Health Professional 2

Mental health professionals

In this section Youthspace provide information for professionals who work with young people in mental health and well-being settings.

One in ten children aged between 5 and 16 years has a clinically diagnosable mental health problem.

 

Youth Mental Health – a Public Health Priority

Resilience and Emotional Well-being

Barriers to Accessing Support and Care

Online Services and Digital Technologies

Meeting Staff Training Needs

Where Public Health and Emotional Well-being Meet

Financial Benefits of a Preventative Approach in Mental Health

Summary

Tools and Resources


Youth Mental Health – a Public Health Priority

For anyone working professionally with young people – mental health and emotional wellbeing is always going to be relevant – and it is vital that staff feel confident and aware of the basics in relation to young people’s developmental and emotional experiences. The Childrens & Young Peoples Report (2012) summarised that rationale as to why focusing on working with young people’s mental health and wellbeing needs is so vital:

■ One in ten children aged between 5 and 16 years has a clinically diagnosable mental health problem. About half of these (5.8%) have a conduct disorder, 3.7% an emotional disorder (anxiety, depression) and 1–2% have severe Attention Deficit Hyperactivity Disorder (ADHD)

■ At any one time, around 1.2–1.3 million children will have a diagnosable mental health disorder

■ Half of those with lifetime mental illness (excluding dementia) first experience symptoms by the age of 14, and three-quarters before their mid-20s

■ The rates of disorder rise steeply in middle to late adolescence. By 11–15 it is 13% for boys and 10% for girls, and approaching adult rates of around 23% by age 18–20 years

■ Self-harming in young people is not uncommon (10–13% of 15–16-year-olds have self-harmed) but only a fraction of cases are seen in hospital settings

■ Although effective treatments are available only around 25% of those who need such treatment receive it

■ 11–16 year olds with an emotional disorder are more likely to smoke, drink and use drugs

■ Around 60% of Looked After Children and 72% of those in residential care have some level of emotional and mental health problem.5 A high proportion experience poor health, educational and social outcomes after leaving care

■ Looked After Children and care leavers are between four and five times more likely to attempt suicide in adulthood

■ One third of all children and young people in contact with the youth justice system have been looked after. It is also important to note that a substantial majority of children and young people in care who commit offences had already started to offend before becoming looked after

■ Young people in prison are 18 times more likely to take their own lives than others of the same age

■ The costs of mental health problems for the English economy have recently been estimated at £105 billion pa

■ Children of teenage mothers are generally at increased risk of poverty, low educational attainment, poor housing, poor physical and mental health, and have lower rates of economic activity in adult life

■ Young people in prison are 18 times more likely to take their own lives than others of the same age

Resilience and Emotional Well-being

Youthspace will be introducing a series of articles on Resilience and Emotional Well-being over the coming months to introduce the most recent thinking and research findings on this important topic.

 "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (World Health Organisation)

Resilience is…

...the ability to bounce back from a negative experience.

…achieving positive outcomes despite challenging or threatening circumstances.

…a broad conceptual umbrella relating to positive adaption (Masten & Obradovic 2006).

''There is no such thing as an 'invulnerable child' who can overcome any obstacle or adversity that she encounters in life. Resilience is not a rare and magical quality. In fact it is quite common'’ (Masten., 2001).

The primary factor in resilience is having positive relationships inside or outside one’s family. It is the single most critical means of handling both ordinary and extraordinary levels of stress.

Barriers to Accessing Support and Care

It is widely understood that current statutory service provision for young people is missing up to 65% of all those experiencing mental disorder at the time problems are first emerging and are unlikely to be able to match the actual need with current resource levels (Kauer et al., 2014). Additional factors that act as barriers to care for young people include stigma, access and location of services and young people relying on peers and family for support with their difficulties rather than contacting professional sources of support. Poor mental health literacy (Jorm et al 2006) reduces the likelihood of identifying symptoms of disorder,(Barnley at al; 2006; Jorm et al; 2007) and there is much work to be done in increasing access to reliable education information and training for all staff who work with young people. There is some evidence that providing alternative sources of information and support such as online and anonymised services may enable more individuals to find the help they need when they need it and we provide information on some of the online support that may be helpful.

Online Services and Digital Technologies

Online services provide an alternative for many young people who prefer to retain autonomy and anonymity in coping with difficulties and the easy access to internet resources and wide availability of online counseling education and advice make this a more palatable option for many young people. What is less clear is how effective such online services are, and whether there is sufficient evidence of uptake and adherence to programmes to invest in these modes of service provision.

