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Looked After Young People and mental health Using a risk and resilience model to reduce self-harmful behaviour

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Title: Looked After Young People and mental health Using a risk and resilience model to reduce self-harmful behaviour


1
Looked After Young People and mental health Using
a risk and resilience model to reduce
self-harmful behaviour
2
Todays programme
  • Mental health Definitions and context
  • Mental Health risk factors and Looked After
    Children
  • Self-harming behaviour
  • Resilience Framework and Looked After Children

3
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

4
Think about the young people who you work with.
Consider the following
  • How would you know if a young persons mental
    health was good?
  • How would they behave?
  • Describe behaviour that would make you concerned.

5
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 childs age and context

6
Problems Disorders
  • Mental health problem
  • A disturbance of function in one area of
    relationships, mood, behaviour or development, of
    sufficient severity to require professional
    intervention.
  • Mental disorder
  • A severe problem (commonly persistent) or the
    co-occurrence of a number of problems, usually in
    the presence of several risk factors

7
A bio-psycho-social model
  • EVENTS
  • (what happens to us)

NATURE (what we are born with)
NURTURE (what we grow up with)
8
Prevalence among children aged 5 15 in the UK
Mental or psychiatric disorder
Risk factors but no obvious problems now
Mental health problems
1.5 million or 10
30,000 or 0.2
3 million or 20
Severe disorder or mental illness
9
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

10
Risk and protective factors
  • Risk Factors
  • Protective
  • Factors

11
Task
  • Consider the following
  • What experiences may a child have prior to coming
    into care, that may effect their mental health?

12
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

13
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

14
Predisposing factors - environment
  • Socio-economic disadvantage
  • Homelessness
  • Disaster
  • Discrimination
  • Other significant life events

15
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

16
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

17
Way attachment develops
18
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

19
Insecure Avoidant
  • Caregiver subtly or overtly reject childs
    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

20
Insecure Ambivalent/Anxious
  • Caregiver will be inadequate at meeting child
    attachment needs (caregiver is passive,
    unresponsive and ineffective)
  • Childs 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

21
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

22
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.

23
Adolescent attachment styles
Compulsive self-reliance Distrusts relationships,
avoids being rejected or relied upon. Prone to
depression or psychosomatic symptoms. Compulsive
care giving Actively involved in relationships
but always as a care giver. Own parents unable to
provide care but might have demanded it from
child. Care-seeking Vigilant to signs of loss or
abandonment. Constantly anxious. Parents probably
unresponsive or threatened to leave family. Angry
withdrawal Generalised anger towards attachment
figure who is seen as unavailable.
24
Positive brain development
  • The way a child is stimulated shapes the brains
    neurobiological structure. Experience has a
    direct impact on a childs capacity for living,
    learning and relating as a social being.

25
Early Brain Development
  • We 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

26
Proliferation of synapses
27
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

28
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

29
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

30
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,
    Everybodys Business

31
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

32
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

33
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34
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?

35
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 SEX
  • HAD AN EATING DISORDER
  • BINGE DRINKING
  • BEING BULLIED
  • SELF HARM
  • SMOKING
  • USING DRUGS
  • WAS A GANG MEMBER

36
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37
Self-Harm
  • How would you define self-harm?
  • What feelings arise when you think about
    self-harm?

38
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)

39
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/

40
How Common is it?
  • In every secondary school classroom there will be
    two young people who have self-harmed

41
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)

42
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.

43
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
    dont 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.

44
Why do young people self harm?
45
The thoughts are in my head every day, I cant
take it. Cutting myself is the only way I can
deal with him being around.
I cut myself when Im angry, it hurts but it
helps my anger.

Cutting takes my mind off things, when Im
unhappy about myself, the way I am.
I dont really like school and nick off as much
as I can. Theres 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.
46
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.

47
Harm minimisation
48
what can we do to help?
49
Advice for young people
  • Prepare yourself with knowledge about self-harm
    before you talk to your friend.
  • Stay calm and dont 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 its
    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 its important that they get
    support.
  • Sometimes you will say the wrong thing. Dont
    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 Im finished and calmed down... Dont
    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. Its important that your friend knows
    they can trust you, so dont gossip about the
    situation your friend is in.
  • Recovery takes time so dont hold yourself
    solely responsible for helping. Be there as a
    consistent support mechanism for them. Talk about
    thoughts and feelings rather than what theyre
    doing.

50
What is resilience?
51
Resilient Children
  • can resist adversity, cope with uncertainty and
    recover more successfully from traumatic events
    or episodes
  • Newman, T (2002)

52
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 lifes 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)

53
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

54
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

55
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

56
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57
Developing a self harm policy
  • What do you think an effective policy would look
    like?
  • Who would it target?
  • What would it need to contain?
  • How will you know that its having an effect?
  • Which local services need to be involved in?

58
youngminds
  • Parents Helpline 0808 802 5544
  • Tel 020 7089 5050
  • Website http//www.youngminds.org.uk and
  • Publications
  • Training Development charlotte.levene_at_youngmind
    s.org.uk
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