With children in mind

Citation

Coverdale, G. and Donovan, H. (2019), "With children in mind", Journal of Public Mental Health, Vol. 18 No. 1, pp. 1-3. https://doi.org/10.1108/JPMH-03-2019-080

With children in mind

We are delighted to be able to present this special edition for the Journal of Public Mental Health (JPMH) “With children in mind: current research and policy developments on mental health and young people”. As two nurses with a background in Specialist Community Public Health Nursing, Gill Coverdale as a School Nurse and Helen Donovan as a Health Visitor, we have a real passion for public health and the prevention of ill health, both physical and mental. We know how vital it is that one supports the other and there is indeed no physical health and well-being without mental and emotional health and well-being. Coverdale’s previous editorial in this journal, which highlighted the importance of well-being in children and young people (Coverdale, 2017), recently became the most popular downloaded article of JPMH and highlights the importance of this area of practice and work.

The Health and Social Care Act set out a commitment to achieve parity between mental health and physical health services, however, the reality is that people with mental health problems still struggle to access the care and services they need (Gilbert, 2018).

This edition presents a range of papers from both the UK and internationally which explore the importance of recognising mental health issues in young people and strategies to support and provide treatment interventions. What is increasingly important is that children and young people themselves are at the centre of any research or service development. The paper “More than just characters in a story” (MacSweeney) proposes a change in emphasis for truly involving young people as the authors and developers of research and services as being essential to achieve better outcomes.

The Government green paper (NAO, 2018) “Transforming Children and Young People’s Mental Health Provision” identifies that there will be 70,000 additional number of children and young people accessing mental health services per year by 2020–2021. The report states that there will be a need for an additional 3,410 people for the NHS children and young people’s mental health workforce by 2020–2021, with £1.4bn additional funding agreed for children and young people’s services 2016–2017 to 2020–2021. The challenge is to understand from where this workforce will come.

The report also examines whether the government is on track to meet its ambitions for children and young people’s services, taking the government’s 2015 strategy Future in Mind as the starting point. The report concludes that the laudable ambitions have not realised a tangible improvement programme or tangible visible activities. The authors caution that there is a long way to go, particularly as demand may be higher than originally thought, and an increased focus on mental health may uncover greater demand.

The proposals within the green paper (NAO, 2018) on the changes to the way children and young people’s mental health is managed are broadly welcome. The rationale behind the plans to have a designated mental health lead in every school supports Gill’s earlier research on promoting emotional well-being in children and young people (Coverdale and Long, 2015). We would caution, however; that this needs to be done alongside the school health services to make sure support is available across the system. With the increasing pressures faced by Child and Adolescent Mental Health Services, school nursing teams are able to continue to support troubled children and young people, their families and the schools through a range of interventions and provide links to the mental health teams. The importance of early recognition and subsequent intervention when a fairly normal and typical teenage stressor can turn into a crisis and a significant mental health issue can never be underestimated. School nurses are in a unique position with the skills to be able to do this and recognised as a valuable by young people (Department of Health, 2012).

The growing prevalence of mental health problems in children and young people and the evidence linking well-being, learning and academic achievement shows that mental health and well-being is a large part of school and needs to be addressed across all these areas. The paper “Supporting the mental health needs of young people: the spatial practices of school nurses” (Sherwin) discusses from a school nursing perspective how different types of space influence the support options available and that school nurses need to be more political and empowered to be able to offer what is needed. Providing this kind of support in schools is a core part of school nursing and public health nurses are clearly recognised as having the skills to do this (Donovan and Warriner, 2017). There is a growing awareness of the need for a multi-professional and societal approach from teachers and the wider community to be able to recognise early signs and potential issues to prevent more serious problems. This need for a whole school and societal approach is addressed in the paper “A review of school approaches to increasing pupil resilience: systematic review” (Joscelyne). There is a growing awareness that we need to ensure that this involves increasing skills and understanding in young people. The paper “Evaluating the peer education programme” (Edbrooke-Childs) explores the efficacy of a Peer Education Project, adding to the evidence to support this approach and the real need to develop skills and to build resilience within young people themselves.

