Building on the Experience of TaMHS : Improving Evaluation and Best Practice for Mentally Healthy Schools Dr Paul Patt

1. Building on the Experience of TaMHS :Improving Evaluation and Best Practice for Mentally Healthy Schools Dr Paul Patterson & Dr Charlotte Connor Public Health Youth & CLAHRC Programme BSMHFT

2. Mental Health � Mental Illness The World Health Organization defines health as: � �a state of (complete) physical, mental and social well-being and not merely the absence of disease or infirmity.� Mental health is: ��the emotional and spiritual resilience which allows us to enjoy life and survive pain, disappointment and sadness. It is a positive sense of well-being and an underlying belief in our own, and others�, dignity and worth.� (Health Education Authority 1997)

3. Background One person in four will experience some form of mental health problems in any year (Goldberg, 1991) In 2002/03 the economic and social cost of mental health problems in England was �77 billion. (SCMH, 2003) Around 63 million working days are lost each year due to mental ill-health (CBI) The economic and social cost of mental health problems is greater than that of crime and larger than the total amount spent on all NHS and social services in the UK (HM Treasury, 2005). Some industries show disproportionately high rates of mental ill-health (e.g. teachers, police, healthcare professionals) Around 30% of GP appointments are used to discuss mental health problem MHFA courses can help to reduce fear, ignorance and discrimination about mental health problems and support people to offer informal support to people in distress. LD&W Mind made contact with Betty Kitchener in Australia with a view to developing an English MHFA and arranged an initial training course for trainers in 2006. Following NIMHE taking an interest in MHFA, LD&W Mind worked with NIMHE. Mental health first aid is a useful concept which makes the point that there is a lot of training and awareness about first aid for physical problems but what about emotional and mental distress. There are however limitations to the concept too � mental health crises are less circumscribed and usually mental health problems are longer term and often complex than cuts, falls and collapses that are the focus for physical first aid. There is great value in having a nationally recognised and led MHFA course to give credibility and focus efforts and expertise. MHFA courses can help to reduce fear, ignorance and discrimination about mental health problems and support people to offer informal support to people in distress. LD&W Mind made contact with Betty Kitchener in Australia with a view to developing an English MHFA and arranged an initial training course for trainers in 2006. Following NIMHE taking an interest in MHFA, LD&W Mind worked with NIMHE. Mental health first aid is a useful concept which makes the point that there is a lot of training and awareness about first aid for physical problems but what about emotional and mental distress. There are however limitations to the concept too � mental health crises are less circumscribed and usually mental health problems are longer term and often complex than cuts, falls and collapses that are the focus for physical first aid. There is great value in having a nationally recognised and led MHFA course to give credibility and focus efforts and expertise.

4. Background Over half of all adults with mental health problems will have begun to develop them by the time they were 14 Approximately 10% of children and adolescents need treatment for MH difficulties Early intervention increases the chances of preventing worse outcomes Stigma reduces the likelihood of young people seeking help for their MH Poorly evaluated emotional resilience / MH interventions in Schools MHFA courses can help to reduce fear, ignorance and discrimination about mental health problems and support people to offer informal support to people in distress. LD&W Mind made contact with Betty Kitchener in Australia with a view to developing an English MHFA and arranged an initial training course for trainers in 2006. Following NIMHE taking an interest in MHFA, LD&W Mind worked with NIMHE. Mental health first aid is a useful concept which makes the point that there is a lot of training and awareness about first aid for physical problems but what about emotional and mental distress. There are however limitations to the concept too � mental health crises are less circumscribed and usually mental health problems are longer term and often complex than cuts, falls and collapses that are the focus for physical first aid. There is great value in having a nationally recognised and led MHFA course to give credibility and focus efforts and expertise. MHFA courses can help to reduce fear, ignorance and discrimination about mental health problems and support people to offer informal support to people in distress. LD&W Mind made contact with Betty Kitchener in Australia with a view to developing an English MHFA and arranged an initial training course for trainers in 2006. Following NIMHE taking an interest in MHFA, LD&W Mind worked with NIMHE. Mental health first aid is a useful concept which makes the point that there is a lot of training and awareness about first aid for physical problems but what about emotional and mental distress. There are however limitations to the concept too � mental health crises are less circumscribed and usually mental health problems are longer term and often complex than cuts, falls and collapses that are the focus for physical first aid. There is great value in having a nationally recognised and led MHFA course to give credibility and focus efforts and expertise.

