Wellbeing, resilience and mental health: language and evidence based practice

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Wellbeing, resilience and mental health language
and evidence based practice
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• What do we mean by.
• Mental health definitions and terms
• Prevalence of problems
• Early intervention
• Evidence based interventions

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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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Prevalence in 2004

• 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)

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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)

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Children in Care

• 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)

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Different labels same children

• Children at risk
• in need Social Care
• vulnerable
• Children with emotional         
• and behavioural difficulties Education
• special needs
• Children with mental illnesses
• psychiatric disorders Health

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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

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The mental health spectrum
From Huppert Ch.12 in Huppert et al. (Eds) The
Science of Well-being
Moderate mental health
Mental disorder
Flourishing
Languishing
Number of symptoms or risk factors
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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
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Early intervention

• By early we mean any (or all) of the following
• Early in a childs life (pre-conception,
  ante-natal, post-natal support and early years
  services)
• Early in the life cycle of the childs
  difficulties (as soon as these are detected)
• Early in the presentation of the childs
  difficulties (very swiftly after the child is
  first seen for a difficulty at a health or social
  care service).

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Early interventions in mental health might
include

• 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

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Why early intervention in CYPs 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)

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Cost benefit? Investment decisions
Impact
Cost of intervention
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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
  casecontrol or cohort studies
• High-quality casecontrol 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 casecontrol or cohort
  studies with a low risk of
• confounding, bias or chance and a moderate
  probability that the
• relationship is causal
• 2 Casecontrol 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

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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

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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 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 therapy
7. 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
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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)

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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

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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.
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• Treatment Foster Care
• Impact on range of outcomes including stability.

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GETTING IN TOUCH
Website www.youngminds.org.uk/bond Email
bond_at_youngminds.org.uk Telephone [phone]