Anxiety-related issues in young people are reported to be increasing (Guardian on Line; Sally Weal, 2018). In this special issue, the paper “Overthinkers, Attention-Seekers and Wallflowers: Peer Perceptions of Clinical Anxiety Disorders in Adolescence” (Hanlon) recognises that anxiety does not manifest as one set of symptoms or one condition but as a range of issues and challenges. There is relatively little research into the different types of anxiety and how these affect people. This paper provides some insight from a small study on the different ways anxiety presents.

Alongside work in schools it is, as ever, necessary to make sure there is ongoing support for the family. It is essential to recognise the risks for children and young people where there is any sort of family breakdown. Researchers from Indonesia have looked at the “Predictors of Loneliness among the Left-behind Children of Migrant Workers in Indonesia” (Faisal). This is not just about parents being absent to go to work, but being absent for long periods of time. In itself it is unsurprising that children experienced more loneliness when one parent is absent. What is of significance is the challenge it posed to children’s emotional resilience and the importance of being more susceptible of experiencing loneliness if they had more access to entertainment gadgets and less support and intimacy from friends, pointing out that social isolation was a key factor. The research identifies the need to think about the need to protect and support families.

For vulnerable children particularly where there is sexual exploitation there are clearly recognised risks of mental health problems that can last a lifetime. The paper “Providing support and therapy for victims and survivors of Child Sexual Exploitation” (Frost) looks at the challenge of getting sustained therapeutic interventions in place to support victims in the long term.

In the paper “Are the early benefits of the Adoption Support Fund (therapeutic support for adoptive families) sustainable?” (King) addresses the need for providing continued support for adoptive parents, acknowledging that adoption is not easy or straightforward and often adoption breaks down with further traumatic impact of the children and young people concerned. The Adoption Support Fund provides targeted support for potential adoptive parents, increases the number who will actually go on to adopt and reduces the number of adoption breakdowns.

There is a growing trend to report on well-being and happiness. The yearly indexes of global happiness from the UN and the OECD measures people’s own sense of satisfaction with their lives and as always the same clutch of Nordic countries come out as the happiest in the world. A recent report co-authored by the Happiness Research Institute (2018) provides a caution on this assumption that life in Scandinavia is “all bicycles and big smiles” and suggests the data masks hidden issues. While the reasons will inevitably vary from one individual and one country to another, the reality it seems is that stress, loneliness and feeling under pressure play a large part in unhappiness generally.

A recent online opinion piece in the Guardian (Gaga and Adhanom, 2018) asserts that in too many places mental health support services are non-existent. With the headline: “800,000 people kill themselves every year. What can we do?” they call for bold action stating that at present, every nation in the world is a “developing” country when it comes to mental health. They go on to assert that suicide is the most extreme and visible symptom of the larger mental health emergency that we are failing to address adequately. Stigma, fear and lack of understanding compound the suffering of those affected and prevent the bold action that is so desperately needed and so long overdue. What is concerning is that we know that young people are particularly vulnerable, with suicide being the second leading cause of death globally among 15–29 year olds. A viewpoint on suicide in young people (Caan) in this special issue further cautions that media reporting itself may possibly increase suicide behaviour, by providing sensational or inappropriate coverage.

The World Health Organisation has implemented the Global Mental Health Atlas, providing information from 177 countries on progress toward achieving the plan’s targets. The key issue is that greater and significant investment must be put in place to expand services that are seen to work. This takes us back to the importance of prevention of mental ill health and the promotion of emotional well-being and good mental health. The evidence synthesis promoting adolescents’ mental health and well-being (Kuosmanen) reviews a number of evidence-based interventions for adolescents delivered in schools communities and across digital platforms. The review supports the delivery of interventions which help raise the awareness of issues and improve young people’s social and emotional learning.

One of the key themes in this special issue is the importance for children and young people to have effective and meaningful relationships which help them to navigate through stresses and life expectations. These are through parents and wider family to schools and clubs and friendships.

We are delighted that we have engaged several authors in our quest to provide you, the reader, with an enjoyable and interesting special issue.