Children and Young People's Mental Health in Scotland - some context

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.