Category: schools

Children and Young People’s Mental Health in Scotland – some context

~ brianorbistc ~ Leave a comment
This is a copy of the speech I gave to a group of ‘Trusted professionals’ in Glasgow this week. These professionals provide tailored support to young people in the form of ‘Activity Agreements’.  these focus on developing skills, capacities and getting young people into positive destinations. Mental Health was becoming an increasing issue for them and they wanted some input on the context for this work in Scotland – which I was happy to try and provide.
 
I was asked to come along today to provide an overview of children and young people’s mental health – to give an overview of the context in Scotland – which I will do. I will talk briefly about the national strategy, the national indicators, the curriculum for excellence and GIRFEC.
 
I was also asked to reflect on approaches or support that can be offered – that is where the conversation expands considerably. There are as many approaches and models as there are diagnosed conditions and they cannot be covered by an input such as this –the truth is the journey of building our own capacity to recognise and respond to mental health issues never ends. Reading, training, workshops, partnerships – these things all build our capacity and that is what I hope to contribute to today.
 
I am pleased to see children and young people’s mental health is on your agenda and I realise for some – it is new to you and can see why you wanted it be able to reflect on it today.
 
Understanding mental health is not about you diagnosing ADHD, Bi-Polar disorder or necessarily recognises an eating disorder immediately – but about being comfortable that you have the skills and knowledge to respond and engage with other medical or professional services.
 
The time you spend with a young person and what you see matters. That’s what the ‘experts’ need to ask or expect from us – to describe how someone behaves – what do they do? – We should not be prevented from contributing because we can’t make a formal diagnosis.
 
You work with teenagers – not feeling good about themselves, being moody and uncomfortable around adults is their job. Some of the young people you work with from your own data, have additional support needs, have been involved in offending, some will or will have been looked after and some use drugs and alcohol. 
 
When I read this data – I did think to myself –of course mental health is going to be an issue with the young people you work with!
Care leavers in particular are up to 5 times more likely to have a diagnosed mental health problem when they leave care – this is due to a number of factors -as is the case for most young people who are marginalised or struggling with some of the issues that lead the them needing a service form you.
 
This includes things like life events, trauma, separation, poor attachments, developmental difficulties that could be genetic too, neglect or parental mental health or illness. These are all things that affect a person’s well-being and can develop into diagnosed mental health conditions or they can exacerbate underlying conditions. These all affect behaviour and can lead to anger, anxiety, self-harm, eating disorders. You deal with behaviour and all behaviour communicates feelings. That’s what we understand best – in my opinion.
 
This matters in your role as mental health is a major cause of absence at work and to people being unable to work or being stigmatised and discriminated against. We also know that many mental health problems begin and develop in adolescence – they don’t just appear on adults – yet services and legislation are still largely set up that way.
 
So, to the context for all of this.  The over-arching context that underpins all of what we shall explore next is GIRFEC – Getting It Right for Every Child is something I am sure you are well aware of –this framework for outcomes compliments the Mental Health Strategy for Scotland, The National Indicators for Children and Young People and The Curriculum for Excellence and so on. All of this should in theory ensure all children are safe, happy nurtured and son on.
 
We have in Scotland a Mental Health Strategy – one that ran from 2012 – 2015. and one that runs form 2017 – 2027. This document sets out the Scottish Government’s priorities and commitments to improve mental health services and to promote mental wellbeing and prevent mental illness. the 2017 one sets out 40 Actions and can be found here  – 
 
These are designed to reflect Government ambitions and National Outcomes so that we can ‘live longer healthier lives’ ‘tackle inequality’  and ‘services are responsive to people’s needs’  – High level outcomes Government ambition (Longer healthier lives) directly impact national policy and strategy which impact money and resources and impact on funding and the desired outcomes funders are looking for you to deliver – it is much easier to argue the case to government when you can easily contextualise your work and ambition in the context of their outcome framework – that’s the language they understand.
The Government has a vison that by 2020 (it’s called the 2020 vison) that sees health services delivered in communities with people at the centre – it encourages health promotion and prevention – and that is where most of you sit – making this a reality that doesn’t focus on medical approaches has still to be achieved.
 
The Mental Health Strategy identifies seven key themes, which emerged from the consultation process
 
Working more effectively with families and carers
 
Embedding more peer to peer work and support
 
Increasing the support for self-management and self-help approaches
 
Extending the anti-stigma agenda forward to include further work on discrimination
 
Focusing on the rights of those with mental illness
 
Developing the outcomes approach to include personal, social and clinical outcomes
 
Ensuring that we use new technology effectively as a mechanism for providing information and delivering evidence based services
 
Four Key Change Areaswere also identified
 
Child and Adolescent Mental Health
 
Rethinking How We Respond to Common Mental Health Problems
 
Community, Inpatient and Crisis Mental Health Services
 
Work with Other Services and Populations with Specific Needs
 
Activity to Support Delivery of the Mental Health Strategy
 
Again you can see this is very medically focussed and children and young people are one of the 4 areas. I feel that sometimes children and young people are relevant in each of the 4 – you can’t just relate them to adults and then just have children’s mental health as a category all of their own.
The other side of the coin is it is finally recognising a need to focus on children and young people’s mental health and it is an area that requires renewed focus.
 
One of the aims of the strategy is that children and young people, following a referral for specialist CAMHS treatment get seen within 26 weeks.
 
A large amount of the strategy focusses on CAHMS interventions and the CAMHS works force –some of it is moving into community based work and partnerships but it is still largely led by a medical model or a deficit model on mental illness and less on the promotion and prevention.
 
It is something we should read if children’s mental health matters to us – it clearly does and it shapes the partnerships we can develop and the work done by colleagues.
 
Part of the on-going work to improve mental health in Scotland was to develop a set of national indicators on mental health – one was developed for adults initially and subsequently one for children and young people – I was on the advisory group for children and young people and it was quite a challenge – doctors, physicians, psychologists, researchers, professors and me! Making up the numbers and representing the voluntary sector social work types.
These indicators were finalised in late 2011 and set out a range of mental health outcomes – things that contribute to mental well-being and to mental health problems and arrange of contextual factors such as family, environment, community, learning environment etc.
 
This is the graphic that illustrates the framework.

The idea is that data can be measured through surveys, existing research, suicide and hospital statistics and specialist tools such as a Strengths and Difficulties questionnaire to give an overall picture of mental well-being and also mental health problems in Scotland – this is then supported by an analysis of contextual factors through surveys, research and data on the contextual factors, health and behaviour in schools surveys, both national and local ones.
 
The first analysis of these was completed in 2013 and indicated that children’s mental health has improved or stayed broadly consistent on the last 10 years – it shows contextual factors like alcohol consumption is down but the units consumed by those drinking going up for example.
 
These trends and data are to be used to influence policy and practice and to challenge and inform media colleagues.
 
The one other area that contextualises work around mental health is the Curriculum for Excellence – significantly the health and well-being outcomes within this. This is what colleagues in schools will be working within and setting lesson plans etc. around. What is new and positive about the curriculum is traditionally literacy and numeracy were the responsibilities of all – well-being sat with guidance and pastoral care – this is no longer the case – all teachers have a responsibility to include and consider how their work, relationships and lessons impact on health and well-being. It recognises that in order to learn and to and develop confidence requires a focus on our mental well-being – this will not be rocket science or news to any of you but it does radically change the paradigm for colleagues in schools.
 
It’s no longer good enough for the history teacher to just teach the history curriculum, they have to be tuned into and recognise the things that can impact on a child’s well-being and their learning. They are expected to promote a culture of respect and trust.
 
I have given inputs to teachers who are just as concerned about what is expected of them as you are – just as concerned that they are worried they will need ot teach lessons or deal directly with the treatment of mental health problems. The message is the same – it’s about being confident to recognise when something isn’t right or a person has changed and knowing where ot go and what to do – who to talk to and where to get help. Signposting and having knowledge of what resources are in your area is vital.
 
