1.1 This submission is a compilation of research, projects and key recommendations that aim to support the Committee’s inquiry on the mental health of young people and children. Drawing on world-class research and lived out projects in this space, it aims to inform and suggest ways to build on pre-existing mental health interventions and demonstrate best practice in this area.
1.2 If the Committee would like to hear from our experts through oral evidence, find out more about the research and projects taking place in Nottingham or read further, please contact Lou Rudkin, Head of Communications, Institute of Mental Health lou.rudkin@nottshc.nhs.uk
1.3 The Institute for Policy and Engagement was created to help form partnerships and networks between the University of Nottingham’s world-class research and people and organisations it can help. Its mission is to support the exchange of knowledge and ideas to enrich policy making, inspire people, support communities, and transform lives and shape the future. It aims to be a beacon, renowned for creating partnerships between researchers, policy makers and the public. Through these partnerships it will tackle together the most compelling challenges, locally, nationally, and globally. For more information, visit https://www.nottingham.ac.uk/policy-and-engagement/home.aspx
1.4 The Institute of Mental Health is an innovative partnership between the University of Nottingham and Nottinghamshire Healthcare NHS Foundation Trust. It seeks to help transform the understanding and treatment of mental health by bridging the gap between campus and clinic. Since its formation in 2006, the Institute has established a track record of success, with achievements in delivering innovative inter-disciplinary research that has a positive impact within the health, social care and criminal justice sectors. For further information, visit www.institutemh.org.uk
2.1 According to and based on research carried out by colleagues from the Institute of Mental Health and University of Nottingham as well as case studies of live projects we recommend the following (ordered in accordance with the rest of the submission):
2.2 Develop policy and strategy to mobilise creative industries outlets such as Aardman as significant contributors to the health of the nation[1]. (Prof Paul Crawford)
2.3 Adopt animated storytelling in public mental health messaging, not limited to young people. (Prof Paul Crawford)
2.4 Only fund and support the development of mental health assets that are co-constructed with key recipients or beneficiaries, for example the young people you are hoping to support. (Prof Paul Crawford)
2.5 Drive research-production research project cycles between universities, creative industries, mental health organisations and communities. (Prof Paul Crawford)
2.6 There should be a holistic approach to mental health provision in primary schools- embedded mental health counselling services in each school, working with all stakeholders including the children and their families[2]. This provision should be extended out of school hours[3]. (Prof Gary Winship & co)
2.7 The uplift in recruitment of teachers should also include a recruitment for mental health leads in schools so that all schools have ring fenced funds for service provision with the aim of all schools having a mental health counsellor by 2022. (Dr Gary Winship & co).
2.8 The standards and the provision of training should be overseen by a working party that draws together the key stakeholder. This working party must include teachers, as well representation from families and children. (Prof Gary Winship & co)
2.9 Preventative programmes in schools and colleges to help young people develop resilience and tackle key risk factors such as impulsivity, emotion regulation and poor coping in relation to self-harm should be implemented. (Prof Ellen Townsend and Self-Harm Research Group)
2.10 A review of how providers of children and young peoples’ mental health have evaluated and adopted Digital Health Interventions (DHIs) during the pandemic should be conducted to highlight evidence of best practice and recommend ways that DHIs can be better utilised. (Dr Aislinn Bergin)
2.11 Children and young people, along with their carers, must be involved in the planning and delivery of DHIs within mental health services. From design, through research and into adoption, there must be an increase in investment to ensure that their needs and priorities are met. Hard to reach groups should be better enabled to participate through national initiatives. (Dr Aislinn Bergin)
2.12 Funding should be provided to develop an agreed taxonomy for mental health DHI research so that evidence can be more easily collated and showcased. (Dr Aislinn Bergin)
2.13 National bodies that already play a role in standardising and regulating children and young peoples’ mental health services should be encouraged to invest in bringing together guidance and curated libraries of effective DHIs. (Dr Aislinn Bergin)
3.1 As principal investigator and project lead, Professor Paul Crawford, Institute of Mental Health, The University of Nottingham carried out the following project in partnership with Aardman Animations (Wallace & Gromit, Shaun the Sheep creators). The collaborative project was funded by the Arts and Humanities Research Council. The team co-created 5 original short films with young people aimed at advancing mental health literacy among 17-24-year olds. The films address life challenges that foundational research established as significant for young people in this period of transition to college, university or the workplace: loneliness, perfectionism, competitiveness, social media and independence. A companion platform was also co-constructed with young people: www.whatsupwitheveryone.com. The platform provided additional upstream mental health information and signposting to the project’s charitable partners and formal clinical services if needed. The films and platform launched on 8 February 2021 on all major social media channels and are also available on Aardman’s YouTube Channel. Alongside foundational research and production, several phases of study are underway to determine the impact of the films and platform on young people’s mental health literacy, gather audience storytelling about the films, identify the level of trust among young people for the digital information provided in both the films and platform, analysis and synthesis of online data concerning the social and cultural impacts of the films and platform. The preliminary pre- and post- research findings are that viewing the films improves young people’s knowledge of mental health, attitudes towards mental health, willingness to seek help and confidence in helping others.
