Defining the issue
Mental health and emotional wellbeing is a complex area and the language and definitions used are varied. This assessment uses the language most commonly used in the UK by Government and the major mental health charities and these are described below.
Mental and Emotional Wellbeing: The Foresight Report (2008) defines mental wellbeing as
‘A dynamic state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community’. [1]
Mental and emotional wellbeing is enhanced when an individual has a clear sense of their own purpose and value within their own society.[2] Therefore mental health and emotional wellbeing is not something we have, but instead something we actively ‘do’ and take part in: [3]
- It is a capacity to enter and sustain mutually satisfying personal relationships
- It is a continuing progression of psychological development
- It is an ability to play and to learn so that attainments are appropriate for age and intellectual level
- It is developing a moral sense of right and wrong
- It is the degree of psychosocial distress and maladaptive behaviour being within normal limits for the child’s age and context.
Mental Health: Your mental health doesn’t always stay the same. It can change as circumstances change and as you move through different stages of your life. This assessment defines mental health as:
“A state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, and is able to make a contribution to her or his community.”
Emotional Wellbeing: While there is no single definition of emotional wellbeing, it is usually associated with positive physical health outcomes, positive peer relationships, school readiness and achievement in school. Emotional wellbeing in children and young people sets the foundation to successfully manage the challenges of life as an adult. This assessment uses the Mental Health Foundation’s definition of emotional wellbeing:
“A positive sense of wellbeing which enables an individual to be able to function in society and meet the demands of everyday life”
Mental Health Problems: This chapter does not cover Mental Health Problems as these are covered in the Chapter on Mental Illness.
Focusing on wellbeing and resilience
The most recent Government mental health strategy, ‘No health without mental health’, defines wellbeing as “a positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment”[4]. The strategy seeks to increase the focus on the wellbeing of the population and sets out evidence based recommendations for approaches that are effective in bringing about change and improving the nation’s wellbeing. These findings and recommendations have been used to inform this chapter.
People with poor wellbeing are in a state of significant distress that impacts feelings, thoughts, social functioning and life satisfaction. Importantly, this is different from mental illnesses (covered in a separate chapter), which are a range of conditions that are diagnosed according to the severity and duration of a set of symptoms, and as such low wellbeing without mental illness is experienced by a significant proportion of the population. However, low wellbeing is also commonly experienced by people with mental illness and can inhibit recovery. People with high wellbeing have positive feelings thoughts, social functioning and life satisfaction. These factors are protective across a range of health outcomes.
Improving wellbeing prevents illness and reduces costs for the NHS, local authorities and for society in general. Strategic commissioning for better wellbeing leads to lower demand on services, and improvements in population health. Furthermore, wellbeing approaches include a focus on assets, aiming to empower people to take action by mobilising existing strengths and resources, to generate health outcomes[5].
Mental health and emotional wellbeing determinants are complex; our genetics, the way we live, our education, influences of our parents and peers, our employment and where we live all have an impact on our mental health and our resilience in adverse circumstances. Many factors can promote and protect emotional wellbeing and mental health.
These influencing factors have been identified as[6]:
- Individual: factors experienced by an individual rather than as part of a group (healthy living, general health, learning and development, emotional intelligence, life events)
- Family: factors which relate to a family and home environment (family relations, family structure, parental health, parental healthy living)
- Learning environment: factors that influence how a person learns, within and outside a formal learning environment (engagement with learning, educational environment, peer relationships, pressures and expectations)
- Community: influencing factors of a person’s wider social and geographic environment which influence their mental wellbeing (equality, social inclusion, participation, social support, physical environment, culture, safety, violence, discrimination)
Some risk factors for low wellbeing can be pre-existing and unchangeable but may still reveal opportunities for action targeted at particular groups. The modifiable risk factors which are most significant in determining poor wellbeing include[7]:
- Inequality and social injustice;
- Lack of control;
- Exclusion, isolation, loneliness;
- Unemployment;
- Low income, financial insecurity, debt;
- Violence;
- Exposure to stressful life events (e.g. bereavement, breakdown of relationship);
- Inadequate housing, fuel poverty.
