Letter to the Editor: Are young people overpathologising their own mental health? We need empirical research.

Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people. To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model. The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published. Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access. The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a priority for us all.

Since the growth of research into neighbourhood effects on young people's health in the 1980s, there have been major societal changes and scientific methodological advancements. In this systematic review we will, therefore, discuss the recent (>2009) literature on the association between neighbourhood deprivation and young people's (0-19 years old) mental health and well-being. We focus on whether neighbourhood deprivation effects exist, and how and for whom the neighbourhood matters. Together, the thirty studies included in the review indicate that overall there are neighbourhood effects on young people's mental health and well-being. The comparison of results from these studies suggests that such associations were more commonly found for well-being and externalising problem behaviour rather than internalising problem behaviour. Also, mental health and well-being seemed to be more often associated with the neighbourhood social environment than neighbourhood socio-economic status and neighbourhood disorder. Studies investigating mediating processes between the linkage between neighbourhood deprivation and mental health and well-being were rare although there was some evidence that processes within the family and peer context are important mechanisms in this linkage. Inconsistent evidence was found regarding the moderating role of age, gender, and ethnicity. There are ongoing challenges of researching the how and for whom neighbourhoods are important. We should work towards rigorous theory and evidence on how different features of residential contexts matter and on differential exposure and vulnerability to these contexts.

Teenpath COVID is a mixed-methods, participatory study exploring the experiences of young people in Ireland since the COVID-19 pandemic and its impacts on existing health inequalities. As part of an exploratory sequential research design, we conducted a stakeholder analysis, online survey, and participatory arts programme evaluation to identify cross-cutting issues impacting the health and well-being of young people in Dublin and across Ireland. Interviews conducted with stakeholders spanning youth service, public health, and education sectors, and young people aged 16-25 explored individuals’ experiences of the pandemic; adaptations to working and maintaining engagement online; key concerns about young people's health and wellbeing; and priorities for future research and policy. Thematic analysis identified impacts of the pandemic on health inequalities with potential policy implications. This informed a subsequent online survey exploring young people's mental health since the pandemic, and an ethnographic case study of a participatory arts programme exploring key issues important to young people in Dublin. Our findings suggest the pandemic has impacted predominantly on young people's mental health and access to youth mental health services; disruption to work, education and social and peer support networks; and health behaviours. Protective measures, from accessing and maintaining social support networks, to developing coping strategies were important for young people's mental health. However the extent to which these were possible was shaped significantly by individuals’ personal circumstances at the time. These findings show the importance of social participation and support for young people in navigating the uncertainties and difficulties of growing up in a pandemic. Participatory approaches can be a pathway for aligning healthy priorities and policy that contributes unique and rich insights into community health, and places young people at the centre of change. Key messages • Young people in Ireland have experienced significant impacts to their mental health since the COVID-19 pandemic began, particularly regarding disruptions to education and social support networks. • Participatory approaches to research and youth engagement with young people is important for gathering high quality and diverse data on complex topics such as mental health and health inequalities.

Young people's mental health globally has been in decline. Because of their low perceived need, young people's services tend to be the first cut when budgets are reduced. There is a lack of evidence on how a reduction in services and opportunities for young people is associated with their mental health. Additionally, how this may be magnified by place and the assets and challenges of place. The aim of this study is to explore trends in young people's mental health measured by GHQ-12 over time in the twelve regions of the UK. We estimated an interrupted time series model using 2010 as a break point from which there was a shift in government policy to a prolonged period of large reductions in central government funding. Repeated cross-sectional data on young people aged 16–25 is used from the British Household Panel Survey and its successor survey UK Household Longitudinal Survey. Results showed a statistically significant reduction in mental health for young people living in the North East, Wales, and the East of England. The North East was the region with the largest reduction in funding and saw the greatest reduction in young people's mental health. Next, we look at how reductions in local government expenditure related to services for children and young people: children's social services, education, transportation, and culture; explain the observed decline in mental health. We employ a Blinder-Oaxaca Decomposition approach comparing young people's mental health between 2011 and 2017. Results show a marginally statistically significant decrease in young people's mental health over this time. Unobserved factors related to transport spending and children's social services explain some of this gap. Area level factors such as deprivation, infrastructure, and existing assets need to be considered when distributing funding for young people's services to avoid exacerbating regional inequalities in mental health.

