Nadzeya Svirydzenka

Mental health problems in children and young people from minority ethnic groups: the need for targeted research

In this editorial we argue for the need for better research evidence on the prevalence of child mental health problems in minority ethnic groups, service utilisation among these groups and whether some service barriers are specific for certain groups. Without such evidence it is not possible to influence policy and practice so that evidence-based and appropriate services can be designed and offered to these populations. The terms ethnicity, race and migration are often imprecisely defined, and mental health needs and outcomes vary between immigrants from different generations. There is also a complex interplay between minority status and social class, with terms such as ethnicity being a proxy for multifaceted sociocultural and economic variables. However, we need to start collecting better data on children from minority ethnic groups so that these relationships can be understood, services tailored on the available evidence and ultimately better care delivered to this group of children.

Characteristics and rates of mental health problems among Indian and White adolescents in two English cities

BACKGROUND Sampling techniques for national surveys have constrained the statistical power in estimating prevalence rates of child mental health problems in minority ethnic groups. AIMS To establish the prevalence rates of mental health problems in ethnic Indian adolescents in England and compare these with matched White adolescents living in the same areas. METHOD A cross-sectional survey with oversampling of Indian adolescents aged 13-15 years of age. RESULTS The sample size was 2900 (71% response rate) with 1087 (37%) Indian and 414 (14%) White adolescents. Ethnically Indian adolescents had lower rates of all types of mental health problems (5% v. 13% and 21% v. 30% for abnormal Strengths and Difficulties Questionnaire and Short Mood and Feelings Questionnaire scores, respectively) and substance misuse (18% v. 57%, 5% v.15% and 6% v. 9% for regular alcohol, smoking and drug use, respectively), with the exception of eating disorders, compared with their White counterparts. The odds of an abnormal score on the mental health questionnaires were worse for White compared with Indian children irrespective of sociodemographic variables. CONCLUSIONS Factors relating to how Indian adolescents are parented or their social support networks may be influencing their mental health and may warrant further investigation.

Young people’s perceptions of mental and physical health in the context of general wellbeing

Objectives: Increased recognition of the need for health education in schools has seen advances in health literacy in recent years. Most of these have focussed on physical health, whereas education about mental health is generally lacking and focussed on tackling stigma rather than promoting good mental health. This study evaluated a pilot intervention designed to improve young people’s understanding of good mental health as a key aspect of wellbeing and explored their perceptions of health and wellbeing. Methods: A total of 218 13-year-olds participated in an interactive workshop about healthy eating, physical activity and mental health. Young people’s understanding and perceptions were assessed through anonymous questionnaires at the start and end of the workshop. Common themes were identified and differences pre- and post-workshop and between girls and boys were analysed. Results: Nearly all young people (100% before, 97% after) perceived being healthy to mean being physically healthy. A minority (8%) also considered mental health to be a component of general health, which increased to 12% after the workshop. Understandings of mental health broadened after the workshop. Interestingly, many mentioned physical health when asked to describe mental health, both before and after the workshop. Girls’ and boys’ responses were similar except for more girls including social relationships in their descriptions of mental health. Conclusion: In this study, we have discovered much about how young people perceive health in general and mental health. Such information is useful for targeting future interventions. Students’ understanding of mental health and its importance to wellbeing can be improved through short combined health interventions.

Schoolchildren's perspectives on the meaning of mental health

Purpose – Mental health of children and young people is often discussed in terms of mental illness, however, such an approach is limited. The purpose of this paper is to explore young peoples views of what mental health is and how to stay mentally healthy. Design/methodology/approach – The paper investigated young peoples views on these two issues through a series of workshops. In total 218, 13-year-old schoolchildren produced posters with their impressions of the issues. Themes that young people identified were then discussed with them in terms of the existing Bright Futures definition of mental health. Poster responses were subsequently transcribed and thematically analysed. Findings – The paper identified a number of themes for each question. Mental health was viewed in terms of personal attributes of an individual, illness, ability for personal management and establishing social relations. Young people saw mental health maintained through a combination of lifestyle choices, personal attributes, mana...

