80% OF TEENAGERS HAVE EXPERIENCED ANXIETY SINCE STARTING SECONDARY SCHOOL – one in ten say terrorism, the Brexit vote and the Trump triumph has left them scared and bewildered.
By Dr Nihara Krause, Consultant Clinical Psychologist and Founder of stem4
Finally, the mental health of children and young people is getting some of the attention it merits. This was confirmed by Theresa May’s commitment, made at the beginning of the year, to ‘transforming’ mental health services. The new focus on young people emphasised additional training of teachers, the development of stronger links between schools and adolescent services and a target for children to receive treatment in their local area by 2021.
All this is timely, since there has been substantial growth in the number of children in England receiving care for their mental health. Data covering 60% of mental health trusts (NHS Digital October 2016) revealed staggering figures: around a quarter of a million children were receiving mental health care in England. Some 12,000 boys and girls aged five and under were noted as receiving help, whilst 235,000 people under the age of 18 were receiving specialist care.
There is no doubt that children and young people are under increasing stress. This month, stem4, the teenage mental health charity, published the results of a survey of 500 12-16 year- olds. It revealed a number of anxieties, including exam worries (41%), work overload (31%), friendship concerns (28%), worries about peer acceptance (23%), lack of confidence (26%), concerns with body image (26%), low self-esteem (15%), and feelings of being overwhelmed (25%). Of course, anxiety may just be part and parcel of being an adolescent, but the increase in worries over exams and performance is more of a modern-day phenomenon.
One statistic however stood out for me: one in ten teenagers reported strong feelings of anxiety over current world affairs. This is an issue that often comes up in the work I do for stem4, in the course of which I have had contact with over 10,000 students through school workshops and conferences and in my clinical work. The world’s instability and unpredictability – whether manifest in terrorism, the Brexit vote or the Trump triumph – has left children and young people scared and bewildered. They are concerned about the decisions that adults around them take and the legacy they are going to be left.
Their sense of insecurity is no doubt further intensified by the rise in the number of parents suffering from mental ill health. One in four adults experience a mental ill health problem (National Centre for Social Research, 2015), while one in five mothers suffer from depression and anxiety during pregnancy or the first year after childbirth (Independent Mental Health Taskforce, 2016). It is estimated that nearly two million adults were in contact with specialist mental health services at some point in 2014/15, but that probably represents just 20% of the people who need help.
The chances are that between one-third and two-thirds of children whose parents have mental health problems will go on to experience difficulties themselves (ODPM 2004). This could be because the young person has to take on inappropriate levels of responsibility as they care for themselves or the household. Equally, it might result from the powerful emotions engendered by living with a parent who has a mental health issue; these include anger, guilt, embarrassment or self-blame, and put a young person at increased risk of difficulty in their relationships with friends, problems at school and vulnerability to harmful behaviours. Above all, poor mental health among parents leads to increased anxiety among children. As a clinician, I have worked with many children and young people whose parents have mental health problems. One of the things that frightens them most is their sense that the people who should be protecting them are vulnerable or fragile.
It’s not surprising that today’s children are increasingly experiencing problems with their mental health. They are fearful. They face challengingly high expectations when it comes to school work and friendships. Meanwhile, they look out on a world where their parents are vulnerable, their friends are troubled, and the geo-political situation is unpredictable and even terrorising.
If we are to stem the increase in mental ill health among young people, we need to find ways of making them feel safe. They need prompt access to effective interventions that can alleviate their internal turbulence. At the same time, we need to make provision for offering equally rapid support and effective intervention to their parents. At the level of society in general, we must find ways of reassuring young people that the decisions taken by their elders will take their safety into consideration, now and in the future.
Developing a practical, easy and adaptable evidence based model of wellbeing in schools – the MINDYOUR5 programme – Dr Nihara Krause, Consultant Clinical Psychologist
There are many wellbeing programmes for schools. Some are targeted for specific groups of students, such as, for example, small, social and emotional skills groups, or groups aimed at reducing problem behaviours or increasing positive behaviours or competence such as exercise. Some programmes, such as the UK resilience programme, are intended for all students. There are also some mentoring and peer support programmes and social action interventions such as the National Citizen Service or the Duke of Edinburgh programme. Ultimately, all programmes aim for the same goal – enabling children and young people to thrive and achieve their full potential and the building of a positive school community.
However, there is significant variation in what each of these programmes provide since the focus can range from increasing competency, to reducing problem behaviours. In addition, some interventions are classroom based whilst others are outside of the classroom, whether they are delivered through extracurricular clubs or through engagement with the wider community. With so many programmes being advocated, what to choose has become increasingly confusing for many schools, particularly with the emphasis and pressure there exists on achieving academic rigour and maintaining quality standards. Most importantly, each school has its own identity and this further confuses choice since ‘one size doesn’t fit all ‘ leaving schools bewildered on the cost benefit of adapting a programme that may not necessarily work for them or that they find hard to implement and to maintain.
In order to clarify a well-being model that can guide choice and help schools create their own bespoke within school model, which can be integrated into the curriculum, I have developed a well-being programme that focuses on the five main categories that psychological research indicates needs to be covered to be comprehensive. Since the five-a-say model is a known one for physical health, I have developed ‘MINDYOUR5’ a well-being model of 5 day for good mental health. The model is simple and educates students, teachers and parents on what the five main categories are and provides examples of what can be done daily in each of the five categories to enhance positive mental health. The activities suggested have been trialled, using feedback from students and are simple and easy to implement and maintain. There is also scope for individual tasks that suit each person to be incorporated, which brings about ownership and therefore more potential for engagement. As well as individual level implementation, suggestions have been made on how the programme can fit into the school curriculum so that the message can be reinforced in lessons. Existing programmes, such as the ones mentioned in the introduction, can also be embedded if so wished, into the relevant category. This provides schools with the option of creating bespoke well-being programmes that suit the school and as a result are more likely to be implemented and maintained.
The model is simple. The five categories are
© Dr Nihara Krause
Case study 1
The five categories of MINDYOUR5 were explained to students and teachers. The programme was trialled for a week in a secondary school with students, teachers and parents all taking part. Feedback was collated at the end of the week. Satisfaction in those taking part was high (92%); attitude shift in terms of realising that it was easy and fun to carry out many of the activities was positive (89%); 90% reported feeling happier at the end of the week, whilst most of the students (97%) said they would wish to continue to keep up with their tasks. All categories were liked although ‘positive thinking’ was seen as the hardest to apply category. Following this, a reminder of the five categories was incorporated into all student planners so that the students could be reminded of their need to maintain these behaviours.
From feedback obtained about the types of tasks as well as how to incorporate this into a school curriculum from a number of different schools, a MINDYOUR5 whole school programme for junior schools has just been developed which maps each category of activity onto the curriculum.
Case study 2
A junior school is currently trialling the MINDYOUR5 programme for the whole school. This has included the following:
There has been a talk to teachers to see if they like the model
Based on full agreement, there has been a teacher training session on how to educate each class on the model
There has been a parent session informing parents about the model
The school has been provided with the programme, a power-point which can be adapted to suit the developmental level of the students, booklets for each child to fill in and guidelines for a school assembly to start the programme.
The school will then be supported in their delivery of the programme and results will be collated at the end of the year.
If you would like to download the new MINDYOUR5 programme for Junior Schools please contact Nihara Krause by email at firstname.lastname@example.org
All rights reserved Dr Nihara Krause Consultant Clinical Psychologist
Baroness Bakewell recently commented about the fact that she thought that anorexia nervosa was a sign of the ‘overindulgence of our modern society’ and a ‘sign of narcissism’ in teenagers. This comment sparked a backlash of responses and I was lucky that my comment to the Sunday Times was published. This is what I said:
“The suggestion that eating disorders are a modern phenomenon caused by focus on body image is not only unhelpful but also inaccurate: the first case of anorexia was written up in 1873. (‘Anorexia is narcissism, says Joan Bakewell’, p1 13 March, 2016).
Anorexia carries the highest mortality rate of all mental health conditions, has a devastating impact on individuals and their families, and is extremely complicated to treat.
Sufferers are not gratifying a “narcissistic” impulse. On the contrary, they usually lack self-esteem, have high levels of anxiety and depression, and present with complex psychological difficulties.
Given the difficulty of motivating them to accept help, suggestions that their illness is the product of vanity is potentially very damaging. Far from seeking to enhance their appearance by simply deciding not to eat, sufferers often feel caught in a trap where their disorder helps them to cope with a bewildering range of emotions and difficult experiences.
Whilst I welcome the public discussion that these comments have provoked since we undoubtedly need to question why looking good is portrayed by our society as the best way to improve self worth, we also need to do more to educate people on the painful reality of eating disorders, and on mental health problems more generally.
The focus on emotional resilience is pretty much at a peak at the moment with the search for embedding it in individuals, especially children and young people, at an all time high. Politicians, schools and companies advocate resilience training programmes, with a great manner of teachings on a variety of ways to increase our emotional elasticity. Don’t get me wrong, education and the instilling of resilience is important, hugely important, and people who know the amount of work I do on building resilience, including my MINDYOUR5 programme, a ‘five a day’ for mental health as well as the many hours I spend offering psychological treatment will verify my belief in it. However, no matter how ‘mindful’ one might be, or curious, or good at CBT, the ugly truth is that resilience alone will not help you to cope with the adversities of life. It will not, solely, enable growth nor lead to keeping mental illness at bay.
The problem is that resilience isn’t a binary concept where you either are or aren’t resilient. Nor is it consistent. You may be resilient to some emotions but not to others, you may be resilient to a number of events but you will have your limit and you may be resilient at some times but vary at others.