Health and well-being extends to food and nutrition, exercise, relationships as well as feelings, anxiety, fear, and mental health problems. The health and Well-being outcomes that teachers use should address issues such as managing relationships, developing resilience, dealing with difficulties, expressing yourself and getting active.
 

This graphic highlights the tools colleagues should be using to plan and deliver learning and making sure these outcomes are the focus.
 
For me, this is the first time education and social work has had a 
similar value based approach to outcomes for children and young people.
 
So as you can see- there is quite a bit of context for the work you do – I haven’t even drilled into parenting strategies or suicide and self-harm or anti-bullying strategies – that all reflect the same values and ambition. There are many of these that can give you access to more detail on how to respond, what works, what good practice looks like, where to get help – the challenge is to familiarise ourselves with the practice and the policy context that affects us and assimilate this into our work.
 
You will learn more about dealing with self-harm when you are dealing with self-harm than you can from having a theoretical understanding of it – this can help it can ensure your first response is a more informed one – same with bullying, same with Bi –Polar disorder or depression. Reflective practitioners learn from their experience – we absorb influences, research, books, advice and guidance with our experience and we us all this to formulate plans and approaches to issues.
 
I think we should be more comfortable at times with the fact we are always learning and always on a journey – not feel we can’t contribute because we are not experts on the minutia of a particular mental health issue- you will be presented with a huge variety of behaviour – there may be some similarities but every child is unique and their issues will be unique to them, where they live, who they live with and where you fit in.
 
The impact of Mental Health problems
 
It is important to just reflect on the impact of metal health on children and young people
 
Stigma
 
Discrimination – these can be immobilising – they are still experienced more from close family and friends
 
Relationships affected – friends can turn away – young people might struggle with how to manage ups and downs – tension can result
 
Life Chances – you miss school and you get no qualifications – your options are limited –the choices you can make are affected
 
Employability – it can impact on attendance at work and the stigma can prevent people from gaining work
 
Drug and Alcohol use – can be a contributor as well as a symptom
 
Developmental delays – some conditions can result in developmental delays and affect conative functions
 
Behavioural problems – as a result of not being able to communicate effectively – or feeling the stigma
 
Physical health – to take part in things like PE, to want to or even be able to –side effects of medication or treatment
 
Motivation – can’t get out of bed!
 
These just some of the impacts – I’ve put motivation in as you will work with some young people who for the moment actually can’t get out of bed – they’ve not yet been diagnosed with depression but all the cajoling on the world won’t address what’s going on – threats will have no impact.
You might also be working with someone who can’t get out of bed because they are not used to it and hate getting up – and cajoling and threats might be the order of the day. There is no one answer for things like this except to try and see the whole person and what their behaviour communicates in the broadest sense and to consider mental health when doing this – for some of the people you work with this will be a first.
 
What we do know is this – A strong relationship with a trusted professional – I don’t just mean the formal role of ‘trusted professional’ but one good positive relationship can make all the difference – there is no shortage of research into brain development in early years – Dr Harry Burns’ stuff is fascinating on how neural pathways are joined up through positive attachments and stimulation and how brain development can be affected by the absence of these – the crucial message he gives, as do many others  is that this ‘damage’ is not beyond repair – adolescents can and do through positive relationships learn to trust , to stretch themselves and grow.
The skills that underpin effective relationships are the ones we use and the ones others need to learn – especially the medical professionals – they have things to learn from you.
 
As I said at the start of this – it is just not possible to cover the area of children and young people’s mental health fully – if affects every single pat of who they are and what they do
 
If you are a social worker – you must consider mental health in your work and decisions
 
If you are a teacher – you must consider mental health in the same way
a youth worker, a classroom assistant, a criminal justice social worker, a foster carer, a residential worker- we don’t always need the ‘expert’ to deal with this aspect of a child’s life
 
There is no health without mental health – we all have mental health – it will be better at some times than others – we will need different things form the people around us depending who we are – what happened and when.
Our response will be dependent on our levels of resilience – did we have interests out of school, someone who cared and went the extra mile, somewhere we knew we belonged and were helped to learn from our experiences.
 