Although it can’t yet be said that young people and their families have universal access to the internet – especially for socio-economically deprived areas – population access is increasing every year. According to a recent survey (emarketer april 2013) the current percentage of UK teens using smartphones – 81% - could rise to as high as 96 per cent by 2017 (higher than the US where currently 70 percent of teens aged 13 to 17 now use smartphones, and 79 percent of young adults between the ages of 18 and 24 own a smartphone – Nielsen). This gives a tremendous opportunity to engage with many young people who may not necessarily actively help-seek via statutory services alongside those who do.

How can Digital Technologies help?

Virtual health spaces such as internet websites can be particularly useful for hard to reach groups who are reluctant to engage with the formal healthcare system or for patients who have stigmatising conditions as they provide a more anonymous and  less threatening environment (Brohan et al, 2010; HM Government 2011) . They allow information to be disseminated to a wide audience and lay people to inform themselves about and evaluate symptoms to help trigger appropriate consultation and on-going management of chronic disease (Andersen & Svensson, 2011). Because of their interactive nature they give patients the opportunity to become part of an on-line community of others with similar medical conditions (Baker & Fortune, 2008). Information providers can also get some feedback about who is accessing their website and how their health messages are being received.  Previous findings show that many individuals are facing logistical and emotional barriers to seeking help in person from conventional professional sources. This indicates a level of unmet need that online cCBT and similar programmes could potentially be effective in engaging with.

Young People and Online Support for Mental Health

Young people of the current generation are brought up as digital technology natives and almost all will learn to employ internet based tools early in their educational and social lives. Online technologies have permeated every aspect of healthcare over the past two decades and increasing access to interactive technologies such as tablets and smartphones suggests the necessity for any health care provider to integrate digital education, training and intervention resources wherever possible. Sources such as the Young and Well Cooperative Research Centre in Australia have been increasing the evidence base which is consistent in stating that digital technologies are key to provide some of these prevention and intervention ‘wrap around’  to current service provision. This literature suggests:

 -  An emerging evidence base for the role of digital technology as a protective factor in the promotion of mental health and the prevention of mental ill health.

 - Growing evidence as to the potential risks that new technologies can have, especially when their role and significance is not explored in the home and school environment.

 - Evidence that digital technology can be important in young people’s mental wellbeing, and that some of the most excluded and potentially at risk young people can have some of the most to gain.           

 -  Evidence that those young people most at risk in an offline world are also those most at risk online.

What are the Digital Technology Options and do they work?

Services can be divided into universal educational programmes generally at the primary care level and targeted interventions that can complement face to face service provision.

Universal programmes include those aimed at provide information on mental health literacy (ie signs, symptoms of mental disorder and knowledge of care pathways) and those promoting positive mental health and resilience to stress.

Targeted approaches can be applied at every stage of development from early mother and child educational programmes to more late adolescent / adult oriented programmes (e.g. MoodGym for depression). There are also blended approaches which have elements of peer support, online access to counselors alongside internet based mental health resources allowing greater flexibility with access times and location (e.g. Kooth; Mindfull; Big White wall).  Smart Phone and Tablet based Applications (Apps) are increasingly proving potentially helpful responses to niche problems and many are available through NHS websites.

A review by Postel et al. (2008) demonstrates the widespread nature of e-therapy. They report on fourteen papers describing RCTs of e-therapy interventions. The use of the internet is ideal for treating mental health difficulties given the anonymity and ease of access; the literature widely acknowledges that the internet represents a suitable platform for treatment delivery because of the stigma associated with mental health difficulties.

Good evidence exists that technologies can be used effectively to improve mental health and wellbeing (Griffiths, Farrer & Christenssen 2010; Spek et al. 2007), especially among young people (Ryan, Schochet & Stallman 2010; Christensen & Hickie 2010; Burns et al. 2010).  Many examples of digital technologies for mental health can be found listed at the end of this report.

Risks and Benefits of Adopting Digital Technologies in Healthcare

A recent survey of 1,024 11 to 16-year-olds from across the UK by the NSPCC found that almost one in five children who use social networking sites suffered a negative experience last year including bullying, unwanted sexual messages, cyber stalking and feeling pressure to ‘look a certain way’.

The NSPCC also reported that a "large number" of users of Facebook, Twitter and YouTube were under the minimum age of 13. The survey also showed that the most common bad experiences among children were bullying and trolling.

There are many sources of information available on the internet and it can be difficult to ascertain the source and reliability of much of the information available. Some websites can appear to encourage negative behaviours such as self-harming and general advice can be variable. Trust in health information sources is related to demographic variables; young adults aged 18 to 34 years were more than 10 times as likely, and adults aged 35 to 64 years were more than 5 times as likely, as those 65 years or older to report a lot or some trust in the Internet. As part of the development of the Youthspace.me website service users requested the retention of the NHS logo as it was associated with a ‘trustable’ source of information.

