with children may notice that they demonstrate inappropriate behaviour and seek to isolate themselves in response to acute problems in their home life or school. Behavioural difficulties which seem entrenched may be indicative of a more severe mental health problem. It is not unusual in schools for pupils to present with mental health problems which may need to be addressed by school staff or ultimately by professionals outside the realm of the school. The importance of school staff working at Tier 1 has been recognised by the Government; thus school staffs, along with a number of other professionals, are seen as promoting and addressing mental health problems of pupils in schools. It may not be advisable that school staff try to work exclusively with pupils who present with serious or long-standing mental health problems; however, there is a role for school staff in the following areas: •
To engage in early intervention and preventative work which lessens the likelihood a pupil developing serious mental health problems.
To ensure that pupils and their families are given early advice and help when pupils show early signs of mental health problems. To work as part of a multi-agency team to support pupils in their efforts to attend school and manage their difficulties.
To enable pupils to reach their optimum potential and improve their attainments.
Signs of Mental Health Difficulties Type of Difficulty Emotional effective
Conduct Hyper-kinetic Developmental
Autism Eating Self-care Post Traumatic Stress Disorder (PTSD)
Somatic difficulties Psychotic difficulties
Examples in the education setting Phobias, anxiety states, depression, regular worry, repeated refusal to attend school and/or to participate in normal childrenâ€™s activities. Persistent nightmares. Significant increase in time spent along. Self-harm and high risk behaviours. Obsessive, compulsive disorders Stealing, defiance, fire setting, aggression and anti-social behaviour Disturbance of activity and attention and extreme fidgeting Delay in acquiring certain skills e.g. speech. Difficulties in processing information as well as relaying their thoughts and ideas. Trouble being understood or understanding others Such disorders may be indicative of a compromised central nervous system Extreme eating fads. Obesity, anorexia nervosa or bulimia nervosa Soiling and wetting Children who experience a physical or emotional trauma e.g. witnessing a disaster or surviving abuse, being in a fatal or tragic car accident, or surviving a violent physical attack may experience PTSD Chronic fatigue syndrome and physical manifestations of psychological problems Schizophrenia, manic depression, druginduced psychosis, recurring thoughts of death and suicide or self-destructive behaviour. An inability to cope with daily problems and activities. Dissociated Identify Disorders (DID) which could be due to sexual or physical abuse. Cutting, overdosing, hearing voices and extreme withdrawal
How are mental health difficulties defined? Children who experience emotional and behavioural problems that are outside of the normal range for their age or gender could be described as experiencing mental health problems or disorders. While, generally, mental health disorders are considered to be more severe and/or persistent than mental health problems, the terms are not precise. From a health service perspective, difficulties may be grouped, as follows: • • • • • • • • • •
Emotional disorders, e.g. phobias, anxiety states and depression that may be manifested in physical symptoms; Conduct disorders, e.g. stealing, defiance, fire-setting, aggression and anti-social behaviour; Hyperkinetic disorders e.g. disturbance of activity and attention; Developmental disorders, e.g. autism; Attachment disorders; Eating disorders; Habit disorders e.g. tics, sleeping problems, soiling; Post-traumatic stress syndromes; Somatic disorders e.g. chronic fatigue syndrome; and Psychotic disorders e.g. schizophrenia and manic depressive disorder.
What are the consequences of mental health difficulties? Mental health problems can interfere with daily living and might result in one or more of the following: • • • • • • • • • •
Refusal to go to school; Difficulty concentrating; Physical symptoms e.g. stomach-aches and headaches; Change in appetite or weight; Loss of energy; Alcohol or substance abuse; Talk about or efforts to run away from home; Recurrent thoughts of death or suicide; Reckless behaviour; Social isolation.
In the longer term, mental health difficulties can be a significant barrier to social mobility.
Who can intervene and how to promote positive mental health? There are a number of different levels of involvement, some of which use internal resources within the school setting and some resources from outside the setting. Section 1: Local Agencies The Educational Psychologist for each school has an allocation for whole school support. The school link EP can advise on young people’s social, emotional, behavioural and mental wellbeing in a variety of ways ranging from: • •
• • • •
Assessment of difficulties to inform appropriate interventions to promote pupil mental health and well being Work with individuals and/or groups (along with school staff) to enhance children’s mental health and well being as well as develop social skills and behaviour management Consultative/coaching work to enable school staff to enhance children’s mental health and well being Whole school work at policy and training level to meet the mental health and wellbeing of children Work to help staff groups and individuals maintain their own mental health and well being Evaluation and analysis of strategies being developed and piloted by the school.
