Public Mental Health for Youth
Dr Paul Patterson - Public Health Lead
Youthspace BSMHFT
Schoolspace
Chisholm, Patterson, Turner, Torgerson, Birchwood (2012)
Supported by NIHR CLAHRC-Birmingham & Black Country
Youth Mental Health – Why is it so important?
Why we should be concerned about the
Mental Health Needs of Young People..

Over half of all adults with mental health problems
will have begun to develop them by the time they are
14

Approximately 10% of all children and adolescents
6-16 years have a diagnosable MH disorder

60 – 70% of these young people have not been
offered or received any evidence based intervention

Earlier intervention increases the chances of
preventing long-term negative outcomes

Current lack of coordinated approach to engaging
with YP at earliest stage (e.g. Schools,internet,media)
Youth Mental Health – a real opportunity for Prevention
“Roughly half of all lifetime mental disorders in most studies start
by the mid-teens and three quarters by the mid-20s. Later onsets
are mostly secondary conditions. Severe disorders are typically
preceded by less severe disorders that are seldom brought to
clinical attention” Kessler et al, Current Opinion Psychiatry, 2007
Early
Intervention in
Psychosis (1996
onwards)
Evolution of a
Youth Model of
Mental Health
• 16 – 35 years
who have
recently
developed a
psychotic illness
Earlier Detection
& Intervention
for YP at risk of
Psychosis (2002
onwards)
• 16-35 years
showing early
‘at-risk’ signs of
developing a
psychotic illness
Early Detection /
Intervention for
YP with MH
problems (2011
onwards)
• 16-25 years
showing
distress
related to MH
problems
Youth Mental Health – a real opportunity for Prevention

Over half of all adults with mental health problems
will have begun to develop them by the time they are
14

Approximately 10% of all children and adolescents
6-16 years have a diagnosable MH disorder

60 – 70% of these young people have not been
offered or received any evidence based intervention

Earlier intervention increases the chances of
preventing long-term negative outcomes

Current lack of coordinated approach to engaging
with YP at earliest stage (e.g. Schools,internet,media)
Youthspace – the BSMHFT response
Integrating research, clinical practice, user involvement & public mental
health into a responsive preventative (phased) strategy for 16-25 yrs

Examine evidence base & plan research & dissemination strategy –
‘CLAHRC NIHR Funding’

Integrate Public & Patient Involvement from planning stage –
‘Youth Board’

Create partnerships to widen ‘net’ and ‘no wrong door’ approach –
‘Fairbridge / Princes Trust Partnership’

Develop Public MH strategy for new service –
‘Youthspace.Media Education & Training’

