A new approach to improving youth mental public health - the TRIUMPH network

In this blog, Professor Lisa McDaid, Programme Leader of the Social Relationships and Health Improvement programme, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, announces the launch of The Transdisciplinary Research for the Improvement of Youth MentalPublic Health (TRIUMPH) Network.

One in eight children and young people experience mental health problems and the majority of these have onset before their mid-twenties. Yet, 70% of young people have not had the appropriate intervention that they need. Young people face considerable pressures as they grow up; pressures that are driven by the ever-changing environment in which we live. Changes in technology, communications and the media that we are exposed to have coincided with an increasing prevalence of mental health problems, especially among girls – just last week, a new study reported that nearly one in four young women aged 17-19 have experienced mental illness. Yet we have few effective solutions for the improvement of youth mental public health.

Treatment and care, when accessible, treats the problems, not the causes.

The traditional mental health sciences most often focus on understanding and solving mental health problems at the individual level, but many of the drivers of poor mental health sit at the broader social, environmental and cultural level and are affected by the relationships we have, and the settings and communities that we live within.

The TRIUMPH Network

In setting up the TRIUMPH (Transdisciplinary Research for the Improvement of Youth Mental Public Health) Network we believe that there is a different, solution-focused approach. One that seeks to understand young people’s strengths, assets and resiliences, which we can draw on to improve health. Moving from problems to solutions is not easy, but if we do not act, we are in danger of failing a generation of young people. 

To improve youth mental public health, the TRIUMPH Network will bring together young people with academics from across the clinical, social, arts and design sciences in sustained collaboration with practitioners, policy-makers and third sector partners.  To make a difference, and deliver a transformative agenda of engagement and research, we will incorporate two core approaches: co-production and co-design with young people.

Co-production

Young people will be at the centre of the TRIUMPH Network. We as researchers will work with young people to facilitate their ideas, using our knowledge, training, methods and techniques to turn these into reality, into new solutions to improve youth mental public health. We will work together to find new ways to improve mental health and wellbeing, especially among marginalised groups, such as lesbian, gay, bisexual and transgender (LGBT) and care experienced young people, where need is greatest. We will target our efforts at the peer groups, social networks and education settings with strongest influence on young people’s health and behaviours.

Co-design

To understand and identify innovative solutions, while recognising the complexity of youth mental public health, we will take a participatory design approach. This means using different visual methods and creative outputs to support engagement with young people, bringing innovation to our planned activities, making the decision-making process more accessible, and supporting productive dialogue across the Network and beyond. This will include workshops to understand the mental health problems facing young people, identify possible solutions and take forward project ideas, and information exchange and community engagement events to share learning and increase the involvement of those most affected by youth mental ill-health.

Youth mental public health is a big problem and identifying solutions at the population-level needs a bold approach. TRIUMPH’s long-term vision is to improve youth mental public health in the UK; to reduce the proportion of young people that do not receive appropriate intervention. By finding the solutions to prevent and reduce mental health problems, we can benefit young people, as well as their families, friends and the communities they live in.

TRIUMPH will achieve this by focusing where need is greatest, co-producing solutions, and building transdisciplinary research capacity to take forward interventions that are effective, acceptable, and sustainable in the real world.

==============================================================

The TRIUMPH network is open to anyone with an interest in young people's mental health and wellbeing, including young people, service uses, those with lived experiences, and others directly affected by mental health issues. If you would like to join, please visit: http://triumph.sphsu.gla.ac.uk/contact 

Disclaimer: The views expressed in this blog are those of the author.

The TRIUMPH Network is funded by UKRI. The MRC/CSO Social and Public Health Sciences Unit is funded by the Medical Research Council and the Scottish Government Chief Scientist Office. The views expressed are not necessarily those of the Medical Research Council or the Scottish Government.

This blog was originally published on 1st December 2018 (https://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/mrccsosocialandpublichealthsciencesunit/sharingourevidence/blog/headline_624666_en.html)

Male suicides rising: exploring the role of alcohol and community support

Dr Amy Chandler, CRFR research associate, talks about some of the issues being raised in her project, Alcohol Stories, a study of middle-aged men, alcohol, mental health, self-harm and suicide.

