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National and local perspectives on population indicators for children and young people’s mental health in Scotland Dr Jane Parkinson Public Health Adviser, NHS Health Scotland and Dr Allyson McCollam Head of Health Improvement, NHS Borders Scottish Faculty of Public Health Conference Aviemore, 10th November 2011 www.healthscotland.com/scotlands-health/population/mental-health-indicators/children.aspx Presentation Overview • Background - aim and rationale • Process • Input from C&YP • Indicators – framework, data gaps • Issues and recommendations • Relevance to other policy agendas • Local perspective • Final and future steps Background - aim and rationale • National, sustainable mental health indicators for C&YP • TAMFS commitment 4 • MH profile – decision-making, policy development & accountability • Mental health = wellbeing and problems • Mental health state & associated contextual factors • National level but….. suitable for local use where applicable • Children and young people aged 0-17 (pre-birth, adults if impacts) • General population of children and young people Process • Built on adult experience • Mixed approach • Views of children and young people • Desirable set, data scoping, practical set, data gaps, new data • Modified adult indicators framework – consultation 2010 HIGH LEVEL CONSTRUCTS Mental wellbeing Mental health problems CONTEXTUAL CONSTRUCTS Individual Family • Supporting work • Expert advisory group Learning Env’ment Community Structural Children and young people’s input • Review of views on impacts on mental health, Shucksmith et al – largely agreed with content of draft framework – informed development of framework & indicators – limitation – some C&YP groups under represented or absent • Focus group consultation on draft framework – Elsley & McMellon – early years, BME, learning disabilities, carers, gypsy travellers, in care etc – framework largely endorsed but certain areas talked about less – strong emphasis on relations – some issues specific to individual groups – resource supplement indicators framework HIGH LEVEL CONSTRUCTS Mental wellbeing Mental health problems CONTEXTUAL CONSTRUCTS Individual Family Learning Environment Community Structural Learning and development Family relations Involvement Participation Equality Healthy living Family structure Peer & friend relationships Social networks Social inclusion General health Parental healthy living Educational environment Social support Discrimination Spirituality Parental health Pressure and expectations Trust Physical environment Safety Violence Emotional intelligence Life events Culture and values High Level • Mental wellbeing – Mental wellbeing some ages data-less – Life satisfaction – Happiness – Pro-social behaviour High Level • Mental health problems – Common mental health problems – Emotional and behavioural problems – Emotional symptoms – Conduct problems – Hyperactivity/inattention – Sadness – Alcohol dependency – Drug-related disorders – Suicide – Self-harm – Eating disorders Individual • Learning and development – Play – Readiness for school • Healthy living – – – – – Physical activity Healthy eating Obesity Alcohol, drug, cigarette consumption Sexual health • General health – Self-reported health – Long-standing & limiting long-standing illness • Spirituality, Emotional intelligence • Life events – Stressful life events – Adverse childhood experiences • Family relations – – – – – – – Parent-child relationship Nurturing adult Family meals Talking to mothers/fathers Treatment by parent(s) Parental discord Caring for family members Family • Family structure – – – – – Lone parent family Reconstituted family Contact with non-resident birth parent Teenage parents Parental imprisonment • Parental healthy living – Maternal smoking in pregnancy – Maternal alcohol/drug use in pregnancy – Parental problematic alcohol/drug use • Parental health – – – – Parental mental wellbeing/common mental health problems Post natal depression Parental alcohol dependency Parental limiting long-standing illness • Engagement with learning – Pre-school home learning environment – School attendance – Liking of school • Peer and friend relationships – – – – – – Early years friendships Close friends Relationship with best friend Peer relationships problems Acceptance by peers Experience of/participation in bullying • Educational environment – – – – – Treatment by teachers Relationship with teachers Relationship with all school staff Control at school School ethos • Pressures and expectations – – – – – Time pressures Choice of how to spend free time Pressure of school work Pressure to succeed Pressure to fit in Learning Environment Community • Participation – – – – Sense of agency Respect of children’s rights Influencing local decisions Participation in clubs, groups, or organisations • Social networks – Contact with peers • Social support – Social support • Trust – Neighbourhood trust – Community cohesion – Informal social control • Safety – Neighbourhood safety • Equality – Absolute/relative/persistent poverty – Income inequality • Social inclusion – – – – Structural Workless households, Homeless Positive and sustained destinations, Education, School exclusion Feeling lonely Looked after children, Additional support for learning • Discrimination – Discrimination and harassment – Perception of attitude of adults towards children and young people – Stigma towards children and young people • Physical environment – Neighbourhood satisfaction, Free time places – Greenspace – House condition, Overcrowding • Violence – Domestic abuse, Child protection – Neighbourhood violence • Culture – Perception of looks, Body image – Culture and values Key Issues • Data source limitations - disaggregation limited age coverage representativeness sustainability • What’s measurable v. what desirable – gaps in data coverage - all ages, especially early years - all areas, eg learning & dev’t, life events, maternity, discrimination, violence - suitable assessment tools • Raising awareness and Influencing data collection systems - SALSUS - WEMWBS • Maintaining links with other policy agendas • Evidence-base Recommendations • 43 recommendations – 38 data gaps • Ranking exercise - criteria – – – – – • advisory group ranking data improvement initiatives policy imperative ease of assessment – available methodology feasibility of introducing new data collection Classification – – – essential desirable and data initiatives to link with desirable, if future data improvement opportunity consider Links to other agendas • Scottish Government strategic outcome indicators • Getting it Right For Every Child (GIRFEC) • Curriculum for Excellence • Early Years Framework • Equally Well • Achieving Our Potential • Youth Justice Framework • Promoting Positive Outcomes • Skills for Scotland: A Lifelong Skills Strategy • Good Places, Better Health • Government Economic Strategy National Performance Framework - Greener Good Places, Better Health Sustainable Development indicators Scottish Government strategic outcome indicators Sustainable Sustainable development development Environmental National Performance Framework Safer and Stronger Social capital Volunteering justice Early years framework Anti-social behaviour Physical environment Maternal & Infant Nutrition Strategy Lifestyles Environment Safety, Trust Health Violence, Domestic abuse Mental Health/ Indicators Crime NPF Healthier Communities Mental health Physical health Education Social justice Equality Relationships Enterprise and lifelong learning Spirituality Discrimination Youth Justice Framework Skills and learning Social inclusion Rights of the child Debt National Performance Framework Wealthier and Fairer Long term indicators for health inequalities Employment Work place environment GIRFEC - SHANARRI Curriculum for Excellence Achieving Our Potential National Performance Framework - Smarter Equally Well Economic strategy – Learning, skills and wellbeing Final and Future steps • Final indicator set launch event 25th November 2011 • Dissemination and reporting on data • Potential wider use – Adults examples; • Local mental health profile • Strategic thinking • Mental health improvement outcomes framework • Strengthening the link to the determinants • SOAs • Future Contact details Dr Jane Parkinson – Mental health indicators Public Health Adviser, NHS Health Scotland [email protected] Allyson McCollam – Chair of the Advisory Group Head of Health Improvement, NHS Borders [email protected] Children and Young People’s Mental Health Indicators www.healthscotland.com/scotlands-health/population/mental-health-indicators/children.aspx WEMWBS www.healthscotland.com/scotlands-health/population/Measuring-positive-mental-health.aspx