Public Mental Health for Youth

1. Public Mental Health for Youth Dr Paul Patterson - Public Health Lead Youthspace BSMHFT

2. SchoolspaceChisholm, Patterson, Turner, Torgerson, Birchwood (2012)Supported by NIHR CLAHRC-Birmingham & Black Country

3. Youth Mental Health – Why is it so important?

4. Why we should be concerned about the Mental Health Needs of Young People.. • Over half of all adults with mental health problems will have begun to develop them by the time they are 14 • Approximately 10% of all children and adolescents 6-16 years have a diagnosable MH disorder • 60 – 70% of these young people have not been offered or received any evidence based intervention • Earlier intervention increases the chances of preventing long-term negative outcomes • Current lack of coordinated approach to engaging with YP at earliest stage (e.g. Schools,internet,media)

5. Youth Mental Health – a real opportunity for Prevention “Roughly half of all lifetime mental disorders in most studies start by the mid-teens and three quarters by the mid-20s. Later onsets are mostly secondary conditions. Severe disorders are typically preceded by less severe disorders that are seldom brought to clinical attention” Kessler et al, Current Opinion Psychiatry, 2007

7. Evolution of a Youth Model of Mental Health

8. Youth Mental Health – a real opportunity for Prevention • Over half of all adults with mental health problems will have begun to develop them by the time they are 14 • Approximately 10% of all children and adolescents 6-16 years have a diagnosable MH disorder • 60 – 70% of these young people have not been offered or received any evidence based intervention • Earlier intervention increases the chances of preventing long-term negative outcomes • Current lack of coordinated approach to engaging with YP at earliest stage (e.g. Schools,internet,media)

9. Youthspace – the BSMHFT response Integrating research, clinical practice, user involvement & public mental health into a responsive preventative (phased) strategy for 16-25 yrs • Examine evidence base & plan research & dissemination strategy – ‘CLAHRC NIHR Funding’ • Integrate Public & Patient Involvement from planning stage – ‘Youth Board’ • Create partnerships to widen ‘net’ and ‘no wrong door’ approach– ‘Fairbridge / Princes Trust Partnership’ • Develop Public MH strategy for new service – ‘Youthspace.Media Education & Training’ • Develop appropriate specialist service for YP – Youthspaceclinical service:

10. Birmingham Youthspace / CLAHRC Programme - Service Redesign - Partnership development - Youth Clinical Team - Training Programmes - -- Youthspace.me Website - Educational Films - Posters/campaigns - Interactive mapping Youth Clinical Service Partnerships: Fairbridge Princes Trust Youthspace media - ‘Schoolspace’ Project - Vulnerable Youth Project - Awareness campaigns - Assess delay ‘hotspots’ - Universal & Targeted Intervention Design - Analysis & Dissemination of outcomes

11. Youth Mental Health – the Policy context..

14. A Children’s Environment and Health Strategy for the United Kingdom: HPA 2009 “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…”

15. The Childrens Plan DCSF 2007 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…’

16. One Year On: the first report from the National Advisory Council for Children’s Mental Health and Psychological Wellbeing 2010 ‘..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..’

17. Healthy Lives, Brighter FuturesDoH2008 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..’

18. ‘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 Marmot Review 2010

20. Youth Mental Health Education in Schools – Why is this so important?

21. Why It’s Important for Students: • UK comes bottom of the rank for children’s well-being in a recent UNICEF study in comparison with North America & 18 European Countries; (UNICEF 2007) • It’s a common problem: At any one time - one in ten children and young people have a diagnosable mental health problem, the majority of which are either emotional disorders, (depression or anxiety), or conduct disorders. • It affects educational achievement: poor mental health is associated with low educational performance and absenteeism; additionally, conduct and hyperkinetic disorders disrupt the educational environment for other children

22. Why It’s Important for Students: • poor mental health is often the underlying factor behind risk behaviours (including substance abuse, risky sexual activity) and health outcomes, (including teenage pregnancy, eating disorders, injuries, bullying and violent behaviour). • Poor mental health can be a symptom of a child at risk: children and young people frequently express their emotional distress in the form of mental disorders and behaviours such as self-harm • Half of all adult MH problems have started before the age of 14 - Not addressing poor mental health in childhood results in ongoing problems including self-harm and increased suicide; low educational and employment achievement; increased violent and offending behaviour.