The novel coronavirus (COVID-19) pandemic in Canada has increased attention and concern paid to young people's well-being and mental health. Narratives of isolation, exacerbated inequalities, and potential unequal recovery for young people, in particular, have been presented as a result of school closures across the country. Through these narratives, young people are framed as vulnerable, passive recipients of adult decisions and interpretations of their experiences. This research examines these narratives by conducting ethnographic fieldwork with a group of young people living in a rural Ontario town through the pandemic. This thesis presents and analyzes these young people's experiences of the pandemic related to mental health and well-being to reveal the missing nuances of adult narratives and to propose suggestions for future inclusive, accessible, rights-respecting programs for young people's mental health and well-being post-pandemic based on young people's accounts. Keywords: ethnography, COVID-19 pandemic, rural young people, mental health and well-being, children's rights

Good mental health is the foundation of children and young people's emotional and intellectual growth, underpinning the development of confidence, independence and a sense of self worth which is vital to their future. However, today one in 10 children aged between five and 16 years have a clinically diagnosable mental health problem and research shows that these children and young people have the poorest life chances of any group of young people.The most recent national survey of mental health among children and young people in Britain was carried out over a decade ago. The 2004 report by the Office for National Statistics, published by the Health and Social Care Information Centre,1 revealed high levels of mental health problems, including depression, stress and anxiety, psychosis, eating disorders and self-harm.The period of time that has elapsed since this last survey suggests that, despite the worrying statistics it contains, insufficient attention has been paid to the mental health of this age group. The government's recent pledge of £1.25 billion by 2020 to support improvements in children and young people's mental health and wellbeing, along with £150 million for eating disorder services, is evidence of a sea-change.The ambition over the next five years for children and young people's mental health, according to National Health Service (NHS) England, is to support clinical commissioning groups (CCGs) to work with partners to build effective, evidence-based outcome-focused Child and Adolescent Mental Health Services (CAMHS), working in collaboration with children, young people and families.Meanwhile, according to the Mental Health Foundation,2 one of the 'most obvious, yet under-recognised factors in the development of major trends in mental health is the role of nutrition'. The charity points to a body of evidence 'growing at a rapid pace' suggesting that good nutrition is essential for mental health and that a number of mental health conditions may be influenced by dietary factors.It says,As well as its impact on short and long-term mental health, the evidence indicates that food plays an important contributing role in the development, management and prevention of specific mental health problems such as depression, schizophrenia, attention deficit hyperactivity disorder.The Foundation adds that nearly twothirds of those who do not report daily mental health problems eat fresh fruit or fruit juice every day, compared with less than half of those who do report daily mental health problems. This pattern is similar for fresh vegetables and salad. Those who report some level of mental health problem also eat fewer healthy foods (fresh fruit and vegetables, organic foods and meals made from scratch) and more unhealthy foods (chips and crisps, chocolate, ready meals and takeaways).Rethink Mental Illness3 further suggests that the increase in use of many additives, food colourings and processed foods - alongside the general rush to eat meals, often while running between different activities - have all played a role in unhealthy eating. These changes, it says, have been linked to some people experiencing mood changes, being irritable and being unable to concentrate.While both the findings of the Mental Health Foundation and Rethink are referring to the population at large, rather than children and young people specifically, a 2012 systematic review of 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents found evidence of a 'significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents'.4 The authors observed a consistent trend for the relationship between good-quality diet and better mental health and 'some evidence for the reverse'.While healthy eating has been shown to impact positively on the mental health of children and young people, the relationship between physical activity and general aspects of psychological wellbeing, self esteem and the management of anxiety and depression and behaviour is also well documented. …