School Nurse Service: See school for contact details. CAMHS Outreach: This team of Mental Health Professionals and Children’s Services offers a service to children/young people and families aged 5 –17 years. Education Welfare Officers/Service: The EWS has a statutory role regarding school attendance and all work is in relation to referrals of children not attending school. Healthy Schools Programme: This programme promotes physical and mental health. Contact Jane Stevens at Teaching and Learning Centre, Ellen Road, Aylesbury. Tel: 01296 334994 Bucks Children Information Service: Parenting in Buckinghamshire offers courses and support groups to encourage children, cope with difficult behaviour, manage problems, develop responsibility, discipline and set boundaries. www.buckscc.gov.uk/parenting
Section 2: Specific Strategies in Schools It should not be underestimated how normal, everyday good practice in schools by school staff can develop resilience. Think of the internal resources and external resources that are available. Use the internal resources, abilities, skills and qualities that a child brings: • • • • • •
A positive relationship with a teacher or learning support worker which recognises the child’s significance Opportunities for positive school experiences: academic, sporting or friendship related. In school staff support forum In school student support forum Local teaching staff networks Networking with external and local agencies extends the range of intervention strategies and possibilities available
Section 3: Specific School Based Programmes FRIENDS FRIENDS is a universal prevention and early intervention programme to use in schools, that originates in Australia, where it has been positively evaluated. It aims to build emotional resilience in order to prevent common mental health problems such as anxiety and depression in children, by teaching them how to cope and manage anxiety. The programme offers 10 structured sessions plus two booster sessions and is based on Cognitive Behaviour Therapy. The programme promotes self-esteem, problem solving, psychological resilience, self expression and building positive relationships with peers and adults. Protective Behaviours This is a process based approach first conceived in the USA to act as an abuse prevention programme. Its main focus is preservation and protection of physical, emotional and sexual health and the prevention of crime.
Section 4: National Sources of Advice on Offering Support to Children and their families Bullying/child safety issues: Kidscape, 0207 730 3300 www.kidscape.org.uk Free helpline 0800 1111 To keep children safe from bullying and prevent abuse
Bullying UK Anti bullying campaign www.bullying.co.uk A chance to gain information on a variety of bullying issues NCPCC Helpline 0808 800 5000 www.nspcc.org.uk To protect children from cruelty, support vulnerable families, campaign for changes to the law Child Mental Health: Young Minds, 0800 018 2138 www.youngminds.org.uk A website offers advice on mental health and emotional well being. Promotes child and adolescent mental health and health services Parenting Issues: Relate, 0300 100 1234 www.relate.org.uk Education supporting couple and family relationships Relate offers a wide range of services for couples, families and individuals Parentline Plus, 0808 800 2222 For parenting help and support www.parentlineplus.org.uk A national charity that works for and with parents, based on the concept that parents want to do the best they can for their children Advice and counselling for young people: Youth Access, 0208 8772 9900 www.youthaccess.org.uk National organisation for young peopleâ€™s information, advice, counselling and support services Confidential service for children: ChildLine, 0800 11 11 www.ChildLine.org.uk Free and confidential 24 hour helpline for children and young people in the UK to talk about any problem
The Samaritans, 08457 909090 www.samaritans.org Emotional support for anyone in a crisis. Provides confidential emotional support 7 days a week to those experiencing despair Separation and divorce National Family Mediation, 01392 271610 www.nfm.org.uk Offering help to couples, married or unmarried who are in the process of separation and divorce Bereavement: Child Death Helpline, 0800 282 986 www.childdeathhelpline.org.uk A free phone service for anyone affected by the death of a child Cruse Bereavement Care, 0181 940 4818 www.crusebereavementcare.org.uk National charity offers free, confidential help to bereaved people Children caring for family members: Young Carers www.youngcarers.net Barnardo’s - Online service for young carers www.barnardos.org.uk Barnardo’s children’s charity works with young carers, as well as counselling, fostering and adoption Drugs: UK National Drugs Helpline 0800 77 6600 www.urban75.com/Drugs/helpline.html A 24 hour, 7 days a week free and confidential telephone service helpline that offers advice and information for those who are concerned or have questions about drugs
Social Emotional Behaviour DA (SEBDA) Tel. 0161 240 2418 www.sebda.org Promotes excellence in services for children and young people who have social, emotional and behavioural difficulties Social and Emotional Aspects of Learning www.bandapilot.org.uk A government initiative for primary and secondary schools to deliver a whole school approach to promoting social and emotional skills that aims, when fully implemented, to involve all members of the school and all aspects of school life Roots of Empathy www.rootsofempathy.org Evidence based classroom to reduce levels of aggression and violence amongst children and raise social competence Enuresis Resource and Information Centre (ERIC) www.eric.org.uk For children and teenagers with wetting and soiling problems Educational Psychology Service County Hall Walton Street Aylesbury Buckinghamshire HP20 1UZ Tel. 01296 383219 Email: email@example.com Royal College of Psychiatrists www.rcpsych.ac.uk UK Psychiatrists promote mental health and information on mental health problems Attention Deficit Hyperactivity Disorder www.adhdmatters.co.uk www.adhdcarepathway.co.uk www.add.org For parents and/or carers ADHD Organisation ADD/AD/HD Family Support Group UK - 1a High Street, Dilton Marsh, Westbury, BA1 34D