looked after young people and mental health using a risk and resilience model to reduce self-harmful...
TRANSCRIPT
Looked After Young People and mental health
Using a risk and resilience model to reduce self-harmful behaviour
Today’s programme
• Mental health: Definitions and context• Mental Health risk factors and Looked
After Children• Self-harming behaviour• Resilience Framework and Looked After
Children
Mental health: A definition
‘the strength and capacity of our minds to grow and develop, to be able to overcome difficulties and challenges and to make the most of our abilities and opportunities’
YoungMinds 2006
Think about the young people who you work with. Consider the following:
How would you know if a young person’s mental health was good?How would they behave?Describe behaviour that would make you concerned.
Child Mental Health
• A capacity to enter into, and sustain, mutually satisfying and sustaining personal relationships
• Continuing progression of psychological development• An ability to play and to learn so that attainments are
appropriate for age and intellectual level• A developing moral sense of right and wrong• A degree of psychological distress and maladaptive
behaviour within normal limits for the child’s age and context
Problems & Disorders
Mental health problemA disturbance of function in one area of; relationships, mood, behaviour or development, of sufficient severity to require professional intervention.
Mental disorderA severe problem (commonly persistent) or the co-occurrence of a number of problems, usually in the presence of several risk factors
A bio-psycho-social model
EVENTS (what happens to us)
NATURE (what we are born with)
NURTURE (what we grow up with)
Prevalence among children aged 5 – 15 in the UK
Risk factorsbut no obvious problems now
Mental healthproblems
Mental orpsychiatric disorder
Severe disorder or mental illness
3 million or 20%
1.5 million or 10%
30,000 or 0.2%
What are risk factors?
Conditions, events or circumstances that are known to be associated with emotional or behavioural disorders and may increase the likelihood of such difficulties
• Risk is cumulative
• Risk is not causal but can predispose children to mental health problems
Risk and protective factors
Risk FactorsProtective Factors
Task
• Consider the following:
What experiences may a child have prior to coming into care, that may effect their mental health?
Predisposing factors - child
• Genetic influences• Low IQ and learning disability• Specific developmental delay• Communication difficulty• Difficult temperament• Physical illness, especially if chronic and/or
neurological• Academic failure• Low self-esteem
Predisposing factors - family
• Overt parental conflict• Family breakdown• Inconsistent or unclear discipline• Hostile and rejecting relationships• Failure to adapt to child's changing developmental needs• Abuse - physical, sexual and/or emotional• Parental criminality, alcoholism & personality disorder• Parental psychiatric illness• Death & loss - including loss of friendships
Predisposing factors - environment
• Socio-economic disadvantage• Homelessness• Disaster• Discrimination• Other significant life events
Attachment Theory
Attachment behaviour is defined as: The seeking of protection when anxious which is triggered by external threats or behaviours
The person to whom a child is attached provides a secure base, a place of safety, warmth and comfort
Attachment Theory
A securely attached child feels confident that should they feel anxious, their parents will respond. Such security is brought on by interactions which are: • Sensitive• Regularly available and reliable• Warm• Responsive• Consistent
Way attachment developsneed
high arousal
satisfyneed
relaxationtrustsecurityattachment
arousal - relaxation cycle
Secure and insecure attachment
“A securely attached child is likely when faced with potentially alarming situations .... to tackle them effectively or seek help in doing so”
Children whose needs have not been adequately met see the world as;‘comfortless and unpredictable and they respond by either shrinking from it or doing battle with it.’
Bowlby (1980) Attachment and loss Vol. 3 and Bowlby (1973) Attachment and loss Vol. 2
Insecure Avoidant
• Caregiver subtly or overtly reject child’s attachment needs at time of stress
• Bids for comfort will be rebuffed• Child keeps his/her attention directed away from their
caregivers in an effort not to arouse anxiety and frustration
• In control because of the need for self reliance• Comfort self rather than accept it from others
Insecure Ambivalent/Anxious
Caregiver will be inadequate at meeting child attachment needs (caregiver is passive, unresponsive and ineffective)
Child’s strategy is to amplify attachment needs and signals in an effort to arouse a response (verbal and behavioural: bubbly affection to rage, anger, panic and despair. All experienced as controlling)
Child may constantly feel that needs are unmet
Insecure Disorganised
Child experiences the carer giver as ‘the source of alarm and its only solution’. (Children from abusive families)
Child in these circumstances is unable to be guided by their mental model of the world because it offers few directions.
Frightened, helpless, fragile and sad At risk of mental health problems or anti-social behaviour
In Essence…
Attachment needs are activated during times of perceived stress (discomfort, environmental, danger, fatigue, illness)
The child must either have these attachment needs met or find other ways to cope.