Paul Crawford is Professor of Health Humanities, lead for the Institute of Mental Health’s Centre for Social Futures and Fellow of the Royal Society for Public Health. As the founding father of the rapidly developing field of health humanities, Professor Crawford has spearheaded research in applying the arts and humanities to inform and transform healthcare, health and wellbeing.
3.2 Between 2011-2014 Dr Gary Winship led a research group, funded by the Institute for Mental Health (IMH) which brought together key stakeholders in Nottingham in response to a significant spike in suicide among children and young people across Nottinghamshire. It included conferences and seminars with people from across the sector and demonstrated local coordinated effort in highlighting research and the importance of working together in this area. Research was drawn together in The Essentials of Counselling and Psychotherapy in Primary Schools – On Being a Speciality Mental Health Lead in Schools (Winship and MacDonald, 2018). The book speaks directly to the challenge set out by the Governments Green Paper (2017) ‘Transforming Children and Young People’s Mental Health Provision’ which has proposed changes to the way children and young people’s mental health is managed in schools. The research looks specifically at the challenge of delivering mental health provision in primary schools, making a specific case for adjustment to the developmental needs of primary school age children. The epistemological focus is orthopedagocical (Broekaert, et al, 2004; Broekaert et al, 2011) and the knowledge advanced here informs a range of intellectual fields, from pastoral counselling to mental health to education and developmental psychology. The case studies not only focus on work with children, but also with parents and teachers.
The research sets out a model for the development of mental health leadership in schools the way in which a designated mental health lead might support schools, parents and children in schools, including lessons on mental wellbeing in schools as part of the PSHE syllabus. Essentially the formula for mental health leadership in schools in built on the idea of a system approach whereby all stakeholders as seen as crucial to a school as a therapeutic community (MacDonald and Winship, 2016).
There are three main research frames that are explicitly outlined in the book:
The book is drawn directly from practice, so it is practice leading research, co-author Shelley MacDonald has been running counselling and psychotherapy services in schools for more than 10 years.
One of the striking features of that original round of policy feed for the Government’s 2017 report was the absence of any schoolteacher or counsellor giving evidence to the commons select committee. So, the research they have produced looks to bring practitioner voice to the fore, and therein the voice of advocacy for younger children. Finally, the research seeks to address the anxiety among schoolteachers about engaging with mental health. Teachers need a much more substantial core of preparation.
The key line of argument in the Cambridge Journal of Education paper (Winship, 2021) is that mental health is best considered in regard to a more holistic approach to schools rather than narrowing it down to responses of children in distress. A more holistic school approach has a much better chance of early identification and prevention of mental health problems. And on this front the paper on the primary school as a therapeutic community is salient. In that paper we point to the concept of therapeutic communities. There are many schools up and down the country who operate as therapeutic communities and are registered with the Royal College of psychiatrists.
