Chase, Mike

Goodings, Lewis

Jobber, Nick

Tucker, Ian

English

UWE Bristol Research Repository

A national crisis?A “national crisis” inthe UK has been reportedin recent years regardingcare and support forchildren and youngpeople’s (YP) mentalhealth and emotionalwellbeing (Collishaw, Maughan, Natarajan, &Pickles, 2010; Cooper, 2014). Statistics show that10% of children and YP aged between 5 and 16have a diagnosable mental health problemincluding: conduct disorder (6% of the YPpopulation), anxiety disorder (3%), hyperactivitydisorder (e.g., ADHD; 2%) and depression (2%)(Mental Health Taskforce (MHT), 2016; ONS, 2004).As many as one in 12 YP are recorded to have self-harmed with 38,000 to the point of beinghospitalised in 2015 (Mental Health Foundation,2006; Young Minds, 2015) and the vast majority ofthe 1.5 million people estimated to have eatingdisorders in the UK are likely to have presentedsymptoms before their 20th birthday (Beat, 2015).Other social and demographic factors areassociated with increased risk of mental ill-healthin YP. For example, children and YP from areas ofsocio-economic deprivation are three times morelikely to present symptoms of mental ill healththan those from more affluent areas (MHT, 2016).95% of imprisoned young offenders have a mentalhealth disorder and are far more likely toexperience Autistic Spectrum Difficulties comparedto the general population (15% compared to 0.6-1.2% respectively). More generally, YP diagnosedwith conduct disorder (e.g., disruptive andaggressive behaviour) are significantly more likelyto leave school without qualifications, three timesmore likely to become a teenage parent, and up tofour times more likely to become ‘drug dependent’(MHT, 2016).This “national crisis” not only reflects increasingand highly complex mental health needs among YPbut also the inadequacies of a system ill-equippedto support YP and their families. In fact themajority of children and YP who have a diagnosablemental health problem are unlikely to receive anysupport, and those who do will typically wait up to32 weeks for routine appointments forpsychological therapy (MHT, 2016). Moreover, YPrequiring acute inpatient psychiatric/ psychologicalsupport are likely to need to travel long distancesto specialist health facilities in neighbouring citiesor further afield (MHT, 2016).Whilst inadequate mental health provision playsa crucial role in the “national crisis”, there areother important contributing factors. The stigmaassociated with mental illness creates a majorbarrier to accessing services and support. The“Talking Taboo” report (Young Minds, 2012)demonstrated that only 10% of YP felt comfortableseeking advice from a GP, teacher or parent aboutthe issue of self-harm; a finding compounded bythe admission of approximately 1/3 of parents whoindicated they would not seek professional help inthe face of their child self-harming because ofconcerns about how the problem reflected on themas parents. A further challenge, and one likely tobe exacerbated by stigma, is the failure to identifyand respond appropriately to early signs of mentalill health. The report “Nobody Made theConnection” (Hughes, Williams, Chitsabesan,Mike ChaseUniversity of East LondonIan TuckerUniversity of East LondonLewis GoodingsUniversity of East LondonNick JobberUniversity of East LondonYoung people’s mental health in the UK: A ‘preventativeturn’ emerging from crisisyoung people’s mental health in the UKChase et al.original articleDavies, & Mounce, 2012), demonstrates thenegative impact of failing to identify and addressYP’s mental health needs at an early stage,particularly neurodevelopmental conditions (suchas ADHD, Autistic Spectrum Disorders or Speechand Language Difficulties) . If we add into the mixthe reported profound inequalities within the UK inacknowledging and meeting the culturally diversemental health needs of different communitiescombined with the dramatic regional variation inservice commissioning priorities and resourcing, wecan begin to appreciate the gaping holes inchildren and YP’s mental health provision(Wilkinson & Pickett, 2009; Friedli, 2009).A ‘preventative turn’In the UK there is broad consensus on how the“national crisis” has evolved; a culmination ofincreasingly complex and significant needs(Collishaw, Maughan, Natarajan, & Pickles, 2010;Mental Health Taskforce, 2016) and woefullyinsufficient past expenditure on mental healthservices (Fonay, 2014). Being able to generate across party political consensus on the need forincreased funding for YP’s mental health during the2015 general election (Young Minds, 2014), despitecampaigning within the economic paradigm of“austerity”, goes some way to illustrate the extentto which the “crisis” is acknowledged. At the sametime, there is a collective