Public Mental Health for Youth

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Public Mental
Health for Youth
Dr Paul Patterson - Public Health Lead Youthspace
BSMHFT
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SchoolspaceChisholm, Patterson, Turner,
Torgerson, Birchwood (2012)Supported by NIHR
CLAHRC-Birmingham Black Country

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Youth Mental Health Why is it so important?
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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)

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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
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Evolution of a Youth Model of Mental Health
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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)

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• 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

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Birmingham Youthspace / CLAHRC Programme
- Service Redesign - Partnership development -
Youth Clinical Team - Training Programmes -
-- Youthspace.me Website - Educational
Films - Posters/campaigns - Interactive mapping

Youth Clinical Service Partnerships Fairbridge
Princes Trust
Youthspace media
- Schoolspace Project - Vulnerable Youth
Project - Awareness campaigns
- Assess delay hotspots - Universal
Targeted Intervention Design - Analysis
Dissemination of outcomes
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Youth Mental Health the Policy context..
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A Childrens 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

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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 2006better techniques for early
  identification and assessment of additional need,
  and more effective joined-up working to support
  swift and easy referral to specialist services

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One Year On the first report from the National
Advisory Council for Childrens 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..

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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..

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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

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Youth Mental Health Education in Schools Why
is this so important?
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Why Its Important for Students UK comes
bottom of the rank for childrens well-being in a
recent UNICEF study in comparison with North
America 18 European Countries (UNICEF 2007)
Its 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
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Why Its 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.
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Schoolspace bringing MH education into schools
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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 Majestys
  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.

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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).

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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?

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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)

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• 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

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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
• Participation in the contact and education
  condition will significantly reduce participants
  prejudice of mental illness in comparison to
  participants in the education only condition
• Participation in the contact and education
  condition will significantly improve
  participants mental health literacy in
  comparison to participants in the education only
  condition
• 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

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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)

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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?

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Anyone feeling anxious..?
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Listen a Film about Depression in Young
People by BSMHFT Service Users (on Youthspace.me)
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Youthspace.me
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Stage two Feasibility trial

• Some feedback from pupils
• 100 of pupils rated day as good or excellent
• The best topic day weve ever had
• I dont feel so bad that sometimes Im bullied
• fun and interesting
• Ive learnt a lot
• I learned that I can talk about things if I need
  to
• I know what to do to get help now
• Ive learnt some words like schizophrenia
• Its good to think positively

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• 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!

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Remember...
No health without mental health..
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WWW.YOUTHSPACE.ME
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WWW.YOUTHSPACE.ME Paul.Patterson_at_bsmhft.nhs.uk