Develop appropriate specialist service for YP –
Youthspace clinical service:
Birmingham Youthspace / CLAHRC Programme
-- Youthspace.me
Website
- Educational Films
- Posters/campaigns
- Interactive mapping
Youth Board
PPI
-
Youth Clinical
Service
Partnerships:
Fairbridge
Princes Trust
Youthspace
media
- ‘Schoolspace’ Project
- Vulnerable Youth
Project
- Awareness campaigns
- Service Redesign
- Partnership
development
- Youth Clinical Team
- Training Programmes
CLAHRC
evaluation
implementation
strategy
- Assess delay ‘hotspots’
- Universal & Targeted
Intervention Design
- Analysis & Dissemination
of outcomes
Youth Mental Health – the Policy context..
A Children’s Environment and Health Strategy for the
United Kingdom: HPA 2009
“A number of workshops have been organised with young people
from across the UK. The groups were asked to identify which
health issues they considered most important..
..Mental health was the highest priority as young
people considered this to be key for good health in all other areas.
Two issues that were consistently highlighted during the youth
participation exercises were the lack of information and
education on health and the environment, and the barriers
caused by current attitudes/peer pressure…”
The Childrens Plan DCSF 2007
The role of schools
• ‘Schools play a vital role in promoting physical and mental
health, and emotional wellbeing, underpinned now by a duty
to promote the wellbeing of pupils in the Education and
Inspections Act 2006…better techniques for early
identification and assessment of additional need, and more
effective joined-up working to support swift and easy referral
to specialist services…’
One Year On: the first report from the National Advisory Council
for Children’s Mental Health and Psychological Wellbeing 2010
‘..While the opportunities for early intervention
through the TaMHS initiative are highly valued
by the field, during our visits people expressed
concern that this will not be sustainable when
central funding ends, placing more pressure on
specialist services..’
Healthy Lives, Brighter Futures
DoH 2008
Standard 9: The Mental Health and Psychological
Wellbeing of Children and Young People
‘All children and young people, from birth to their
eighteenth birthday, who have mental health
problems and disorders have access to timely,
integrated, high quality multidisciplinary mental
health services to ensure effective assessment,
treatment and support, for them and their families..’
Marmot Review 2010
‘The importance of investing in the early years is
key to preventing ill health later in life, as is investing
in healthy schools and healthy employment as well
as more traditional forms of ill-health prevention
such as drug treatment and smoking cessation
programmes.
The accumulation of experiences a child
receives shapes the outcomes and choices they will
make when they become adults.’
Marmot Review 2010 – Fair Society Healthy Lives p.33
Youth Mental Health Education in Schools –
Why is this so important?
Why It’s Important for Students:
• UK comes bottom of the rank for children’s well-being in a recent
UNICEF study in comparison with North America & 18 European
Countries; (UNICEF 2007)
• It’s a common problem: At any one time - one in ten children and
young people have a diagnosable mental health problem, the
majority of which are either emotional disorders, (depression or
anxiety), or conduct disorders.
• It affects educational achievement: poor mental health is
associated with low educational performance and absenteeism;
additionally, conduct and hyperkinetic disorders disrupt the
educational environment for other children
Birmingham Early Detection & Intervention Team
Why It’s Important for Students:
• poor mental health is often the underlying factor behind risk
behaviours (including substance abuse, risky sexual activity) and health
outcomes, (including teenage pregnancy, eating disorders, injuries,
bullying and violent behaviour).
• Poor mental health can be a symptom of a child at risk: children and
young people frequently express their emotional distress in the form of
mental disorders and behaviours such as self-harm
• Half of all adult MH problems have started before the age of 14 - Not
addressing poor mental health in childhood results in ongoing problems
including self-harm and increased suicide; low educational and
employment achievement; increased violent and offending behaviour.
Birmingham Early Detection & Intervention Team
Birmingham Early Detection & Intervention Team
Schoolspace – bringing MH education into
schools…
Early intervention in schools

Growing pressure for schools to address not only traditional academic
learning, but also the emotional well-being needs of their pupils (Department of
Health, 2004; Sainsbury Centre for Mental Health, 2006; Office of the Deputy Prime Minister, 2004; The Children and
Adolescents’ Mental Health Coalition, 2010; Her Majesty’s Government, 2004; The Office for National Statistics, 2008)

Previous research findings

Systematic reviews by; Wells et al., 2003; Spence and Shortt, 2007;
Schachter et al (2008)

Inconsistency of findings, reporting standards, and methodologies have
led many systematic reviews to argue that the evidence for these types of
interventions is inconclusive and that further research is needed

Previous research also indicates that even if positive results are found we
still need to address ways to produce larger effect sizes, particularly in
view of convincing commissioners that this type of work within schools is
justified.
Aims






To develop and evaluate a universal educational intervention for
secondary school aged pupils aimed at improving mental health literacy,
stigma of mental illness, and resilience/emotional well-being (year 8, age
12-13)
Stage one: Development of educational intervention for pupils
Identify and develop content for an educational intervention though
searching previous systematic reviews, conducting new systematic
reviews, conducting group interviews, and piloting intervention within one
school
Stage two: Evaluation of a randomised controlled trial
Evaluate feasibility intervention trial in 9 schools. Pre and post tests and 6
month follow up.
In particular the research aims to address the ‘contact hypothesis’ which
has been used previously in stigma research (Pinfold et al., 2005; Schulze et al., 2003).
Stage one: Development of educational
intervention for pupils

Group interviews:

What does mental health mean to you?

Do you think mental health is relevant to someone from your age group?

If you were to be taught about mental health in school what would you
want to be taught?

If you were worried about a friend, and thought they might have a mental
health problem, what would you do?

What sort of difficult feelings or problems do people your age face?