understanding about theneed to intervene earlier and in a morepreventative manner (O’Keeffe, O’Reilly, O’Brien,Buckley, & Illback, 2015) if we are to reducemorbidity (and mortality) associated with mentalhealth in the young. However, services arestretched beyond capacity and consequently facesevere challenges to adequately support childrenand YP.One major challenge for Child and AdolescentMental Health Services in the UK is YP ‘failing toengage’ with services and being prematurelydischarged as a result (Roy & Gillett, 2008).Campaigns such as Time-to-Change(http://www.time-to-change.org.uk) are creatingopportunities to challenge public stigmasurrounding mental health, but providers also needto ensure they offer YP and their families serviceswhich are sufficiently meaningful, inclusive andnon-stigmatising. Recognising that the contextswithin which we seek to meet the mental healthand emotional needs of children and YP are asmuch political and economic as they are social andpsychological suggests a move towards aperspective of practice that is more embeddedwithin “community”. Moreover, we need toconceptualise community in its widest sense. Forexample, for many YP, community is not just abouttheir local surroundings and links through familyand friends, but it is also constituted online andvia social media. Prevention and support initiativesmust therefore be firmly embedded within theonline and social media community.In the face of current failings in mental healthsupport and services for YP, and in the realisationthat an effective response to growing needs isunlikely to ever be sustainable through crisisreactive models of practice and provision alone,there is a ‘preventative turn’ beginning to emergein the UK (e.g., MHT, 2016). A growing body ofparticipatory and innovative initiatives are beingpiloted and implemented which aim to addressmental health prevention and support in engaging,timely and flexible ways (e.g., HeadStart,YoungMinds, CUES-Ed, & Bounce Back). CUES-Ed(http://cues-ed.co.uk/), for example, is a class-room based initiative targeted at primary schoolchildren who are introduced to ‘emotionalresilience’ and ‘efficacy building’ through ageadapted forms of CBT. ‘Young Minds vs’ series ofcampaigns (http://www.youngmindsvs.org.uk), onthe other hand, are aimed at ‘resilience building’initiatives for older children in relation toimportant challenges faced at school and beyond;including bullying, sex and relationships, schoolyoung people’s mental health in the UKChase et al.stress, employment and access to services.Moreover, outside of the classroom, and in thewider conceptualisation of prevention and‘community’, more exclusive online resources arebeing implemented through the development ofengaging digital tools. For example, APPs areemerging to include:- doctor consultations(http://www.docready.org)- information about medications(http://www.headmeds.org.uk)- talking about feelings and mood(https://moodbug.me)- counselling(https://www.kooth.com)as well as accessible, anonymous and ‘safe’ onlinepeer support (e.g., http://www.silentsecret.com).Early indication is that YP are engaging withonline and other preventative resources and‘communities’, and that learning and skillsdevelopment is evident (Hart & Heaver, 2015).However, a stronger evidence-base is undoubtedlyneeded. For example, while YP may be engagingwith online ‘resilience building’ initiatives, whichones are the most effective, and what impact dothey have on longer term mental health difficultiesand the uptake of secondary mental healthresources (Hart & Heaver, 2015)? Moreover, asFriedli (2009) and others have argued, there is aneed to elevate ‘resilience’ and ‘efficacy building’from an ‘individual focus’ to one that embraces thewider economic, health and social whichcontextualise ‘mental health’, ‘agency’ and‘resilience’ e.g., ‘building resilience’ should notexcuse our collective duty to improve the social,educational and economic determinants which arelikely to exacerbate poor mental health andwellbeing. Nevertheless the emergent ‘turn’ from apredominant and inadequate crisis-resolutionmental health provision, to one which is moreequipped and focussed on prevention andengagement in YP appears to be an importantopportunity which has surfaced from “crisis”.Conclusion: From crisis toopportunityA recent independent review (Mental HealthTaskforce, 2016) highlighted many of theweaknesses in current mental health services for YPand their families and offered a clear framework fortransformation of services over the next 5 years.The concern remains that whilst we are seeking toaddress a chronically underfunded area of need, aswell as improve what is actually on offer, fundingcuts to much-needed services and supportundermine their ability to function productively.We