Download What is Mental Health?

INTRODUCTION TO CHILDREN & YOUNG
PEOPLE’S MENTAL HEALTH & WELLBEING
Cumbria County Council
YOUNGMINDS
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Parents Helpline: 0808 802 5544
Tel: 020 7089 5050
Website: http://www.youngminds.org.uk and
Publications
Training & Development:
[email protected]
LEARNING OBJECTIVES
You will be able to:
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Describe conceptual models for thinking about mental
health, mental health problems and disorders in C&YP
Briefly describe theories and research relating to;
attachment and brain development and explore their
relevance to your area of practice
Explore your own perspectives on children and young
people’s mental health and emotional wellbeing and
establish a foundation for further learning
THE MENTAL HEALTH SPECTRUM
From: Huppert Ch.12 in Huppert et al.
(Eds) The Science of Well-being
Flourishing
Moderate
mental
health
Languishing
Mental
disorder
Number of symptoms or risk factors
EFFECT OF SHIFTING THE MEAN OF THE MH SPECTRUM
From: Huppert Ch.12 in Huppert et al.
(Eds) The Science of Well-being
Flourishing
Moderate mental
health
Languishing
Mental disorder
Number of symptoms or risk factors
MENTAL HEALTH: A DEFINITION
‘the strength and capacity of our minds to grow
and develop, to be able to overcome difficulties
and challenges and to make the most of our
abilities and opportunities’
YoungMinds 2006
CHILD MENTAL HEALTH
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A capacity to enter into, and sustain, mutually satisfying and
sustaining personal relationships
Continuing progression of psychological development
An ability to play and to learn so that attainments are
appropriate for age and intellectual level
A developing moral sense of right and wrong
A degree of psychological distress and maladaptive
behaviour within normal limits for the child’s age and
context
AN INTEGRATIVE APPROACH
THINKING
BEHAVIOUR
FEELING
Prevalence among children
aged 5 – 15 in the UK
Risk factors
but no obvious
problems now
Mental health
problems
3 million or
20%
1.5
million
or 10%
Mental or
psychiatric
disorder
30,000 or
0.2%
Severe disorder or
mental illness
MOST COMMON PROBLEMS
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Emotional and conduct disorders are by far the
most common
Co-morbidity is the norm not the exception
Children who face 3 or more stressful life
events (eg bereavement, divorce, serious
illness) are 3 times more likely than other
children to develop emotional and behavioural
disorders
PROBLEMS & DISORDERS
Mental health problem
A disturbance of function in one area of;
relationships, mood, behaviour or development, of
sufficient severity to require professional
intervention.
Mental disorder
A severe problem (commonly persistent) or the cooccurrence of a number of problems, usually in the
presence of several risk factors
A BIO-PSYCHO- SOCIAL
MODEL
NATURE
EVENTS
NURTURE
RISK AND PROTECTIVE FACTORS
Risk Factors
Protective
Factors
WHAT ARE RISK FACTORS?
Conditions, events or circumstances that are known
to be associated with emotional or behavioural
disorders and may increase the likelihood of such
difficulties
Risk is cumulative
Risk is not causal but can predispose children to
mental health problems
PREDISPOSING FACTORS - CHILD
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Genetic influences
Low IQ and learning disability
Specific developmental delay
Communication difficulty
Difficult temperament
Physical illness, especially if chronic and/or
neurological
Academic failure
Low self-esteem
PREDISPOSING FACTORS - FAMILY
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Overt parental conflict
Family breakdown
Inconsistent or unclear discipline
Hostile and rejecting relationships
Failure to adapt to child's changing developmental needs
Abuse - physical, sexual and/or emotional
Parental criminality, alcoholism & personality disorder
Parental psychiatric illness
Death & loss - including loss of friendships
PREDISPOSING FACTORS - ENVIRONMENT
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Socio-economic disadvantage
Homelessness
Disaster
Discrimination
Other significant life events
“can resist adversity,
cope with uncertainty
and recover more
successfully from
traumatic events or
episodes”
Newman, T (2002)
RESILIENT CHILDREN
RESILIENCE
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Normal development under difficult circumstances. Relative
good result despite experiences with situations that have
been shown to carry substantial risk for the development of
psychopathology (Rutter)
The human capacity to face, overcome and ultimately be
strengthened and even transformed by life’s adversities and
challenges .. a complex relationship of psychological inner
strengths and environmental social supports (Masten)
Ordinary magic .. In the minds, brains and bodies of
children, in their families and relationships and in their
communities (Masten)
FINDING RESILIENCE IN ME
Think of a time in your life when you have
struggled to cope with emotional difficulties
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What did you think?
How did you feel?
What actions did you take?