24. Schoolspace – bringing MH education into schools…

26. Growing pressure for schools to address not only traditional academic learning, but also the emotional well-being needs of their pupils (Department of Health, 2004; Sainsbury Centre for Mental Health, 2006; Office of the Deputy Prime Minister, 2004; The Children and Adolescents’ Mental Health Coalition, 2010; Her Majesty’s Government, 2004; The Office for National Statistics, 2008) Previous research findings Systematic reviews by; Wells et al., 2003; Spence and Shortt, 2007; Schachter et al (2008) Inconsistency of findings, reporting standards, and methodologies have led many systematic reviews to argue that the evidence for these types of interventions is inconclusive and that further research is needed Previous research also indicates that even if positive results are found we still need to address ways to produce larger effect sizes, particularly in view of convincing commissioners that this type of work within schools is justified. Early intervention in schools

27. To develop and evaluate a universal educational intervention for secondary school aged pupils aimed at improving mental health literacy, stigma of mental illness, and resilience/emotional well-being (year 8, age 12-13) Stage one: Development of educational intervention for pupils Identify and develop content for an educational intervention though searching previous systematic reviews, conducting new systematic reviews, conducting group interviews, and piloting intervention within one school Stage two: Evaluation of a randomised controlled trial Evaluate feasibility intervention trial in 9 schools. Pre and post tests and 6 month follow up. In particular the research aims to address the ‘contact hypothesis’ which has been used previously in stigma research (Pinfold et al., 2005; Schulze et al., 2003). Aims

28. Group interviews: What does mental health mean to you? Do you think mental health is relevant to someone from your age group? If you were to be taught about mental health in school what would you want to be taught? If you were worried about a friend, and thought they might have a mental health problem, what would you do? What sort of difficult feelings or problems do people your age face? Pilot: Within one school Practicalities- is the intervention pitched at the right age level? do the timings work? what elements work best? what elements work worst? Stage one: Development of educational intervention for pupils

29. Three ways to tackle stigma (Thornicroft): - Protest, Education, Contact Contact + Education likely to have greater impact on knowledge, attitudes, behaviour (Woolfson et al.,2008; Pinfold et al., 2005) lesson is less abstract increased impact of message drop in stigma leads to better attitudes towards help-seeking (Schomerus et al., 2009) The contact hypothesis

30. Outcome measures Primary: • Reported & Intended Behaviour Scale RIBS (Evans-Lacko, Rose, Little, Rhydderch, Henderson, and Thornicroft, 2009) • Mental Health Knowledge Scale MAKS (Evans-Lacko, Little, Meltzer, Rose, Rhydderch, Henderson and Thornicroft, 2010) • The Resilience Scale (Neill & Dias, 2001) Secondary: • Help-seeking (see; Sheffield et al. 2004; Carlton and Deane, 2000) • The Strengths and Difficulties Scale (Goodman, Meltzer, and Bailey, 1998) • General Well-Being Index (Heubeck and Neill, 2000) • The Schizotypal Personality-Brief Form (Fonseca-Pedrero, Paíno-Piñeiro, Lemos-Giráldez, Villazón-García, and Muñiz J, 2009; Raine and Benishay, 1995; Raine, 1991) • General measure of academic functioning over previous 3 months

32. Redesign intervention using feedback from pilot Quantitative evaluation: Randomisation: pupils will be randomly allocated to one of the experimental conditions (education and contact or education only) at the level of school. Pre and post tests: pre-test will occur before randomisation. Post test 1-2 weeks after the intervention. There will be a further follow up after 6 months. Hypotheses: Participation in the contact and education condition will significantly reduce participants’ prejudice of mental illness in comparison to participants in the education only condition Participation in the contact and education condition will significantly improve participants’ mental health literacy in comparison to participants in the education only condition Participation in the contact and education condition will significantly improve participants’ resilience to mental illness in comparison to participants in the education only condition Qualitative Feedback Group interviews Evaluation of feasibility trial

33. Potential Benefits: Behaviours associated with conduct disorder are reduced, and pro-social behaviour increased (Naylor et al. 2009) Improved school achievement, family engagement, school outcomes, and decreased disciplinary referrals, and emotional and behavioural problems (Burns et al., 2004; Scott et al., 2001; Stormshak et al., 2005) Potential for increased impact of study over others: Contact hypothesis (Pinfold et al., 2005; Schulze et al., 2003; Woolfson et al.,2008) Outcomes

34. Is anyone ‘normal’? • Maybe it is the differences between us and not the ‘normal’ things about us (both good and bad) which make us interesting. Would being completely ‘normal’ be a good thing or a bad thing?

36. Anyone feeling anxious..?

37. ‘Listen’ – a Film about Depression in Young People by BSMHFT Service Users (onYouthspace.me)

38. Youthspace.me

39. Some feedback from pupils: 100% of pupils rated day as good or excellent ‘The best topic day we’ve ever had’ ‘I don’t feel so bad that sometimes I’m bullied’ ‘fun and interesting’ ‘I’ve learnt a lot’ ‘I learned that I can talk about things if I need to’ “I know what to do to get help now” “I’ve learnt some words like schizophrenia” “It’s good to think positively” Stage two: Feasibility trial

40. Youth Mental Health – what we need to be doing.. • Recognise that Youth Mental Health is a priority for all of us • Joining in Partnerships to - challenge stigma - improve MH ‘literacy’ - support local MH initiatives in schools and other youth settings; - Improve our own and others MH by adopting healthy ways of reducing stress - assist early help-seeking for those in emotional distress • Ask young people ‘how we can best help’ – and listen to what they say.. • Use the ‘Youthspace.me’ website!

41. Remember... • ‘No health without mental health..’

42. WWW.YOUTHSPACE.ME

43. WWW.YOUTHSPACE.ME Paul.Patterson@bsmhft.nhs.uk