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

Mental well-beingThe positive capacities and qualities that enable young people to deal with the ups and downs of life.

Mental health problemsBroad 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 disorderProblems 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 illnessRefers to the most severe types of mental disorder

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)

• 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)

• 13% of boys had a mental disorder

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)

Children at risk;in need; Social Carevulnerable

Children with emotional         and behavioural difficulties; Educationspecial needs

Children with mental illnesses; psychiatric disorders Health

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

FlourishingModerate

mental health

LanguishingMental

disorder

From: Huppert Ch.12 in Huppert et al.

(Eds) The Science of Well-being

Number of symptoms or risk factors

Flourishing Moderate mental health Languishing

Mental disorder

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

Number of symptoms or risk factors

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).

• 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

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 of intervention

Impa

ct

Level of evidence Type of evidence1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs

with a very low risk of bias1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with

a low risk of bias1– Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of

bias*2++ High-quality systematic reviews of case–control or cohort studies

High-quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal

2+ Well-conducted case–control or cohort studies with a low risk ofconfounding, bias or chance and a moderate probability that therelationship is causal

2– Case–control or cohort studies with a high risk of confounding bias, orchance and a significant risk that the relationship is not causal*

3 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 arecommendation

• 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

Category  

Types of work included

1. Social and emotional skills development of pupils

Social and Emotional Aspects of Learning (SEAL) programmes, Nurture groups and Circle time

2. Creative and physical activity for pupils

drama, music, art, yoga, outward bound activities  

3. Information for pupils advice lines, leaflets, texting services, internet based information

4. Peer support for pupils buddy schemes, peer mentoring 5. Behaviour for learning and structural support for pupils

behaviour support, behaviour management, celebrating success, lunchtime clubs, calm rooms

6. Individual therapy for pupils counselling, cognitive and/or behavioural therapy7. Group therapy for pupils interpersonal group therapy, cognitive and/or behavioural therapy

groups 8. Information for parents leaflets, advice lines, texting services, internet based information

9. Training for parents parenting programmes such as Webster Stratton and Triple P programmes

10. Counselling/ support for parents  

individual work for parents, family therapy, family SEAL – can include children and parents or just parents, or a combination

11. Training for staff specific training from a mental health professional 12. Supervision and consultation for staff

on-going supervision or advice from a mental health professional

13. Counselling/ support for staff provision to help staff deal with stress and emotional difficulties

Types of mental health work in schools (from TaMHS national evaluation 2012)

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)

• 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

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 TOUCHWebsite: www.youngminds.org.uk/bondEmail: bond@youngminds.org.ukTelephone: 020 7089 5050