Meeting Staff Training Needs

In addition to more focused psychological interventions, the use of engaging and interactive blended modules for training purposes can greatly enhance capacity to roll-out specific elements or a new model or maintain fidelity of approach across or between services in varied locations. If training provision is accompanied by real-time feedback from those trained – the ability to update and tweak training materials and focus is enable keeping the service relevant and appropriate.

Much of the function of staff and community training could feasibly and appropriately be carried out by a service-user led and supported groups such as the Youthspace youth board – who have already been instrumental in designing and providing training platforms for staff with differing roles and designations.

Where Public Health and Emotional Well-being Meet

 There has been a lot of recent interest in how emotional resilience and wellbeing and mental health interventions can be linked into a complementary system of support and interventions for young people – Public Health England and The Royal College of Psychiatry have been promoting such approaches for some time.  The JCPMH  Public Health Commissioning Guidance suggest how linking prevention and intervention strategies can be beneficial:

1 Primary prevention aims to prevent ill health happening in the first place by addressing the wider determinants of illness and using ‘upstream’ approaches that target the majority of the population

2 Secondary prevention involves the early identification of health problems and early intervention to treat and prevent their progression

3 Tertiary prevention involves working with people with established ill health to promote recovery and prevent (or reduce the risk of) recurrence.

Similarly, promotion can also occur at three levels:

1 Primary promotion involves promoting the health and wellbeing of the whole population

2 Secondary promotion involves targeted approaches to groups at higher risk of poor health and wellbeing

3 Tertiary promotion targets groups with established health problems to help promote their recovery and prevent recurrence.

Health promotion interventions target the determinants of health and well-being rather than illness itself. They can take place at an individual, community or structural level.

Financial Benefits of a Preventative Approach in Mental Health

A recent DoH report estimated cost savings for public mental health interventions (Knapp et al 2011) and found that for every £1 invested, the net savings were:

• £84 saved – school-based social and emotional learning programmes

• £44 saved – suicide prevention through GP training

• £18 saved – early intervention for psychosis

• £14 saved – school-based interventions to reduce bullying

• £12 saved – screening and brief interventions in primary care for alcohol misuse

• £10 saved – work-based mental health promotion (after 1 year)

• £10 saved – early intervention for pre-psychosis

• £8 saved – early interventions for parents of children with conduct disorder

• £5 saved – early diagnosis and treatment of depression at work

• £4 saved – debt advice services.

Summary

There has never been a better time for Public Health planners to align with mental health, social care and statutory education providers to apply a best practice model in which mental health promotion, mental illness prevention and mental disorder intervention knowledge can be applied across key developmental milestones in maintaining positive mental health. The understanding of mental health as a distinct and key health topic deriving from the literatures of emotional wellbeing (state) and resilience (health enhancing behaviours) adds great potential for improving  the efficacy of youth mental health services by embracing active education and training alongside digital modes of delivery and evaluation – a holistic approach.

Tools and Resources

Check out our extensive list of information and downloadable Youthspace leaflets in the Resources section. We also have compiled detailed descriptions of Antidepressants, Mood Stabilisers, Antipsychotics and Tranquillisers; helpful for clinicians and clients alike.

Youthspace have compiled a table of Resilience Programmes for young people, which adopt both digital and face to face elements.

NHS Apps The first public release of the NHS Health Apps Library was launched in March 2013 - making it simple for you to you to easily find safe and trusted apps to help you manage your health. These have been reviewed by the NHS to ensure they are clinically safe and relevant to people living in England. http://apps.nhs.uk/about/

Mindtech is based in Nottingham and is a new digital R&D technology support centre applying stringent research and evaluation to product development  http://www.mindtech.org.uk/

MindEd is a set of online tools and resources to support mental health and emotional resilience across developmental milestones in childhood adolescence and early adulthood. Some of this is still in development in association with the Royal College of Pediatric Medicine. http://www.rcpch.ac.uk/minded

Who's who in mental health? An alphabetical guide to the different organisations and professionals in mental health, provided by Mind.

National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are collaborative partnerships between universities and surrounding NHS organisations, focused on improving patient outcomes through the conduct and application of applied health research. Summaries of CLAHRC research findings can be found in the CLAHRC BITEs (Brokering Innovation Through Evidence) and more information on  CLAHRC - West Midlands here.

National Institute for Health Care and Excellence (NICE) The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care.

Department of Health (DH) lead, shape and fund health and care in England, making sure people have the support, care and treatment they need, view their Publications.

NHS England works with NHS staff, patients, stakeholders and the public to improve services and health outcomes for people in England.