Introduction to Children and Young Peoples Mental Health

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• Introduction to Children and Young Peoples
  Mental Health
• National Inter-Agency Training Resource
• Day One

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Meanings

• In small groups discuss what is emotional health
  and well-being/mental health?
• Record your discussion on flipchart paper

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Framework for Promotion, Prevention and Care
(FPPC)

• a state of well being in which the individual
  realises his or her own abilities, can cope with
  the normal stresses of life, can work
  productively and fruitfully, and is able to make
  a contribution to his or her community

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Scottish Needs Assessment Report (SNAP)

• Mental health is both personal and socialit is
  the capacity of each and all of us to feel, think
  and act in ways that enhance our ability to enjoy
  life and deal with the challenges we face. It is
  a positive sense of emotional and spiritual
  well-being that respects the importance of
  culture, equity, social justice, interconnections
  and personal dignity

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NHS Health Advisory Service

• A capacity to enter into, and sustain, mutually
  satisfying and sustaining personal relationships
• Continuing progression of psychological
  development
• An ability to play and to learn so that
  attainments are appropriate for age and
  intellectual level
• A developing moral sense of right and wrong
• A degree of psychological distress and
  maladaptive behaviour within normal limits for
  the childs age and context

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Key message

• Local agencies and practitioners need to
• engage in discussion about their differences,
  with a view to developing shared accounts of the
  young persons needs.

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7 Outcomes

• Safe
• Nurtured
• Healthy
• Achieving
• Active
• Respected Responsible
• Included

• Scottish ministers expect children and young
  people in Scotland to be valued by ensuring that
  they are

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FPPC Principles

• Promotion by all who come into contact with
  children and young people
• Needs led
• Rights of the child as a core value
• Mainstreamed in childrens services
• Coherent combination of promotion, prevention,
  intervention and care
• Intelligent Networks

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FPPC Contexts

• Early Years - universal
• School Years - universal
• Community Based Activity
• Additional and Specific Supports
• Specialist CAMHS

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Child Development

• For each stage describe childrens
  characteristics and tasks.
• The stages are 0-2, 3-6, 7-12, 13-18, adult
• Write a strap line to sum up the stage.

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Early Brain Development

• We are born with most of the neurons we will
  ever own (around 200 billion)
• At birth the brain is 25 of its adult weight -
  by the age of 2 this has increased to 75 and by
  age 3 it is 90 of adult weight.
• This growth is largely the result of the
  formation and hard wiring of synaptic
  connections
• Babies brains are both experience expectant
  and experience dependent

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Importance of positive brain development

• The way the child is stimulated shapes the
  brains neurobiological structure. What happens
  in the early years has a direct impact on the
  childs capacity for living, learning and
  relating as a social being.

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The Learning Years 5-10

• Synaptic pathways that are regularly used are
  reinforced. This is the basis of learning.
  Reinforcement leads to permanent neurological
  pathways.
• Neural connections needed for abstract reasoning
  are developed
• Motor skills are refined

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Adolescent Brain Development

• Brain development continues up to at least the
  age of 20
• There is a significant remodelling of the brain
  in adolescence, particularly the frontal lobes
  and connections between these and the limbic
  system
• The frequency and intensity of experiences shapes
  this remodelling as the brain adapts to the
  environment in which it is functioning and
  becomes more efficient

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Emotional Functioning in Adolescence

• There is a mismatch between emotional and
  cognitive regulatory modes in adolescence
• Brain structures mediating emotional experiences
  change rapidly at the onset of puberty
• Maturation of the frontal brain structures
  underpinning cognitive control lag behind by
  several years
• Adolescents are left with powerful emotional
  responses to social stimuli that they cannot
  easily regulate, contextualise, create plans
  about or inhibit

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Adolescent Psychological Development

• The developing adolescent brain regions affect
  the ability to make the distinction between first
  person and third person perspective
• Perspective-taking capacity dip during puberty
• Adolescents are significantly poorer at
  responding to third-person scenarios compared to
  first-person scenarios

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Attachment Theory

• Attachment behaviour is defined as -
• The seeking of protection when anxious,which
  is triggered by external threats or behaviours.
• The person to whom a child is attached provides a
  secure base, a place of safety, warmth and
  comfort.

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Attachment Theory

• A securely attached child feels confident that
  should they feel anxious, their parents will
  respond. Such security is brought on by
  interactions which are
• Sensitive
• Regularly available and reliable
• Warm
• Responsive
• Consistent

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Attachment Styles

• Secure attachment
• Insecure avoidant attachment
• Insecure ambivalent/anxious attachment
• Disorganised attachment

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In Essence

• Attachment needs are activated during times of
  perceived stress (discomfort, environmental,
  danger, fatigue, illness)
• The child must either have these attachment needs
  met or find other ways to cope.