Dr Gary Winship is an Associate Professor of Education and Mental Health and Course Leader (MA Trauma Informed Practice) in the University of Nottingham’s School of Education. He is also a visiting Professor at the Moscow Institute of Psychoanalysis and University of Reaviz.
3.3 The Self-Harm research group, led by Prof Ellen Townsend ask ‘What measures are needed to tackle increasing rates of self-harming and suicide among children and young people?’. In their research, they encounter many young people who simply receive no treatment or support for self-harm and the mental distress associated with it. Instead they are sent away from services with information leaflets, e.g. about harm minimisation, that are not evidenced-based and are likely to be harmful when suggested in the absence of other supports and services (Wadman et el, 2020).
Unfortunately, even when young people manage to access services and supports for self-harm they often encounter negative, patronising attitudes or feel services offer ‘empty promises’ leaving them feeling that they are not being listened to and let down by services as a result (Wadman et al, 2017; 2018; 2019). Young people from different backgrounds demonstrate differing patterns of access and preferences in relation to services for self-harm and have mixed views about how CAMHS are (Holland et al, 2020). In Patient and Public Involvement work with young people, they have expressed a desire to see preventative programmes in schools and colleges to help young people develop resilience and tackle key risk factors such as impulsivity, emotion regulation and poor coping. We know from studies in Europe that school-based ‘Youth Awareness of Mental Health’ programmes can be useful in preventing suicide ideation and self-harm (Wasserman et al, 2015) but such programmes require testing and replication in the UK.
A range of interventions have been trialled with young people who self-harm though the evidence-base is limited (Hawton et al, 2015) compared to the literature on adult interventions which shows that talking therapies like CBT can be helpful for those who self-harm (Hawton et al, 2016). New interventions are needed in this field including those that focus on key risk factors such as emotion regulation, impulsivity and coping, and in specific settings such as crisis teams, primary care, and the digital environment. It is vital that people with lived experience are involved meaningfully in designing interventions throughout the research process.
Ellen Townsend is Professor of Psychology and Head of the Self-Harm Research Group in the School of Psychology at The University of Nottingham. In the summer of 2020, she established Reachwell (www.reachwell.org) a committee of child and adolescent mental health experts to advise the UK government to prioritise protecting the health and wellbeing of children and adolescents during the pandemic.
3.4 NIHR MindTech Mental Health MedTech and In-vitro diagnostic Co-operative has been active since 2013, working in partnership with healthcare professionals, patients and the public, researchers and industry to identify unmet needs and support the development, adoption and evaluation of new technologies for mental healthcare.
Digital Health Interventions (DHIs) can be effective at improving mental health outcomes in children and young people (CY&P) across a range of conditions. However, research has typically highlighted gaps where their effectiveness has been challenged:
There are many examples of best practice which are to be highlighted in a separate, individual submission from Dr Aislinn Bergin.
Within practice, Mindtech’s work with providers has also demonstrated that the use of DHIs within C&YP’s mental health may also be challenged at the level of delivery. Mindtech’s work with children, young people, and their families and carers has emphasised how important it is to include them within research and the delivery of DHIs. The full potential of DHIs within C&YP’s mental health treatment and management is unlikely to be realised unless there is an increased focus on how to translate research into practice. Mindtech’s research and work with industry has found that evidence based DHIs, many funded by public monies, are often not adopted into the national health service. Several barriers have been identified in this space:
Dr Aislinn Bergin is a Research Fellow at the NIHR MindTech MedTech Co-operative, with a PhD in Digital Mental Health and a BA (Hons) in Developmental Psychology. MindTech is a national centre focusing on the development, adoption and evaluation of new technologies for mental healthcare and dementia.
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March 2021
[1] ‘shadow health service’ Crawford, 2018; ‘health humanities’ Crawford et al 2015; ‘creative public health’ Crawford, 2020
[2] Ingredients of Counselling – Specialist Mental Health Leadership in Schools
[3] Anne Longfield and Robert Falon