Apologies for a slightly longer post than usual - this is a
copy of the speech I gave to a group of 'Trusted professionals' in Glasgow this
week. These professionals provide tailored support to young people in the form
of 'Activity Agreements'. these focus on developing skills, capacities
and getting young people into positive destinations. Mental Health was becoming
an increasing issue for them and they wanted some input on the context for this
work in Scotland - which I was happy to try and provide.
I was asked to come along today to provide an overview of
children and young people’s mental health – to give an overview of the context
in Scotland – which I will do. I will talk briefly about the national strategy,
the national indicators, the curriculum for excellence and GIRFEC.
I was also asked to reflect on approaches or support that
can be offered – that is where the conversation expands considerably. There are
as many approaches and models as there are diagnosed conditions and they cannot
be covered by an input such as this –the truth is the journey of building our
own capacity to recognise and respond to mental health issues never ends.
Reading, training, workshops, partnerships – these things all build our
capacity and that is what I hope to contribute to today.
I am pleased to see children and young people’s mental
health is on your agenda and I realise for some – it is new to you and can see
why you wanted it be able to reflect on it today.
Understanding mental health is not about you diagnosing
ADHD, Bi-Polar disorder or necessarily recognises an eating disorder immediately
– but about being comfortable that you have the skills and knowledge to respond
and engage with other medical or professional services.
The time you spend with a young person and what you see
matters. That’s what the ‘experts’ need to ask or expect from us – to describe
how someone behaves - what do they do? – We should not be prevented from
contributing because we can’t make a formal diagnosis.
You work with teenagers – not feeling good about themselves,
being moody and uncomfortable around adults is their job. Some of the young
people you work with from your own data, have additional support needs, have
been involved in offending, some will or will have been looked after and some
use drugs and alcohol.
When I read this data – I did think to myself –of course
mental health is going to be an issue with the young people you work with!
Care leavers in particular are up to 5 times more likely to
have a diagnosed mental health problem when they leave care – this is due to a
number of factors -as is the case for most young people who are marginalised or
struggling with some of the issues that lead the them needing a service form
you.
This includes things like life events, trauma, separation,
poor attachments, developmental difficulties that could be genetic too, neglect
or parental mental health or illness. These are all things that affect a
person’s well-being and can develop into diagnosed mental health conditions or
they can exacerbate underlying conditions. These all affect behaviour and can
lead to anger, anxiety, self-harm, eating disorders. You deal with behaviour
and all behaviour communicates feelings. That’s what we understand best – in my
opinion.
This matters in your role as mental health is a major cause
of absence at work and to people being unable to work or being stigmatised and
discriminated against. We also know that many mental health problems begin and
develop in adolescence – they don’t just appear on adults – yet services and
legislation are still largely set up that way.
So, to the context for all of this. The over-arching context that underpins all of
what we shall explore next is GIRFEC – Getting It Right for Every Child is
something I am sure you are well aware of –this framework for outcomes
compliments the Mental Health Strategy for Scotland, The National Indicators
for Children and Young People and The Curriculum for Excellence and so on. All
of this should in theory ensure all children are safe, happy nurtured and son
on.
We have in Scotland a
Mental Health Strategy – that runs form 2012 – 2015. This document sets out
the Scottish Government's priorities and commitments to improve mental health
services and to promote mental wellbeing and prevent mental illness.
These are designed to reflect Government ambitions and
National Outcomes so that we can ‘live longer healthier lives’ ‘tackle
inequality’ and ‘services are responsive
to people’s needs’ - I am not here to
cheerlead or bore you with Government rhetoric – I do feel it is important to
fully understand the context of our work – High level outcomes Government
ambition (Longer healthier lives) directly impact national policy and strategy
which impact money and resources and impact on funding and the desired outcomes
funders are looking for you to deliver – it is much easier to argue the case to
government when you can easily contextualise your work and ambition in the
context of their outcome framework – that’s the language they understand.
The Government has a vison that by 2020 (it’s called the
2020 vison) that sees health services delivered in communities with people at
the centre – it encourages health promotion and prevention – and that is where
most of you sit – making this a reality that doesn’t focus on medical
approaches has still to be achieved.
