A Multidisciplinary Handbook of Child and Adolescent Mental Health for Front-line Professionals

Second Edition

Nisha Dogra, Clay Frake, Fiona Warner-Gale, Andrew Parkin

• Publisher: Jessica Kingsley Publishers
• Year: 2008
• Print ISBN: 9781843106449
• eBook ISBN: 9781846428463
• Edition: 2
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

This fully updated edition of A Multidisciplinary Handbook of Child and Adolescent Mental Health for Front-line Professionals is an accessible introduction to child mental health, covering the nature, prevalence, treatment and management of mental health problems in children and young people.

The authors explore issues such as assessing and meeting the mental health needs of young people, specific mental health problems such as attention deficit hyperactivity disorder (ADHD) and learning difficulties, and legal aspects of working with child mental health. They also assess diversity issues as an integral part of practice, and highlight practice issues for readers. The book contains illustrative case studies and self-directed exercises, and outlines the services available to children with mental health problems. This second edition also includes additional material on working with culture and diversity, plus the latest clinical guidelines and current medication.

This handbook is an invaluable resource for students, trainers and professionals working with children with mental health problems in a medical and non-medical environment as well as parents wanting to know more about the subject.

PART 1

Defining and Meeting the Mental Health Needs of Children and Young People

CHAPTER 1

Defining Mental Health

Definitions of mental health

The Health Advisory Service Report (HAS Report 1995) Together We Stand defined mental health in children and young people as:

•a capacity to enter into and sustain mutually satisfying personal relationships

•continuing progression of psychological development

•an ability to play and learn so that attainments are appropriate for age and intellectual level

•a developing moral sense of right and wrong

•not necessarily present when psychological distress or maladaptive behaviour is appropriate given a child’s age or context.

This definition implies that there is an ideal state of mental health that all strive to reach. Another similar and also commonly used definition (Mental Health Foundation 1999) states that children who are emotionally healthy will have the ability to:

•develop psychologically, emotionally, creatively, intellectually and spiritually

•initiate, develop and sustain mutually satisfying personal relationships

•use and enjoy solitude

•become aware of others and empathise with them

•play and learn

•develop a sense of right and wrong

•resolve (face) problems and setbacks and learn from them.

Again this definition may be criticised for presenting an idealised and simplified view of mental health. It also perhaps fails to acknowledge the diversity of human responses to different experiences and the diversity of human individuality and ability. However, both definitions focus on trying to define what mentally healthy young people should be able to do should they so wish, and in that way they begin to provide some clarity about when young people are not mentally healthy. The second definition also makes no mention of the impact of developmental issues playing a central part when considering young people’s mental health.

Mental health is to some extent a culturally bound concept, and these definitions are clearly set out from Western perspectives. Despite this, they provide a common starting point from which young people’s mental health can be considered. It is important to remember that good mental health is not a static state, good mental health is dependent on several factors and a change in these factors may lead to changes in mental health status. The World Health Organization (WHO) (2001) states that mental health is an integral component of health through which a person realises his or her own cognitive, affective and relational abilities. With a balanced mental disposition, one is more effective in coping with the stresses of life, can work productively and fruitfully, and is able to make a positive contribution to one’s community. Mental disorders affect mental health and impede or diminish the possibility of reaching all or part of the goals above.

It is important to emphasise that there is a continuum between emotional and mental well-being and mental disorder or mental illness. At one end of the spectrum is complete mental health and at the other severe mental disorder. The continuum between the range of ‘normal’ human experience and mental disorder (with the exception of psychosis) means that the cut-off between what is normal and abnormal can be hard to define. It is not just the presence of symptoms that defines a disorder but also its impact on the individual’s functioning. For example, feelings of anxiety before big events are perceived as a normal response and something that most people experience. However, in some individuals the levels of anxiety may prevent functioning and therefore warrant attention. In others the symptoms may be severe but manageable and therefore not seen as limiting. Similarly, a phobia of spiders may have little impact on an individual, whereas a phobia of needles may be less easily ignored.

Using the notion of a continuum, there are behaviours which in certain contexts may indicate mental illness. These include erratic behaviour; mood lability (changeable mood); agitation; disinhibition; paranoia; incoherent speech; unusual or inappropriate behaviour; repetitive actions; hearing voices; and holding fixed irrational beliefs that are not culturally contextual. However, it is important to note that these behaviours may also be indicative of other problems that are not associated with mental health.

There can be an inability or unwillingness by some young people, parents and professionals to recognise that distress is a component of human experience and not necessarily a mental health problem. If this is recognised, it can be appropriately addressed rather than labelled as a mental health problem and passed on to specialists for management. It is also important to empower individuals to take responsibility for their own health, including mental health, in appropriate ways. That requires greater openness and willingness to talk about mental health. It means making mental health everyone’s business. All professionals working with young people have a responsibility to consider young people’s psychological health as well as to pay attention to their physical health.

