National Children’s Bureau: Local and national responses to the challenges in children and young people’s mental health

Principles for responding to crisis situations such as natural disasters and violent attacks are well established and embedded into responses from local and national government and other players. The challenges of ‘slower’ and more insidious situations, such as the worrying rates of mental health difficulties among children and young people, bring different challenges and require different approaches. But can we use some of the principles for responding to disasters and attacks to guide our response to this other crisis?

Earlier this year, the UK Trauma Council produced guidance for educational communities on creating the best environment for recovery for children, young people and staff following critical incidents. These incidents include events that affect a large part of the school community: events that every local authority and senior leadership team dreads. 

The guidance is structured around five key principles. These were published by a group of global trauma experts (Hobfoll et al, 2007) building a consensus drawing on multi-cultural evidence of the best ways to promote recovery following disasters and mass violence. They are intended to guide support for individual children, young people and adults, and for communities, from the hours after a disaster or attack until several months have passed. 

The principles are:

• Promote a sense of safety
• promote calm
• promote sense of self- and collective efficacy
• promote connectedness
• promote hope.

The principles have been used across the globe to guide responses to sudden traumatic events, disasters, tragedies and mass losses. 

In a later interview reflecting on the application of the principles, first author Stevan Hobfoll reminded readers that as well as these ‘fast disasters’ there are ‘slow disasters like poverty’  (Dückers, 2014).

‘Slow-moving’ or ‘slow-onset’ disasters are those that unfold progressively over a period of time. They have a tendency to creep up on societies and decision-makers. Typically, they are the result of multiple causes that can be difficult to disentangle. Preventing and addressing them is likely to require intervention by many different groups and alliances, at many different levels. The complexity of causes and solutions can be overwhelming, leading to a lack of coordination, despair, and inaction.

Could we describe the current challenging landscape of children and young people’s mental health in the UK as a slow disaster? Certainly this situation has multiple causes: the pressure of social media; the lingering effects of the Covid-19 pandemic; the cost-of-living crisis; adverse experiences in childhood and long-term disinvestment in services have all been posited as among the contributing causes. Despite multiple voices sounding the alarm, and reforms from successive governments, the prevalence of mental health difficulties has been rising for some time. 

So, it seems that the crisis in young people’s mental health does fit aspects of the commonly understood definition. Which begs the question: could we use Hobfoll and his colleagues’ principles to help frame our response? 

Applying the principles

Four of the principles seem particularly relevant here.

Promoting a sense of safety

Helping people to feel safer can reduce physiological responses to stress, and also challenges the negative ways of seeing the world that can accompany threats (such as believing the world to be a ‘completely dangerous place’). Promoting a sense of safety at an individual level can include teaching grounding techniques and encouraging more realistic and contextual judgements. At a community level, a sense of safety can be promoted by reducing people’s exposure to shocking, sensationalist or unbalanced news reports, while of course seeking to restore actual physical safety. 

How could we apply this principle in tackling the complex collective challenge in children and young people’s mental health? Perhaps we need to focus on balanced messaging. It’s of critical importance that we raise concerns about growing risk factors and rising rates of distress and disorder. We need politicians and the public to sit up, take notice, and act. But to promote a sense of safety, from which action might be most effective, these messages need to be balanced with reporting of individual and family stories of resilience and recovery, and community stories of how local areas have worked together to promote and address young people’s mental health and wellbeing.

Promoting a sense of self-efficacy and collective efficacy

Self-efficacy is defined as a person’s belief that their actions are likely to lead to generally positive outcomes. Effective interventions focus on empowerment and agency: supporting people to feel confidence in their own abilities to solve problems and cope with challenges, rather than an external expert doing everything for them. At a collective level, community efficacy is the confidence that a group or society has in its ability to tackle problems together, and to rebuild and restore order. 

So, in the face of challenges in children and young people’s mental health, this principle suggests we should focus on solutions that involve co-production and champion leadership by children and young people and their families. That’s why approaches being developed as part of the UKRI-funded Adolescence, Mental Health and Developing Mind initiative are so encouraging: involving young people in designing, conducting and disseminating research into mental health alongside researchers from across disciplines and methodologies.

Promoting connectedness

Feeling connected to other people and groups is of critical importance in combatting stress and trauma. Tackling loneliness and promoting social connections are key at an individual level following traumatic events, including over the longer term.

In relation to the challenge in children and young people’s mental health, promoting connectedness can translate into interagency working, bringing health, social care, youth justice, and voluntary sector agencies together with children, young people and their families to shape the design and delivery of integrated services across local areas. The National Lottery-funded HeadStart programme is a great example: six local authority-led partnerships worked with local young people, schools, families, charities, community and public services to design and try out new interventions that could make a difference to young people’s mental health, wellbeing and resilience. Cross-systems working brought tangible changes and showed promise in harnessing connectedness across local areas.

Promoting hope

Traumatic events are often accompanied by a sense of bleakness and catastrophizing about the future, which leave little room for hope. But interventions which help people to envisage a more positive set of possibilities for the future start to make room for optimism, which allows for the possibility of hope for recovery and change.

In the face of the stark challenges in children and young people’s mental health, it can be hard to maintain the hope of change. To do this, we need to maintain a focus on what is working well, celebrating successes in prevention, identification, support and treatment, and highlighting advances. It’s critical that we highlight the evidence from promising approaches across different levels of need, from the Trailblazer sites for Mental Health in Schools Teams to a growing understanding of the active ingredients of effective interventions for anxiety and depression in young people.

Summary

Principles for interventions to respond to mass trauma and disaster situations are well developed and embedded. These principles also have potential application for addressing ‘slow-onset’ disasters, which could describe the crisis in children and young people’s mental health.

Promoting a sense of safety, a sense of collective efficacy, a sense of connectedness and a sense of hope may hold promise for guiding local government, health and other players’ responses to this complex and urgent challenge.