FINDING RESILIENCE IN ME
Talk to family or friends
• Sleep
• Eat
• Walk away, take time out
• Counselling
• Educate self about situation
• Laugh
• Throw self into new stuff
• Seek company – or solitude
• Realise you have choices
• Use own skills positively
• Relate to past experience
• Break into manageable bits
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Peer support
• Positive feedback
• Retail therapy
• Chocolate
• Self expression
• Diary writing
• Spend time with animals
• Take time for yourself
• Spirituality
• Exercise
• Focus on work
• Meditation
• Medication
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RESILIENCE IN THE CHILD
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being female
secure attachment experience
an outgoing temperament as an infant
good communication skills, sociability
planner, belief in control
humour
problem solving skills, positive attitude
experience of success and achievement
religious faith
capacity to reflect
RESILIENCE IN FAMILIES
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At least one good parent-child relationship
Affection
Clear, firm consistent discipline
Support for education
Supportive long term relationship/absence of
severe discord
RESILIENCE IN COMMUNITIES
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Wide supportive network
Good housing
High standard of living
High morale school with positive policies for
behaviour, attitudes and anti-bullying
Schools with strong academic and non-academic
opportunities
Range of sport/leisure activities
Anti-discriminatory practice
WAY ATTACHMENT DEVELOPS
need
relaxation
trust
security
attachment
satisfy
need
arousal - relaxation cycle
high
arousal
SECURE ATTACHMENT
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Is associated with;
Emotional regulation and containment of anxiety
Capacity to tolerate uncertainty
Trust, adaptability, hope and belonging
The child’s ‘internal working model’
The child’s capacity to mentalize
“A securely attached child is likely when faced with potentially
alarming situations .... To tackle them effectively or seek help in
doing so”
J Bowlby (1980) Attachment and loss Vol 3
INSECURE ATTACHMENT
Children whose needs have not been
adequately met see the world as;
‘comfortless and unpredictable and they
respond by either shrinking from it or doing
battle with it.’
John Bowlby (1973) Attachment and loss Vol 2
AVOIDANT ATTACHMENT
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Caregiver subtly or overtly reject child’s attachment needs
at time of stress
Bids for comfort will be rebuffed
Child keeps his/her attention directed away from their
caregivers in an effort not to arouse anxiety and
frustration
Child is in control because of the need for self reliance
Comfort self rather than accept it from others
AMBIVALENT (OR ANXIOUS) ATTACHMENT
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Caregiver will be inadequate at meeting child
attachment needs (caregiver is passive,
unresponsive and ineffective)
Child’s strategy is to amplify attachment needs and
signals in an effort to arouse a response (verbal and
behavioural: bubbly affection to rage, anger, panic
and despair. All experienced as controlling)
Unlovable and helpless selves & unpredictable and
withholding others.
DISORGANISED ATTACHMENT
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Child experiences the carer giver as ‘the source of alarm
and its only solution’.
Child in these circumstances is unable to be guided by
their mental model of the world because it offers few
directions.
Frightened, helpless, fragile and sad
At risk of mental health problems or anti-social
behaviour
POSITIVE BRAIN DEVELOPMENT
The way a child is stimulated shapes the brain’s
neurobiological structure. Experience has a direct
impact on a child’s capacity for learning, developing
and relating as a social being.
EARLY BRAIN DEVELOPMENT
At birth the brain is 25% of its adult weight - by the age of 2
this has increased to 75% and by age 3 it is 90% of adult
weight – but this is not about new neurons
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This growth is largely the result of the formation and ‘hard
wiring’ of synapses (700 new neural connections every second
for the first few years)
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Babies brains are both ‘experience expectant’ and
‘experience dependent’
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FEELING AND THINKING
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Circuits involved in the regulation of emotion are
highly interactive with those associated with ‘executive
functions’ which are intimately involved in the
development of problem solving skills
Well regulated emotions support executive functions
Poorly regulated emotions interfere with attention and
decision making
THE LEARNING YEARS: 5-10
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Synaptic pathways that are regularly used are
reinforced. This is the basis of learning.
Reinforcement leads to increasingly permanent
neurological pathways.
Neural connections needed for abstract reasoning
are developed
Motor skills are refined
A child learns through interacting with the world
and making meaning out of it
ADOLESCENT BRAIN DEVELOPMENT
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Brain development continues up to at least the age of
20
There is a significant remodelling of the brain in
adolescence, particularly the frontal lobes and
connections between these and the limbic system
The frequency and intensity of experiences shapes
this remodelling as the brain adapts to the
environment in which it is functioning and becomes
more efficient
EMOTIONAL FUNCTIONING IN ADOLESCENCE
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There is a mismatch between emotional and cognitive
regulatory modes in adolescence
Brain structures mediating emotional experiences
change rapidly at the onset of puberty
Maturation of the frontal brain structures
underpinning cognitive control lag behind by several
years
Adolescents are left with powerful emotional
responses to social stimuli that they cannot easily
regulate, contextualise, create plans about or inhibit
THE TRIUNE BRAIN
The Neo-cortex – associated with executive function
- is the last to mature
TRAUMATIC STRESS
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The automatic response to trauma, involving the
production of toxic amounts of stress hormones which
affect:
Brain function
All major body systems
Social functioning
A bio-psycho-social injury
IMPACT OF TRAUMA
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In the face of interpersonal trauma, all the systems of
the social brain become shaped for offensive and
defensive purposes. A child growing up surrounded by
trauma and unpredictability will only be able to
develop neural systems and functional capabilities
that reflect this disorganisation.
Source: National CAMHS Support Service, Everybody’s Business
EFFECTS ON BRAIN DEVELOPMENT AND FUNCTION
These functions may be diminished or lost:
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Language, especially spoken language
Words for feelings
Sense of meaning and connection
Empathy
Impulse control
Mood regulation
Short term memory
Capacity for joy