Pilot:

Within one school

Practicalities- is the intervention pitched at the right age level? do the
timings work? what elements work best? what elements work worst?
The contact hypothesis
Three ways to tackle stigma (Thornicroft):
- Protest, Education, Contact


Contact + Education likely to have greater impact
on knowledge, attitudes, behaviour (Woolfson et al.,2008; Pinfold et
al., 2005)



lesson is less abstract
increased impact of message
drop in stigma leads to better attitudes towards
help-seeking (Schomerus et al., 2009)
Outcome measures
Primary:
 Reported & Intended Behaviour Scale RIBS (Evans-Lacko, Rose, Little,
Rhydderch, Henderson, and Thornicroft, 2009)
 Mental Health Knowledge Scale MAKS (Evans-Lacko, Little, Meltzer, Rose,
Rhydderch, Henderson and Thornicroft, 2010)
 The Resilience Scale (Neill & Dias, 2001)
Secondary:
 Help-seeking (see; Sheffield et al. 2004; Carlton and Deane, 2000)
 The Strengths and Difficulties Scale (Goodman, Meltzer, and Bailey, 1998)
 General Well-Being Index (Heubeck and Neill, 2000)
 The Schizotypal Personality-Brief Form (Fonseca-Pedrero, Paíno-Piñeiro,
Lemos-Giráldez, Villazón-García, and Muñiz J, 2009; Raine and Benishay, 1995;
Raine, 1991)
 General measure of academic functioning over previous 3 months
Evaluation of feasibility trial







Redesign intervention using feedback from pilot
Quantitative evaluation:
Randomisation: pupils will be randomly allocated to one of the experimental conditions
(education and contact or education only) at the level of school.
Pre and post tests: pre-test will occur before randomisation. Post test 1-2 weeks after the
intervention. There will be a further follow up after 6 months.
Hypotheses:
1.
Participation in the contact and education condition will significantly reduce participants’
prejudice of mental illness in comparison to participants in the education only condition
2.
Participation in the contact and education condition will significantly improve participants’
mental health literacy in comparison to participants in the education only condition
3.
Participation in the contact and education condition will significantly improve participants’
resilience to mental illness in comparison to participants in the education only condition
Qualitative Feedback
Group interviews
Outcomes

Potential Benefits:

Behaviours associated with conduct disorder are reduced,
and pro-social behaviour increased (Naylor et al. 2009)

Improved school achievement, family engagement, school
outcomes, and decreased disciplinary referrals, and
emotional and behavioural problems (Burns et al., 2004; Scott et al., 2001;
Stormshak et al., 2005)

Potential for increased impact of study over others:

Contact hypothesis (Pinfold et al., 2005; Schulze et al., 2003; Woolfson et al.,2008)
Is anyone ‘normal’?

Maybe it is the differences between us
and not the ‘normal’ things about us
(both good and bad) which make us
interesting.
Would being completely ‘normal’ be a
good thing or a bad thing?
Anyone feeling anxious..?
‘Listen’ – a Film about Depression in Young People
by BSMHFT Service Users (on Youthspace.me)
Youthspace.me
Stage two: Feasibility trial
Some feedback from pupils:
 100% of pupils rated day as good or excellent
 ‘The best topic day we’ve ever had’
 ‘I don’t feel so bad that sometimes I’m bullied’
 ‘fun and interesting’
 ‘I’ve learnt a lot’
 ‘I learned that I can talk about things if I need to’
 “I know what to do to get help now”
 “I’ve learnt some words like schizophrenia”
 “It’s good to think positively”
Youth Mental Health – what we need to be doing..
 Recognise that Youth Mental Health is a priority for all of us
 Joining in Partnerships to
- challenge stigma
- improve MH ‘literacy’
- support local MH initiatives in schools and other youth settings;
- Improve our own and others MH by adopting healthy ways of
reducing stress
- assist early help-seeking for those in emotional distress
 Ask young people ‘how we can best help’ – and listen to what
they say..
 Use the ‘Youthspace.me’ website!
Remember...
‘No health without mental
health..’
WWW.YOUTHSPACE.ME
WWW.YOUTHSPACE.ME
Paul.Patterson@bsmhft.nhs.uk
Birmingham Early Detection & Intervention Team