Can Sport improve Mental Health and Wellbeing of young people?

1. Can Sport improve Mental Health and Wellbeing of young people? Stephen McLeod Head of Specialist Children’s Services NHS Greater Glasgow and Clyde

2. Contents Definitions & Determinants Glasgow’s School Children – active and healthy? Young People’s development – what is normal? Distress V Disorder Resilience Actions

3. 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)

4. 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

5. The social determinants of mental health

6. ‘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

7. “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.

8. Screen time – computer games, surfing the net, social networking, smart phone and TV25% 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

9. Arts, culture and mental health Contribute to effective health education Contribute to therapeutic and relaxed environments in health services Develop creativity Improve quality of life Raise expectations of what is possible and desirable …plausible link to mental health outcomes but more research required

10. Benefits of Physical Activity • Environmental • Reduces traffic congestion • Reduces air pollution • Reduces greenhouse emissions • Reduces noise pollution • Creates safer places with people out and about • Social • Encourages family/community connectedness • Improves social skills/networks • Prolongs independent living for older people • Reduces isolation, loneliness • Enhances self-esteem, confidence Physical Activity Benefits • 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

11. Glasgow Schools Survey

12. 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

13. Travel to School 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

14. 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

15. Mental health is important too Widen awareness of mental health issues Mental health promotion considered in all plans and service designs Promote value of positive environments and activities Stronger focus and leadership on physical activity even in these times of austerity

16. The challenges to mental health and wellbeing High levels of child and family poverty More likely to be admitted to hospital through assault More likely to be reported to the Children’s Panel through violence Higher rates of looked after and accommodated children Lower 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

17. Erik Erickson’s Stages of Psychosocial Development

18. Developmental Goals (6 to 12) Ages 6 to 12 To develop industry Begins to learn the capacity to work Develops imagination and creativity Learns self-care skills Develops a conscience Learns to cooperate, play fairly, and follow social rules

19. Normal Difficult Behavior Ages 6 to 12 Arguments/Fights with Siblings and/or Peers Curiosity about Body Parts of males and females Testing Limits Limited Attention Span Worries about being accepted Lying Not Taking Responsibility for Behaviour

20. Cries for Help/More Serious IssuesAges 6-12 Excessive Aggressiveness Serious Injury to Self or Others Excessive Fears School Refusal/Phobia Fire Fixation/Setting Frequent Excessive or Extended Emotional Reactions Inability to Focus on Activity even for Five Minutes Patterns of Problem behaviors eg property damage

21. Adolescence

22. Developmental Goals Developing Identity-the child develops self-identity and the capacity for intimacy Continue mastery of skills Accepting responsibility for behavior Able to develop friendships Able to follow social rules

23. Normal Difficult Behavior Moodiness! Less attention and affection towards parents Extremely self involved Peer conflicts Worries and stress about relationships Testing limits Identity Searching/Exploring Substance use experimentation Preoccupation with sex

25. Cries for Help- Ages 13-18 Sexual promiscuity Suicidal/homicidal ideation Self-mutilation Frequent displays of temper Withdrawal from usual activities Significant change in grades, attitude, hygiene, functioning, sleeping, and/or eating habits Delinquency Excessive fighting and/or aggression (physical/verbal) Inability to cope with day to day activities Lots of somatic complaints (frequent flyers)

26. Discussion How do you make the distinction between the Concerning versus the Unconcerning? Prevalence Quiz…..

27. 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)

28. 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)

29. Distress V Disorder Mental Health Distress Mental Health Disorder

30. Mental Health Distress Sadness Anger Worry

31. 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)

32. 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

33. Mental Health Distress canlead 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

34. 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.

35. 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

36. 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.

37. Building Resilience Focus on strengths Identify what they are good at, recognise it, value it, celebrate it and build on it. Promote connectedness Positive 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 observers Observation 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 regulation The 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.

38. Remember… You are not there to be the mental ‘disorder’ expert Your job is to support young people, not find labels You are a young person expert You can be a witness to fact – listen, observe, be the dependable adult, advocate Encourage help and support seeking

39. “Comparative studies have demonstrated that exercise can be as effective as 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)

40. "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

41. “I worked in mental health for ten years… Out of all the things that I did as a mental health worker, I found that the benefits from football far outweighed anything else that I did. I could see the progress that people made by being involved in a physical activity.” Rob Thomas, Mental Health Lead, Everton in the Community