www.le.ac.uk

How schools and Camhs might work better together to promote mental

health in children?

Nisha Dogra Professor of Psychiatry EducationGreenwood Institute of Child Health,University of LeicesterAnd Clare Short Consultant in Child and Adolescent Psychiatry, Bristol

Plan

• Outline of child mental health

• Interventions with children and teachers to promote child mental health

• Supporting teachers

Bright Futures Definition

• Develop psychologically, emotionally, creatively, intellectually and spiritually

• Initiate, develop and sustain mutually satisfying personal relationships

• Use and enjoy solitude• Become aware of others and empathise with

them• Play and learn• Develop a sense of right and wrong• Resolve (face) problems and setbacks and learn from them.

The World Health Organisation (WHO) (2001)

States that mental health is an integral component of health through which a person realises his or her own cognitive, affective and relational abilities.

With a balanced mental disposition, one is more effective in coping with the stresses of life, can work productively and fruitfully, and is able to make a positive contribution to one’s community.

Child mental health symptoms, problems and disorders:

Disorders

Symptoms

Problems

What are Mental Health Problems?

• Feeling sad or unhappy

• Feeling worried

• Behaviour problems

• Can be an exaggeration of feelings or behaviours that we all have but interfere with the young person’s life in a negative way

What are Mental Disorders?

• More severe and complex

• Have difficulties that limit normal functioning

• May be destructive to self and/or others

• Behavioural or emotional

What is Mental Illness?

• A mental disorder that is more severe and complex than most.

• Can have significant problems

• Biological basis

• May lose touch with reality

• E.g. psychosis, severe depression

Some factors that impact on young people include:

• Bereavement• Not being loved or listened to, feeling left out • Changing school • Moving home • Losing friends • Their parents arguing • Their bodies, getting ill or feeling abnormal • Sex • Exams, not doing well • Being abused physically, sexually or emotionally

Frequency of Mental Health Problems:

• 10-15% mental health disorders in general population

• 20-25% mental health problems in general population

• Rates are higher in deprived areas and in young people with multiple needs/high risk. Can be up to 3x higher (e.g. LAC, young offenders)

Continuum of Mental Health and Illness

At one end of the spectrum is complete mental health and at the other severe mental disorder. The continuum between the range of ‘normal’ human experience and mental disorder (with the exception of psychosis) means that the cut-off between what is normal and abnormal can be hard to define.

It is not just the presence of symptoms that defines a disorder but also its impact on the individual’s functioning.

Positive Factors for Mental Health Generally:

• High IQ

• Special skills

• A supporting adult outside of the family

Background and context of work already undertaken with schools

Two projects

• Project to establish the prevalence of mental health problems in children of Indian ethnicity

• Mental health as one component of overall health as part of a wider health promotion project run by GENIE/NIHR CLAHRC-LNR

• Initially no real strategy, just ad hoc and opportunistic

Project 1: Mental Health Problems in Young People of Indian Ethnicity

• Meant engagement with schools including local schools

• Of nine schools involved, six utilised the opportunity of meeting to discuss their school specific results and the implications of these

• Five of the schools used the data to decide how they wanted to use the offer of training to staff or sessions with children to promote child mental health

• One of the schools wanted two one-hour staff seminars

• Least rewarding and least time consuming option

• Another school expressed interest but anticipated that staff turnover would limit their further participation

• Two Leicester and two London schools wanted a longer term partnership dependent on our resources

• Both London schools elected to have staff training of mental health awareness

• One Leicester school has asked for support in developing their PHSE curriculum in mental health and the other sessions on specific topics

Learning Outcomes for Training

• Evaluate their personal views of mental health and illness

• Outline some behaviours that might be indicative of mental health difficulties

• Consider the different types of support services available for young people with mental health problems

Feedback on training

• Very well received (14 feedback sheets and verbal)

• Teachers wished it had been longer!

• “I was riveted.”

• “All teachers should have this, not just the pastoral staff. …Should be part of PGCE programme.”

