If you had half a million pounds to experiment with creating projects to improve the mental health and personal resilience of children and young people aged 10-14 what would you do? Where would you begin? Who would you need to help you to make a systemic positive impact on young people’s lives? What daily or weekly activities would you propose children and young people undertake to avoid acquiring serious mental conditions and keep their minds healthy and strong?
We all know that we must brush our teeth daily to insure our long-term dental health and prevent tooth decay and both parents and schools (and dentists) pass this on to children, it is common knowledge. However, when it comes to our mental health, how to stay healthy and well in an increasingly complex world is more ambiguous. We are left to fend for ourselves. In general, our education systems do not teach children what they must do daily, or weekly to look after their long-term mental health and become more resilient to any adverse events they may face. Children may learn techniques or experience tools and ideas that may support them with their own mental well being and resilience at home, but this is in an ad-hoc manner and varies widely amongst families and communities. The Big Lottery Fund has developed an investment fund called HeadStart to give 12 regions of the UK precisely this opportunity: to support multi-stakeholder partnerships in developing new approaches to improve children’s and young people’s mental health and personal resilience.
Today young people in the UK are suffering from serious mental health conditions more than ever before. There is a lack of evidence on the causes of this trend or the right solutions for how to prevent it. Through this initiative, the Big Lottery are seeking to develop an evidence base to show how preventive measures taken for individuals in this age group can help them avoid serious mental health conditions, and reduce subsequent costs to public services, in later years.
The Headstart investment represents the single largest investment made to support the resilience of young people aged 10-14 in England. It is an opportunity to experiment, make mistakes, and learn what works to improve young people’s lives. This may involve working with a year group of children and extending to a whole school, or starting with a school and extending to a county.
Why Is This Needed?
The Big Lottery created the HeadStart Fund in response to both trends that show the mental health of British children and young people is getting worse rather than better and to consultations with young people that showed they need support to access help, understand mental health and well being and overcome the stigma surrounding mental health and mental health conditions. Research from the UK Charity Young Minds (see www.youngminds.org) shows that three children in every British classroom have a diagnosable mental health disorder; 1 in 5 young adults show signs of an eating disorder; 1 in 12 deliberately self harm; and nearly 80,000 children and young people suffer from severe depression.
Alarmingly, recent research shows the rate of self-harm is going up in the UK: the number of children aged between 10 and 14 requiring hospital treatment in England after deliberately hurting themselves has risen 70% in the past two years according to recent data from the NHS. In total some 6,500 children aged 10-14 had been treated for acts of self-harm in 2013 alone. Experts suggest that self-harm is not an isolated event but rather a coping mechanism for other issues that may include sexual abuse, social isolation, bullying, or troubles at home or school.
The exact causes of the rise in mental health issues are unknown but factors known to contribute are exam and school and exam pressure, body image issues, online culture, and cyberbullying. Whilst not a mental health condition but a symptom of underlying emotional distress, the rise in self-harm has been suggested by many commentators as facilitated by the Internet. Authors cite the rise in children uploading pictures of acts of self-harm and videos of how to self-harm and acts of self-harm on tumblr and Youtube. Whatever the cause in the rise of self-harm in children, research on both the causes and how to prevent it or protect children from adopting such behaviours is desperately needed.
Resilience Can Be Taught
Research shows that to bounce back from the pressures, stresses, and even traumas of their young lives, children and young people need to be resilient (the word “resilience” is derived from the Latin resalire, to spring back). We know from psychologists that it’s not the case that a person is born with resilience or not—resilience can be taught. It is true that two different people may have different reactions to the same event. For example, in the case of two people who both lose their jobs: One of them might feel depressed following this event, while the other might immediately look for another opportunity. Though each of us responds differently to events, we all have the capacity to learn how to deal with adversity in ways that lead to better outcomes.
However, the best way to build resilience in children and young adults at scale, particularly for the 10-14 age group, is yet to be well evidenced. There are some pioneering patches of work such as whole school approaches towards emotional well being, Emotional First Aid, Mindfulness for Children, the MindUP program supported by Goldie Hawn and the Penn State Resilience program that have achieved practical results with helping young people to become more resilient and nipping serious mental health problems in the bud. The question remains how to build this capacity in children across a region and, crucially, how to do it for children with a range of needs and backgrounds at scale is yet to be evidenced.
The urgent need to develop an evidence base for approaches to preventative care in young people’s mental health was the impetus behind the Big Lottery inviting 12 areas of the UK to pilot experiments that explore how you build the resilience of individuals at risk, of whole schools, and of children from specific backgrounds or with a particular profile (targeted interventions). The Big Lottery asked the 12 areas to also design into their projects an awareness of the major influences on young people’s lives and mental health: school, family, capacity to access services, and digital lives.
The areas selected by Big Lottery to receive the investment were a spread of 12 different local authority regions in England: Birmingham, Newham, Wolverhampton, Knowsley, Kent, Cornwall, Cumbria, Hull, Middlesbrough, Blackpool, Lewisham, and Southampton. All the areas had been selected because they have high levels of deprivation. The Big Lottery also sought to pick areas for variability; for example, rural Cumbria is one of the most sparsely populated counties in England, and Birmingham is the second-biggest city in the UK, with high levels of poverty and cultural and religious diversity.
For each area, local government (the local authority) convened a range of partners from across CAMHS (Children and Adolescent Mental Health Services), commissioners, mental health experts, psychiatrists and counsellors, public health professionals, the voluntary sector, youth services, schools, the police force, universities, and community-based organizations.
For each location, various organisations were brought together to explore what young people say they want and need, what parents say they want and need, and how the local health systems might be redesigned to service young people in a way that enables them to thrive in the face of adversity.
Systemic Change in Children and Young People’s Mental Health
The intention of the Big Lottery is to catalyse a systemic change in children and young people’s mental health and personal resilience. To prevent young people developing more serious mental health conditions they recognised a systemic approach was needed that engaged a range of stakeholders and formed connections between service providers, schools, community groups and families. Reos brought our experience of systemic change to provide support and development services to the areas to help them to form robust proposals to win the first phase of funding.
Reos was invited to facilitate the formation of the multi-stakeholder partnerships, explore the issues and the opportunity, and support the groups in discussing and innovating new approaches to addressing children’s personal resilience and mental health. We provided support and development services to the partnerships, including workshops on systemic thinking, evaluation, facilitation, digital strategies, and parental engagement. We ran a diagnostic for each partnership proposal to identify the weak spots that needed additional work.
Another aspect to our role was to insure that the ideas were co-designed with young people. Young people played a central part in the meetings, had their voices heard, and instead of merely being consulted, were actively involved in articulating what they wanted and needed for the HeadStart program. Partnerships had the opportunity to include young people’s groups in the governance and decision-making of HeadStart. The young people’s participation in the meeting was important and enabled conversations and planning to get real. In some instances, they talked openly in front of a group of 40 professionals about their own experiences with mental health issues including acts of self-harm and periods of bullying, social isolation and depression. They also talked about their experiences as peer mentors, where they supported other students and looked for any student who might be facing an issue. They shared their hopes and dreams and their worries for the future. Most importantly, they held the adult professionals accountable for their contributions, made queries when the language was unclear or jargony, and insisted that any ideas considered offered a clear benefit to young people, from a young person’s perspective.
We are pleased to write that all 12 areas were awarded their first phase of funding of 500,000 pounds. After the 12 areas pilot their projects, they then have the opportunity to apply for 5-10 million pounds for a further five years of funding for their region. This is a competitive process, so it is expected that roughly half of the regions will win the funding for the full five years.
“Tooth-Brushing for the Mind”
Recently, I took my son to a 4-year-old’s birthday party. Instead of the standard clown or magician, the boy’s parents had invited a yoga teacher who specialized in movement, play, and meditation for 4-year-olds. I sat in the summer sun talking to other parents and smiling as we watched our children successfully meditate in a way that had them lying on the floor using their inhaling bellies to lift paper dinosaurs. Whilst what the yoga teacher did was simple, it was effective. The children were having fun as well as learning how to manage their bodies and their breathing and spending time with each other in calm ways.
Whilst learning meditation may seem like a simple action and perhaps a grown-up activity, it has great promise in helping children and young people in managing their emotions. Some of the worrying trends mentioned earlier in this article such as the rise in self-harm amongst children, is a partly a coping mechanism for children who have strong emotions and try to escape an emotional pain through physical pain. Brain scientists such as Richard Davidson at the Waisman Lab for Brain Imaging and Behaviour has found that found that the neural pathways in monks in the prefrontal cortex in contrast are extremely active, the part of the brain concerned with positive emotions (http://archive.wired.com/wired/archive/14.02/dalai.html). Other neuroscientists have found the parts of the brain concerned with flight or fight responses to trauma and anxiety are very active in children who are self-harming, in contrast.
Scientists hypothesise that through the thousands of hours of meditation, undertaken by the monks, that monks are strengthening their neural pathways for happiness. The monks are undergoing daily teeth brushing for the mind and strengthening their mental health. Therefore if children, or adults, can be taught to meditate, they can learn to manage strong emotions and emotional stress in ways that will become stronger over time. The crucial point is that the brain can change through training and this has a host of implications, particularly learning how to be happier and to manage emotions more effectively.
Life throws us ups and downs whoever we are, whatever background, religion, or socio-economic standing we are. Even Buddhist monks face problems to overcome. What if we could find simple ways to equip our young people with the skills, resources, and words to be resilient, emotionally intelligent and to support themselves and each other through whatever life sends their way? What if the stigma of mental health conditions and the reluctance to talk about feelings and emotions became a thing of the past? What if small daily actions undertaken by children at home or school could prevent depression, eating disorders, self-harm, and suicide? The HeadStart fund moves beyond the “what if” questions, to actually piloting ideas in real life with real children. The project will generate lessons that we hope will not just improve lives in 12 areas of England, but if piloted successfully, benefit generations of children and young people.