Understanding these factors and being able to quantify them allows the identification of opportunities to improve mental wellbeing. However it is also important to recognise that some groups are more vulnerable to mental health problems than others. These include those who have one or a number of risk factors in the following domains:[8]
- Low-income households; families where parents are unemployed
- Families where parents have low educational attainment
- Children and young people who are looked after by the local authority
- People with disabilities (including learning disabilities)
- People black and other ethnic minority group
- Lesbian, gay, bisexual or transgender (LGBT)
- People in the criminal justice system
- Existence of a parent with a mental health problem
- Substance misusers
- Refugees or asylum seekers
- Gypsy and traveler communities
- Children and young people who are being abused.
There is a strong moral and economic case for tackling the rising challenge of mental health problems for individuals and communities. There is evidence that supporting families and carers, building resilience through childhood and into adulthood and supporting self-care reduces the burden of mental and physical ill health over the whole life course, reducing the cost of future interventions, improving economic growth and reducing health inequalities.[9]
The New Economics Foundation’s (NEF) report, Five Ways to Wellbeing, sets out five actions that promote wellbeing.[10] These are not just an individual’s responsibility, but can be influenced by ‘upstream’ interventions, shaping existing services or providing new services in such a way that they encourage behaviours that promote the five ways to wellbeing.
The breadth of indicators that support positive mental health and wellbeing are captured in the scoping report on understanding local needs for wellbeing data[11] and highlight the scale of the challenge in getting all services to work more effectively together.
[1] Foresight Mental Capital and Wellbeing Project (2008). Final Project report. The Government Office for Science, London.
[2] Public Health England. How healthy behaviour supports children’s wellbeing. (2015) Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/232978/Smart_Restart_280813_web.pdf
[3] Bates et al, CAMHS: Together we stand. Health Advisory Service, London, HMSO, (1995)
[4] HM Government (2012) No Health Without Mental Health: Implementation Framework , HM Government.
[5] Michaelson, J. et al (2012) Measuring Well-being: A guide for practitioners, NEF.
[6] Public Heath England. Measuring mental wellbeing in Children and young People. Crown Copyright 2015
[7] National Mental Health Development Unit (2010) The mental Well-being Impact Assessment Toolkit, NMHDU.
[8] HM Government. 2010. Healthy Lives, Healthy People: Our strategy for public health on England. London: TSO
[9] Annual Report of the Chief Medical Officer: Health in Scotland 2011, Transforming Scotland’s Health (Chapter 3). Scottish Government: December 2012
[10] The New Economics Foundation (2008). Five Ways to Wellbeing, The Evidence
[11] Brown H, Abdallah S Townsley R. Understanding local needs for wellbeing data measures and
Indicators. Happy City and what Works Wellbeing
Fig 1: Indicators affecting wellbeing
Source: Understanding local needs for wellbeing data measures and Indicators. Happy City and what Works Wellbeing
The National Drivers for Investing in Children and Young People’s Mental Health and Emotional Wellbeing
Government policy clearly highlights that mental health is to be given equal status, or parity of esteem, to physical health. This includes parity not just in health and social care services, support and treatment, but in terms of public health and health improvement.[1] This is reflected in a number of strategic documents at a national level that have elevated the profile of mental health.
Table 1: Strategic documents on Mental Health
| Every Child Matters (2003)[2] | · Outlines how to ensure children are healthy, safe, achieving, making a positive contribution and have economic wellbeing |
| Children and Young People in Mind: The Final Report of The
National CAMHS Review (2008)[3] |
Makes recommendations for improved access to specialist mental health services, particularly for vulnerable groups. It also advocates better advice and support for parents. |
| Fair Society, Healthy Lives; The Marmot Review (2010)[4] | Acknowledges the links between health inequalities and mental wellbeing and physical health and the importance of addressing these, particularly for the early years of children’s development |
| Healthy People, Healthy Lives: Our Strategy for Public Health in England (2010)[5] | Emphasises health and wellbeing throughout life. Gives a commitment to support interventions that promote mental health resilience and effective early treatment, including talking therapies, for children and adolescents with mental health problems. |
| Confident Communities, Brighter Futures: A Framework for Developing Well-being (2010)[6] | Sets out the argument and evidence base for prioritising well-being, and provides a systematic approach to improving mental well-being with selected evidence-based approaches and interventions that have been shown to be effective across the life course. |