This job – this role gives you the chance to be that person for someone who needs it.
 

 

Thank you for listening folks – enjoy the rest of today.

Do we really all have to be friends?

~ brianorbistc ~ Leave a comment

The line that gave respectme its name has served us very well over the years and made for a very popular poster and video campaign – ‘You don’t have to like me, agree with me or play with me… but you do have to respect me’. The thinking behind this was the need for a way to describe how we wanted to help children and young people shape the terms for relationships and interactions with peers.

While this sounded quite catchy and lends itself well to a campaign – I always wanted to it have substance – and that is why we always follow this up by exploring what does this statement actually mean or what does it actually feel or look like for children and young people?

It is a nice demand to make of people I know but again, what does it mean. For the most part – it means simply leaving someone alone – you don’t need to connect with them, learn about them, understand them or become friends with them – just let them be.

The example I tend to use when discussing this, relates to an experience I had when my second oldest was at nursery. As reputations were being built and lost around the sandpit I heard the teacher tell the boys and girls who were playing and getting out of hand that ‘they should all be friends and play nicely’. This was of course said with warmth and with the best of intentions but at the time it really got me thinking – ‘’Do they all haveto be friends?’ how realistic an expectation is this?

Now, if a bunch of 4 year olds cannot behave around the sandpit we need to intervene and let them know how they should behave but do they all need to be friends? No – should they be expected to play near each other in a civilised way? Yes – perhaps a better response is along the lines of ‘if you are all going to play here together you need to be nicer to each other, no grabbing or shouting and you take turns – that’s one of the rules here’.

That is an easier boundary to set and easier to role model, if you tell them they need to be friends you are setting up an unrealistic expectation that they can’t possible manage – friends with everyone in your class? Are we as adults expected to be friends with everyone we work with? Do we even like everyone we are related to at times? Of course not.

I know for some this is not a huge issue but friendship is one of the first currencies children have to withhold or bargain with – it is a very powerful tool in early years and as such I think we can frame it more effectively. I would rather see a group of P1’s who can get along on different tasks, are respectful of each other and make friends on their terms. This also lets us talk about what it means to be a ‘good friend’ and help them understand that there will always be a wide group of people around them throughout school, some you’ll be friends with. Some you’ll know and say hello to and some you won’t get on with or agree with.

The skills needed to understand and negotiate this will serve them well in life not just school. Anti-bullying agencies get a bit of stick at times because the impression they give is that all they want is for everyone to be nice to each other and in fact this is unrealistic – I think it’s no bad thing to want everyone to be nicer but I agree that it’s not realistic.

What I do believe is that we should be asking children to respect their peers and that can mean a whole range of things. It can include talking and listening to someone and perhaps becoming friends, or it can mean fixing what was once a friendship or it can mean learning to be quiet and not shouting at or about someone you don’t like. I think friendships are vitally important to our children and young people – they rely on them, value them and as they get older, they turn to them for support and comfort – all this message and these campaigns seek to do is to help frame an understanding of what it really means to be friends.  

Learning that it is okay not to like someone, that it’s okay not to agree with them is important – it’s what you do that matters. Not being friends does not have to mean that you are enemies. That is a message I have seen young people benefit from exploring on many occasions.

If you think about it there must be a few people in your life you don’t like, you don’t and never will agree with – you don’t hound and abuse them at every opportunity – you may have learned the hard way that a family Christmas dinner is not the time to get these feelings off your chest. It might be a colleague or your boss – most people learn to use their developed social skills that enables them to work effectively or not fall out with the whole family.

If you pick on, exclude or verbally abuse someone in person or online you don’t like or agree with then that’s the kind of bullying that will cause problems for everyone – if you are able to let them walk by, be online or in the corridor without you responding in some negative way – then everyone will be a lot happier.