This is a very much a ‘work in progress’ blog – reflecting on recent statistics on suicide in the UK, and thinking through how this relates to issues I am addressing in a new research pilot project.

New figures released by the UK Office for National Statistics show that suicides among men have risen, with levels now the same as in 2011 – a potential reversal of what had been a downward trend. Rates among younger men are often highlighted, since suicide in men aged 15-29 is the leading cause of death. These latest figures show that suicides among older men, aged 45-59, are now higher than any other age group.

http://www.theguardian.com/news/datablog/2015/feb/19/rise-in-middle-aged-men-committing-suicide-all-the-uk-data

I am currently at the start of a pilot project, funded by Alcohol Research UK, which is using biographical methods to study the life-stories of men in this older age group. The study will focus especially on men’s accounts of the complex interplay between alcohol use, self-harm, suicidality, and mental health.

The men I am speaking to are in some ways ‘lucky’ – they are all being supported by community-based mental health and substance use support services. Despite this, their accounts (so far) highlight difficulties they have faced in accessing and using support at various points across their lives. News stories about the latest suicide statistics were accompanied by coverage of one particular suicide, with a bereaved family keen to highlight what they see as limitations in current mental healthcare provision in the UK. The story of Martin Strain was, sadly, familiar when I read it – elements of his struggle are reflected in the accounts of the men I have spoken with so far. In particular, Martin’s history of drug and alcohol misuse is said to have resulted in him being denied access to one-to-one psychiatric support. This highlights a significant challenge in tackling mental ill health in general, but especially for men, who are more likely to turn to alcohol to manage distress.

Around 50% of deaths by suicide occur in the context of alcohol use; and those who are alcohol dependent are at increased risk of suicide. Despite this, those identified as having alcohol use problems are – like Martin Strain – in some cases, diverted away from psychological support, into alcohol use services. Unless appropriate community based support is available (which is patchy, and will be reliant on the whims of local authority funding), people who have both mental ill-health and alcohol problems may not receive any kind of ‘joined up’ support. One of the issues I am investigating in the current study is the extent to which mental health is supported by substance use services; and conversely, how well alcohol misuse is responded to by mental health services.

In a limited way, I will also be exploring the role that community based support can have for men, who are often framed as ‘hard to reach’ and ‘hard to engage’. Yet clearly, some are reached, and some do engage – how do men account for this? In particular, I will be building on existing research which has examined the accounts that men provide when they engage in potentially ‘un-masculine’ practices, such as accessing a talking therapy. Studies have suggested that there are important differences between men in how they deal with such issues: with some men more able than others to frame ‘talking’ or ‘connecting’ with others as a responsible reaction to depression and thoughts of suicide (Oliffe et al 2011).

Additionally, I am looking at the way in which men themselves talk about their use of alcohol in the context of mental ill-health. Not all suicides are related to alcohol, and not everyone who uses alcohol will have problems with mental health, self-harm, or suicide. Already, variations are emerging in how men talk about alcohol use, and this study will provide useful insights into the diverse ways in which alcohol and mental health are understood.

Contact Amy by email.

Now they are 7: what influences children's wellbeing?

The most recent findings from Growing Up in Scotland (GUS) explore the possible influences on children’s wellbeing and their behavioural and emotional difficulties. Lesley Kelly, GUS Dissemination Officer, outlines key findings.

GUS aims to find out about how the circumstances and experiences of children in Scotland are changing, and how early experiences influence later outcomes. The first group of children invited into the study are now 7 years old and for the first time they have answered questions themselves. This provides a really interesting aspect to the study as we find out about both mother and child perspectives.

This new research uses information collected from over 3,000 mothers and children, interviewed during 2012/13. Mothers were asked about their child’s emotional and behavioural difficulties using a behavioural screening tool called the Strengths and Difficulties Questionnaire (SDQ). The children were asked about their life satisfaction using a series of questions including ‘do you feel your life is going well?’ and ‘do you wish your life was different?’ (adapted from the Huebner Student Life Satisfaction Scale). 

