Editorial

Citation

Caan, W. (2018), "Editorial", Journal of Public Mental Health, Vol. 17 No. 2, pp. 49-50. https://doi.org/10.1108/JPMH-06-2018-073

A “Good Start in Life” can underpin lifelong mental wellbeing. The first JPMH issue of 2019 will be a special issue, “With children in mind: current research and policy developments on mental health and young people”, edited by Helen Donovan and Gill Coverdale (31 July 2018 is the deadline to submit a manuscript for this). In the hope of inspiring readers to make expert, international contributions to the special issue, I am focusing this editorial on some examples of current research and policy, in this country.

In this journal, the nature and promotion of resilience has been a frequent theme (e.g. Caan, 2016). I am indebted to the Association for Young People’s Health (2016) for their youth perspectives on resilience. This year, mental health promotion figured in several contributions to the 10th Anniversary Conference of the Association for Young People’s Health in London on 21 February 2018. Research presentations on the StreetGames national sport pilots and the Redthread violence intervention by youth workers were especially impressive. This inter-disciplinary meeting took place against the current policy background of a “green paper” for England on Transforming Children and Young People’s Mental Health Provision (Department of Health and Department for Education, 2017). A consultation on this cross-departmental policy is still underway as I write this, but will finish shortly (Hunt, 2018).

Readers from many countries will relate to current problems in England, around under-funding of care for the population with mental illness (Royal College of Psychiatrists, 2018). Here, increased demand for clinical care is predicted to rise by about a million persons per decade (Caan, 2017). Only widespread social policy interventions to address the determinants of mental health can prevent such a tide of misery (and prevent services being overwhelmed). One possible area for policy innovation was shown by a book launch on 8 February 2018 in Parliament. This book was a comprehensive report on Addressing Adversity (Bush, 2018). Adversity can take many forms, but cumulative childhood adversity becomes a strong predictor of developing mental illness. Bush (2018) identifies eight personal, structural and environmental factors that protect against mental problems, for example “access to a wider, supportive and understanding community”. For school age children, their school “community” is a good starting point for prevention. In theory, mental wellbeing should be covered in schools during personal, social, health and economic education (PSHE) sessions. However, in most English schools the educational “reforms” have fractured the system and currently PSHE is neither mandatory nor quality assured.

I am most grateful to the Westminster Education Forum, for their seminar held on 8 February 2018 in London: “Preparing for implementing compulsory relationships and sex education in schools”. In particular I liked the expression of one speaker, the Teacher Laura Foley, that staff need to be trained for “purposeful PSHE”. Overall, there was a consensus that thriving in childhood was built on a variety of positive relationships. Effective PSHE needed to link with safeguarding duties (protecting vulnerable children) and school nursing (healthcare) roles. This made co-ordinated workforce planning necessary, across both education and health sectors (see Merrifield, 2018). There was a need to recognise both current adversity (like bullying) and also that some children had previously experienced traumatic events. To develop better community practice would, of course, require the inclusion of young people and parents!

For some adults including parents, it is difficult to see with a young person’s perspective, but at present in the UK, many adolescents report being victimized over their appearance (Siddique, 2018). In our era of mass communication and online bullying, social policy needs to address problems around body image (and vulnerable self-esteem) across the young population.

In addressing adversity, resilience refers to patterns of positive adaptation in the context of significant risk or adversity (Ungar, 2018). It seems that the local context can influence the elements that build up resilience. This week I took part in a training event for improved community resilience, around the county of Essex. We learned lessons about young people who experienced a massacre at a pop concert, and other young people who witnessed an appalling fire with multiple casualties. Crucially, the response by services needs to be prompt, local and respectful to young people. Professional responders, volunteers and mutual aid groups can all bring something valuable to the community affected. Chaos or competition can develop when very different groups work under pressure with a small, unfamiliar community, but future Public Health training should include skills to develop harmony between such responders. Recent re-organisation of the Department of Health and Social Care offers a unique opportunity. With a “Public Health” understanding of population health and of changing behaviour, the urgent appeal of NHS England (2018) to harmonise care from the National Health Service and from Local Government, could be realised—one community at a time.

Sometimes early adversity is not as visible as the blazing fire in which 72 neighbours were seen to perish. In Parliament on 13 February 2018 another meeting looked at the consequences of children growing up with an alcoholic parent (Parliamentary Office of Science & Technology, 2018). Left unrecognised and unsupported, that sort of invisible childhood adversity can cast a long shadow on adult health. However, the consensus of the meeting was that a culture of openness, backed up by research evidence, was starting to guide the development of new policies. Not only was a new light being shone on previously unrecognised children—the benefits of improved support, now, might extend to future generations.

Adversity avalanche

Too much, too soon,

Problems can overflow:

Too little, too late,

Services come to know.

Search high, search low,

Before lives sink, in snow.

Hear cries, clear paths,

And young minds, still, may grow.