The Children and Young People's Mental Health Trailblazer programme is funding the creation of new mental health support teams to work in schools and further education colleges. Mental health support teams directly support children and young people with 'mild to moderate' mental health problems and work with school and college staff to promote well-being for all. A new workforce of education mental health practitioners is being trained for the teams. The National Institute for Health and Care Research Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of mental health support teams in the programme's first 25 'Trailblazer' sites. A mixed-methods evaluation, comprising three work packages: 1. Establishing the baseline and understanding the development and early impacts of the Trailblazer sites, including two rounds of surveys with key informants and participating education settings in all 25 sites. 2. More detailed research in five purposively selected Trailblazer sites, including interviews with a range of stakeholders and focus groups with children and young people. 3. Scoping and developing options for a longer-term assessment of the programme's outcomes and impacts. Fieldwork was undertaken between November 2020 and February 2022. The University of Birmingham Institute for Mental Health Youth Advisory Group was involved throughout the study, including co-producing the focus groups with children and young people. Substantial progress had been made implementing the programme, in challenging circumstances, and there was optimism about what it had the potential to achieve. The education mental health practitioner role had proven popular, but sites reported challenges in retaining education mental health practitioners, and turnover left mental health support teams short-staffed and needing to re-recruit. Education settings welcomed additional mental health support and reported positive early outcomes, including staff feeling more confident and having faster access to advice about mental health issues. At the same time, there were concerns about children who had mental health problems that were more serious than 'mild to moderate' but not serious enough to be accepted for specialist help, and that the interventions offered were not working well for some young people. Mental health support teams were generally spending more time supporting children with mental health problems than working with education settings to develop 'whole school' approaches to mental health and well-being, and service models in some sites appeared to be more clinically oriented, with a strong focus on mental health support teams' therapeutic functions. Despite efforts to maximise participation, survey response rates were relatively low and some groups were less well represented than others. We were not able to gather sufficiently detailed data to develop a typology of Trailblazer sites, as was planned. Key lessons for future programme implementation include: - Whether mental health support teams should expand support to children and young people with more complex and serious mental health problems. - How to keep the twin aims of prevention and early intervention in balance. - How to retain education mental health practitioners once trained. The findings have important implications for the design of a longer-term impact evaluation of the programme, which is due to commence in summer 2023. Ethical approval from the University of Birmingham (ERN_19-1400 - RG_19-190) and London School of Hygiene and Tropical Medicine (Ref: 18040) and Health Research Authority approval (IRAS 270760). The Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre is funded by the National Institute for Health and Care Research Health Services and Delivery Research programme (HSDR 16/138/31). The Policy Innovation and Evaluation Research Unit is funded by the NIHR Policy Research Programme (PR-PRU-1217-20602).

Leaving child and adolescent mental health services in the MILESTONE cohort: a longitudinal cohort study on young people's mental health indicators, care pathways, and outcomes in Europe

There is an increasing focus on structural and social determinants of inequalities in young people's mental health across different social contexts. Taking higher education as a specific social context, it is unclear whether university attendance shapes the impact of intersectional social identities and positions on young people's mental health outcomes. Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was used to predict the odds that mental distress during adolescence, sex, socioeconomic status, sexual identity, ethnicity, and their intersections, were associated with young people's mental health outcomes at age 25, and whether this differed based on university attendance. Data from the Longitudinal Study of Young People in England cohort study were analysed with the MAIHDA approach, and the results did not reveal any evidence of multiplicative intersectional (i.e., aggravating) effects on young people's mental health outcomes. However, important main effects of social identities and positions (i.e., an additive model) were observed. The findings suggested that being female or identifying as a sexual minority increased the odds of young people experiencing mental health problems at age 25, although the odds of self-harming were half the size for sexual minorities who had attended university. Black and Asian individuals were less likely to declare a mental illness than White individuals. Young people who grew up in a more deprived area and had not attended university were more likely to experience mental health problems. These findings imply that mental health interventions for young people do not necessarily have to be designed exclusively for specific intersectional groups. Further, university attendance appears to produce better mental health outcomes for some young people, hence more investigation is needed to understand what universities do for young people, and whether this could be replicated in the wider general population.

Providing the growing number of children and young people seeking mental health support with timely access to care poses a significant challenge. Increased use of digital technology in the delivery of children and young people's mental health services has been proposed as a means of increasing access to treatment. We conducted three interrelated studies to provide multi-perspective insights into the use of digital therapeutic interventions within children and young people's mental health services in the UK. Study 1 used semi-structured interviews and an online survey to collect the views of digital therapeutic interventions of families who self-identified as facing additional barriers to accessing mental health support (n=13). Study 2 involved eight focus groups with children and young people's clinicians, service managers, commissioners, and policy leads (n=28), exploring participants' views and experiences of implementing and sustaining digital therapeutic interventions. Study 3 was a consensus exercise which aimed to identify actions needed to bridge the gap between the development and use of digital therapeutic interventions for children and young people's mental health through focus groups with parents/carers and professionals (n=17), and three Delphi-survey rounds. Our findings revealed considerable enthusiasm for the increased use of digital mental health interventions for children and young people across stakeholder groups, but also identified key barriers to their implementation. Actions perceived to facilitate more effective implementation included: a) co-producing interventions, commissioning decisions and implementation plans with children and parents/carers, b) enhancing national guidance and local leadership, c) integration of digital offers within existing clinical pathways, and d) efforts to ensure accessibility and inclusivity. Digital therapeutic interventions offer a promising solution to the challenge of improving access to mental health support for children and young people. Strengthened guidance and leadership, sustained funding and further evidence-generation are urgently needed to enable this promise to be realised.

