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Can Sport improve Mental Health and Wellbeing of young people?Stephen McLeodHead of Specialist Children’s ServicesNHS Greater Glasgow and Clyde
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Definitions & DeterminantsGlasgow’s School Children – active and healthy? Young People’s development – what is normal?Distress V DisorderResilienceActions
Contents
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Definition of health
“A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (WHO 1948)
We need to reframe a definition for our time to reflect the population age and the pattern of illness changes
“The ability to adapt and self manage” in the face of social, physical and emotional challenges. (Huber et al BMJ 2011)
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Positive mental health can be promoted through
Physical activity-incorporating exercise into everyday activities
Labour market activity-having meaningful work and a daily routine
Social activity-being connected to family, friends and our communities
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The social determinants of mental healthSociety Community Family Individual
Equality of opportunity
Safety and social order
Family structures and networks
Lifestyle (e.g. food, exercise, alcohol intake)
Employment opportunities
Housing and amenities
Family dynamics (e.g. high/low expressed emotion)
Attributional style (i.e. how events are understood) and self efficacy
Social cohesion Quality of physical environment and green space
Genetic characteristics
Financial security
Educational opportunities
Social connections and networks
Intergenerational relationships
Physical health
Health care provision
External influence and control
Parenting skills and resources
Individual relationships
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• ‘Recovery capital.’… the things, the people, their resources, their understanding and concern for the individual which can help them have a sense of belonging and connection which helps them to firstly help them consider, and then initiate change in their lives. Sometimes this change is slow, but it can be sustainable change, change that’s supported by others in a meaningful and very personal way.
• My vision for a healthy Glasgow is one where people have a common sense of hope and purpose in their lives”
Neil Hunter, Chief Reporter to the Children’s Panel
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“Many folk in Glasgow spend five or more hours a day watching television – particularly commercial channels. My vision for a mentally flourishing Greater Glasgow and Clyde is one where
people spend less time watching television and more on activities, which support them socially and emotionally.
Carol Craig,Director, Centre for Confidence and Wellbeing.
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Screen time – computer games, surfing the net, social networking, smart phone and TV
25% of secondary school pupils 12 or more hours of screen time
• One in four (25% 1,166 pupils) spent more than 12 hours a day on screen-based activities on school days
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Arts, culture and mental health
Contribute to effective health educationContribute to therapeutic and relaxed environments in
health servicesDevelop creativityImprove quality of lifeRaise expectations of what is possible and desirable…plausible link to mental health outcomes but more
research required
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Physical & mental• Improves quality of life• Manages weight• Reduces risk of chronic diseases• Improves sleep• Reduces stress, depression• Develops motor skills• Improves concentration, memory
& learning
Economic• Creates employment• Draws tourism• Means of transport • Supports local businesses• Reduces absenteeism • Reduces crime• Reduces health savings
Social• Encourages family/community
connectedness• Improves social skills/networks• Prolongs independent living for
older people• Reduces isolation, loneliness• Enhances self-esteem,
confidence
Environmental• Reduces traffic congestion• Reduces air pollution• Reduces greenhouse emissions• Reduces noise pollution• Creates safer places with
people out and about
Benefits of Physical Activity
Physical Activity Benefits
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Glasgow Schools Survey
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Sport, exercise and travel
• 4/5 report taking part in a sports club out of school
• Swimming, football, dance are most popular
• 51% used active travel methods to journey to school
• ¾ report owning a bicycle
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Level of walking remains high but trend towards greater car use and less walking over past 20 years
Some examples of schools with high levels of active travel despite pupils travelling longer that average distances
No difference by whether or not school has a travel plan
Cycling levels low – just over 2%- but ten times as many secondary pupils would like to cycle than do currently
Travel to School
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Best practice in planning for physical activity (NICE)
Identify groups of children and young people least likely to exercise at least 1 hour a day
Understand the factors that help or prevent them getting involved
Involve them in design, planning and delivery
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Mental health is important too
Widen awareness of mental health issuesMental health promotion considered in all
plans and service designsPromote value of positive environments and
activitiesStronger focus and leadership on physical
activity even in these times of austerity
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The challenges to mental health and wellbeing
High levels of child and family povertyMore likely to be admitted to hospital through assaultMore likely to be reported to the Children’s Panel through
violenceHigher rates of looked after and accommodated childrenLower rates of referral to social services as a result of concerns
(public or professionals)Worse school attendance Higher proportion of 16-19s not in education, employment or
training
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Psychosocial Crisis Stage Life Stage Virtue age range, other descriptions
4. Industry v Inferiority School Age Competency 5-12 yrs, early school
5. Identity v Role Confusion Adolescence Fidelity 13-18 yrs, puberty, teens*
6. Intimacy v Isolation Young Adult Love18-40, courting,
early parenthood
7. Generativity v Stagnation Adulthood Care 30-65, middle age, parenting
8. Integrity v Despair Mature Age Wisdom 50+, old age, grandparents
Erik Erickson’s Stages of Psychosocial Development
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Developmental Goals (6 to 12)
Ages 6 to 12To develop industry
Begins to learn the capacity to workDevelops imagination and creativityLearns self-care skillsDevelops a conscienceLearns to cooperate, play fairly, and follow social
rules
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Normal Difficult Behavior Ages 6 to 12
Arguments/Fights with Siblings and/or PeersCuriosity about Body Parts of males and femalesTesting LimitsLimited Attention SpanWorries about being acceptedLyingNot Taking Responsibility for Behaviour
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Cries for Help/More Serious IssuesAges 6-12
Excessive AggressivenessSerious Injury to Self or OthersExcessive FearsSchool Refusal/PhobiaFire Fixation/SettingFrequent Excessive or Extended Emotional
ReactionsInability to Focus on Activity even for Five MinutesPatterns of Problem behaviors eg property damage
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Adolescence
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Developmental Goals
Developing Identity-the child develops self-identity and the capacity for intimacyContinue mastery of skills
Accepting responsibility for behaviorAble to develop friendshipsAble to follow social rules
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Normal Difficult Behavior
Moodiness!Less attention and affection towards parentsExtremely self involvedPeer conflictsWorries and stress about relationshipsTesting limitsIdentity Searching/ExploringSubstance use experimentationPreoccupation with sex
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Cries for Help- Ages 13-18
Sexual promiscuitySuicidal/homicidal ideationSelf-mutilationFrequent displays of temperWithdrawal from usual activitiesSignificant change in grades, attitude, hygiene, functioning,
sleeping, and/or eating habitsDelinquencyExcessive fighting and/or aggression (physical/verbal)Inability to cope with day to day activitiesLots of somatic complaints (frequent flyers)
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Discussion
How do you make the distinction between the Concerning versus the Unconcerning?
