AN INTEGRATED APPROACH TO MENTAL HEALTH

OR : THE ROLE OF SCHOOLS IN THE 21ST CENTURY

SARAH BRENNAN

OUTLINE

I want to argue that • The most effective interventions to support

social and emotional competence are ones that promote integration

• That integration starts with helping children to be their whole selves

• That individual programmes are pieces of a larger whole and that their impact is influenced by how well coordinated the larger context is

ABOUT YOUNGMINDS.... Leading national organisation promoting

children and young people’s good mental health:

Young people’s participation: VIK National Panel and consultation with over 3000 cyp

Parents’ helpline and support, over 7000 Training and Consultancy (schools work) Resources for professionals, parents and

young people Service development, Policy influencing and

campaigns

HOW MANY YOUNG PEOPLE NEED HELP? 850,000 children aged 5 – 16 years of age

have diagnosable mental health problem (2004 ONS)

Around 1 in 12 children and young people deliberately self harm (MHF 2006)

3 children in every classroom have a diagnosable mental health problem (Green H, McGinnity A, Meltze r H et al 2005)

Nearly 80,000 children and young people suffer sever depression (ONS 2004)

45% of children in care have a mental health disorder (Meltzer, Gatward, Corbin 2003)

EVERYBODY’S BUSINESS

“Anyone in contact with a child has an impact on that child’s mental health and psychological wellbeing. The challenge for all of us is to remember that and to be able to respond if things start to go wrong”.

Children and Young People in Mind; final report of the CAMHS Review 2008

NO HEALTH WITHOUT MENTAL HEALTH

“If we are to build a healthier, more productive and fairer society in which we recognise difference, we have to build resilience, promote mental health and wellbeing and challenge health inequalities. We need to prevent mental ill health, intervene early when it occurs and improve the quality of life of people with mental health problems and their families”

No health without mental health: a cross government mental health outcomes strategy for people of all ages. HM Government February 2011

CHILD CENTRED MODELS

• Are not the same as child focused• Start from where children and young people are –

from their lived experience - and look out from there• Challenge us to listen (with our eyes and ears) and

to reflect on, and act on, what we hear• Require us to build services around C&YP needs• Challenge us to understand behaviour as

communication and to remain curious about what is being communicated rather than leaping to conclusions

Education Education

Social Health SocialHealth

Care Care Housing Housing

Child Focussed Child Centred

WHAT CHILDREN & YOUNG PEOPLE TELL US

• Key points from the Manifesto: • Young people feel judged• Sense that family, friends and teachers

are scared of their illness• We need to talk about how we feel

inside• Teachers need to notice when we are

distressed at school• We need help early on not when its too

late

SARAH 14 A VIK MEMBER

Sarah was abused from a young age and bullied at school. She was excluded from the classroom because of her disruptive behaviour which made her feel unworthy, unwanted and bad.

In summary ‘Notice our distress and be helpful’

CHILDREN, SCHOOLS AND MENTAL HEALTH

• Children exist within the context of families, carers, peers, schools, communities and the wider society

• Mental health has its roots in relationships

• The solutions to mental health problems are similarly located in relationships

• A child centred approach has to work with all of that complexity

JAKE’S STORY.....

A MODEL OF CHILD MENTAL HEALTH

• A child’s wellbeing is the product of healthy individual development within a sympathetic environment

• Physical maturation is matched by the successful completion of cognitive, social and spiritual ‘tasks’ appropriate to each group

• This is empowered by good relationships with family, peers and community in a mutually reinforcing cycle

MENTAL HEALTH: A DEFINITION

‘the strength and capacity of our minds to grow and develop and to be able to overcome difficulties and challenges and to make the most of our abilities and opportunities’

YoungMinds 2006

PARENTS VOICES:

“We set up this resource because we had been struggling for four years with a child who was unable to attend school. During that period we were at extremes of relationships with her, and between ourselves.  We have been continually frustrated by the lack of co-ordinated support.  Individually, educators, health workers, social workers, psychologists and psychiatrists have all looked for a solution, but there was no co-ordination of effort.”

Victims of bullying 8% School refusal 6% Exclusions 3% Reading and writing difficulties 3% Perpetrators of bullying 1% Statementing problems 1% Academic pressure/exam stress 17%

41% of helpline calls linked to school-based issue in 2010

“He has not been to school for the past three months and no one is helping. They say I should just get him to school. I do try, but he just can’t, its difficult for him. He has panic attacks at home and when he gets to school he just lashes out. He screams, cries and has to be dragged in. How can I leave him in that state? It breaks my heart to see him like this. Everyone looks at us - looking shocked and horrified . The teachers think I am to blame. They think I can’t control my child think I just want to keep him at home like I am a bad parent. If only school had listened to me in the first place when I told them about the trouble I was having getting him to school, things would not have got so bad. It’s a very lonely experience and agonising being around people with normal kids. I just wished he was like other little boys who go to school”.

Mother of a 9 year old boy, with an anxiety based disorder.

17

“I am in no doubt that this school’s adaptable and very supportive approach will be the turning point on which our daughter’s future hinges. University is still some way off, as is independent living, perhaps. But we are making steady progress…”

“We are not good at sharing our anxieties about our children. We are prepared to extol their virtues – but not publicise their failings. As a result, it is difficult to identify options that may help us, as parents, cope and find solutions. “

A MENTALLY HEALTHY CHILD

A clear sense of identity, belonging and self worth

A sense of self efficacy - belief that what they do makes a difference

Motivational drive Ability to recognise, label and manage own

emotions Respect for the feelings of others – a ‘theory

of mind’

These things are the product of complex interactions between nature, nurture and events

A BIO-PSYCHO-SOCIAL MODEL

EVENTS (what happens to us)

NATURE (what we are born with)

NURTURE (what we grow up with)

A POSITIVE IMPACT ON MENTAL HEALTH

• Minimize Risk and• Build Resilience

INTERVENTIONS IN CONTEXT

• Interventions in school have to negotiate their way and find their place with school leaders, teachers, other school staff, children and parents

• Independent interventions interact with whole schools – with varying degrees of success

• The diversity of schools means that interventions will be diverse in their impact and their sustainability

SUCCESSFUL INTERVENTIONS

• Secure a place that is integral to what the school exists to do – its purpose

• Engage and empower children, parents and professionals

• Make explicit the impact on all e.g. How children’s mental health and staff mental health are intimately connected through their interactions

• Are developmental – doing, reflecting, learning and doing differently next time

THEORY INTO PRACTICE: YOUNGMINDS IN SCHOOLS

Action Learning project working with 4 clusters of schools in England

Setting up local steering groups of parents, teachers, local authority, mental health, community

Facilitating, resourcing and supporting those groups to establish whole school approaches for emotional wellbeing

IN CONCLUSION

Work from the child in distress as the starting point – child centred

Integrate services Support schools and school staff Schools vital as where children are – or

are not Build the relationships with parents and

with local communities and services

Whilst almost all of the support agencies did try to find a solution, nothing seemed to make a difference. We felt pushed and pulled by conflicting demands, not helped.....

WWW.YOUNGMINDS.ORG.UK