1. David Wall-Jones
Senior Mental Health Promotion
Specialist
Education Bradford & Bradford & Airedale PCT
Mental Health and Emotional
Wellbeing

2. Exercise
• Talk to person sitting next to you and briefly
describe a child who you know or who you
believe is leading a emotionally, mentally and
healthy life.
• What are the key characteristics of this child?
Please display these as thoughts or behaviours
on the sheet provided.

3. Learning Together –
• Understand and respect others
• Maintain confidentiality
• Taking equality and diversity seriously
• Commitment to learning
• Time out

4. n
• In 2004 one in ten children in
Great Britain aged 5-16 had a
clinically recognisable mental
disorder. This is the same
proportion recorded in
1999.
• Mental illness
disproportionately affects
children in low income
households, large families,
step families or single parent
families.
• Expenditure on children's’
mental healthcare varies
dramatically by health
authority.

5. Definition of Mental
HealthMental health is …having the capacities of:
•The ability to develop psychologically,
emotionally, intellectually and spiritually
•The ability to initiate, develop and sustain
mutually satisfying personal relationships
•The ability to become aware of others and
empathise with them
•The ability to use psychological distress as a
developmental process.(HAS, 1995)

6. Another Definition of
Mental HealthWhen looking at mental health we need to take into
account emotional well-being; happiness; integrity &
creativity; the capacity to cope with stress and
difficulty.
Mental health, in effect refers to the capacity to live a
full, productive life as well as the flexibility to deal with
its ups and downs. In children and young people it is
especially about the capacity to learn, enjoy friendships,
to meet challenges, to develop talents and capabilities.
(YoungMinds, 1996)

7. Young People’s View of
Mental HealthThe young people identified four main factors as contributing to mental
health:
• Family and friends
• Having people to talk to
• Personal achievement, and
• Feeling good about yourself
• Pets, presents and having fun were also mentioned.
Friends and family were seen as making young people feel secure,
supported and wanted and conversely as preventing feelings of
isolation.

8. Prevalence of mental health
problems in children and young
people
Distinction needs to be made between mental health
problems and disorders
The former are seen to encompass a very broad range
of emotional and behavioural difficulties which may
cause concern or distress. They are relatively
common. The latter however are more severe and
persistent and usually defined using fairly clear
diagnostic criteria.

9. Classification of mental disorders
Emotional disorders phobias, anxiety states and
depression
Conduct disorders stealing, defiance, fire setting,
aggression, & anti social
behaviour
Hyperkinetic disorders disturbance of activity and
attention
Developmental disorders
(general, pervasive or specific)
For example; learning disability,
ASD, delay in acquiring certain
skills e.g. speech and language

10. Classification of mental disorders
Eating disorders pre-school eating problems,
anorexia nervosa, bulimia
nervosa
Habit disorders tics, sleeping problems, soiling
Post traumatic syndromes Effects of witnessing or
experiencing traumatic event(s)
e.g. disaster or abuse
Somatic disorders chronic fatigue syndrome
Psychotic disorders schizophrenia, bi-polar disorder,
psychoses including drug induced
psychoses

11. Prevalence
•One child in five (around 20%) display a
mental health problem.
•10% of children have diagnosable disorder
•Greater in the upper age group
•Level increasing over time (for some
disorders)
•Differences across ethnic groups
•Differences between family types
•Variations with household income

12. Prevalence of any mental disorder
by age and sex
0
2
4
6
8
10
12
14
Percentage
of children
with a
mental
disorder
5 - 10 yrs 11 -15 yrs All
Age
Boys
Girls
All

13. Prevalence of emotional
disorders by age and sex
0
1
2
3
4
5
6
Percentage
of children
with
emotional
disorders
5 - 10 yrs 11 -15 yrs All
Age
Boys
Girls
All

14. Prevalence of conduct disorders
by age and sex
0
1
2
3
4
5
6
7
8
9
Percentage
of children
with conduct
disorders
5 -10yrs 11 - 15yrs All
Age
Boys
Girls
All

15. Prevalence of hyperkinetic disorders
by age and sex
0
0.5
1
1.5
2
2.5
Percentage
of children
with
hyperkinetic
disorder
5 - 10yrs 11 -
15yrs
All
Age
Boys
Girls
All

16. Prevalence of any Disorder by
Ethnicity
White 9.75%
Black 12%
Indian 4%
Pakistani & Bangladeshi 8%
Other groups 10%
All C&YP 9.75%

17. Prevalence of any mental disorder by
gross weekly household income
0
2
4
6
8
10
12
14
16
18
U
nder
£
100
£1
00-£
199
£2
00-£
299
£3
00-£
399
£4
00-4
99
£5
00-5
99
£6
00-7
70
O
ver
£7
70
Gross weekly household income
Percentageofchildrenwithamental
disorder

18. Bradford
Up to 6,800 (5%) requiring specialist helpUp to 6,800 (5%) requiring specialist help
Source: Dr. Julia Raines July 2004Source: Dr. Julia Raines July 2004
Between 13,600 and 27,200 (10-20%) with disorderBetween 13,600 and 27,200 (10-20%) with disorder
Up to 54,400 (40%) with a mental healthUp to 54,400 (40%) with a mental health
problemproblem
July 2003 – total number of children & young people aged 0-18 registered with a BradfordJuly 2003 – total number of children & young people aged 0-18 registered with a Bradford
GP 135,596.GP 135,596.
Source: Bradford Health Informatics ServicesSource: Bradford Health Informatics Services

20. Exercise
Case Studies1) What do you think are the issues in this case study?
2) Do you think there is a mental health problem?
3) What are the key factors that you feel need to be
considered?
4) What further information would you like to have to
be clearer about what to do next?
5) Suggest a specific intervention.
6) Do you think this case requires specialist?