| The Munro Review of Child Protection: Final Report, A Child-centred System (2011)[7] | Recommends that the Government places a duty on local authorities and their statutory partners to secure the sufficient provision of local early help services for children, young people and families. This should lead to the identification of the early help needed by a particular child and their family and to the provision of help where their needs do not meet the criteria for receiving children’s social care services. The aim is to support families to break out of a cycle of poor outcomes, protect children from harm and maximize opportunities to experience supportive relationships. |
| Early Interventions Next Steps (2011)[8] | Describes how intervention in children’s earliest years can eliminate or reduce costly and damaging social problems |
| No Health without Mental Health (2011)[9] | The National Mental Health Strategy, setting out the Government’s strategy for mental health in England (2011) |
| Health and Social Care Act (2012) [10] | · Sets out the new commissioning arrangements for England, which commenced in April 2013. |
| Preventing Suicide in England (2012)[11] | · The cross government strategy
|
| · Annual Report of the Chief Medical Officer 2013: (2014)[12] | Public mental health priorities |
| Children’s and Young People’s Health Outcomes Strategy (2012)[13] | Highlights that those who work with children outside the healthcare system have an important contribution to make to improve health outcomes, but that their training in mental health is minimal or non-existent. Also recognises the impact that poor maternal mental health has on both the physical and mental health of the child. |
| NICE Local Government Public Health Briefing: Social and Emotional Wellbeing for Children and Young People (2013)[14] | Provides those involved in commissioning and delivering services for children and young people with the information to adopt an approach that increases resilience and wellbeing. |
| How Healthy Behaviour Supports Children’s Wellbeing (2013) | Public Health England briefing looking at health behaviours, their positive and negative effects and the implications for practice and parents. |
| The Mandate: a mandate from the Government to the NHS Commissioning Board (2013–2015) | Emphasises the parity between mental health and physical health. This means everyone who needs mental health services having timely access to the best available treatment. |
| · Promoting Children and Young People’s Emotional Health and Wellbeing, (2015)[15] | A whole school approach. Outlines the eight principles to promoting a whole school and college approach to emotional health and wellbeing |
| Future in Mind. | · Promoting, protecting and improving our children and young people’s mental health and wellbeing (2015)[16] |
| · Five Year Forward View (2014)[17]
|
Sets out how the health service needs to change, arguing for a more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health. |
| · Crisis Concordat (2014)[18] | Improving outcomes for people experiencing mental health crisis |
Despite these national drivers to improve outcomes for people with mental health problems and to create environments that protect the population’s emotional wellbeing, it is generally recognised that there are still significant improvements required across the health and care system in order to improve mental health outcomes nationally and locally.
[1] PHE14-36 PHE approach to improving the publics mental health v00.08 (20141119).docx 19/11/2014 18:24
[2] Department for Education and Skills (2003) Every child matters. London: Department for Education and Skills
[3] CAMHS Review. 2008. Children and Young People in Mind: The final report of the National CAMHS Review. London: DfE
[4] Marmot (2010) Fair Society Healthy Lives http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review
[5] PHE (2010) Healthy People Healthy Lives: Our strategy for public health in England. Crown copyright
[6] Department of Health (2010) Confident Communities, Brighter Futures. A framework for developing well-being
[7] Department for Education (2011) The Munro Review of Child Protection: Final Report. A child centered system. Crown copyrigh
[8] Graham A. (2011) Early Intervention: The next steps. An independent report to Her Majesties Government.
[9] Department of Health. No health without mental health. UK: Department of Health, (2011).
[10] Health and Social Care Act 2012, c.7. Available at http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted
[11] Department of Health Preventing suicide in England a cross government outcomes strategy to save lives. Crown Copyright (2012
[12] Department of Health (2014) Annual Report of the Chief Medical Officer 2013. Public Health Priorities investing in the evidence’ Crown Copyright
[13] Children and Young People’s Outcome Forum. Children and Young People’s Outcome Strategy (2012)
[14] National Institute for Health and Care Excellence (2013) Social and emotional wellbeing for children and young people. NICE Advice [LGB12]
[15] Public Health England and Children and young People’s Mental Health Coalition (2015) Promoting children and young people’s emotional health and wellbeing. A whole school approach. Public Health England, Crown Copyright (2015)
[16] Department of Health, NHS England (2015) Future in mind. Promoting, protecting and improving our children and young people’s mental health and wellbeing. Department of Health, NHS England, Crown Copyright, (2015)
[17] NHS (2014) Five Year Forward View. (2014)
[18] http://www.crisiscareconcordat.org.uk/about/