Mental health service use by adolescents of Indian and White origin

Background Despite the available epidemiological evidence on the prevalence of mental health problems in childhood and adolescence, there is limited knowledge on whether there are differences in the level of need and service utilisation by young ethnic minority groups. Methods Adolescents of 13–15 years from nine schools in two English cities in which children of Indian ethnicity were over-represented (n=2900), completed rating scales on different types of mental health problems, contacts with services and informal supports. Results Indian adolescents scored significantly lower on general mental health and depression symptoms. They were also less likely than White adolescents to self-report having mental health problems, even for a similar level of need. Among those with mental health scores within the clinical range, Indian adolescents were less likely to have visited specialist services. Instead, they were more likely to first approach family members, teachers or general practitioners. Conclusions Rather than a blanket approach being applied to policy and service planning to meet the needs of diverse communities of young people, more specific evidence needs to be gained about patterns of referrals of minority groups and their strategy of accessing supportive adults.

Review of mental health promotion interventions in schools

PurposeThe prevalence of mental disorders amongst children and adolescents is an increasing global problem. Schools have been positioned at the forefront of promoting positive mental health and well-being through implementing evidence-based interventions. The aim of this paper is to review current evidence-based research of mental health promotion interventions in schools and examine the reported effectiveness to identify those interventions that can support current policy and ensure that limited resources are appropriately used.MethodsThe authors reviewed the current state of knowledge on school mental health promotion interventions globally. Two major databases, SCOPUS and ERIC were utilised to capture the social science, health, arts and humanities, and education literature.ResultsInitial searches identified 25 articles reporting on mental health promotion interventions in schools. When mapped against the inclusion and exclusion criteria, 10 studies were included and explored. Three of these were qualitative and seven were quantitative.ConclusionsA range of interventions have been tested for mental health promotion in schools in the last decade with variable degrees of success. Our review demonstrates that there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations.

A qualitative exploration of how adopted children and their parents conceptualise mental health difficulties

Adopted children tend to have high levels of emotional, behavioural and developmental need and are more likely to present to a range of services, including Child and Adolescent Mental Health Services (CAMHS). Although research exploring adopted childrens perspectives is growing, it remains limited. Furthermore, there has been little work to engage adopted children in research. Our project aimed to examine adopted childrens viewpoints of mental health and services alongside those of their adoptive carers. Results indicated that although there were some similarities between carer and child perspectives, they also frequently differed. They provided different constructions of the problem but agreed that family relationships were strained. Some acknowledgement of the role of the school was offered and other external sources of support cited. Coping was considered to be complex and while some issues were analogous to ‘normal’ family life, much was inherent to the adoption status.

Research and partnerships with schools.

PurposeDespite the quantity of research on child and adolescent mental health being done in schools, little output has focused on the practical aspects of recruiting schools and students into a study. Furthermore, there is limited knowledge on how to develop and sustain productive and mutually beneficial partnerships with schools after the project finishes.MethodsA large study examining prevalence of mental health problems in young people involving nine schools is used as an example for the procedure of recruitment and carrying out a research project, while developing and sustaining partnerships with schools.ResultsWhile recruiting the schools, a three-stage model was developed that corresponded closely to the school’s needs and existing demands. The suggested procedure for the study, thus, closely reflected the varying existing cultures of participating schools. Partnerships, developed as a result of the project, were used in developing further projects and interventions for promoting good mental health in schools.ConclusionsRather than a blanket research recruitment and procedural approach with an end to school involvement at the end of the project, the paper advocates for a deeper understanding of the schools’ internal culture for improved recruitment and study outcomes. Developed partnerships, when sustained past the completion of research, prove to be a useful tool in applying the findings in promoting good mental health in schools and continuing research further.

Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives

BackgroundDefining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders“ understanding of the meaning of quality in the context of CAMHS.MethodThe study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant’s views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS.ResultsAn initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS.ConclusionsNo respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.