21. What helps - Anxiety
• Prevention - A number of causes of general anxiety in childhood can be
prevented by sensible handling
• For illogical fears that are not quite phobias, simple explanations and
reassurance will help many children gradually get over them
• Detailed interview with child and family
• Look to other agencies for interventions eg Educational Psychologists or
Education Socal Workers if anxiety is about school, social workers if
about home life

22. What helps - Anxiety
• Talking to or helping children and parents to understand how
the problem has developed
• Specific fears are usually treated by helping children confront
their fear in a way and at a pace that they can manage eg
carefully planning a gradual return to school if the anxiety is
school based
• Teaching relaxation
• Help children talk through their anxieties using drawing or
play

23. What helps - Depression
• About 10% of children and young people with depression recover
spontaneously within 3 months
• Be able to determine, recognise and assess those with depression
• Ensure timely information is available on the nature, cause and treatment
in all local languages
(NICE, 2005)
• Ask sympathetically how they are and listen to the response
• Encourage them to remain active
• Praise all efforts
(Royal College of Psychiatrists, 1999; YoungMinds)

24. What helps - Hyperactivity
• Learn about hyperactivity and what it means
• Give structure and encourage regular routine
• Give clear instructions, sufficient time to complete tasks
• Provide a variety of physical activity
• Reward any achievements
(HASCAS, 2004)

25. What helps – conduct
disorder
• All approaches are grounded in respect for the child
• Empathy, attention and involvement, play, problem-solving, listening,
talking.
• Praise any achievements and reward them
• Encouragement
• Clear limits and consistent rules with consistent follow-through
• Ignore negative behaviour, distract from negative behaviour (positive
verbal redirection) and use re-engagement strategies
• Remind of expected behaviour and warn of consequences
• Use consequences

26. What else helps children’s and young
people’s mental health?
• Adults being self-aware
• Feeling helpless/angry/rejected
• Learn from your experiences
• Respect their view even if an alternative adult view is presented
• Understanding
• Them
• Their peer group
• Their developmental stage/age
• Their life circumstances

27. What else helps children’s and young
people’s mental health?
• Listening
• Actively
• Open questions
• Warmth and empathy
• Take account of cultural issues
• Never promise to keep a secret
• Child protection procedures
• Emotional language

28. What else helps children’s and
young people’s mental health?
• Boundaries
•Knowing what they can and can’t do
•Be consistent
•Expect challenge
• Skill Development
•Enabling children and young people to improve
their mastery of stressful situations

29. What else helps children’s and
young people’s mental health?
• Being there
•Links with attachment
•Even if they don’t talk to you, the main thing is
not to put them off talking to someone in the
future
•Doing what you promise – don’t let them down!

30. Beginnings
• Where do you begin?

31. Resilience
Resilience involves several related elements.
Firstly, a sense of self-esteem and confidence;
Secondly a belief in one’s own self-efficacy and ability to deal
with change and adaptation;
Thirdly, a repertoire of social problem solving approaches’ (Rutter 1985)

32. Resilience Factors -Child
• Secure early relationships
• Being female
• Higher intelligence
• Easy temperament when an infant
• Positive attitude, problem-solving approach
• Good communication skills
• Planner, belief in control
• Humour
• Religious faith
Capacity to reflect

33. Resilience Factors - Family
• At least one good parent-child relationship
• Affection
• Clear, firm and consistent discipline
• Support for education
• Supportive long-term relationship/absence of
severe discord

34. Resilience Factors -
Community• Wider supportive network
• Good housing
• High standard of living
• High morale school with positive policies for
behaviour, attitude and anti-bullying
• Schools with strong academic and non-
academic opportunities
• Range of sport/leisure opportunities

35. Promoting resilience in relationships
• Increase warmth and pleasure parent feels for the
child
• Foster concern/interest as this helps to develop self-
esteem
• Foster ability to predict child’s needs
• Use activities which foster connectedness
• Help parents and children to do funny things
together
• Build parental confidence and skills

36. Outcome
• Be healthy
• Stay safe
• Enjoy and achieve
• Make a positive contribution
• Achieve economic well being

37. Emotional Presupposing

38. Thinking about how we use language of emotion
Relational
Autonomous

39. Emotional Posture of a
Child
Do they want to
meet?
How will they
feel when
they meet
you?
Will they be
relaxed/ reflective?
Will they be focussed on
listening or protesting?
What will they want
you to appreciate
about them?

40. Emotional Posture of the Teacher
Are you looking
forward to meeting
them?
What might you
experience in your
body or notice about
their body/
What feelings will you
carry from the earlier?
How might your
posture affect how you
can be with these
people?
Which posture is likely to invite
respect, safety and collaboration?

41. How would you like to be with this child?

42. Presuppose the postion
of the child, family, school, community and ourselves
Who might they ask
you to be?
How might they invite
you to act?
What might you need to do?
What position
do you prefer
to offer?
What is your
storyline?

43. Extend your repertoire of postions
If you did something
different what would
happen?
What other postions
might you invite?