Compulsive self-relianceDistrusts relationships, avoids being rejected or relied upon. Prone to depression or psychosomatic symptoms.Compulsive care givingActively involved in relationships but always as a care giver. Own parents unable to provide care but might have demanded it from child.Care-seekingVigilant to signs of loss or abandonment. Constantly anxious. Parents probably unresponsive or threatened to leave family.Angry withdrawalGeneralised anger towards attachment figure who is seen as unavailable.
Adolescent attachment styles
Positive brain development
The way a child is stimulated shapes the brain’s neurobiological structure. Experience has a direct impact on a child’s capacity for living, learning and relating as a social being.
Early Brain DevelopmentWe are born with most of the neurons (brain cells) we will ever own but;
At birth the brain is 25% of its adult weight - by the age of 2 this has increased to 75% and by age 3 it is 90% of adult weight.
This growth is largely the result of the formation and ‘hard wiring’ of synaptic connections
Babies brains are both ‘experience expectant’ and ‘experience dependent’
Proliferation of synapses
The Learning Years: 5-10
• Synaptic pathways that are regularly used are reinforced. This is the basis of learning. Reinforcement leads to permanent neurological pathways.
• Neural connections needed for abstract reasoning are developed
• Motor skills are refined
Adolescent Brain Development
• Brain development continues up to at least the age of 20
• There is a significant remodelling of the brain in adolescence, particularly the frontal lobes and connections between these and the limbic system
• The frequency and intensity of experiences shapes this remodelling as the brain adapts to the environment in which it is functioning and becomes more efficient
Emotional Functioning
• There is a mismatch between emotional and cognitive regulatory modes in adolescence
• Brain structures mediating emotional experiences change rapidly at the onset of puberty
• Maturation of the frontal brain structures underpinning cognitive control lag behind by several years
• Adolescents are left with powerful emotional responses to social stimuli that they cannot easily regulate, contextualise, create plans about or inhibit
Impact of trauma
In the face of interpersonal trauma, all the systems of the social brain become shaped for offensive and defensive purposes. A child growing up surrounded by trauma and unpredictability will only be able to develop neural systems and functional capabilities that reflect this disorganisation.
Source: National CAMHS Support Service, Everybody’s Business
Traumatic stress
When children and young people experience persistent stress
they are likely to produce toxic amounts of cortisol which can
have a detrimental effect on
Brain function
All major body systems
Social functioning
Over production of stress hormones
These functions may be diminished or lost:
Ability to learn language and to speak Understanding feelings or having words to describe them Connection between how we feel and our sensory
experience Empathy Control of impulse Regulation of mood Short term memory Enjoyment
Reducing Risk
Consider the different risk factors we talked about earlier and the effects of early years experiences
What can you do to ensure that these risk factors are not increased once a young person is in care?
What worries us?Teachers, GPs, parents and young people were asked to rate the following concerns in order of how worried they would be if a young person they knew were affected by the following issues:
HAVING RISKY SEXHAD AN EATING DISORDERBINGE DRINKINGBEING BULLIEDSELF HARMSMOKINGUSING DRUGSWAS A GANG MEMBER
Self-Harm
How would you define self-harm?
What feelings arise when you think about self-harm?
Defining Self harm
• When some people feel sad, desperate, angry or confused, they can hurt themselves. This is called ‘self-harm’.
• People can do this in a number of ways and for different reasons.
• People who harm themselves on more than one occasion may do so for a different reason each time. They may also harm themselves and not tell anyone about it
NICE Guidance on Self Harm (2004)
truth hurts
Young people who self-harm do so because they have no other way of coping with problems and emotional distress in their lives…. It provides only temporary relief and does not deal with the underlying issues.’
Truth Hurts, Mental Health Foundation (2006) http://www.mentalhealth.org.uk/publications/truth-hurts-report1/
How Common is it?
In every secondary school classroom there will be two young people who have self-harmed
How common is it?• Between 1 in 12 and 1 in 15 young people self-harm
(truth hurts 2008)• 7% of young people aged 15-16 in England self-harm
(Hawton, et al., 2002)• 37,000 young people presented to hospital in 2010/11
and many report previous episodes when they did not go to hospital (hospitals admissions statistics 2010)
• Inpatient admissions of young people under 25 for self harm have increased by 68% in the last 10 years (hospitals admissions statistics 2010)
The ONS report ‘Mental Health of Children and Young People in Great Britain, 2004’ found that:
• 28% of children aged 11-16, with an emotional disorder reported that they have self-harmed. This compares to 6% without an emotional disorder.
• 21% of children aged 11-16, with a conduct disorder reported that they have self-harmed. This compares to 6% without a conduct disorder.
• 18% of children aged 11-16, with a hyperkinetic disorder reported that they have self-harmed. This compares to 7% without this disorder.
