Child and adolescent mental health – a guide for healthcare professionals
June 2006
Mental health promotion
As discussed in the chapter on strategies for improving care (England), - read more here, one of the aims of reforms in CAMHS is to concentrate on preventing mental health problems developing, rather than focusing on the consequences of problems once they have arisen. An important element of prevention is mental health promotion, educating the population in the importance of mental health and the means of enhancing and sustaining good mental wellbeing. Mental health promotion can also play a role in tackling health inequalities. Go here for discussion on health inequalities. Core elements of mental health promotion include raising awareness, provision of information and support services. Multi-pronged approaches to promotion of mental health to communities have been shown to be useful, as has promotion tailored to those particularly at risk. [Go to notes 46 and 92]
Many national and local strategies place emphasis on mental health promotion. Standard 1 of the mental health NSF focuses on promotion to improve the mental health of the population and tackle discrimination against those with mental health problems. [Go to note 90]. The children’s NSF highlights the importance of promotion and intervention: relevant initiatives include those to tackle bullying, and providing education about mental health and support for children with particular needs. Children, young people and their parents need information and support in dealing with problems as they occur. Services must ensure that an emphasis is placed on those children who are vulnerable to mental health problems. [Go to note 7]. The Scottish National programme for improving mental health and well-being focuses on promotion and prevention, and tackling discrimination. [Go to note 118]. For more information go here. In Northern Ireland, a five-year strategy and action plan for promoting mental health was launched in 2003. [Go to note 125]. For more information go here.
Standard 1 of the children’s NSF is concerned with the promotion of health and wellbeing, including mental health, of children and young people. [Go to note 46]. It sets out a programme of action to be led by the NHS, in partnership with LAs and other organisations. The Child health promotion programme outlines a framework for promoting health and wellbeing and reducing health inequalities. Increasing awareness, information provision and improving access are key to this. Additional funding has been made available to increase NHS capacity, and there is a growing range of staff in schools (eg school nurses) to help achieve the recommendations set out in this programme.
There are many different methods of delivering mental health promotion. Information should be targeted at specific age groups as well as parents and carers, and be available in a variety of formats, including written materials, audio visual, the internet and through the media. CAMHS should consider a variety of settings, such as outreach, schools and community venues to reach a wider number of people. [Go to note 51]. A huge range of factors can affect mental health, for example, a healthy diet, physical exercise, talking about feelings, learning new skills, creative activities, and the environment in which one lives. The importance of such elements should be widely disseminated to the general public. [Go to note 51]. The Youth matters green paper includes a variety of proposals to empower young people, increase opportunities for participating in activities, and encourage them to make valuable contributions to society, which can in turn benefit their emotional wellbeing. [Go to note 89].
Schools have an important role to play in mental health promotion. The National Healthy Schools Programme provides support for all health promotion, including mental health. As part of this, the National Healthy Schools Standard provides a model for partnership working between health and education in promoting a healthy lifestyle to children. [Go to note 130]. The school environment, as well as curriculum content, provide a good opportunity to disseminate information, foster good habits and raise children’s awareness of mental health. Initiatives to tackle bullying, provide pastoral support and promote an equal, fair and non-discriminatory environment can all play a part. School nurses have a key role in promoting the health of school children; the Chief Nursing Officer and DfES are working in partnership to modernise school nursing and develop best practice guidance. [Go to note 36]. The promotion of emotional wellbeing is essential for national healthy school status. [Go to note 131]. Government has stated that it expects that half of all schools will be healthy schools by 2006, and all schools should be working towards this status by 2009. The National Healthy Schools Programme is currently prioritising schools in the most disadvantaged areas, and evaluation has shown that it is beginning to have a positive effect. For example, young people in healthy secondary schools tend to have higher self-esteem. [Go to note 36].
Mental health promotion has a role in strengthening the training and support for professionals working with children, whether these be educational, social care or health professionals. [Go to note 131]. Mental health promotion is the responsibility of everyone: all staff working with children should be aware of the role they have to play in children’s emotional wellbeing and social development. Staff should be able to access support from specialist CAMHS to help them in this role, [Go to note 7] and to receive adequate training on how to identify and help those with mental health problems. Professionals working with children also have a role in promoting good mental health. The DfES’ common core skills for all professionals working with children and young people includes an element on promoting good health. [Go to note 132]. [38] Read more information on the common core skills here.
Promotion must be properly funded and planned over the long term, as must CAMHS. The YoungMinds 'Minority voices' survey found examples of services that were not promoting themselves as they did not have the resources to do so, were already running at full capacity and struggling to meet demand, or their funding was unstable and thus there was uncertainty as to how long the service would be available. [Go to note 51]. The Mental Health Foundation has called on the government to recognise the importance of investment in mental health promotion to children and young people, and ensure that this investment is forthcoming. [Go to note 133].
Mental health promotion is an important element of tackling health inequalities. Specific services should be targeted at identified risk groups: the children’s NSF1 stated that PCTs and LAs should work with other agencies to develop health promotion strategies for children in special circumstances, including looked after and asylum seeker children. [Go to note 46]. Research has found that many CAMHS were not targeting BME groups for a variety of reasons, including an inability to provide translation services. [Go to note 51]. The fact that fewer BME children and young people access CAMHS, and when they do it tends to be at a crisis point, emphasises the need for more mental health promotion to these groups as a means of addressing health inequalities.
Mental health promotion should not be aimed solely at children and young people, but also at their families and carers; indeed, efforts should be made to actively engage parents in treatment. [Go to note 92]. Health promotion programmes should focus on the family and environment as well as the individual. [Go to note 131]. Parents can also play a vital role in ensuring that their children have good mental health; children need security and caring surroundings to develop confidence and self esteem to deal with life. Parents and carers need access to appropriate advice and information to support them in this. Parenting classes have been shown to be effective in developing parenting skills and encouraging greater self-awareness among parents. Further information can be found in 'Growing up in Britain' [Go to note 8]. It is important that families are able to recognise problems as they develop, as early intervention helps to prevent mental health problems becoming serious. Families also need information about the needs of a child with a mental health problem, and support in caring for them. Caring for a child with mental health problems can place a significant burden on the family, while the support of family and friends is important for young people with mental health problems. [Go to notes 2 and 92]. Various strategies, including the children’s NSF and Choosing Health, [Go to notes 91and 36] acknowledge the necessity of supporting parents. Families should be included in planning services for children to ensure that they are relevant and meet their needs. For example, the Sure Start Unit has been tasked with developing a programme to promote parental involvement in children’s early development in disadvantaged areas. [Go to note 36]
Recommendations:
- There is a need to improve public knowledge and understanding of mental health.
- There should be better provision and dissemination of information about mental health aimed at children and young people, appropriate to different age ranges. This should include information about the different types of mental health disorders, how and where to access help and support, what different mental health professionals do, and what treatments entail. Information should be presented in a variety of media that appeal to children and young people, and in different languages.
- There is a need for more and better mental health promotion to BME groups in order to address health inequalities.