Researchers were interested in learning about the role of child and family characteristics , parenting behaviours, school experiences, friendships, leisure activities and the importance of materialistic attitudes, ie having ‘expensive things’ on both child mental health and well-being. The researchers measured for behavioural and emotional problems as reported by the mother and low sense of well-being as reported by the child.

The numbers

• This research suggests that 1 in 25 children in Scotland experience both mental health problems and low subjective well-being:
• 11% of children in the study were classed as having high levels of behavioural and emotional problems, while 25% reported low life satisfaction. 4% of children experienced both.
• 21% of children had low life satisfaction but no behavioural and emotional difficulties. 7% had a high level of difficulties but did not report low life satisfaction.
• Children with high levels of difficulties were more likely to report low well-being (39%) than those with normal levels (24%).

The factors

Children who had both child mental health problems and low life satisfaction were more likely to experience: greater conflict in the mother-child relationship; lower parental knowledge of the child’s activities or relationships when not at school; difficulties adjusting to the learning or social environment at primary school; and poorer quality friendships with other children.

 

Economic factors and some other aspects of family life (including family structure and the child’s leisure activities) were not clearly associated with either measure of social and emotional well-being, after allowing for other influences. Materialistic values (the importance of ‘expensive things’ to the child) were not associated with their life satisfaction.

 

The research also found that family ‘stressors’ such as mother’s experiencing poor health, family mental health/ substance use problems and low levels of warmth in the mother-child relationship were associated with child mental health difficulties but not the child’s sense of well-being. Conversely, experiencing a recent bereavement, illness or accident in the family, and less positive parenting (defined as less positive reinforcement of good behaviour and less involvement in the child’s activities) did appear to affect children’s life satisfaction, irrespective of whether they experienced behavioural and emotional difficulties.

 

The implications

This research supports the idea that social relationships, involving parents, teachers and friends, are of key importance for children’s well-being. A holistic approach, which recognises the different components of well-being and the range of influencing factors, should be adopted. Approaches to promoting social and emotional well-being could be developed for use in both family and school settings.

 

These findings help to identify which children are at risk of low well-being and might benefit from some targeted support. Parents and children could be offered better access to professional and advice and support services to improve parent-child relationships and to effectively manage behavioural problems. Given the importance of adjustment to the learning and social environment at school, greater attention to the transition to school may be required for some children. Children who experience difficulties making friends might also be helped by initiatives designed to help build relationships within and outwith school. Finally, support for children and families experiencing ill health and/or bereavement is crucial. Good practice in these areas should be extended so that every child can access the support they need for their emotional health and wellbeing.

 

The full report ‘Growing Up in Scotland: Family and school influences on children’s social and emotional well-being’ by Alison Parkes, Helen Sweeting and Daniel Wight is available from the GUS website www.growingupinscotland.org.uk.

 

GUS is funded by the Scottish Government and is carried out by ScotCen Social Research in collaboration with the Centre for Research on Families and Relationships at the University of Edinburgh and the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow. 

 

Contact Lesley by email 

When soundbites don’t help addicted parents …or their children

Sarah Nelson, Author of Care and Support Needs of Male Survivors of Sexual Abuse (February 2009)

The poignantly short life and brutal death of the toddler Brandon Muir, violently killed by his mother’s boyfriend in Dundee, has provoked renewed debate and soul-searching among politicians, media and many of the public. Not just about apparent failings in child protection generally, but in particular about how to safeguard children in the estimated 50,000 Scottish families where one parent at least is addicted to drugs.

As three separate child protection reviews get underway in Dundee, drastic “solutions” have been touted, as they are each time such deaths happen. These range from taking all or most addicts’ children into care - unrealistic without huge resources, given the large numbers of children and the hard-pressed, shrunken fostering and residential sectors – to giving addicts contraception along with their methadone. (A eugenic “solution” familiar to historians, it is unclear exactly what type of contraception is being dreamt of, and how it will be given: as so often happens, the restraint seems to apply only to females).