Poster competition

• 14 entries

• Presentation evening

• School partnership

Examples of the Entries

Project 2: Health Education Reaching Out (HERO)

• GENIE CETL and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care for Leicestershire, Northamptonshire and Rutland (NIHR CLAHRC-LNR initiative

• Annette Cashmore, Julian Barwell. Nicola Suter-Giorgini and Joanne Singletary

Healthy Body, Healthy Mind Events September 2011

• Aim to discover more about 13-14 year olds’ attitudes to mental health and physical health in context of general health

• Research questions:1. Is there a difference in mental and physical health

awareness and attitudes to mental and physical health before and after the event?

2. Is there a difference in attitude to mental health compared to physical health or health in general?

• Two events for 226 year 9 pupils from 5 local schools

• Each event had a short welcome/health and safety instruction and preliminary questionnaire

• Two workshops:– Diet and activity workshop consisted of a small introductory

talk followed by a variety of interactive activities– The mental health workshop consisted of small group work

looking at what mental health is

Context for Mental Health Inclusion

• Mental health of children and young people is often discussed in terms of mental illness, however such an approach is limited

• But discussions about mental illness without touching on mental health are conceptually flawed

• Mental illness needs contextualizing

Findings

Mental health was viewed in terms of

• personal attributes of an individual

• illness

• ability for personal management

• establishing social relations

Responses relating to ‘mental’ health in workshops included:

• Having a high self esteem

• Positive thinking/attitudes

• Avoiding stressful situations

• Being organised and thinking clearly

• Engaging in mentally stimulating activities and pursuits

• Having good social relationships and support networks

Young people saw mental health maintained through:

• a combination of lifestyle choices

• personal attributes

• management of self and environment

• social support and relationships

• treatment of illness

These themes corresponded to the ones identified by the Bright Futures.

Bright Futures Definition

• Develop psychologically, emotionally, creatively, intellectually and spiritually

• Initiate, develop and sustain mutually satisfying personal relationships

• Use and enjoy solitude• Become aware of others and empathise with

them• Play and learn• Develop a sense of right and wrong• Resolve (face) problems and setbacks and learn from them.

• Led to DVD which promotes discussion of mental health in schools through young people giving their perspective of what they understand good mental is and how to achieve and maintain it.

Aims

• The project developed and evaluated a mental health promotion intervention video for young people. The intervention was intended to be delivered both during school lessons and on social media sites, in order to assess the impact of the purpose made video and method of delivery.

Interventions

• A four minute mental health promotion video focussed on the meaning of mental health and strategies for positive mental health from the perspectives of four teenagers, who shared their opinions of good mental health.

• Copies of the DVD were made for distribution to schools.

Sample/procedure

• Two schools (one in London and one in Leicester) were able to take part in timescales available.

• Young people from all school year groups (11-18) participated.

• Response rate 946/1600 (59%)

• The intervention was carried out during PSHE classes in January 2014.

• A questionnaire to assess participant’s views on mental health was completed before and after the video was viewed and follow up 6-8 weeks later.

Summary

• Short DVD could help – point is to make it part of everyday conversation in thinking about mental health rather than illness

• Schools are viewed as appropriate places for conversations about this and preferred to on line sources

• Young people receptive to this (more so than teachers?)

Schools

• Is it possible for schools to undertake a mental health promotion role in their work?

• If not what are the barriers?

• What could they do?

• What support might they require?

What about teachers?

No education with teachers

No teachers without health

No health without mental health (Prof Sue Bailey)

The Divided Brain

https://m.youtube.com/watch?v=dFs9WO2B8uI

Teaching - a rewarding job?

High prevalence of work- related stress (Naghieh et al. 2015).

Focus on detrimental effects of stress on children’s wellbeing at the expense of impact of occupational stress on teacher’s health Roeser et al. 2013).

50 % teachers either do not take up a post or leave the profession within the first 5 years (Dolton & Klaauw, 1999; Hayes, 2004; Ingersoll & Smith, 2003).

UK higher attrition rate than other European countries (Ladd 2007).

The Stand up kid - Sit down teacher

https://m.youtube.com/watch?v=dFs9WO2B8uI

Narcissism vs Reflection

Resilience and emotional regulation

An overused term?

What do we really mean by it?

How does it fit in with neurodevelopmental theory

How can we take this forward?

The art of conversation .....

to ‘turn together’

from Latin conversationem/conversatio ‘act of living with’verto, vertere ‘to turn’, conversare ‘to turn around and around’