have discussed a ‘preventative turn’ in the UKwhere a number of innovative interventionsdesigned to build ‘emotional resilience’ areemergent out of the “crisis”; albeit with‘individualistic’ focus. Building on the opportunitythis affords, we propose evidenced-based‘community’ and participatory preventativestrategies will go a long way to address the gapingshortfalls that exist in Children and YP mentalhealth services in the UK.AcknowledgementThe authors would like to thank Nick Barnes forhis valuable guidance and feedback for this paper.ReferencesBeat (2015, February). The costs of eating disorders:social, health and economic impacts. Retrievedfrom https://www.b-eat.co.uk/assets/000/000/373/PwC_2015_The_costs_of_eating_disorders_Final_original_original.pdf?1426603077Collishaw, S., Maughan, B., Natarajan, L., & Pickles,A. (2010). Trends in adolescence emotionalproblems in England: a comparison of twoyoung people’s mental health in the UKChase et al.national cohorts twenty years apart. Journal ofChild Psychology and Psychiatry, 51, 885–894.doi:10.1111/j.1469-7610.2010.02252.xCooper, C. (2014, August 20). Exclusive: children'smental healthcare in crisis, Care MinisterNorman Lamb admits. The Independent.Retrieved fromhttp://www.independent.co.uk/life-style/health-and-families/health-news/exclusive-childrens-mental-healthcare-in-crisis-care-minister-norman-lamb-admits-9679098.htmlDepartment of Health (2015). Future in mind:Promoting, protecting and improving our childrenand young people’s mental health and wellbeing.Retrieved fromhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdfFonay, P. (2014, 20 April) . Children and youngpeople's improved access to PsychologicalTherapies Newsletter. Retrieved from Childrenand young people's improved access toPsychological Therapies website:http://www.cypiapt.org/site-files/Newsletter%20April%202014%20Final.pdfFriedli, L. (2009). Mental health resilience andinequalities. Retrieved from World HealthOrganization Regional Office for Europe website:http://www.euro.who.int/__data/assets/pdf_file/0012/100821/E92227.pdfHart, A., & Heaver, B. (2015). Resilience approachesto supporting young people’s mental health:Appraising the evidence base for schools andcommunities. Retrieved from Young Mindswebsite:http://www.youngminds.org.uk/assets/0002/3917/BB_resilence_evidence_base_appraisal.pdfHughes, N., Williams, H., Chitsabesan, P., Davies,R., & Mounce, L. (2012). Nobody made theconnection: The prevalence of neurodisability inyoung people who offend. Retrieved fromChildren's Commissioner website:http://www.childrenscommissioner.gov.uk/publications/nobody-made-connection-prevalence-neurodisability-young-people-who-offendMental Health Taskforce (2016, 14 February). Thefive year forward view for mental health.Retrieved from National Health Service (NHS) inEngland website:https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdfNuffield Foundation (2012). Changing AdolescenceProgramme briefing paper: Social trends andmental health: Introducing the main findings.London: Nuffield Foundation.O’Keeffe, L., O’Reilly, A., O’Brien, G., Buckley, R., &Illback, R. (2015). Description and outcomeevaluation of Jigsaw: An emergent Irish mentalhealth early intervention programme for youngpeople. Irish Journal of Psychological Medicine,32, 71–77. doi:10.1017/ipm.2014.86Press Association (2014, 20 August). Child mentalhealth services 'stuck in the dark ages', saysNorman Lamb. The Guardian. Retrieved fromhttps://www.theguardian.com/society/2014/aug/20/child-mental-health-dark-ages-norman-lambRoy, H., & Gillett, T. (2008). Email: a newtechnique for forming a therapeutic alliancewith high-risk young people failing to engagewith mental health services? A case study.Clinical Child Psychology & Psychiatry, 13,95–103. doi:10.1177/1359104507086344Wilkinson, R., & Pickett, K. (2009). The spirit level.London, England: Penguin.Young Minds (2015, 30 April) . Keep your wordcampaign. Retrieved fromhttp://www.youngminds.org.uk/news/blog/2730_join_our_keepyourword_campaignyoung people’s mental health in the UKChase et al.young people’s mental health in the UKChase et al.Mike ChaseProgramme Leader B.Sc. Clinical &Community Psychology, School ofPsychology, University of EastLondon, UKm.chase@uel.ac.ukIan TuckerUniversity of East London, UKi.tucker@uel.ac.ukLewis GoodingsUniversity of East London, UKL.Goodings@uel.ac.ukNick JobberUniversity of East Londonu1414579@uel.ac.uk

Young people’s mental health in the UK: A ‘preventative turn’ emerging from crisis

https://uwe-repository.worktribe.com/6650689/1/Young people’s mental health in the UK: A ‘preventative turn’ emerging from crisis

Young people’s mental health in the UK: A ‘preventative turn’ emerging from crisis

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