It’s understandable that concerned people feel despairing at times about the problem, and about the suffering of some addicts’ children, and are therefore tempted by the sound and fury of such drastic solutions. Angry feelings against addicted parents, and renewed blaming of social workers and health visitors, may be merited in individual cases; but when generalised, do they help vulnerable children, or distract attention from measures that will be more constructive for them?

Does it make sense for instance to spend more on the children and less on the adults?
Some recent research suggests that putting more resources into supporting addicted adults may actually make the children benefit from better, safer parenting. One issue which has consistently been neglected in policy, despite much research and practice evidence is the very damaging trauma in the backgrounds of many addicted parents.

Those who have been addicted for a long time, or who have found it impossible to remain “clean” from substance misuse, are often using drugs and alcohol as a kind of self medication- in a sometimes desperate effort to blot out very distressing experiences and memories. That kind of misuse is much harder to stop, because the cost to them, without support, is to resurrect sometimes unbearable flashbacks and memories.

These bad experiences can include childhood beatings and sexual abuse, neglect, emotional cruelty and for adults domestic abuse from violent partners. For example my own Beyond Trauma research, published in 2001, with women who experienced childhood sexual abuse trauma revealed that a high percentage had sought refuge in drink and drugs, even as children or teenagers, and needed skilled support to help them cope with the trauma once this “crutch” was removed.

In my latest study, Care and Support Needs of Male Survivors of Sexual Abuse, a quarter of the interviewees were addicted even before their teens, and half of them by their teenage years. The prisoner and ex-prisoner group were addicted very young to a variety of drugs, after experiencing extreme forms of trauma.

Of course, not all drug addicted parents are victims of abuse. However, many are – for example in 2004, one specialist drugs counsellor in a large and busy Edinburgh health centre found that 85 % of her client group had suffered childhood sexual abuse. In fact a growing number of international studies had already revealed links between substance misusers and a history of child abuse when Dr Jane Wilson of Stirling University carried out her Scottish research , with colleagues Susan Morris and Rowdy Yates, more than ten years ago.

Her research team found even higher figures than existing studies suggested. They used the Childhood Trauma Questionnaire with male and female addicts at three Scottish treatment units. The average age when these had first misused more than one substance was only 15.

Among the women, two-thirds had experienced childhood sexual abuse and more than half childhood physical abuse. Almost half of the men had experienced childhood physical abuse, and more than a third sexual abuse. Wilson and her colleagues called for a wider look at young people and adults with poly-drug use. They warned that in most cases trauma histories may not have been shared with health and social care professionals, and that their needs may have been “unidentified and unmet”. They urged more staff training and recommended “integrated programmes, which address both trauma and substance misuse.”

Those recommendations have made little headway in those ten years, despite further recommendations from major Scottish Executive reports like “Mind the Gaps” in 2003. Specialist, dedicated resources to help addicted adults recover as far as possible from childhood sexual trauma and other violence are still tiny, particularly (and ironically) in major cities like Edinburgh where there have long been serious addiction problems.

Yet research and practice experience indicates that they can actively enable addicted adults to become both more secure and competent as parents, and equally important, to regain the self-esteem which has usually been severely undermined or lost altogether. That loss is one key reason why women in particular often feel they are worth no more than to accept a violent and abusive partner, who is dangerous not only to themselves but to their children.

Obviously, the most basic aim in child protection has to be preventing children being abused in the first place. But creating safer less neglectful home environments for those children, free of possibly dangerous people who may wander in and out to collect or to deal in drugs, will be one part of that primary prevention exercise. Boosting post- trauma services for desperate, addicted parents, and giving staff the training and confidence-building to deliver these services on a wide scale, would prove a small cost in terms of potential benefits to both vulnerable parents and their children.

For more information about the project that led to the report Care and Support Needs of Male Survivors of Sexual Abuse see http://www.crfr.ac.uk/Research/malesurvivors.html