this role is still being decided. Within the Green Paper, there are proposals to introduce MentalHealth Support Teams into schools to provide support with identifying needs and providing targeted intervention. Specific risk groups are identified. These include those who are looked after, those who identify as Lesbian, Gay, Bisexual and Transgender (LGBT), those in gangs and those not in education, employment or training (DfE / DoH, 2017). According to the Green Paper ‘Children with a persistent mentalhealth problem face unequal chances in life. This is one of the burning injustices of our time’ (DfE / DoH, 2017, p.6). It is estimated that 850,000 children and youngpeople experience a mentalhealth need (DfE/DoH, 2017). Currently, access to support is variable across England and, for many, the support comes too late. This can lead to devastating consequences for youngpeople. Additionally, many children and youngpeople do not meet the threshold criteria for a successful referral to Child and Adolescent MentalHealth Services and within this context the role of schools in identifying needs early and providing early intervention is critical.
associated protective factors, and can develop incorrect beliefs about the effectiveness of therapeutic interventions (Jorm et al, 2006; Kelly et al, 2007). Additionally, the stigma associated with mentalhealth problems becomes apparent to people at an early age (Campos et al, 2018). However, research suggests that the attitudes of youngpeople can be changed more easily than those of adults (Corrigan and Watson, 2007) and therefore schools can play a critical role in improving young people’s mentalhealth literacy through the introduction of curriculum programmes which are specifically designed to develop young people’s knowledge about mentalhealth and shape the development of positive attitudes towards it, thus reducing stigma. Research has demonstrated that young women have higher levels of mentalhealth literacy than boys (Martínez-Zambrano et al, 2013). This could be because girls may be more willing to engage in help-seeking behaviours such as seeking advice in relation to their mentalhealth. This highlights the need for boys to access mentalhealth literacy programmes. We have recently conducted research with Cambridge United Community Trust on an intervention which was designed to promote students’ mentalhealth literacy through a 6-week mentalhealth curriculum delivered by sports coaches and footballers. The programme led to statistically significant improvements in students’ mentalhealth literacy.
Behavioural disorders were evident in 2.5% of preschool children, consisting mostly of oppositional defiant disorder (1.9%). Autism spectrum disorder (ASD) was identified in 1.4% of 2 to 4 year olds. Other disorders of specific relevance to this age group were also assessed, of which sleeping (1.3%) and feeding (0.8%) disorders were the most common.
• Some people selected for the survey could not be contacted or refused to take part. The achieved response rate (52%) is in line with that of similar surveys (Bolling & Smith, 2018). A problem for all such studies is how to take account of those who do not take part, either because contact could not be established with the selected household or individual, or because they refused to take part. This may include children and youngpeople who were at a greater risk of mental disorders (for example children in long term inpatient care would not have been interviewed), or who were hard to reach (for example students living in halls of residence). The weighting included a non-response adjustment (outlined in the weighting section) to help account for non-response bias.
The effects of new technology and social media on overall health and wellbeing are still relatively unknown. Sampasa-Kanyinga and Lewis (2015) found an independent association between using social media sites for more than two hours per day and self-reported poor mentalhealth, increased levels of psychological distress and suicidal ideation. This prevalence survey also found an association between mental disorders and spending more than four hours on social media per day, whether it was a school or non-school day. Youngpeople with a disorder were also more likely to agree that they spend longer online than they intend to.
The MentalHealth of Children and YoungPeople (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and youngpeople were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, youngpeople and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer
Many children and youngpeople have some rituals or superstitions, e.g. not stepping on the cracks in the pavement, having to go through a special goodnight ritual, having to wear lucky clothes for exams, or needing a lucky mascot for school sports matches. It is also common for youngpeople to go through phases when they seem obsessed by one particular subject or activity, e.g. cars, a pop group, a football team. But what we want to know is whether the child has any rituals or obsessions that go beyond this.
Parents of 5 to 16 year olds and youngpeople aged 17 to 19 were asked whether they had been in contact with any professional services (from a list of examples) or informal sources of support in the past year because of worries about the child or young person’s mentalhealth. Professional services included contact with a mentalhealth specialist, GP or teachers. Informal sources of support included family and friends, the internet or self-help groups. Specialist service records were not examined in this survey. Note that while the wording of the question establishes that contact with services or support took place, the nature or extent of that contact was not established. In theory, contact could have involved a single interaction.
This approach has quality implications for other survey aims. For example, a survey of the resident population excludes those who were living in a care home (for example mentalhealth units and young offender institutions). As discussed in this publication, people living in such settings are likely to have worse mentalhealth than those living in private households, which may have an effect on the quality of the prevalence estimates produced by this survey. However, the proportion of the overall population not living in private households is so small that this would have little (or no significant) impact on the prevalence estimates for the disorders examined, as such the decision was made that the improvement in the survey’s ability to provide an estimate of the treatment gap justified this trade-off between these two survey outcomes. Details of the strengths and limitations of the results of this survey are detailed in full in the Survey Design and Methods Report.
Current estimates suggest that over 60% of parents with a serious mental illness (SMI) live with one or more children or youngpeople (CYP) under the age of 18 . Evidence indicates that CYP living, or in regular contact with a parent with SMI can be vulnerable to poorer mental and physical health, behavioural, social and edu- cational difficulties, as well as maltreatment and neglect in comparison to other CYP . The effects can be long-lasting, with many at increased risk of socio-occu- pational dysfunction, psychiatric morbidity, alcohol or substance misuse, and premature death  in adulthood. CYP of parents with SMI are said to have a 50% chance of developing a mentalhealth problem, with a 32% prob- ability of developing a SMI . The problems arise not only because parents with SMI find it difficult to manage their role as carers, but also because they are often coping with multiple deprivation and have ongoing con- cerns about their children being moved to out-of-home care .
