Children’s mental health

When we think about children’s mental health it’s important to recognise that a young person is not a small adult; they have a unique make-up that contributes to their mental health and well-being.

Mental health issues affecting children may include:

• anxiety
• depression
• behavioural conditions
• self-harm
• para suicide (a sub-lethal attempt at suicide) and suicidal thoughts and behaviours.

These are usually a result of what’s happening or has happened in children’s lives so far.

You need to consider that a young person’s mental health and emotional well-being is just as important as their physical health and development. In this way you can help a young person build their resilience and become a resilient, healthy adult.

Some factors make some young people more prone to experience mental health issues than other children. This list isn’t exhaustive: some factors will be relative and others more absolute; some young people will be influenced more than others and some children will not be affected at all:

• coming from a home affected by inter-parental conflict
• being a young carer
• finding school or education learning styles difficult
• confusion about their sexuality
• experiencing discrimination of any type
• living in poverty or being homeless
• living in care
• being bullied
• experiencing or living with abuse
• experienced bereavement
• having parents/carers in prison or mental health institutes
• having parents/carers with mental health issues or issues with alcohol or drugs
• experience of breaking the law and the justice system.

Action for Children has produced a video which shows the impact adverse childhood experiences (ACEs) can have on someone’s life

Public Health Wales also has a video about ACEs, which highlights the physical as well as emotional affect that can have on young people as they grow older.

Single incidents don’t usually lead to mental health issues. But if a young person is already vulnerable, certain life changes can trigger mental health issues, including:

• the birth of a new sibling
• starting a new school or school year
• exams
• moving to a new house or home
• being bullied
• being the victim of abuse or witnessing abuse
• feelings threatened or in danger
• going through puberty and body/emotional changes.

It’s important that young people feel safe in accepting who they are. You should support them to understand it’s ok to not feel ok, and that it’s good to talk and share and express their feelings without fear of being teased or ridiculed.

This can help children manage changes in their lives, whether they are external influences or bodily changes and transition into adulthood, and help them avoid experimenting with drugs, alcohol, legal and illegal highs that can also impact on their mental health.

Factors such as stress, isolation, social media and the pressure to fit in can contribute to poor mental health in young people, with teenagers being more susceptible to depression than younger children. Research by the Children’s Society showed that childhood happiness rose between 1995 – 2010 but has reversed since then.

The Good Childhood Report

There are many mental health conditions but the following gives an overview of some of the issues you may come across.

Self-harm is more common than people realise. It’s important to understand that it may not be an act of looking for attention: the majority of self-harm is hidden and done in private. It may be a coping mechanism for the young person and you need to understand the trauma and factors behind it. Self-harm is not normally an attempt by a child to take their own life but a way of dealing with issues in their life.

Research by the Children’s Society suggested that in 2018 nearly a quarter of 14-year-old girls in the UK were self-harming. The report, based on a survey of 65,000 young people, also found that girls were more than twice as likely to self-harm as boys (22 per cent vs 9 per cent). Rates of self-harm were particularly high in young people who were attracted to the same gender or both genders (46 per cent).

If you are working with a child who is self-harming, it’s important to stay calm and follow their care plan.

Childline has advice and videos about self-harm

Eating disorders usually start in the teenage years. When you hear the term, you might automatically think of anorexia nervosa or bulimia nervosa but don’t forget that over-eating, comfort eating, poor diet and poor nutrition are also eating disorders.

Beat Eating Disorders is a dedicated website with advice and videos

Most people will have a traumatic experience at some point in their lives. But if a young person is displaying symptoms of PTSD (whether they’ve been diagnosed with the condition or not), you must seek professional help and support. The right support is crucial to help a young person with PTSD understand and process their feelings, emotions and symptoms.

PTSD Symptoms in children and young people include:

• avoiding situations that make them recall the traumatic event
• experiencing nightmares or flashbacks about the trauma
• playing in a way that repeats or recalls the trauma
• acting impulsively or aggressively
• feeling frequently nervous or anxious
• experiencing emotional numbness
• having trouble focusing at school.