We will always respond to bullying more effectively when we focus on what someone actually did and the impact it had. If they behaved in a way that is unacceptable then we focus on their actions and what they should be doing in future.  This will be more effective than trying to fix or reframe a dynamic between two people that might not need ‘fixed’- nor will it ever fit into what we might think a ‘friendship’ is.

 

Brian

Gender based bullying and Sexual Violence

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An issue that we at respectme  have talked about many times in recent years arose again this year.  Various events and media, coverage saw the term ‘Sexual Bullying’  being used to describe a lot of very concerning behaviour.  I first responded to this particular ‘umbrella term’ several years ago (2009) following an article in The TESS – this is the letter

Your article “Sex pest boys are not only targeting girls, but teachers too” (March 27) opens by referring to the practice of “sexual bullying”.

This term is being used increasingly across the country and it is important to give the view of respectme, Scotland’s anti-bullying service on this. We believe people need to be careful when using this term. Sexually aggressive behaviour should be seen as just that. While there may be elements of this conduct that could be seen as bullying based on gender, what you described is sexually aggressive and inappropriate.

Using the term “sexual bullying” may well dilute sexually-aggressive behaviour or harassment to the status of “just another type of bullying” and, sadly, we know not everyone takes bullying seriously.

The converse side is that it elevates bullying to the same status as sexual harassment and sexual assault, which is not always the case.

We know the solutions to these behaviours can be very different. We must ensure that our children and young people understand that sexually aggressive behaviour and bullying are completely unacceptable, and that the consequences of taking part in either can be serious – without confusing the two.

This was discussed by the then Scottish Anti-Bullying Steering Group and it was agreed that this was the approach we would take in Scotland. Colleagues in LGBT Youth Scotland also felt to include Homophobia under the term ‘sexual bullying’ was reductive; being gay or lesbian is not about ‘sex’. Guidance from other parts of the UK includes homophobia on almost every occasion they define ‘sexual bullying’.

I have also read in another piece of guidance that a boy putting his hands up a girl’s skirt and touching her can also be sexual bullying, I am of the opinion this is in fact a sexual assault.

Some other organisations have given us even more concerning definitions that state, and I quote, ‘Sexual bullying in its most extreme form can be sexual assault or rape’.(Bullying.co.uk)

I strongly believe that this is an unhelpful and potentially dangerous road to go down. Bullying and rape is not the same thing. If we are looking for schools to discuss rape and sexual assault and sexual abuse under the umbrella of anti-bullying we run the risk of diluting this very serious behaviour.

Rapists are not bullying their victims, they rape them and they abuse them. Predatory males do not bully children they manipulate and abuse them – framing this abuse as bullying is, as I stated, reductive.

The Daily Telegraph also informed us this year that ‘15 children a day are excluded from school for sexual bullying’ – now while the behaviours described are concerning and rightly need to be addressed, 15 pupils a day were excluded for a range of behaviours including, lewd behaviour, sexual abuse, assault, bullying, daubing sexual graffiti, and sexual harassment. This also includes ‘sexting’, behaviour which is largely consensual but can and does spiral out of control. I suppose a headline informing parents that 15 children a day are excluded for a range of inappropriate sexualised behaviour isn’t quite as snappy.

Gender-based bullying and gender-based violence is a real problem for our children and young people. Children are bullied because they do not conform to gender norms, because they don’t dress the way others feel that’s how boys or girls should dress. Or that they are or are perceived to be gay or lesbian, this is still about gender, identity and norms. Or sadly, they believe that as males, they can treat the women in their life as objects and with a lack of respect.

Many of these behaviours can lead to violence and abuse – it can be a pattern that escalates, it can lead to manipulation and control, something many girls especially experience.

I have shared this thinking with colleagues from a range of services, from The Violence Reduction Unit, The Police, LGBT Youth Scotland, Zero Tolerance, NSPCC and Local Authorities and we plan to take this forward in the coming months and find a coherent and consistent way of talking about gender based-bullying and its links to violence and abuse.

