This week (5-11 February 2024) is Children’s Mental Health Week. The UK government recently published guidance from the department of health and social care into improving the mental health of babies, children and young people.
Early years are formulative, and can set the course for mental health in later life. As the guidelines state; 75% of mental illnesses start before the age of 18 and 50% of mental health problems in adult life (excluding dementia) take root before the age of 15.
What does the guidance say?
The guidance makes clear that children are more likely to develop poor mental health if they experience many adverse risk factors. The more risk factors they are exposed to the more likely they are to have mental health challenges. The more protective factors they experience the less likely they are to develop mental health challenges.
The 2024 guidance from the Government in the UK breaks down risk factors into 4 main categories:
Individual factors:
- premature birth
- exposure to adversity or traumatic events
- poor attachment to parents or caregivers
- speech, language and communication abilities
- physical health and health behaviours
- substance misuse
- gambling
- resilience challenges
- body image challenges
- the way in which social media and screen time are engaged
- not getting enough time to enjoy hobbies and leisure time including arts, culture and play
Interpersonal factors:
- poor quality of relationships with parent or caregiver
- poor quality of relationships between parents or caregivers
- poor relationships with peers and adults outside of the home
- abuse and neglect
- poor physical and mental health of parent or caregiver
- parental substance misuse
- poor experience of being in care
- bullying, including cyber bullying
Community factors:
- poor educational attainment and attendance
- not being in a safe, calm, supportive and inclusive learning environment
- not having mental health literacy, and social and emotional learning
- difficult transitions between stages of education or into employment
- poor quality, security and nature of employment
- poor community networks, engagement and inclusivity
- lack of safety or exposure to crime and violence
- poor access to health, care and support services
- loneliness and isolation
Wider Environment and Society Factors:
- poverty
- poor quality of housing and the built environment
- poor access to quality green and blue space, and engagement with nature
- poor quality and accessibility of transport
- poor access to digital resources
- experience of discrimination, stigma and prejudice
- exposure to online, media and advertising harms
- conflict, natural disasters and humanitarian crises
- climate change
What doesn’t it say?
While the guidance clearly identifies the significance of social influences, economic status, environment and physical health on the mental health of children, and it does list risk and protective factors that can affect mental health, there are some omittances.
Whilst the guidance includes details of external factors. It, concerningly, does not include any mention of genetic or biological influences. These factors cannot be overlooked when considering approaches to mental health in children, young people and adults.
The document produced by the Government aims to help organisations, public health professionals, the NHS, local authorities and other parts of the public sector, the voluntary and community sector to make changes to help improve the mental health of children and young people moving forward.
The guidance recommends we improve the mental health of children and young people by taking action in those 4 areas of society, community, interpersonal and individual:
Society can…
- reduce pollution, reverse climate change and prevent natural disasters (globally, nationally and locally)
- provide accessible green and blue spaces
- reduce alcohol, drugs and tobacco-related harm (this might mean changes in price, availability, marketing, licensing and more)
- tackling obesity
- tackling online harms (MQ are supporting a report currently underway into how we can have healthier relationships with the internet)
- social and economic development - education, food security, housing, financial security and income equality
- mass media anti-stigma campaigns tackling prejudice
- violence reduction strategies, programmes and interventions
Local communities can…
- provide community networks, engagement and volunteering
- take action to prevent suicide
- encourage meaningful activities that promote wellbeing and build resilience
- Provide Family Nurse Partnership and healthy child programme: health visitor and school nursing
- For babies, provide programmes that promote school readiness, speech, language and communication
- For infants upwards, include whole education approaches to mental health
- For children upwards, include approaches to reduce bullying.
- For young adults and upwards, include workplace mental health training and support, and debt advice.
Families, caregivers, adults and friends can…
- Intervene early to help address and prevent violence and abuse
- promote positive parent or caregiver to child relationships
- promote positive inter-parental or caregiver relationships
- prevent, treat and mitigate parental mental disorder
- For pregnancy, birth, and early years and infants promote healthy attachment, including breastfeeding support, and psychological intervention to help prevent perinatal depression
- Engage with universal and targeted parenting programmes
- Engage with poor wellbeing or ambassador programmes
Individuals can…
- Live by example and encourage a balanced diet, sleep and physical activity
- promote of engagement in positive hobbies and leisure, including arts, culture and play
- engage with preconception care
- engage with psychological interventions to help prevent depression and anxiety, and promotion of resilience and effective self-care
- engage with efforts to help prevent teenage pregnancy and provide intensive support
What’s missing is research
In MQ’s 10 year history, the inequality of children and young people’s mental health has long been noted and proactively addressed.
MQ’s funding landscape report looking at the years of 2014-2017 found that only 26% of mental health research money is spent on children and young people. To counteract this, 31.8% of MQ’s grant portfolio has had a focus on improving the mental health of children and young people.
“Young people are the reason MQ exists as a charity. MQ is encouraging a cross-generational conversation about improving mental health interventions. That conversation has seen young people taking a lead in all areas – at home, in school and at work. Young people are the key to mental health improving worldwide in the future. It’s who MQ exists for.” Cynthia Joyce, Founding CEO of MQ and Science Council member
MQ are using research to prevent Mental Illness for Children
Back in 2013, at the very beginning of MQ’s journey as a charity, MQ Fellow Dr Joshua Roffman found that by increasing the consumption of folic acid during pregnancy, changes occur in children’s brain development, thus reducing the incidence of psychotic symptoms in later life. Public health policies changed worldwide to increase levels of foods fortified with folic acid.
“MQ has enabled research that may result in measurable impact in prevention of mental illness in young people… MQ brings together a wide range of specialists from different areas, with a driving focus on impact, especially for young people.” Dr Joshua Roffman, MQ Fellow 2014
Another milestone in preventing severe outcomes of mental illness in young people is the HOPES project. The team analysed data from over 9,000 14 to 25-year- olds to identify specific brain mechanisms linked to suicidal thoughts and behaviours.
HOPES’ findings of how brain structure, psychological and social factors interact provide a framework to investigate and understand why suicide risk develops. Identifying those who are vulnerable helped to develop interventions that work to alleviate suicidal thoughts and behaviours, potentially saving young people’s lives.
MQ are Improving Interventions for Young People
MQ are supporting researchers looking into improving interventions for children and young people.
Whether it’s Professor Helen Fisher who uncovered the key factors that lead to the development of psychotic symptoms in children, which led to improvements in clinical interventions for vulnerable young people or Professor Jessica Deighton who used large data sets to identify how treatment services could be better tailored to young people or Dr Ruchika Gajwani who is working on improving the detection and diagnosis of young people with borderline personality disorder – MQ is at the forefront of UK-based research for young people.
Another major breakthrough for young people’s mental health came thanks to MQ researcher Colette Hirsch. Colette’s work to develop an evidence-based intervention to lower levels of worry and anxiety will inform the development of psychological interventions for stress-related mental health in young people.
MQ are Encouraging Research Focus on Children and Young People
MQ has been aware of the lack of equality for children and young people when it comes to research since we first were founded. At MQ’s very first Mental Health Science in 2015, the meeting of researchers focused on opportunities to investigate young people’s mental health.
One of the most impactful projects MQ has supported has been the ground-breaking Adolescent Data Platform (ADP) which brought together anonymised health data from schools, local authorities, NGO’s, the Criminal Justice system and the NHS, and made it accessible for research.
The Principal Investigator, Professor Ann John, and her team from Swansea University have been analysing the data and presenting their findings to mental health services, policy makers, practitioners and young people. The ADP continues to improve prevention, detection and early intervention for depression in young people.
An innovation workshop was held by MQ in 2017 for multi-disciplinary experts to address the mental health challenged children and young people face. The following year MQ supported two research priority setting partnerships through the James Lind Alliance, one on young people. Most recently, in 2021, MQ advised the new Healthy Brains Global Initiative (HGBI) on their strategy to invest in research into young people’s anxiety and depression.
MQ continues to steer resources towards gaps in mental health research and challenged inequality in mental health by investing in projects which involve low-and medium-income countries, projects that focus on young people, and on preventing mental health conditions from developing.
MQ are Helping Vulnerable Children
The Government guidelines released last month notes the groups of young people that may be more at risk of mental illness than others, including those who identify as LGBT, those living in rural areas or who have experienced homelessness and those living in poverty.
Poverty and financial hardship is a crucial factor for mental well-being, which is why MQ have invested in creating the 2023 cost of living report which gives guidance to all sectors of society about how to look after our mental health and the mental health of others during these difficult financial times.
In addition to this MQ has invested in supporting several studies focused on looking after children and young people who are more at risk of developing mental illness. Two examples include Dr Teresa Tavassoli who, thanks to MQ’s support, shed light on the relationship between sensory differences and mental health symptoms in autistic children and the IDEA project.
“The MQ Brighter Futures grant had a transformative impact at the adolescent depression programme I direct… {Thanks to the IDEA project} we’ll be able to understand the risk for, and ultimately prevent and decrease the burden associated with adolescent depression across the globe – and it isn’t possible without MQ’s support.” Dr Christian Keeling, Associate Professor of Child Adolescent Psychiatry, Universidade Federal do Rio Grande do Sul, Brazil
Since 1 in 5 people experience depression in their lifetime, MQ funded the IDEA project to better understand how depression develops in young people. The IDEA team successfully developed a tool that can predict which young people are at highest risk of developing depression in later life. This tool could ensure that the children worldwide are able to get help before they develop symptoms - potentially stopping depression within a generation.
MQ are Researching Social and Environmental Factors
While the Government guidelines clearly state the social and environmental factors that cause mental illness and poor mental health in Babies, Children and Young People, MQ has been investigating these factors for many years.
MQ supported researchers looking into this area include, Professor Jean-Baptiste Pingault who in 2016 found strong evidence around the direct impact of bullying on the development of mental health problems in young people, Professor Liz Twigg who in 2018 used survey data on adult and children's mental health, social media use and parent-child relationships to understand how children's wellbeing is affected and Dr Katherine Young and Dr Colette Hirsh who investigated the impact of the pandemic on young people’s mental health.
“I found the experience really helpful which amazed me. I feel more positive and happier. I would like to say a big thank you to the team and I hope others will be as satisfied as I am.” Participant from Dr Katherine Young’s and Dr Colette Hirsch’s study
Colette’s previous 2015-2019 study developed an intervention for anxiety and worry (a key risk factor for escalating anxiety). Building on this, Colette has recently co-produced an App with young people who suffer from extreme worry, which is specifically designed for young people aged 16 to 25 and aims to make their worry manageable.
MQ has Involved Young People in Research
Patient and public involvement is a huge part of MQ’s focus, encouraging researchers to use people with lived experience of mental illness at every step of the process of their work.
Only 1% of researchers who included PPIE said they believed it would make the research more valuable; 96% of those including PPIE said it improved their work; 0% reported a negative impact of PPIE on any part of the process; 92% said they would include PPIE in future research even if it wasn’t a requirement of the grant; Most researchers said they had learned to include PPIE earlier in studies, if not from the very start.
This focus continues in work targeted towards the mental health of children and young people, not only in studies such as Professor Andrew Thompson who in 2016 involved young people in the design of his study which developed a successful VR intervention for psychosis and schizophrenia, but also in the MQ Young Person’s Advisory Panel.
Empowering young people to be a key part of research is the backbone of this initiative. Beginning in 2017, the Young Persons Advisory Panel is a collective of young people with lived experience of mental health conditions and experiences.
“Being a member of MQ’s Young Person’s Advisory Group was a fantastic opportunity to input in to MQ’s projects in an environment where the perspective of young people with lived experience was centred and valued.” Matilda Simpson, Member of the MQ YPAG
The guidance offered by the government in the UK offers helpful information, but without research we cannot do more to improve the mental health of babies, children, and young people. Thank you for supporting MQ Mental Health Research in providing vital facilitation of crucial mental health research.
Read our article on Children’s Mental Health Week 2024 and why children’s voices matter.