The Mental Health Strategy identifies seven key themes,
which emerged from the consultation process
Working more
effectively with families and carers
Embedding more peer
to peer work and support
Increasing the
support for self-management and self-help approaches
Extending the
anti-stigma agenda forward to include further work on discrimination
Focusing on the
rights of those with mental illness
Developing the
outcomes approach to include personal, social and clinical outcomes
Ensuring that we use
new technology effectively as a mechanism for providing information and
delivering evidence based services
Four Key Change Areas
were also identified
Child and Adolescent
Mental Health
Rethinking How We
Respond to Common Mental Health Problems
Community, Inpatient
and Crisis Mental Health Services
Work with Other
Services and Populations with Specific Needs
Activity to Support
Delivery of the Mental Health Strategy
Again you can see this is very medically focussed and
children and young people are one of the 4 areas. I feel that sometimes
children and young people are relevant in each of the 4 – you can’t just relate
them to adults and then just have children’s mental health as a category all of
their own.
The other side of the coin is it is finally recognising a
need to focus on children and young people’s mental health and it is an area
that requires renewed focus.
One of the aims of the strategy is that children and young
people, following a referral for specialist CAMHS treatment get seen within 26
weeks.
A target of 26 weeks for treatment – makes my heart sink but
a new one has been set of 14 weeks starting in December of this year. A large
amount of the strategy focusses on CAHMS interventions and the CAMHS works
force –some of it is moving into community based work and partnerships but it
is still largely led by a medical model or a deficit model on mental illness
and less on the promotion and prevention.
It is something we should read if children’s mental health
matters to us – it clearly does and it shapes the partnerships we can develop
and the work done by colleagues.
Part of the on-going work to improve mental health in
Scotland was to develop a set of national indicators on mental health – one was
developed for adults initially and subsequently one for children and young
people – I was on the advisory group for children and young people and it was
quite a challenge – doctors, physicians, psychologists, researchers, professors
and me! Making up the numbers and representing the voluntary sector social work
types.
These indicators were finalised in late 2011 and set out a
range of mental health outcomes – things that contribute to mental well-being
and to mental health problems and arrange of contextual factors such as family,
environment, community, learning environment etc.
This is the graphic that illustrates the framework.
The idea is that data can be measured through surveys,
existing research, suicide and hospital statistics and specialist tools such as
a Strengths and Difficulties questionnaire to give an overall picture of mental
well-being and also mental health problems in Scotland – this is then supported
by an analysis of contextual factors through surveys, research and data on the
contextual factors, health and behaviour in schools surveys, both national and
local ones.
The first analysis of
these was completed in 2013 and indicated that children’s mental health has
improved or stayed broadly consistent on the last 10 years – it shows
contextual factors like alcohol consumption is down but the units consumed by
those drinking going up for example.
These trends and data are to be used to influence policy and
practice and to challenge and inform media colleagues.
The one other area that contextualises work around mental
health is the Curriculum for Excellence – significantly the health and
well-being outcomes within this. This is what colleagues in schools will be
working within and setting lesson plans etc. around. What is new and positive
about the curriculum is traditionally literacy and numeracy were the
responsibilities of all – well-being sat with guidance and pastoral care – this
is no longer the case – all teachers have a responsibility to include and
consider how their work, relationships and lessons impact on health and
well-being. It recognises that in order to learn and to and develop confidence
requires a focus on our mental well-being – this will not be rocket science or
news to any of you but it does radically change the paradigm for colleagues in
schools.
It’s no longer good enough for the history teacher to just
teach the history curriculum, they have to be tuned into and recognise the
things that can impact on a child’s well-being and their learning. They are
expected to promote a culture of respect and trust.
I have given inputs to teachers who are just as concerned
about what is expected of them as you are – just as concerned that they are
worried they will need ot teach lessons or deal directly with the treatment of
mental health problems. The message is the same – it’s about being confident to
recognise when something isn’t right or a person has changed and knowing where
ot go and what to do – who to talk to and where to get help. Signposting and
having knowledge of what resources are in your area is vital.