As advances in technology continue at an ever increasing pace around the world, it is vital that there is contemporaneous advancement in the practitioners’ awareness of the wide reaching scope of digital technology when working in the field of children and young people’s mentalhealth. It is acknowledged that internationally, childhood is difficult to define and when planning age appropriate digital resources for self-assessment and help, caution must be exercised, as it is clear that one size does not fit all. Practitioners need to have detailed knowledge of child development theory and awareness that the widespread use of technology often begins in the pre-school years. The digital navigation skills of the young service user can outstrip those of the practitioners developing interventions aimed at offering mentalhealth help. There can be a discontinuity in digital knowledge between practitioner and the young person, however, there can also be a digital divide within the young population itself, therefore consultation and collaboration may be one way forward incorporating the additional help of software designers.
One of the biggest challenges is identifying when and how to support COPMI effectively in a non-stigmatising and accessible way. Our consultation work with CYP  expressed the need for interventions to improve their coping skills and mentalhealth literacy. The earlier phase of this study, involving focus groups and inter- views with parents with mental illness, highlighted that CYP and parents desired mentalhealth literacy, and that communication and problem-solving skills should be the driving principles underlying each of the interventions. These views were mirrored by professionals working in the NHS and third sector organisations. A more recent mixed-methods study additionally supports these find- ings . It is thought that a significant “paradigm shift is required at all levels of service development, delivery and policy”  to enhance the lives of these CYP and their families.
This practice example provides a brief overview of how the case study schools improved awareness of, and understanding about, mentalhealth amongst children and youngpeople, and the activities that were included in a preventative approach to mental ill health. The facilitators and challenges encountered while developing a preventative approach are discussed, along with the benefits and resources needed to create the approach. Finally, some top tips on how to develop a preventative approach, drawing on the experiences of staff at the case study schools and colleges are provided as well as a short resources section of further suggested reading.
Having pastoral or support teams made up of designated staff (e.g. safeguarding leads, tutors, student support managers or external counsellors) with defined roles in relation to mentalhealth was seen as crucial , as part of a continuum of support ranging from universal, preventative activity to targeted, specialist provision. All staff needed to be aware of whom to approach and when, to supplement any support they provided personally. Particularly in secondary schools and colleges, these meetings were important to ensure the early identification of need as they provided an opportunity for all staff to raise concerns (see practice example Identification and Assessment of need ).
Institutions also referred pupils to a number of specialist mentalhealth services, including NHS or other specialised children and young people’s mentalhealth services (CYPMHS) (93%), GPs (73%) and other specialist voluntary or independent services (53%). A referral to a specialist service often resulted in case study schools withdrawing their support so as to avoid having more than one therapy being delivered at a time. In contrast, pupils in special schools and PRUs tended to already have pre-existing relationships with NHS CYPMHS, and schools worked in tandem with these services. Most (68%) institutions had a dedicated member of staff responsible for linking with external services, but only one in five (19%) had a single point of contact in external services that could be accessed for help and advice. This lack of a single point of contact was especially common in mainstream schools, and a lack of time and capacity within external services to link with schools was highlighted as a key barrier to joint working. Having a single point of contact within NHS CYPMHS helped to build relationships and provided valuable specialist support and guidance for schools, and institutions with a single point of contact in external services reported higher levels of satisfaction with NHS services than those without these arrangements.
By undertaking further development of knowledge and skills within this field, this would support the school nursing role in practice by ensuring early identification and intervention of mentalhealth issues in children, youngpeople and their families as soon as possible. Furthermore this would assist in improving access to support and treatment and will prevent huge numbers of referrals to an already stretched CAMHS system.
The other less common disorders assessed on the survey include autism spectrum disorder (ASD), eating disorders, and other types of disorder, including tics. The survey sample was too small to examine some of these other disorders each in detail. For this reason, they were grouped together for the purposes of the current analyses. ASD include a number of disorders characterised by severe impairment in social interaction, communication, and the presence of stereotyped behaviours, interests, and activities. Symptoms include: language problems; difficulty relating to other people; unusual forms of play; difficulty with changes in routine, and repetitive movements or behaviour patterns.
For some youngpeople it could be a relief to have an explanation for feelings and behaviour that they find hard to make sense of, whereas for others it could exacerbate feelings of blame, guilt and self-loathing. The enduring social stigma of mentalhealth problems, combined with institutionally racist practices, provides an overall context for these feelings to be repressed, displaced, or acted out.
Self-esteem can have both a positive and negative impact on mentalhealth. This survey showed that one in twenty children with a mental disorder had high self- esteem, compared to one in four children without a mental disorder. Research has shown that high self-esteem can serve as a protective buffer against the impact of negative influences (Mann et al., 2004), and that adolescents with high self-esteem suffer fewer symptoms of anxiety, depression and attention problems over time (Henriksen et al., 2017). Conversely, low self-esteem is considered to be a risk factor for mentalhealth. Trzesniewski et al. (2006) found that adolescents with low self- esteem had more mentalhealth problems during adulthood than those with high self-
The MentalHealth of Children and YoungPeople (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and youngpeople were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, youngpeople and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer Assisted Self Interview (CASI), between January and October 2017. A short paper or online questionnaire was completed by a nominated teacher for children aged 5 to 16 years old. Data collection varied with the selected child’s age: