Children and young people's mental health and emotional wellbeing (health and wellbeing needs in South Tyneside)

There is compelling evidence of the cost benefit of early intervention using evidence-based programmes and methods. Key examples are suggested below.

Conduct disorder is the most common mental disorder in childhood. By the time they are 28 years old, individuals with persistent antisocial behaviour at age ten have cost society ten times as much as those without the condition. Parent education and training programmes can have good medium to long term effects at relatively low cost. (SERVICE, 2011)

• If services had intervened early for just one in ten of the young people sentenced to prison each year, public services could save over £100 million annually.
• The cost to society of adult mental health problems is currently estimated at more than £100 billion.
• The savings associated with providing an early intervention service approach rather than standard mental health care for patients with psychosis have been conservatively estimated at £50 million per year in the short term and more than £20 million in the long term. The savings relate to increased work, decreased suicide and decreased homicide. (SERVICE, 2011)

The current spend for Children and Young People Mental Health can be found here.

Looked after children

Around half of looked-after children in England are reported to have emotional and behavioural difficulties. Boys are more likely than girls to have higher scores on the strengths and difficulties questionnaire (SDQ), which indicates emotional difficulties (40.9% compared with 33.2%). Looked-after children also have poorer educational outcomes than children who are not looked after. (NICE, 2010)

This guideline also states that Looked after children should be one of the priorities for the local authority.

• The services that are commissioned should focus on health promotion, early identification and prevention of physical and emotional health problems, access to specialist services, including child and adolescent mental health services and also access to professional advice for the looked-after children and young people's care team.
• Transition from children's to adults services should also be a priority.
• 'Ensure that equal priority is given to identifying the needs of those children or young people who may not attract attention because they express emotional distress through passive, withdrawn or compliant behaviour' (NICE, 2010)

Early Years Provision

Nice guidelines on the Emotional Wellbeing in the Early Years stress the importance of the mother-child bond. (NICE, Social and Emotional Wellbeing: the early years, 2012). It advises that vulnerable families are identified. Health visitors or midwives should offer a series of intensive home visits by an appropriately trained nurse to parents assessed to be in need of additional support. The trained nurse should visit families in need of additional support a set number of times over a sustained period of time (sufficient to establish trust and help make positive changes) Activities during each visit should be based on a set curriculum which aims to  achieve specified goals in relation to: maternal sensitivity (how sensitive the mother is to her child's needs), the mother-child relationship, home learning (including speech, language and communication skills), parenting skills and practice.

Amongst other recommendations, its states that the greatest cost savings could be achieved by intervening during the early years of life. It was judges that, if effective evidence-based interventions are systematically implemented, then cost savings are likely to be achieved over 3 to 4 years and also in the longer term.

Older Children

A 'whole schools based approach' is recommended by Public Health England (England, 2015) based on eight principles.

• Leadership and management eg having a senior leaderships for emotional health and wellbeing
• School ethos and environment- promoting and respecting diversity
• Curriculum, teaching and learning eg is focus is given within the curriculum to social and emotional learning and promoting personal resilience, and how is learning assessed-
• Student voice eg ensuring all students have the opportunity to express their views and influence decisions
• Staff development, health and wellbeing eg how are staff supported in relation to their own health and wellbeing and to be able to support student wellbeing
• Identifying need and monitoring impact eg How does the school or college assess the needs of students and the impact of interventions to improve wellbeing
• Working with parents/carers eg How does the school or college work in partnership with parents and carers to promote emotional health and wellbeing
• Targeted support eg How does the school or college ensure timely and effective identification of students who would benefit from targeted support and ensure appropriate referral to support services?

Key findings of the Review of Emotional Health and Wellbeing by South Tyneside Public Health Team found the following

1. lack of cohesion between programmes and services
2. lack of awareness of emotional health and wellbeing services for young people
3. training is required for all people who work with or look after young people
4. no consistent educational programmes or use of resources
5. gaps in anti-bullying provision
6. self harm is a common problem
7. training should incorporate social media

It recommended the following:

1. annual Emotional Health and Wellbeing training incorporating all local prevention programmes, referral processes
2. raising awareness including the School Nurse drop in, identify a champion in EHWB
3. consistent educational programme
4. provide and promote quality assured resources with young people
5. look at other provision in the borough
6. anti-bullying provision
7. address self harm including training, school nurse recording pathways
8. social media

Health Visiting and School Nurse Programme: Supporting implementation of the new service offer: Promoting emotional wellbeing and positive mental health of children and young people

The five steps provide the framework for Health Visitors and School Nurses working with children, young people and families, as well as an organisational tool to effect cultural change (PHE and DH).

Connect... Enable young people to spend time with friends and family.

Be active... Urge young people to exercise regularly, either on their own or in a team.

Take notice... Encourage awareness of environment and feelings.

Keep learning... Keep young people's world as large as possible, encouraging their natural curiosity.

Creativity and play... Encourage children's imagination and creativity as they grow

Recognising Diversity and Risk

The diversity of children should be identified and addressed. Core assessments should contain an accurate and comprehensive picture of the child or young person's needs relating to their cultural, religious and ethnic identity, and pay particular attention to race, sexual orientation, language, faith and diet.