Health and well-being extends to food and nutrition,
exercise, relationships as well as feelings, anxiety, fear, and mental health
problems. The health and Well-being outcomes that teachers use should address
issues such as managing relationships, developing resilience, dealing with
difficulties, expressing yourself and getting active.
This graphic highlights the tools colleagues should be using
to plan and deliver learning and making sure these outcomes are the focus.
For me, this is the first time education and social work has
had a
similar value based approach to outcomes for children and young people.
So as you can see- there is quite a bit of context for the
work you do – I haven’t even drilled into parenting strategies or suicide and
self-harm or anti-bullying strategies - that all reflect the same values and
ambition. There are many of these that can give you access to more detail on
how to respond, what works, what good practice looks like, where to get help –
the challenge is to familiarise ourselves with the practice and the policy
context that affects us and assimilate this into our work.
You will learn more about dealing with self-harm when you
are dealing with self-harm than you can from having a theoretical understanding
of it – this can help it can ensure your first response is a more informed one
– same with bullying, same with Bi –Polar disorder or depression. Reflective
practitioners learn from their experience – we absorb influences, research,
books, advice and guidance with our experience and we us all this to formulate
plans and approaches to issues.
I think we should be more comfortable at times with the fact
we are always learning and always on a journey – not feel we can’t contribute
because we are not experts on the minutia of a particular mental health issue-
you will be presented with a huge variety of behaviour – there may be some
similarities but every child is unique and their issues will be unique to them,
where they live, who they live with and where you fit in.
The impact of Mental
Health problems
It is important to just reflect on the impact of metal
health on children and young people
Stigma
Discrimination - these
can be immobilising – they are still experienced more from close family and
friends
Relationships
affected – friends can turn away – young people might struggle with how to
manage ups and downs – tension can result
Life Chances – you
miss school and you get no qualifications – your options are limited –the
choices you can make are affected
Employability – it
can impact on attendance at work and the stigma can prevent people from gaining
work
Drug and Alcohol use
– can be a contributor as well as a symptom
Developmental delays
– some conditions can result in developmental delays and affect conative
functions
Behavioural problems
– as a result of not being able to communicate effectively – or feeling the
stigma
Physical health – to
take part in things like PE, to want to or even be able to –side effects of
medication or treatment
Motivation – can’t
get out of bed!
These just some of the impacts – I’ve put motivation in as
you will work with some young people who for the moment actually can’t get out
of bed – they’ve not yet been diagnosed with depression but all the cajoling on
the world won’t address what’s going on – threats will have no impact.
You might also be working with someone who can’t get out of
bed because they are not used to it and hate getting up – and cajoling and
threats might be the order of the day. There is no one answer for things like
this except to try and see the whole person and what their behaviour
communicates in the broadest sense and to consider mental health when doing
this – for some of the people you work with this will be a first.
What we do know is
this - A strong relationship with a trusted professional – I don’t just
mean the formal role of ‘trusted professional’ but one good positive relationship
can make all the difference – there is no shortage of research into brain
development in early years – Dr Harry Burns’ stuff is fascinating on how neural
pathways are joined up through positive attachments and stimulation and how
brain development can be affected by the absence of these – the crucial message
he gives, as do many others is that this
‘damage’ is not beyond repair – adolescents can and do through positive
relationships learn to trust , to stretch themselves and grow.
The skills that underpin effective relationships are the
ones we use and the ones others need to learn – especially the medical
professionals - they have things to learn from you.
As I said at the start of this – it is just not possible to
cover the area of children and young people’s mental health fully – if affects
every single pat of who they are and what they do
If you are a social worker – you must consider mental health
in your work and decisions
If you are a teacher – you must consider mental health in
the same way
a youth worker, a classroom assistant, a criminal justice
social worker, a foster carer, a residential worker- we don’t always need the
‘expert’ to deal with this aspect of a child’s life
There is no health without mental health - we all have
mental health – it will be better at some times than others – we will need
different things form the people around us depending who we are – what happened
and when.
Our response will be dependent on our levels of resilience –
did we have interests out of school, someone who cared and went the extra mile,
somewhere we knew we belonged and were helped to learn from our experiences.
This job - this role gives you the chance to be that person
for someone who needs it.
Thank you for listening folks – enjoy the rest of today.
