Key learning points:
- Underlying principles of positive psychology
- Best practice in communication with children and young people and their parents or guardians
One in five young people in the UK are estimated to have a mental health problem, with one in 10, aged 5-16 years, having a diagnosed mental disorder (1).
For example, one-in-12 children and young people (CYP) use self-harming behaviour, 80,000 are severely depressed, with 8,000 being under the age of 10 years old, and 72% of CYP in care have behavioural and/or emotional problems (1,2,3).
It is important to remember that the figures above represent CYP who have been diagnosed with a mental illness and, while a cause for concern many others will experience emotional problems that remain hidden from parents, family, teachers, health and social care professionals or are below the threshold for psychiatric diagnosis.
For example, since the mid 1980s to the mid 2000s the number of adolescents reporting frequent feelings of anxiety and depression has doubled; for boys aged 15/16, from one in 30 to two in 30, and for girls from one in 10 to two in 10 (4).
Globally poor mental health in young people has been attributed to bullying, school problems, physical and sexual abuse, parental illness, bereavement and poor family relationships, (5,6,7) these difficulties often being exacerbated by lower educational achievements, substance misuse, conduct problems and, due to stigma, keeping the problem hidden (8).
Often the problems identified are complex, particularly those that involve other family members and require practitioners to demonstrate sensitivity towards the story being told by the young person.
A recent review of CYP’s views of health professionals in England (9) identified a range of attributes and skills they want health professionals to possess. Good communication was fundamental and included; being familiar, available, accepting, informed and informative, empathic and able to ensure privacy and dignity.
Clearly, good communication and ‘being listened to’ are essential if CYP are to feel respected and understood and ultimately have a sense of being empowered.
Getting the communication right
In the past assessing the well-being of CYP has focused on deficit criteria, for example lack of sense of achievement, use of alcohol and inhalants and poor family situations (10). Those who are unable to achieve optimal psychosocial well-being are more likely to experience adverse health outcomes (11).
More recently a shift in thinking has advocated focusing on the strengths of CYP when assessing their mental wellbeing,12 positive psychology,13 whereby the strengths of young people are built on, suggests those who feel competent will be more likely to seek out help as and when necessary (14,15).
Positive psychology focuses on optimism enabling CYP to flourish regardless of the adverse circumstances they might find themselves in (16). Focusing on the strengths of CYP, such as personal emotional competency and social functioning are important components of improving mental well-being as they can be harnessed to develop resilience, promote self-efficacy and build confidence (11,14,15).
Practitioners need to nurture such strengths by listening to, believing and validating the difficulties that CYP are facing. Taking a positive approach is also useful when addressing the needs of parents whose child is experiencing mental health problems.
Many parents have difficulty accepting and/or understanding the problem, leading to guilt and self blame.
When growing pains are more than growing pains: Taking action
The age of the young person needs to be taken into account in terms of communication and how parents/guardians should be involved.
The three examples (see Box 1, 2, 3) prompt thoughts about how you might address the emotional needs of children, young people and parents:
The case studies are designed to help you think about some of the issues you might face when working with CYP who have emotional problems and their parents/guardians. Good communication cannot be emphasised enough. It is important to remember:
- Listen carefully to the story being told – show you are listening by looking at the person, hearing the words they use and do not interrupt until they have finished speaking.
- Do not make judgements or use criticism.
- When working with younger children be creative – drawing, painting, clapping, singing, using toys might be a way of supporting them in telling their story.
- Be honest, don’t make promises you can’t keep, for example ‘I won’t tell anyone else’, you might have to (Sophie); ‘your mum will be okay’ (Lucy).
- Use a common language – to ensure they know you have understood and they can understand you. For example ‘I cut my legs,’ ‘How does cutting your legs make you feel’? Rather than ‘How does self-harming make you feel’?
- Remember it is not up to CYP to broach the subject with you, but for you to offer opportunity to them to voice their concerns. Put your pen down, make sure your phone is at least on silent, focus your attention on the person.
- Focus on their strengths – establish what these are and reinforce them. For example it is always useful to ask what coping strategies they have used in the past and encourage them to think how these could be used again in the present situation.
- Do not use placatory statements – for example – ‘don’t worry, all boys have a growth spurt’ (Linda).
- Never underestimate the power of the story you are being told – Lucy’s fear of being left on her own if both parents die; Sophie’s fear of her parent’s volatile relationship and the possibility that she might be responsible for it.
- Remember what CYP wanted from health and social care professionals; being familiar, available, accepting, informed and informative, empathic and ensuring privacy and dignity.
This article has explored problems of mental ill health among CYP. Some of the common reasons that compromise the mental wellbeing of CYP have been identified and the complexity acknowledged.
Positive psychology has the potential to enable us to build on the person’s strengths leading to resilience, self-efficacy and improved confidence, all of which contribute to emotional competency, better social functioning and ultimately mental wellbeing.
Case studies are offered as a way of encouraging you to think about your own practice and how best to approach some of the difficult situations you might encounter. Finally, pointers are offered as to what is important in the process of communication with CYP and their parent/guardians.
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