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Resilience

• Normal development under difficult circumstances
• Bouncebackability (Ian Dowie)
• Innate human capacity to cope with adversity

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Three types of resilient child

• Children who do not succumb to adversity in spite
  of their high risk status
• Children who develop coping strategies in
  situations of chronic stress
• Children who have suffered extreme trauma and who
  recover and prosper
• Masten, A et al (1990) Resilience and
  development contributions from the study of
  children who overcame adversity. Development and
  Psychopathology, 2 425-44

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Resilience

• In the child
• gender
• secure attachment experience
• an outgoing temperament as an infant
• good communication skills, sociability
• planner, belief in control
• humour
• problem solving skills, positive attitude
• experience of success and achievement
• religious faith
• capacity to reflect

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Resilience

• In the family
• At least one good parent-child relationship
• Affection
• Clear, firm consistent discipline
• Support for education
• Supportive long term adult relations/absence of
  severe discord

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Resilience

• In the community
• Wider supportive network
• Good housing
• High standard of living
• High morale school with positive policies for
  behaviour, attitudes and anti-bullying
• Valued social role, e.g. a job, volunteering,
  etc.
• Range of sport/leisure activities

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Resilience is developed by..

• Compensatory experiences
• Challenges
• Protection
• Ungar, M (2004) Nurturing Hidden Resilience in
  Troubled Youth Toronto UTP
• Change childs appraisal and cognitive processing
  of events
• Reduce exposure to risk
• Rutter,M (1987) Psychosocial resilience and
  protective mechanisms American Journal of
  Orthopsychiatry, 57,3 pp316-331

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Domains of Resilience
Secure base
Social competence
Positive values
Education
Talents interests
Friendships
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• Introduction to Children and Young Peoples
  Mental Health
• National Inter-Agency Training Resource
• Day Two

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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 persons life even though they may not be
  diagnosable as a mental disorder.

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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 persons daily life
• Mental illness
• Refers to the most severe types of mental
  disorder

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General Prevalence

• Mental health problem in perhaps one child in
  five (20)
• Diagnosable disorder in around 10 of children
• Greater in the upper age group
• Level increasing over time (for some disorders)
• Differences across ethnic groups
• Differences between family types
• Variations with household income

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Incidence and Prevalence in Scotland

• 760,000 children in Scotland (2001 Census)
• 1 in 10 have a mental disorder (76,000)
• children with emotional/conduct disorders were
  more than twice as likely as other children to
  live with parents who had no educational
  qualifications and were about three times as
  likely to live in households in which neither
  parent was working
• children with emotional/conduct disorders were
  more likely as other children to have a household
  income of less than 200

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Risk factors mental health

• Risk factors in children
• Genetic influences
• Low IQ and learning disability
• Specific developmental delay
• Communication difficulty
• Difficult temperament
• Physical illness, especially if chronic and/or
  neurological
• Academic failure
• Low self-esteem.
• Risk factors in families
• Overt parental conflict
• Family breakdown
• Inconsistent or unclear discipline

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Risk factors mental health (continued)

• Hostile and rejecting relationships
• Failure to adapt to a childs changing needs
• Physical, sexual and/or emotional abuse
• Parental mental health problems or mental
  disorder
• Parental criminality, alcoholism or personality
  disorder
• Death and loss including loss of friendship.
• Risk factors in environments
• Poverty and deprivation
• Homelessness
• Disaster
• Discrimination and / or bullying
• Other significant life events.

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Classification of mental disorders
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Classification of mental disorders
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Traumatic stress

• When children and young people experience
  persistent stress they are likely to produce
  toxic amounts of cortisol which can have a
  detrimental effect on
• Brain function
• All major body systems
• Social functioning

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What prevents brain development?

• Prenatal exposure to drugs and alcohol
• Malnutrition
• Neglect lack of stimulation
• Poor attachments
• Physical and sexual abuse
• Parental ill-health
• Chronic stress
• US Department of Health and Human Services

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Effects of overproduction of stress hormone on
child development

• These functions may be diminished or lost
• Ability to learn language and to speak
• Understanding feelings or having words to
  describe them
• Connection between how we feel and our sensory
  experience
• Empathy
• Control of impulse
• Regulation of mood
• Short term memory
• Enjoyment

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The 4 Ps

• Predisposing e.g. risk factors
• Precipitating e.g. current triggers
• Perpetuating e.g. long standing issues/lack of
  services
• Protective e.g. resilience factors

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Problems in Inter-professional working

• Expect others to act when theres been no
• previous relationship
• Danger of projecting own agency shortcomings onto
  others
• Professional stereotypes, fears and jealousies
• Budget protection strategies
• Different agency priorities and time frames
• Different languages
• Confidentiality can act as a barrier
• More comfortable not to change

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Consensus, competition and conflict

• How did that make you feel and why did it make
  you feel that way?
• What would you change about the task so that you
  could work in partnership with others to achieve
  your aims?

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Effective multi-agency working

• Clear structures
• Effective support for children and families
• Joint performance targets
• Time to get to know partners
• Flexibility
• Common strategies
• Pooling resources
• Sharing information
• Common goals

• Child and family centred objectives
• Effective evaluation of working together
• Consistency
• Avoidance of duplication and repetition
• Common understanding and language
• Transparency
• Equality