NHS Inform has a simple explanation of the causes and symptoms of PTSD

Overactive or hyperactive behaviours can look extreme but you must understand that the child or young person is not misbehaving: there are actual physical and chemical differences in their bodies that may be responsible for their behaviour.

Anxiety can lead to extreme worry and concern. This can be a generalised anxiety disorder or a specific anxiety disorder. If left untreated the young person can develop a more extreme type of anxious behaviour and worries, linked with self-harm or maladaptive coping strategies.

Anxiety can be a cause or contribute to other mental health conditions, for instance self-harm. You should be aware that because children living in residential care can face many situations that are anxiety-inducing, for instance time with family or moving homes.

If you can reduce a young person’s anxiety levels, this can have a positive effect on their development and ability to engage in education, friendships and society.

NHS Inform has a simple explanation of the causes and symptoms of anxiety

There are many more mental health conditions and you can find further information in the following resources.

Childline’s YouTube channel has a number of videos with young people talking about a range of mental health issues

Young Minds has a collection of resources for professionals about mental health in young people

Public Health Wales can help you to locate local services and resources Public Health Wales

You can support children with positive mental health in many ways, including:

• giving consistent care and support
• keeping your behaviour predictable and reliable
• supporting them to follow a balanced diet and get regular exercise or play, indoors or outdoors
• providing a family atmosphere in the home
• offering them support when needed
• allowing children the space to learn and develop.

Following the advice above will help children to see your as trustworthy and feel safe in their environment.

You can also:

• support your young people to attend a school and/or youth groups that considers their emotional well-being
• support an environment in the home where they feel safe, trusted, loved, and can express themselves without ridicule
• show them optimism and hope, and encourage their growth and development
• encourage children to accept they will not succeed at everything, but this doesn’t mean they’re a failure
• give them control over parts of their lives to help them develop their decision making and problem solving skills.

Showing active listening to the young person is also important. You can do this by:

• being on the same level as the child
• leaning in to listen
• taking their feelings seriously and not dismissing or discounting the child’s feelings (for example; child: I am worried about my exam, you: I can understand that they are difficult (not: don’t worry it will be fine)
• asking them how you can help instead of telling them how to fix something
• hugs and safe physical touch are an important part of helping a young person to feel safe, if a child feels comfortable with this and within your organisation’s policies
• teaching relaxation techniques and coping strategies.

You should encourage children and young people to maintain their hobbies and interests, as this is crucial to supporting their well-being, self-esteem and increasing their resilience. Hobbies and interests also support them to have balanced experiences, which helps them to develop positively into adults.

If used effectively, leisure activities and hobbies can help children and young people to maintain relationships with friends, which further increases their resilience.

Don’t forget the importance of play activities. Often the children you care for will have missed out on play opportunities but these are a crucial part of healthy childhood development. You should make sure your young people have access to a variety of indoor and outdoor play resources.

You should encourage the young people you care for to take part in slow-paced activities, such as cooking, art or craft. These are calming and relaxing rather than stimulating. As well as short-term pleasure, there’s evidence these activities can develop new pathways in the brain, which can support positive thinking following the experience of trauma.

Slow-paced activities can also help young people to slow their thinking and get more control of decision-making in their lives.

Some homes have a quiet room and a loud room. While the loud room has its obvious attractions, this is often a short-term space. The quiet room helps young people to develop their focus and attention and young people tend to spend more time there than the loud room.

Negative emotions and feelings in young people usually pass quickly, but if the child is showing more long-term signs of distress, anxiety, panic or worry, you need to seek professional help.

Explain any concerns or care plans to the professional and get them involved in the support process. This will help them understand the issues around the child.

Professionals who can help with mental health issues in children and young people include:

• your manager
• social workers
• GPs
• teachers
• head teachers
• school counsellors
• youth workers
• care organisations
• pastoral care in schools
• school nurse
• looked after children’s nurse
• therapists
• psychiatrists
• child and adult mental health services (CAMHS).

The professionals above can help direct you to more specialised support in young people’s mental health. This list isn’t limited and there are many other people who may be able to help.

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