Wellbeing, resilience and mental health: language and evidence based practice.
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Transcript of 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
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 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
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)
• 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)
• 13% of boys had a mental disorder
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)
Children at risk;
in need; Social Care
vulnerable
Children with emotional
and behavioural difficulties; Education
special needs
Children with mental illnesses;
psychiatric disorders Health
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
FlourishingModerate
mental health
LanguishingMental
disorder
From: Huppert Ch.12 in Huppert et al.
(Eds) The Science of Well-being
Number of symptoms or risk factors
Flourishing Moderate mental health Languishing
Mental disorder
From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being
Number of symptoms or risk factors
By early we mean any (or all) of the following;
•Early in a child’s life (pre-conception, ante-natal, post-natal 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).
• 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
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)
Level of evidence Type of evidence1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs
with a very low risk of bias1+ Well-conducted meta-analyses, systematic reviews of RCTs, or
RCTs with a low risk of bias1– 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 causal2+ Well-conducted case–control or cohort studies with a low risk of
confounding, bias or chance and a moderate probability that therelationship 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 arecommendation
• 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
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 therapy7. 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
Types of mental health work in schools (from TaMHS national evaluation 2012)
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)
• 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
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 TOUCHWebsite: www.youngminds.org.uk/bond
Email: [email protected]
Telephone: 020 7089 5050