Children and Adolescent Mental HealthSession 4 – An overview of a key Mental Health Disorder in ChildrenOctober 18th, 2011

Aims

Go over key Tasks and dates due. This includes your Placement Task

Begin looking at Emotional Wellbeing in schools

Look at some of key mental health disorders

Focus on Depression: look at symptoms and consequences of depression

Consider what schools can do to help.

Placement TaskTask

Observe and then deliver a SEAL-type activity within your setting. Present a detailed evaluation of the approaches and outcomes observed.

Guidance

Undertake a reflective response which critically evaluates the benefits and limitations of the approaches and outcomes observed. With reference to your findings and relevant literature/research, make recommendations to enhance further development of SEAL-type activities.

Introduction

Many societies have neglected children’s emotional needs and preferred to concentrate on academic achievement.

Recent research has show that while poor mental health can impact on academic ability, good academic ability has little affect on on a child’s ability to cope positively with life. (Lazarus and Folkman, 1984)

Children need opportunities for learning how to cope with a variety of common difficulties and stressful life events in order to develop into emotionally secure and productive adults (Wolchick and Sandler, 1997).

Research has shown that a person’s emotional well-being can be affected by their perceptions of a stressful situation and how competent they are at reacting to it (Humphrey, 1988; Miars, 1995).

Successful coping skills correspond to a decreased likelihood of experiencing serious difficulties in adolescence and adulthood, including suicidal behaviour (Spence et al, 2003).

Importance of Emotional Health and Wellbeing in

SchoolsNew research suggests effective learning can only take place when children experience emotional well being (Weare, K 2004)

Maslow’s research suggested that if a person does not attain well-being he/she is likely to find learning either unimportant or difficult to attain.

Daniel Goleman reinforced the suggestion that emotional intelligence is as important educationally as rational or intellection intelligence and indeed cognitive ability.

‘Emotional health and well-being is a state. It is only possible to learn if we have a reasonable level of emotional health and well-being’ (SEAL Staff Development booklet)

Some Common Mental Health Disorders…

Depression

Anxiety

Behaviour disorders

Attention deficit hyperactivity disorder.

Eating Disorders

Self Harm

Drug abuse

Bullying

DepressionIt is a serious medical illness that involves the brain. It is one part of bipolar disorder.

It can be a symptom, a syndrome and nosologic disorder. Usually starts between the ages of 15 and 30 and is much more common in women.

The symptoms are persistent and interfere with every day life.

Key symptoms(key symptom) Persistent Sadness or low or irritable mood.Loss of interest or pleasure in the activities that used to be enjoyedFatigue or low energy

• Associated symptomsDifficulty sleeping or oversleepingFeelings of worthlessnessThoughts of death or suicide.Difficulty concentratingGuilt or self-blame

Mild – up to 4 symptoms

Moderate – 5-6 symptoms

Severe – 7- 10 symptoms

What is it?

Steven Fry explains

Diagnosis and Stigma

Depression and Drug Use

Depression in ChildrenVery uncommon in young children, rare during middle childhood but increasing significantly during adolescence. (Costello, Foley, & Angold, 2006)

It has been estimated that 1% of pre-pubertal children and 3% post –pubertal young people suffer from it. (Depression in Children, Clinical Knowledge Summaries, 2009)

Children and adolescents with depression frequently have psychosocial, education and family difficulties.

It often occurs with co-morbid psychiatric disorders, increased risk of suicide, substance abuse, and behavioural problems.

It is often recurrent and often continues episodically into adulthood.

Differences between Adult and Teen

SymptomsIrritable or angry mood – irritability rather than sadness is predominant mood in depressed teens.

Unexplained aches and pains – headaches/stomachaches. If there is no physical cause then it could be depression.

Extreme sensitivity to criticism – depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection and failure. This is a particular problem for over-achievers.

Withdrawing from some, but not all people – adults tend to isolate themselves – teens usually keep up at least some friendships. However they may socialise less, pull away from parents or start hanging out with a different crowd.

Effects of teen depression

Problems at school – can cause low energy and concentration difficulties.

Running away – many run away or talk about running away.

Drug and alcohol abuse – this could be an attempt to ‘self medicate’ their depression.

Low self-esteem. Can trigger and intensify feelings of ugliness, shame, failure and unworthiness

Internet addiction – go online to escape problems

Reckless behaviour – may engage in high-risk behaviours

Violence – some depressed teens (usually boys who are the victims of bullying) become violent.

Risk Factors

Family Discord

Bullying

Physical, sexual or emotional abuse

History of parental depression

Ethnic and cultural factors

Refugee status

Living in institutional settings.

What can schools Do?• Only about 25% of children and young people with

depression are detected and treated. (NICE

• With 75% of sufferers going undetected, those involved with the care of children and young people need to be able to better identify the signs of depression.

• There are a number of ways that schools are actively promoting the emotional health and well-being of all children:• Structured and effective pastoral care systems eg SEAL• Emotional and Behaviour Skills Programme• Circle Time• National Healthy Schools Programme

• Many schools and their partner agencies are also choosing to offer more targeted support of groups for individual children through initiatives.

How can Staff help?Don’t jump to conclusions – offer in-school support and observe behaviour closely. NICE recommend 4 weeks ‘watchful waiting’ and to:

Try to understand reasons for the behaviourPromote a healthy lifestyle

– Offer non-directive support including active listening

– Encourage children to talk to their parents and friends or a teacher or adult they can trust

– Offer activities to raise self esteem– Teach self-reward and self-praise– Support development of problem solving and

social skills– Promote activities which help develop

supportive friendships– Encourage access to in house services e.g.

school counselling

When do you Refer to CAMH services?

• Continued presence of at least 2 of symptoms identified earlier

• History of depression in family members which may place child at greater risk of depression

• No response to support offered in school after 2 – 3 months

• Relapse after a time after an initial period of improvement

• Unexplained self-neglect of at least 1 month’s duration

• Suicidal ideas or plan

• Young person or parent/carer requests referral.

After the referral….• Family therapy

• Cognitive behavioural therapy

• Interpersonal therapy

Medication is rarely offered to young children and only offered to adolescents if they do not respond to psychological therapies alone.

Teachers/staff need to be aware of why lessons might have been missed and help should be offered to catch up.

Where we stand..

• Report into schools (2005) showed that schools had a lack of knowledge of DfES guidance which meant there were missed opportunities to improve the quality of provision for pupils with mental health difficulties.

• ‘The large number of schools visited for this survey who were not working towards meeting the NHSS is of serious concern.’

Conclusions

• While 2-5% of children and adolescents experience clinical depression, it is often missed by those around them

• Left untreated it can have a significant negative impact on development, well-being and future happiness.

• If treated the majority of patients show improvement, with a shorter duration of their depression and a reduction in the negative impact of their symptoms.

Bibliography• WHO (2004)Mental Health Promotion: Case Studies from Countries

WHO: France

• NICE (2005) Depression in chidlren and young people: understanding NICE Guidance.

• Ofsted (2005) Healthy Minds: promoting emotional health and well-being in schools.

• DfES (2007) Secondary Social, Emotional and Behavioural Skills (SEBS) Pilot evaluation

• DfES(1999) National Healthy School Standard Guidance, DfES

• DfES (2002) National healthy School Standard Report, DfES

• CAMHs (2008) Improving the mental health and psychological well-being of children and young people