7. �..while the health of most families and children has improved, health inequalities persist. In England today, social status and place of birth continue to be strongly associated with the health outcomes for children and young people � in terms of life expectancy, a boy born in Manchester is likely to live 10 years less than a boy born in the London areas of Kensington, Chelsea and Westminster..� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

8. �..Over half of all adults with mental health problems will have begun to develop them by the time they were 14. For some people, mental health problems last for many years, particularly if inadequately treated.� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

9. Improving mental health brings benefits to individuals and society and we know a great deal about what works. There is a clear association between good mental health and better outcomes across a number of domains: years of life, physical health, educational achievement, criminality, maintaining a home and employment status. NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

10. Disorders in childhood are associated with depression and anxiety in adult years, which in turn can create a vicious circle: children of mothers with poor mental health are at much higher risk themselves of emotional and conduct disorders. The recent CAMHS review indicated that � some children found it difficult to access the help they needed. Not getting help at the first sign of a problem can lead to emotional and behavioural disturbances.. at great cost to the young person, their families and society. NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

11. The role of schools �Schools play a vital role in promoting physical and mental health, and emotional wellbeing, underpinned now by a duty to promote the wellbeing of pupils in the Education and Inspections Act 2006�better techniques for early identification and assessment of additional need, and more effective joined-up working to support swift and easy referral to specialist services�� �Because social and emotional skills are of such importance to unlocking children�s potential, we will develop a national measure of children and young people�s social and emotional skills at key transition points in their education..� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

12. �A number of workshops have been organised with young people from across the UK. The groups were asked to identify which health issues they considered most important.. ..Mental health was the highest priority as young people considered this to be key for good health in all other areas. Two issues that were consistently highlighted during the youth participation exercises were the lack of information and education on health and the environment, and the barriers caused by current attitudes/peer pressure.� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

13. General duties of governing body of maintained school The governing body of a maintained school shall, in discharging their functions relating to the conduct of the school: (a) promote the well-being of pupils at the school, and (b) in the case of a school in England, promote community cohesion. (�well-being�, in relation to a person, means his well-being so far as relating to- (a) physical and mental health and emotional well-being; (b) protection from harm and neglect; (c) education, training and recreation; (d) the contribution made by him to society; (e) social and economic well-being.�) NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

14. General duties of governing body of maintained school The governing body of a maintained school shall, in discharging their functions relating to the conduct of the school: (a) promote the well-being of pupils at the school, and (b) in the case of a school in England, promote community cohesion. (�well-being�, in relation to a person, means his well-being so far as relating to- (a) physical and mental health and emotional well-being; (b) protection from harm and neglect; (c) education, training and recreation; (d) the contribution made by him to society; (e) social and economic well-being.�) NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

15. Standard 1: Promoting Health and Wellbeing, Identifying Needs and Intervening Early �The health and wellbeing of all children and young people is promoted and delivered through a co� ordinated programme of action, including prevention and early intervention wherever possible, to ensure long-term gain, led by the NHS in partnership with local authorities..� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

16. Standard 9: The Mental Health and Psychological Wellbeing of Children and Young People �All children and young people, from birth to their eighteenth birthday, who have mental health problems and disorders have access to timely, integrated, high quality multidisciplinary mental health services to ensure effective assessment, treatment and support, for them and their families..� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

17. �The importance of investing in the early years is key to preventing ill health later in life, as is investing in healthy schools and healthy employment as well as more traditional forms of ill-health prevention such as drug treatment and smoking cessation programmes. The accumulation of experiences a child receives shapes the outcomes and choices they will make when they become adults.� Marmot Review 2010 � Fair Society Healthy Lives p.33 NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

18. �Mental health is very closely related to many forms of inequality. The social gradient is particularly pronounced for severe mental illness. For example, in the case of psychotic disorders the prevalence among the lowest quintile of household income is nine times higher than in the highest� .. also evident for common mental health problems, with a two-fold variation between the highest and lowest quintiles.� Marmot Review 2010 � Fair Society Healthy Lives p.55 NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

19. �..While the opportunities for early intervention through the TaMHS initiative are highly valued by the field, during our visits people expressed concern that this will not be sustainable when central funding ends, placing more pressure on specialist services..� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

21. �Early Intervention� - to prevent problems escalating - is increasingly a mantra for both Health and Education services: we should be establishing a partnership based on common goals reflected in common policy directions: . Every Child Matters (7 references) The Children�s Plan (10) TAMHS Guidance Document (9) Healthy Lives, Brighter Futures (13) New Horizons (37) One Year On (7) NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

22. Why is a common health promotion strategy necessary?

23. Common Intentions � Education & Health Our CLAHRC Public Health Strategy

24. Many innovative projects to 2011 with TaMHS � but what about longer term follow-up and consolidation? Confluence of Health and Education policy directives emphasising emotional well-being & mental health Relative scarcity of �gold standard� tested and validated approaches to MH knowledge, literacy; stigma reduction and positive resilience work Lack of focus on teaching and support staff MH awareness needs � essential to pave way for �mentally health� schools NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

25. Increase MH awareness and confidence of teaching staff Build on the current TaMHS investment and initiatives Increase MH literacy of young people with additional health benefits Encourage local joined-up thinking about Young People and mental health / emotional wellbeing Create the foundations of a �prevention� approach to mental ill-health within a healthy schools environment NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�

27. Please talk to us if you are keen to work together to establish what is the best approach locally for mental health in young people Paul.Patterson@bshmft.nhs.uk Charlotte.Connsmhft.nhs.ukonno s.uk Thank You! NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job� NB Stress is not a �well defined medical condition� but covered under DDA It was funnier before quite so many institutions collapsed to note the definition of: �A Recession was when other people lost their jobs � A Depression comes when you lose your own job