Prevalence Quiz…..
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Prevalence Quiz
One in ten children between the ages of one and 15 has a mental health disorder.
(The Office for National Statistics Mental health in children and young people in Great Britain, 2005)
Estimates vary, but research suggests that 20% of children have a mental health problem in any given year, and about 10% at any one time.
(Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding The Lifetime Impacts, Mental Health Foundation, 2005)
Rates of mental health problems among children increase as they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged 11-15.
(Mental Disorder More Common In Boys, National Statistics Online, 2004)
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Prevalence Quiz
One in two LAC children between the ages of one and 15 has a mental health disorder.
(The Office for National Statistics Mental health in children and young people in Great Britain, 2005)
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Distress V Disorder
Mental Health Distress
Mental Health Disorder
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Mental Health Distress
Sadness
Anger
Worry
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Common Mental Health Disorders
Behavioural Problems (e.g. ADHD)
Anxiety and/or Phobias
Depression
Suicidal Thoughts and/or Self Harm
Everything else (Psychosis, Eating Disorders etc)
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Mental Health Distress
Distress is a normal human emotion and
reaction to sadness or suffering
Distress tends to disappear when the situation
is relieved or the stressor goes away
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Mental Health Distress can lead to a Disorder when:
The child has significant trouble with a stressful situation and his/her response is not appropriate
Problems do not go away when the stressful situation is resolved
The child cannot adapt to the stressful situation
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Resilience
A child with a mental health disorder does not necessarily have poor mental health.
When a child has strong character traits, they are able to build resiliency.
Resiliency is the ability to overcome challenges and stress in a way that promotes health and wellness.
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Community Sources of Resilience
One Good Adult –dependable, mentoring, guiding, befriending
Whole Team approach to mental health – ethos, curriculum, positive behaviour, anti-bullying
Network of Youth Services – confident, skilled and able to intervene
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Community Sources of Resilience
Guide to the ‘Service Maze’ – a range of supports and able to find quickly
Distress, Self Harm and Suicide Prevention –staff are confident, able to help those in distress, including self harm and risk of suicide
Peer Help and Social Media – young people who share their problems enjoy better mental health; use opportunities to use peer support and social media.
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Building Resilience
Focus on strengthsIdentify what they are good at, recognise it,
value it, celebrate it and build on it. Promote connectednessPositive impact of one supportive adult or one
adult who a child knows is thinking about them even when they are not there. For most children that will be a parent or carer but for some it may be a coach or volunteer.
Become better observersObservation is about noticing and reflecting on
behaviour (the visible spectrum) in order to understand what is going on in the areas of our experience that are hidden from others. This includes, but is not confined to, observing children’s behaviour.
Model emotional regulationThe last thing you need if you are a young
person who feels out of control and distressed is an adult who reacts to your high display of emotion with an equal level of anxiety and distress.
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Remember…You are not there to be the mental ‘disorder’ expertYour job is to support young people, not find labelsYou are a young person expertYou can be a witness to fact – listen, observe, be the
dependable adult, advocateEncourage help and support seeking
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“Comparative studies have demonstratedthat exercise can be as effectiveas medication or psychotherapy.”
Mental Health Foundation on depression (2010)
“Miracles are being achieved every day…Football groups are saving lives.”
Participant in Time to Change focus group, for football
and mental health project attendees (2011)
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"Working in football isn't always good for your mental health, but being physically active definitely is: that's why we're pleased to get behind SAMH's Get Active campaign".
Danny Lennon, manager at St Mirren
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“I worked in mental health for ten years… Out of all thethings that I did as a mental health worker, I found that thebenefits from football far outweighed anything else that I did.I could see the progress that people made by being involvedin a physical activity.”
Rob Thomas, Mental Health Lead, Everton in the Community