• 25% of parents, who had a child with an autistic spectrum disorder, reported that their child had self-harmed, compared to on 2% whose children did not have the disorder.
Is there a link between self harm and suicide?
• While studies have shown that young people who self-harm are more at risk of suicide, people don’t necessarily self-harm because they want to take their own lives.
• The young people we work with describe self harm as a coping mechanism to manage overwhelming feelings; and young people who took part in this survey (TASH) describe it as a diversion of painful feelings.
Why do young people self harm?
“
“I don’t really like school and nick off as much as I can. There’s always
arguments at home so I go out and hang around with a group of lads and lasses. We all drink a bit; sometimes I
cut my arm with a bit of broken glass. It feels good, but then I regret it the next
day when I see the scar.”
“I don’t really like school and nick off as much as I can. There’s always
arguments at home so I go out and hang around with a group of lads and lasses. We all drink a bit; sometimes I
cut my arm with a bit of broken glass. It feels good, but then I regret it the next
day when I see the scar.”
“The thoughts are in my head every day, I can’t
take it. Cutting myself is the only way I can deal
with him being around.”
“The thoughts are in my head every day, I can’t
take it. Cutting myself is the only way I can deal
with him being around.”
“I cut myself when I’m angry, it hurts but it helps my anger.”
“I cut myself when I’m angry, it hurts but it helps my anger.”
Cutting takes my mind off things, when I’m
unhappy about myself, the way I am.”
Biological Effects of Self Harm
• Self harm can bring its own physical release.• Neurochemicals can play an important role in self-harm.• Endogenous opioids and serotonin may bring about a
very positive feeling of calm and well-being.• These chemicals are released particularly when the
body is injured in any way.• They produce insensitivity to pain which help the
individual survive when faced with danger.• It is likely that the body grows to expect a higher level
of these chemicals.
Harm minimisation
what can we do to help?
Advice for young people• Prepare yourself with knowledge about self-
harm before you talk to your friend.• Stay calm and don’t over react. The person you
are talking to is clearly upset or stressed. Being shocked or angry could make it worse.
• Talk it through with someone confidentially beforehand. This could be a parent or teacher, or even an organisation like ChildLine.
• Offer advice about where to go. They could speak to a teacher, their GP or one of the organisation at the bottom of this page.
• Accept that they might not want to talk, but it’s important though for you to try and encourage the person to open up. This might take more than one conversation.
• If you are concerned that they might really hurt themselves consider explaining the situation to a teacher, parent or ChildLine so that you have support. It might feel like you are ‘telling’ on your friend but it’s important that they get support.
• Sometimes you will say the wrong thing. Don’t worry about it or let it stop you having a conversation. The most important thing is you show you care and keep talking to your friend.
• “Wait till I’m finished and calmed down...” Don’t try stop someone in the middle of self-harming as they will be in an agitated state. Be there for them to listen.
• Look out for signs and clues that someone is self-harming.
• Stay loyal. It’s important that your friend knows they can trust you, so don’t gossip about the situation your friend is in.
• Recovery takes time; so don’t hold yourself solely responsible for helping. Be there as a consistent support mechanism for them. Talk about thoughts and feelings rather than what they’re doing.
What is resilience?
Resilient Children
“can resist adversity, cope with uncertainty and recover more successfully from traumatic events or episodes”
Newman, T (2002)
resilience
• Normal development under difficult circumstances. Relative good result despite experiences with situations that have been shown to carry substantial risk for the development of psychopathology (Rutter)
• The human capacity to face, overcome and ultimately be strengthened and even transformed by life’s adversities and challenges .. a complex relationship of psychological inner strengths and environmental social supports (Masten)
• Ordinary magic .. In the minds, brains and bodies of children, in their families and relationships and in their communities (Masten)
Resilience in the child• being female• secure attachment experience• an outgoing temperament as an infant• good communication skills, sociability• planner, belief in control• humour• problem solving skills, positive attitude• experience of success and achievement• religious faith• capacity to reflect
Resilience in families
• At least one good parent-child relationship• Affection• Clear, firm consistent discipline• Support for education• Supportive long term relationship/absence of
severe discord
Resilience in communities
• Wide supportive network• Good housing• High standard of living• High morale school with positive policies for
behaviour, attitudes and anti-bullying• Schools with strong academic and non-academic
opportunities• Range of sport/leisure activities• Anti-discriminatory practice
Developing a self harm policy
• What do you think an effective policy would look like?
1.Who would it target?2.What would it need to contain?3.How will you know that its having an effect?4.Which local services need to be involved in?
youngminds
Parents Helpline: 0808 802 5544 Tel: 020 7089 5050 Website: http://www.youngminds.org.uk and
Publications Training & Development: