Mental Health and Referral Training

Mental Health and Referral Training

Mental Health in Schools Level 1 All Staff Hertfordshire School CAMHS Link [email protected] Welcome Exercise In pairs, share the following about each other: - Name and where you live. One thing that you are passionate about. One thing you have achieved that you are proud of.

What edible item you absolutely cannot live without? Quiz time! What is mental health? In pairs or small groups, list or brainstorm what comes to mind when we hear the phrase: mental health. Defining mental health Mental health has been defined as: A state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is

able to make a contribution to his or her community. WHO 2004 Emotional wellbeing has been defined as: A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment. WHO 2007 For CYP: Mental health, in effect refers to the capacity to live a full, productive life as well as the flexibility to deal with its ups and downs. In children and young people it is especially about the capacity to learn, enjoy friendships, to meet challenges, to develop talents and capabilities. Young Minds What is mental illness? Mental disorder / illness

Depression Heartbroken, sorrowful, demoralised, mournful, grieving, mournful Mental health problem Upset, annoyed, sad, angry, disappointed, bitter, glum, forlorn, depressed, down

Pensive, thoughtful, peaceful, happy, delighted Brain is not functioning as it should. having significant impact to MH. Happens to 1 in 6 at some point. Requires diagnosis and treatment by a mental health professional Normal brain response to severe or persistent life problem EG: bereavement, bullying. Happens to everyone many times in their life. May require *support

but not treatment Mental distress No distress, problem or disorder Normal brain response to everyday stresses E.G exams, relationships. Happens to everyone every day, helps us learn to cope, does not need treatment.

*without support, a disorder/illness could develop Clinical terminology

Neurodevelopmental Psychosis Bipolar disorder Personality disorder Depression Hyperkinetic Schizophrenia Obsessive compulsive disorder (OCD) Post traumatic stress disorder Prevalence

At least one in four people will experience a mental disorder at some point in their life and one in six adults has a mental disorder at any one time. One in eight children aged between 5 and 19 years have a mental disorder. (2017) Emotional disorders were the most prevalent type of mental disorder experienced by 5 19 year olds (8.1%). 50% of mental health problems are established by the age of 14 and 75% by the age of 24. (Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. (2005). Most children with a disorder who has used professional services found them to be helpful. This includes 73.1% who found educational support services to be helpful.

Awareness Children and young people will often let us know about their distress in one of the following ways: Direct disclosure of a practical problem, situation or life event, Direct disclosure of their feelings, Giving signals through their behaviour or presentation. Here are some of the behaviours you may see Some presenting behaviours: Becoming withdrawn, isolated, quiet or very sad, friendships/bullying issues, tearful, Worry, stress, anxiety, panic attacks and fears. Obsessive or repetitive behaviour or rituals.

Troubling dreams or memories sleep or eating problems. Problems focusing or concentrating, over activity Aggressive or disruptive behaviour, getting into fights. Self harm and or talking about not wanting to be around anymore, drug and alcohol use. School refusing or producing disturbing work. These are just some of the behaviours children and young people may present with but remember that everyone is different! 2 3

1 Survival Reaction Basic needs fight or flight The triune brain, Paul D. MacLean. Understanding Behaviour / symptoms 2 processes information coming into our brain

If it is tagged with an emotion it blocks access to the thinking brain (3) if overwhelmed, shuts down to the survival responses in 1 Can you think straight when you panic, are frightened or angry? Responding to behaviour / symptoms Behaviour: We see and respond to this

??? Thoughts and feelings driving the behaviour: We dont usually see or respond to this Ironically, behaviour is often punished repeatedly but if the thoughts and feelings are resolved or eased, the behaviour will change.

When X happened, what were you thinking and what were you feeling? Behind the behaviour Nurture Portrait 2015/16 A snapshot of the social, emotional and behavioural difficulties in pupils throughout the UK, The Nurture Group Network The mental health of children and young people in England , PHE, Dec 16 The Adolescent Brain Andrew Curren neurobiology in adolescence:

Good mental health among pupils is fundamental to their wellbeing and success. At the moment too many young people are unfairly labelled as trouble-makers when in fact they have unmet mental health problems. Teachers are not therapists but they play a vital role in the lives of their pupils. Teachers who know how and when to help can make all the difference for children with mental health problems. (Education Minister Elizabeth Truss)

Social Media and Mental Health Enables greater connection with people and sources of support, can increase resilience. Online risks include cyber bullying, harmful content, sharing personal info. UK has a higher level of teenage extreme internet users (37% of 15 year olds 6+ hrs per day) Correlation between extreme social media use and harmful effects on wellbeing. Link between periods spent using social media and rise in mental health problems. *Social media and childrens mental health: a review of the evidence Emily Frith, EPI, 2017 So what can everyone in school do to help? Acceptance and kindness can help people to regulate themselves. Treat children and young people as individuals (avoid labelling). Emotional responses to life problems are normal. Ask what they think will help. Listen attentively, make reasonable adjustments, provide information e.g: Self-help websites, online support (Kooth) during school time if needed. So what can everyone in school do to help?

Show unconditional positive regard for pupils and their families; acceptance and kindness can help people to regulate themselves Treat children and young people as individuals; avoid labelling (pupils may define themselves by their behaviours or difficulties) Help pupils to see that emotional responses to life problems are normal; deescalate their anxiety if they are experiencing a normal response

Respond to the causes of emotional difficulties such as bullying, family issues, struggling to access learning etc. Ask them what they think will help, listen and make reasonable adjustments Provide access to self help websites / online support such as Kooth during school time if needed

Use the Five Ways to Wellbeing to audit wellbeing strategies and introduce more exercise, social interaction, mindfulness, learning and giving where needed Provide opportunities for pupils to complete activities that help them to cope such as colouring, listening to music etc. Why is early intervention important?

Better chance of success Stopping unnecessary distress Improving educational and life outcomes Shorter and less specialised intervention can be effective (cheaper) A common phrase that we hear But Im a teacher I shouldnt have to do mental health work

When we see mental ill health as an issue for specialist health services only, we fail to support CYP at an early stage. If we fail to acknowledge distress as a normal part of life, we further stigmatise mental health problems We fail to create opportunities for help to be sought

It helps to know what the expectations are; teachers are not expected to deliver therapy or do more work, but notice use of language and the little things that can make a difference. It helps to know that reducing emotional distress creates the best learning environment Key assessment questions

How severe are the difficulties? How long have they persisted? What impact are the difficulties having on the young person, school, family, peers? Are the difficulties present at home, school and in the community? Are the difficulties proportionate to life events? What helps / what does the young person / family think will help? Dont underestimate the value of Sleep Food Belonging Love, relationships, family, friends

Exercise, being outside, feeling connected to the environment Nurturing, pets, plants, gardening Goals and personal achievement Rewards, having fun and relaxation Helping others, feeling good about yourself, giving Be Connect active Take notice Keep learning Give

And good initial responses Validate children and young peoples feelings: I can see that you are very sad / angry How are you feeling right now? Normalise the feeling and make a human connection: I would feel very sad / angry if that had happened to me I can understand why you are feeling sad / angry I would think most people would feel sad / angry if that happened to them Give them time to reconnect their thinking brain: Its hard to think things through when we are upset /

angry so we need to figure this out when you are feeling less upset / angry Give children as much choice and control as possible: Would you like to do it now or later? Would you like to tell you mum or shall we do it together? Create a sense of collaboration: What do you think we should do next? You dont have to know the answers: Im not sure what to do about that. I need to have a think about it but I will try my best to help you. Thank children and young people when they tell you about

feelings or other difficulties: Thank you for telling me about this, I can imagine it wasnt an easy thing to do. Give hope for the future: I know this is a really difficult feeling but I want you to remember that you wont always feel like this, the feeling will go. Respond - Reassure - De-escalate Empower Pass on - Hold in mind What about me? Your sense of wellbeing has a significant impact on your pupils

Dont forget to look after yourself 5 ways to wellbeing, Action for Happiness, Mindfulness etc You can check your wellbeing level on the NHS choices online mood self assessment For support, search online for the Wellbeing Team Hertfordshire or visit Just Talk: A mental Health campaign for Hertfordshire - Key messages We are all affected by mental health, just like physical health Talking shows strength not weakness Youre more likely to get better if you seek help early There are simple and relevant ways to improve your own mental

health (or to support others to improve their mental health) There is support and information available, and it can really help Just Talk campaign info for parents, professionals and young people can be found on: Toolkits containing useful resources e.g. posters, lesson plans, form time activities, speaker directory, quizzes, parent top tips leaflet. Any questions: [email protected] Support and resources Strategic Mental Health Leads in Schools: East and North Herts CCG

Breda O'Neill Breda.O'[email protected] Mobile: 07827 937 573 Herts Valleys CCG Yael Leinman [email protected] Mobile: 07717 427 590 Admin support: [email protected]

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