Improving the public’s mental health

Public Health England has published two resources looking at mental health promotion and prevention of mental ill-health

Stocktake of local mental health prevention planning arrangements is a high level summary of how local areas are currently incorporating mental health prevention in their planning processes.

The stocktake was undertaken by the Kings Fund on commission from Public Health England. The findings are based on analysis of key planning documents in 35 local areas. This included a random sample of 16 areas across England and 19 areas selected as possible examples of transferable effective practice.

Prevention concordat for better mental health: planning resource

This resource has been developed to help local areas put in place effective arrangements to promote good mental health and prevent mental health problems. It does so by offering a 5-part framework of focus for effective planning for better mental health.

It also highlights a range of actions and interventions that local areas can take to improve mental health and tailor their approach. This includes illustration through practice examples and links to further supporting resources. There is also a resource infographic available to download.

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Through Each Other’s Eyes Programme

The Through Each Other’s Eyes (TEOE) programme was a one-year programme operating in the local authority of Haringey from March 2016 to April 2017 | Mental Health Foundation

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Image source: MHF

The TEOE programme sought to promote infants’ social and emotional development using video interaction guidance (VIG) with families. Through VIG, parents are given increased opportunities to observe and reflect on video recordings of their positive interactions with their child.

The overall aim of the programme was to support parents to bond with their baby. This report describes the evaluation of a service development project in its implementation of a VIG programme in Haringey and makes a preliminary assessment of the programme’s feasibility and acceptability for use with families living in the borough who have infants of 12 months or younger.

Results from the preliminary outcomes and process evaluations show that VIG has benefits for parents, practitioners and managers within early years services.

Cyberbullying: comparatively rare, not especially damaging or pernicious

A frequently voiced fear is about the use of social media and in particular the extent to which children and young people are vulnerable to bullying on social media. After all, ‘everyone knows’ that cyberbullying is a major problem for young people, don’t they? | Mental Elf Blog

This study addressed two key questions:

  • First, how common are different types of bullying, including cyberbullying?
  • Second, what is the association between different types of bullying and well-being?

Of concern is the finding that almost a third (30%) of 15 year olds reported that they were regularly bullied. Girls were more likely than boys to report all types of bullying except physical bullying. Of interest, cyberbullying was not common; under 4% of young people reported any form of regular cyberbullying. In addition, almost everyone who reported cyberbullying also reported being bullied in traditional ways; fewer than 1% of young people reported being cyberbullied with no experience of other forms of bullying. This suggests that cyberbullying simply adds another method to the bully’s arsenal and that the same children are likely to be bullied, regardless of the method used.

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However, even if it is rare, cyber-bullying might be especially damaging to young people; unlike other types of bullying it is harder to avoid, can be anonymous, and can happen anywhere and at any time. The authors examined the association between different types of bullying and well-being. After controlling for the effects of gender, material deprivation and ethnicity, bullying accounted for 5% of the variance in well-being; the relationship between cyber-bullying and well-being was weaker and accounted for only 0-1% of well-being. Therefore the assumption that cyberbullying is especially damaging or pernicious was not supported by these data.

Sexual orientation and suicidal behaviour

Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors | The British Journal of Psychiatry

Aims: To assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.

Method: A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12–26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.

Results: Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60–3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21–4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.

Conclusions: Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Full reference: Miranda-Mendizábal, A. et al. (2017) Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis. The British Journal of Psychiatry. Vol. 211 (no. 2) pp. 77-87. 

Transitional Services for Teens and Young Adults With Attention-Deficit Hyperactivity Disorder

A Process Map and Proposed Model to Overcoming Barriers to Care | Journal of Pediatric Psychology

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Objective: To provide a topical review of the personal vulnerabilities and systemic barriers facing transitional age young adults with attention-deficit hyperactivity disorder (ADHD), followed by a proposed model for overcoming those barriers.

Methods: Drawing from a growing, but limited, literature on the topic, we outline a process map for identifying and troubleshooting barriers to care in this at-risk population.

Results: Young adults with ADHD frequently lack the organizational skills, time management, prioritization, and persistence to manage their health care at an expected level of adult independence. These difficulties are compounded by a health-care system that has less time or fewer resources for supporting young adult patients.

Conclusions: Recommendations for easing the transition from pediatric to adult care for late adolescents with ADHD include heavily leveraging the doctor–patient relationship, and capturing the young adult’s attention through technologies that already absorb them.

Full reference: Fogler, J.M. et al. (2017) Topical Review: Transitional Services for Teens and Young Adults With Attention-Deficit Hyperactivity Disorder: A Process Map and Proposed Model to Overcoming Barriers to Care. Journal of Pediatric Psychology. Published online: 01 August 2017

Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England

In England, clinicians and professional organisations report that higher numbers of adolescents with more severe psychosocial difficulties are accessing specialist services | Journal of Adolescence

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A lack of national data on patterns of access to specialist services means there is limited information to inform policy. We examined whether severity of psychosocial difficulties in adolescents accessing mental healthcare has changed over time. Adolescents seen in specialist child mental healthcare in 2009 vs. 2014 were matched on demographics and problem types using propensity score matching; final sample N = 2776 adolescents. We found:

  1. stability over time in overall severity of difficulties,
  2. an increase in severity of young women’s emotional problems,
  3. a decrease in adolescents’ conduct problems. The findings suggest the intriguing possibility that the criteria for accessing mental healthcare are not universally rising, but rather the patterns in access to specialist services may mirror epidemiological changes in severity of psychosocial difficulties in the population.

Full reference: Edbrooke-Childs, J. et al. (2017) Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England (2009–2014). Journal of Adolescence. Vol. 60 (October) pp. 47-52

Improving care and support for children and young people with mental health problems

Three Royal Colleges have jointly agreed five shared principles designed to improve care and support for children and young people with mental health problems.

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The Royal College of General Practitioners, The Royal College of Paediatrics and Child Health and The Royal College of Psychiatrists have issued a position statement saying that as well as the commissioning of specialist treatment, an effective child and young people’s (CYP) mental health system required:

  • acknowledgment that CYP mental health is everybody’s business and should be supported by a shared vision for CYP mental health across all government departments
  • a preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion
  • a system of national and local accountability for population-level CYP mental health and well-being, delivered via integrated local area systems
  • training and education for the whole children’s workforce in their role and responsibilities for CYP mental health
  • more support, both from specialist services and other sectors, for professionals dealing with CYP who do not meet referral threshold to CAMHS.

Full document: Position statement on children and young peoples’ mental health