This independent article from Professor Jim McManus, ADPH President and Sarah Muckle, ADPH Policy Lead for Children and Young People is part of the LGA children and young people's mental health think piece series. The piece explores the question 'what are the conditions for ensuring good mental health and wellbeing in children, young people and families?'
Mental health is determined by a vast range of factors that can have either a negative, or positive impact.
Individual factors include predisposition, relationships with family and friends and the education we receive. In addition, there are also wider societal factors at play, including the communities we live in and physical environment around us.
These factors come in to play at different times in a child’s life, and with differing levels of impact depending on the age and stage the child is experiencing them. The risk factors also interact throughout childhood and adolescence, feeding into and building on each other, accumulating to form varying degrees of either a vicious, or virtuous, cycle.
As early as in the womb, exposure to external stress can impact a child’s later mental health, as can premature birth. After birth, a child’s first years are fundamental in shaping future health, with the first 1,001 days widely accepted as the most critical time. Speech and language development, parental attachment and physical health all have a part to play, as have sleep, nutrition and levels of physical activity and exposure to drugs and alcohol, with increasing evidence indicating that both physical and mental health and wellbeing are affected by all these and more.
Children today are facing an unprecedented set of circumstances. Measures designed to combat Covid-19 meant that the majority of children stopped going to school, stopped socialising and in many cases even stopped playing outdoors for weeks at a time, on and off for over two years. The enforced isolation caused widespread anxiety and loneliness and drove a new era of online communication resulting in long-lasting reliance on technology for just about every aspect of life.
These effects of the pandemic took a lasting toll on many children and young people’s mental health, with people from less advantaged areas disproportionately affected, thereby exacerbating existing health inequalities. Then, when the threat from Covid-19 had passed, the cost-of-living crisis began to bite, pushing more families than ever into poverty and widening the gap between rich and poor still further.
There are now record numbers of children and young people presenting with poor mental health, with one in six adults also affected.
The solution to this stark picture is twofold. First, we need to support those millions of children and young people – and their families.
For these families, we need to watch and learn – and fast. Improving children’s mental health now is of vital importance. These children will grow up to be the next generation’s parents and study after study has shown us that poor mental health in pregnancy and in parents and carers of babies has a negative impact on a child’s mental health, along with a range of other outcomes.
Up and down the country, local public health teams are supporting initiatives to improve children and young people’s health and wellbeing. They work with nurseries and schools, youth groups and charities and parents and carers to provide education and training to support children who are experiencing difficulties. This support takes all forms, whether it be providing warm hubs in winter months or promoting mental health resources in schools.
Secondly, we need to future proof society so that our children can grow up in a supportive environment which will promote and preserve positive mental – and physical – health.
How to achieve this second step is of course, a complex issue. With so many factors interplaying at different levels and at different times throughout a child’s life, it is vital that the right conditions are created for building resilience from the very start. Measures and strategies need to be implemented collaboratively and consistently by all – especially parents and carers who have such a critical influence on children’s development.
Given too that the first 1,001 days are recognised as a pivotal time, it is logical that we should focus our efforts on ensuring that parents and carers are given particular support to create the right environment in these first few years of childhood.
Of course, no one is suggesting that it is possible to take away all situations and circumstances that can result in poor mental health and so building resilience is key. Then, risks can be mitigated, and strategies can be taught to catch problems before they snowball into determining factors with knock on adverse effects.
What is crucial to understand though is that this resilience building is not solely the responsibility of individual children, parents and carers. The community we live in has a huge role to play and, as we saw during the pandemic, can mobilise to implement incredibly effective programmes to improve wellbeing that are specifically tailored to local needs.
However, as professionals, we need to look even more widely, at what can be done at a societal level to improve the outcomes for our child population.
For example, Directors of Public Health (DsPH) are responsible for sexual health services, which work to reduce unwanted pregnancy. This in turn reduces the number of babies born who may be at risk of neglect. They also work with drug and alcohol rehabilitation programmes, helping to ensure that fewer children are born into households where substance use is an issue and commission health visitors and school nurses to promote health in homes and schools. DsPH also work with planning departments, to reduce the number of fast-food outlets being opened near schools – this then helps to decrease obesity levels, which in turn improves mental health. They advocate for active travel and more green spaces that encourage physical activity – another contributory factor in mental health.
The list of specific examples goes on, but the message is clear: the success stories are there. However, we don’t have all the answers. As well as sharing examples of good practice and implementing similar schemes that are tailored to local needs then, we should be embracing and empowering those with lived experience to teach us how to do it even better.
What is also needed is a reflection of this local success at a national level. In partnership with a wide range of organisations, the Association of Directors of Public Health (ADPH) are advocating for children’s mental health and representing the views of DsPH in national conversations. In all this work, we emphasise the need for health to be put at the heart of any new policy and encourage the full consequences for health of any decision to be considered, including the likely impact on children’s mental health and wellbeing.
This is because the answer does not lie in providing money for quick-fix initiatives. Instead, it lies in changing society’s norms and expectations and that will require bold action and a sustained, cross-party commitment. Without such a commitment, we run the risk of compounding the issues facing our children today and creating another generation susceptible to mental health issues – and that is unthinkable.