Stigmatisation

The severe and pervasive effects of the stigma of mental health are known to impact on individuals and families, and can result in intense feelings of shame, social exclusion and a reluctance to seek help (Wahl 1999). There is an increasing body of knowledge that explores the impact of stigma in children and young people, who may have mental health needs. There is potential for the effects of stigma to be so insidious that it can significantly reduce access to children’s mental health services; it can create fear, marginalisation and low self-esteem in children, and diminish the effectiveness of interventions. Stigma can have such a significant effect that there is a potential for mental health problems to increase in severity. Often, the experience of stigma has been described as on a par with the experience of having a mental health problem (Gale 2008).

Many of the terms used to describe individuals with mental health problems are derogatory. Individuals with mental illness are often perceived to be unpredictable (volatile, emotional, unstable, off the wall), aggressive (violent, crazy) or having something missing (a slice short of a loaf; a penny short of a pound; lights are on but no one’s home; etc.). There is little differentiation between mental health problems and formal mental illness. Terms may be loosely used and poorly understood. There is also a discrepancy between lay and professional use of widely used terms such as depression, panic and stress.

Stigmatisation is a worldwide phenomenon as shown by the need for the five-year anti-stigma campaign ‘Changing minds – Every family in the land’, which began in the UK in 1998 (Royal College of Psychiatrists 1998), and by the WHO campaign ‘Stop exclusion – Dare to care’ (WHO 2001). There is still much to be done in reducing the stigma attached to mental health problems by individuals and organisations. Mental health problems are stigmatised by health professionals and the public alike, although the degrees may vary. There are at least two main reasons for stigmatisation, which is a complex area. The first is fears regarding people with mental health problems because of perceived aggression and unpredictability; there can also be fears that individuals with mental illness have criminal intentions. The second relates to concerns that there can be a fine line between ‘normal’ experience and mental health problems. It is often easier to see mental health problems as belonging to others (i.e. the ‘them-and-us’ mentality) as this allows individuals not to have to consider the vulnerability we all have to experiencing mental health problems. A fear of the unknown and an unwillingness to be open about mental illness can perpetuate prejudice.

Negative attitudes towards the subject of mental health problems and those who experience mental health problems are already present in young people with beliefs that little can be done to address the problems of stigmatisation (Bailey 1999). When attempts are made to address stigmatisation of mental health, interventions need to be made at all levels, i.e. with individuals, with communities, with institutions and at strategic and policy making level. There is a tendency to avoid using terms such as ‘mental health’ and an emerging preference to talk about ‘emotional literacy’ or ‘positive health’ thus colluding with the assumption that ‘mental’ is a negative and pejorative term. Experience shows that the attitudes of mental health professionals can help shape attitudes towards those with mental health problems. Therefore those working in the mental health field need to ensure that they do not subconsciously change their language to accommodate prejudice.

Exercise 1.1

1.How comfortable are you talking about mental health and mental health problems?

2.What terms do you use to describe mental health problems or individuals experiencing mental health problems?

3.What is your own understanding and experience of mental health and mental health problems?

4.Do you think there are areas of your practice in which you could do more to help destigmatise mental health problems? If not, what are you already doing to ensure that you provide equitable services (whatever area you are in) to all young people you come into contact with?

5.If you think you could do more to destigmatise mental health, howdoyou thinkyou mightbeabletodothis?

References

Bailey, S. (1999) ‘Young people, mental illness and stigmatisation.’ Psychiatric Bulletin 23, 107–110.

Gale, F. (2008) ‘Tackling the stigma of mental health in vulnerable children and young people.’ In P. Vostanis (ed.) Mental Health Interventions and Services for Vulnerable Children and Young People. London: Jessica Kingsley Publishers.

Health Advisory Service Report (1995) Together We Stand: The Commissioning, Role and Management of Child and Adolescent Mental Health Services. London: HMSO.

Mental Health Foundation (1999) Bright Futures: Promoting Children and Young People’s Mental Health. London: Mental Health Foundation.

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Table of contents

• Cover
• Half Title
• Of Related Interest
• Title Page
• Copyright
• Contents
• Foreword By Panos Vostanis
• Acknowledgements
• How to Get the Best Out of this Handbook
• Abbreviations
• Part 1: Defining and Meeting the Mental Health Needs of Children and Young People
• Part 2: Child and Family Development
• Part 3: Factors that Influence the Mental Health of Young People
• Part 4: Specific Mental Health Problems of Childhood and Adolescence
• Part 5: Treatment and Management Strategies
• Part 6: Medico-Legal Aspects of Child Mental Health
• Part 7: Exercise and Case Study Solutions
• Subject Index
• Author Index