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…..
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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;
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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;
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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
Mental disorder
Languishing
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, postnatal 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…
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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)
Impact
Cost benefit? Investment decisions…
Cost of intervention
Levels of evidence for intervention studies (from National
Iinstitute of Clinical Excellence)
Level of evidence
Type of evidence
1++
High-quality meta-analyses, systematic reviews of RCTs, or RCTs with
a very low risk of bias
1+
Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs
with a low risk of bias
1–
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 of
confounding, bias or chance and a moderate probability that the
relationship is causal
2–
Case–control or cohort studies with a high risk of confounding bias, or
chance 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 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
4. Peer support for pupils
5. Behaviour for learning and
structural support for pupils
6. Individual therapy for pupils
7. Group therapy for pupils
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
8. Information for parents
9. Training for parents
10. Counselling/ support for parents
advice lines, leaflets, texting services, internet based information
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
specific training from a mental health professional
12. Supervision and consultation for on-going supervision or advice from a mental health professional
staff
13. Counselling/ support for staff
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: bond@youngminds.org.uk
Telephone: 020 7089 5050