Children and Adolescent Mental Health

1. Children and Adolescent Mental Health Session 4 – An overview of a key Mental Health Disorder in Children October 18th, 2011

2. 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.

3. Placement Task Task 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.

4. 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).

5. Importance of Emotional Health and Wellbeing in Schools • New 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)

6. Some Common Mental Health Disorders… • Depression • Anxiety • Behaviour disorders • Attention deficit hyperactivity disorder. • Eating Disorders • Self Harm • Drug abuse • Bullying

7. Depression • It 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 enjoyed • Fatigue or low energy • Associated symptoms • Difficulty sleeping or oversleeping • Feelings of worthlessness • Thoughts of death or suicide. • Difficulty concentrating • Guilt or self-blame

8. What is it? Steven Fry explains Diagnosis and Stigma Depression and Drug Use

9. Depression in Children • Very 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.

10. Differences between Adult and Teen Symptoms • Irritable 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.

11. 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.

12. Risk Factors • Family Discord • Bullying • Physical, sexual or emotional abuse • History of parental depression • Ethnic and cultural factors • Refugee status • Living in institutional settings.

13. 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.

14. 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 behaviour • Promote 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

15. 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.

16. 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.

17. 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.’

18. 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.

19. 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