This study aimed to investigate coaches' awareness of mental health in youth sport, as well as their perceived role breadth and ability to support young people's mental health. Interviews were conducted with 13 sports coaches of young people aged 12–18 from Canberra, Australia. Interview transcripts were analysed using a combination of inductive and deductive qualitative content analysis. Coaches recognised that their role breadth allows them to be a useful source of support for young people's mental health by way of identifying concerns, facilitating help-seeking behaviour and promoting engagement in sports. Further training in mental health would boost coaches' ability to assist confidently and effectively, leading to benefits for young people's mental wellbeing and sporting experience. Coaches are in a position to positively impact young people's mental health, and set expectations for themselves to actively support young people in this way. Supporting mental health may be an area of future growth for the role of a youth sports coach.

The impact of the Covid-19 pandemic on young people's (YP) mental health has been mixed. Systematic reviews to date have focused predominantly on quantitative studies and lacked involvement from YP with lived experience of mental health difficulties. Therefore, our primary aim was to conduct a qualitative systematic review to examine the perceived impact of the Covid-19 pandemic on YP's (aged 10-24) mental health and wellbeing across Europe. We searched MEDLINE, PsycINFO, Embase, Web of Science, MEDRXIV, OSF preprints, Google, and voluntary sector websites for studies published from 1st January 2020 to 15th November 2022. European studies were included if they reported qualitative data that could be extracted on YP's (aged 10-24) own perspectives of their experiences of Covid-19 and related disruptions to their mental health and wellbeing. Screening, data extraction and appraisal was conducted independently in duplicate by researchers and YP with lived experience of mental health difficulties (co-researchers). Confidence was assessed using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. We co-produced an adapted narrative thematic synthesis with co-researchers. This study is registered with PROSPERO, CRD42021251578. We found 82 publications and included 77 unique studies in our narrative synthesis. Most studies were from the UK (n = 50; 65%); and generated data during the first Covid-19 wave (March-May 2020; n = 33; 43%). Across the 79,491 participants, views, and experiences of YP minoritised by ethnicity and sexual orientation, and from marginalised or vulnerable YP were limited. Five synthesised themes were identified: negative impact of pandemic information and restrictions on wellbeing; education and learning on wellbeing; social connection to prevent loneliness and disconnection; emotional, lifestyle and behavioural changes; and mental health support. YP's mental health and wellbeing across Europe were reported to have fluctuated during the pandemic. Challenges were similar but coping strategies to manage the impact of these challenges on mental health varied across person, study, and country. Short-term impacts were related to the consequences of changing restrictions on social connection, day-to-day lifestyle, and education set-up. However, YP identified potential issues in these areas going forward, and therefore stressed the importance of ongoing long-term support in education, learning and mental health post-Covid-19. Our findings map onto the complex picture seen from quantitative systematic reviews regarding the impact of Covid-19 on YP's mental health. The comparatively little qualitative data found in our review means there is an urgent need for more high-quality qualitative research outside of the UK and/or about the experiences of minoritised groups to ensure all voices are heard and everyone is getting the support they need following the pandemic. YP's voices need to be prioritised in decision-making processes on education, self-care strategies, and mental health and wellbeing, to drive impactful, meaningful policy changes in anticipation of a future systemic crisis.

British Journal of School NursingVol. 13, No. 10 RepresentationSchool nursing's potential to have an impact on the prevention agenda and mental health outcomes: A position statementSharon WhiteSharon WhiteSearch for more papers by this authorSharon WhitePublished Online:18 Dec 2018https://doi.org/10.12968/bjsn.2018.13.10.514AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Youth Council. Our School Nurse: Young people's views on the role of the school nurse. 2011. BYC Google ScholarDay P. Motivating Teen Spirit: Early metal health intervention. BJSN. 2016;11(2): 93 Link, Google ScholarDepartment of Health. Healthy Child Programme: 5 to 19 years old. 2009. https://bit.ly/2rk8dmA Google ScholarDepartment of Health. Chief Medical Officer annual report 2012: children and young people's health. 2013. https://bit.ly/1iTKqlz Google ScholarDepartment of Health. Future in mind—Promoting, protecting and improving our children and young people's mental health and wellbeing. 2015. https://bit.ly/2Kr7RTn Google ScholarDepartment of Health, Department for Education. Transforming Children and Young People's Mental Health Provision: a Green Paper. 2017. https://bit.ly/2H51qGU Google ScholarDepartment of Health, Public Health England. Maximising the school nursing team contribution to the public health of school-aged children—Guidance to support the commissioning of public health provision for school aged children 5–19. 2014. DH, PHE Google ScholarDepartment of Health and Social Care. Prevention is better than cure: our vision to help you live well for longer. 2018. https://bit.ly/2SLpZvG Google ScholarDepartment of Health and Social Care, Public Health England. Overview of the 6 early years and school aged years high impact areas. Health visitors and school nurses leading the Healthy Child Programme. 2018. https://bit.ly/2AqfGVG Google ScholarKay CM, Morgan DL, Tripp JH, Davies C, Sykes S. To what extent are school drop-in clinics meeting pupils self-identified health concerns? Health Education Journal. 2006;65(3):236–251 Crossref, Google ScholarKelly N, Greaves C, Buckland L, Rose J. ‘School nurses: well placed to address challenging behaviour’. Community Practitioner 2005;78(3):88–92 Google ScholarMarmot. Fair society, healthy lives: The Marmot Review: strategic review of health inequalities in England post-2010. 2010 Google ScholarMasters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health. 2017 Aug;71(8):827-834. doi: https://doi.org/10.1136/jech-2016-208141 Crossref, Google ScholarPublic Health England. All Our Health: about the framework. 2018. https://bit.ly/2qipnAM Google ScholarRoyal College of Nursing. 2017. The Best Start: The Future of Children's Health: Valuing school nurses and health visitors in England. https://bit.ly/2Rwu2uG Google Scholar FiguresReferencesRelatedDetailsCited byExtending the mental health expertise of school nurses: Evaluating a training programmeStephen Abbott, Rosamund Bryar, Ruth Cohen, Jane Gibbons, Lucy Marks15 November 2019 | British Journal of School Nursing, Vol. 14, No. 9 2 December 2018Volume 13Issue 10ISSN (print): 1752-2803ISSN (online): 2052-2827 Metrics History Published online 18 December 2018 Published in print 2 December 2018 Information© MA Healthcare LimitedAcknowledgments:Thanks go to Kate Murdock, children's health service manager, South Locality—Trafford Division, and Sallyann Sutton, professional lead—school nursing, for leadership in pulling together this position statement on behalf of SAPHNA.PDF download

There is a need for African people living in Australia to consider leveraging Ubuntu values as a cultural strength to address mental health and emotional wellbeing issues. for African people living in Australia. This paper is a systematic review research which employed key terms such as mental health, emotional wellbeing, African Australian, Young people. There were no participants involved, however the research articles that were reviewed in the study only focused on the African Australian community. Mental health issues among African Australian youth need to be better understood, as studies have shown they are at a higher risk for mental health, yet there has been insufficient research on the topic. In this study, most articles we employed highlighted that the extensive research on that reported migrants to be at ten times higher risk of experiencing mental health issues compared to the general population. Many studies carried out in the African Australian community have drawn more attention to the African Australian culture. This raises the need for research to be conducted on African Australian young people aged 15-29 years which is the Australian age range of a young person, to sensitize the African Australian community on mental health issues, and factors leading to young people's mental health problems in African Australian society. The aim of the study was to raise awareness about mental health issues facing the African, Australian young people and suggesting ways forward to support young people. The finding of the study demonstrates significance and values to address mental health issues in African-Australian Community groups. Research asserted that young immigrants are at greater risk of developing mental illness due to resettlement, cultural transition, and separation from extended family members. Young people lacking a secure base for emotional support from their families are more likely to face mental health issues in their lives. Mental health issues in the African context may not be categorized as a vast problem, but instead identified as life circumstances that every individual encounter. Since mental health subject is a taboo in the African culture, the study encouraged young people to pair up with other African youths to create awareness and advocate to access mental health services should need arise. This study encourages young people and their families from African heritage to leverage Ubuntu values and principles as their cultural strengths in dealing with challenging issues such as mental health and emotional wellbeing issues. How to reference using ASWNet style: Kagola F. & Abur W. (2023). Leverage Ubuntu values and principles as cultural strength to overcome mental health and emotional well-being issues. African Journal of Social Work, 13(6), 312-324. https://dx.doi.org/10.4314/ajsw.v13i6.5 Visit journal website: https://ajsw.africasocialwork.net

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.