None of us feel ‘sexual bullying’ is an accurate or helpful term but want to ensure we highlight the work being done and the work that needs to be done on gender roles, gender based violence, domestic violence and on sexually aggressive behaviour. If we lump all of this behaviour together we may find it harder to find solutions and things can become blurred as a result. This is not to minimise the link but the language we choose is very important. We need to be clear what behaviour we are talking about and not try to find catch all terms that may be convenient or media friendly.  

There is, I believe, a link between gender based bullying and sexual violence and that we should look to intervene effectively with gender based bullying as it may reduce the risk of violence. When I was delivering training in Austria last month, the delegates included several therapists and social work staff who work with the victims of sexual abuse. They found the term ‘sexual bullying’ very confusing – it would not occur to them to equate or talk about gender based bullying and sexual abuse or assault in the same way.

The day we start to think about rape or sexual assault as a type of bullying is a day when we will have really lost our focus. These are violent crimes and should be viewed as such – bullying is about relationships, relationships that are not respectful and anti-bullying work can help reduce the impact of this and help repair relationships and build respect. Can anti-bullying work underpin approaches and support work on sexual violence? I believe it can. Is sexual assault and sexual violence bullying? Absolutely not, it is much more serious than that.

 Brian

Brian Donnelly

Breaking the walls of silence…

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Earlier this month I was lucky enough to be part of a Scottish Delegation at the ‘Breaking the Walls of Silence’ Conference in Slovenia. The main aim of this event was:

•             To explore current situations and trends regarding homophobia, biphobia and transphobia in education / schools in the EU countries,

•             to provide a platform for key individuals to meet and facilitate sharing of experience, knowledge, strategies and materials on how to best support teachers / NGOs attempting to open up the topic within a school environment,

•             to get insight of good practice in preventing homophobia and including LGBT issues in teaching at both classroom and institutional levels and

•             to conclude the Breaking the Walls of Silence project, present and disseminate the results, challenges, effects and its local and national influence

I attended with colleagues from LGBT Youth Scotland, who was a partner in the organising of this conference, Education Scotland and Glasgow City Council.

The conference took place in the beautiful city of Ljubljana, beautiful and very cold for the most part! Our role was to share how each of the Scottish delegation had worked in partnership to help improve and ensure the inclusion of LGBT young people in schools and how we contributed to challenging homophobia and transphobia.

I enjoyed the opportunity to reflect on how having an equalities focus in our anti-bullying work supports the work and values of LGBT Youth Scotland and helps mainstream, in a policy sense to begin with the issues of homophobia and transphobia. The service ensures that schools in particular do not just have say, an anti-homophobic bullying policy and an anti-racist bullying policy but instead having am inclusive and robust anti-bullying policy.

It is not good enough to say, ‘all types of bullying are unacceptable here’. Our approach to policy and training ensures we are more prescriptive about what these behaviours are and that they reflect the equality strands and the realities of the bullying young people face. At times the statement ‘all bullying is unacceptable’ has allowed stakeholders to ‘body-swerve’ their responsibility to include homophobic bullying in particular. Research has shown that having an explicit policy commitment to addressing issues such as homophobia can lead to a better outcomes and experiences in school.

What was evident too was the marked difference in the last 8 years or so that colleagues in other parts of Europe are and have experienced. Countries such as Slovenia, Poland and Romania are in relative terms still behind Scotland in terms of LGBT young people’s inclusion.  The fact we have a national approach to anti-bullying in Scotland that is equalities focussed, Government commitment to the agenda, a legislative framework, School Inspectors and Local Authorities who are accountable to this, gives us at the very least a more positive environment and framework to improve the experiences of LGBT young People.

We were keen not to paint an overly rosy picture of what is happening in Scotland as many challenges remain and young people still experience homophobia and transphobia every single day. Our colleagues from across Europe did recognise that there is a much more joined up approach in Scotland than they currently experience and this is something they would like to be able to emulate and is something they can learn from.

What was very evident was the passion and commitment of delegates from all over Europe who are committed to change and to challenging the prejudice experienced by LGBT young people on a daily basis.

They will make a difference.
Brian