It also doesn’t matter how resilient you are, there are many external factors that can affect you. Apart from the predictable ones such as loneliness, financial problems, social breakdown and huge amounts of stress, others such as the impact of the speedy and relentless dissemination of distressing information through digital sources and the constant struggle to keep ahead, will affect you, hugely, deeply. The impact of experiences and ultimately our genetic inheritance will all affect resilience like acid rain on a growing plant. Resilience education can’t just focus on the individual, if we truly want to be more resilient, then it needs to move towards considering and strengthening external factors that contribute to mental ill health – the strain posed by the ‘outside’ world on the individual. Whilst we work to equip ourselves to face tumultuous weather conditions, lets also take steps to prevent how we might contribute to climate change in the first place.
In a meritocratic society there is a belief that you get what you deserve. ‘Internalisers’ who believe that anything and everything is within their control will not like the fact that contrary to the sentiment expressed in ‘There is occasions and causes why and wherefore in all things’, (Shakespeare, Henry V, Act 5, Scene 1) there is sometimes no why and wherefore to mental illness. The biggest problem of resilience education is the instillation of a belief that a breakdown in your mental health or wellbeing is solely based on the inability of the individual to apply and manage suitable and effective thoughts, emotions or behaviours. Sure, being resilient will help you to bounce back from adversity quicker, just as strengthening the external ‘systems’ that affect the individual – their families and communities will also help, but a breakdown in mental health is not proof of weakness (or that all those mindful courses haven’t worked) it is also part of the human condition.
In an area where there has been so much stigma, and this stigma mainly being due to a mistaken concept that mental illness, unlike physical illness, is as a consequence of ‘being weak’ – we need to take care in our message. It is important that we educate on resilience and provide young people with tools to negotiate their way through the turbulence of life effectively, but we need this message to be balanced and realistic. Lets do what we can to keep our mental wellbeing at its peak and feel confident about effectively dealing with what we face, but lets also focus on creating a more robust environment that supports growth and agree that sometimes, through no fault of anyone or anything, ‘bad stuff’ happens and that when it does, we don’t feel despairing or condemned that in some way we have proved our weakness and failed in the resilience stakes.
According to various Psychological studies about 20% of us are procrastinators – those who wait until the very last minute to deliver. This seems somewhat of an underestimate if the discussions I’ve had with young people in the many schools I work with reveal. A number of them quite proudly admit to doing things at the very last minute. Why? ‘I cant be bothered’ is the most common answer, together with ‘there are better things to do.’ Other answers tend to fall into the categories of ‘I know I can get away with it’ to ‘its boring.’ A small number will say its because it makes them anxious to start.
Why do we put things off? There’s certainly a lot written about procrastination together with a whole range of tips on how to overcome this behaviour. The answers range from indicating that we all have an internal ‘cost benefit’ question we ask ourselves when we have to work; needing to value something to do it; fearing failure and to being lazy. Nike in their slogan ‘just do it!’ addresses this lethargy. Oh, if it were only so easy!
Most young people of today, contrary to popular belief, work hard, incredibly hard. From the time they are very young they are trained to be tested, to be accomplished in a range of extracurricular activities and to represent themselves to a high standard. In an incredibly competitive world, there is no time to ‘take it easy.’ As adults we wouldn’t want to bring our work home after a hard day’s work, young people have to do just that. Even recreationally, they are constantly evaluated. How many likes, how many followers, they can be built up in a few seconds and destroyed on the stage of social media with just one click – an outcome they can’t predict or control. Viral destruction. That’s apart from all the messages they get about the effort they need to put in to succeed, get ahead, get into a good school, stay on top of their set, to look good, be popular and generally keep abreast.
If we want young people to learn to overcome procrastination, perhaps we need to address some fundamental facts. The first, is an intellectual snobbery that admitting putting effort into academic success is a failing – that if we are bright we should ‘just be able to do it’ and that therefore, we should pretend to others that we’ve achieved without effort. The second, that parents should challenge their own competitiveness to ‘get ahead’ through the effort they put in on behalf of their child. The number of school projects, essays, and creative pieces completed by parents on behalf of their children surely far outweigh a child’s own work? Ultimately children know, that should they procrastinate, their parents will step in to deliver an amazing result. The third point is tricky – are children exhausted by the hard work that drives their days? The constant homework, the testing, the rote preparation for exams? Well, teachers certainly are, so I guess children must be too. In a culture dominated by anxiety and a fear of failure, the need to put in constant effort to achieve a perfect result has become too big a pressure for some, with procrastination an almost inevitable result.
Many people have heaved a sign of relief that ‘dry January’ has come to an end because although some may be virtuous in their ability to have completed the month, (which is, of course, no small feat and should be heartily commended), for many, it wouldn’t have been the most successful, as is backed by the BUPA 2015 poll that states that approximately 43% break their resolution within the first month. I got thinking when I overheard a friend of mine, known to pass out at many a party due to alcohol excess, saying the other day ‘Well, I couldn’t stick to dry January, but then I don’t drink that much anyway’.
The fact is we are terrible self-deceivers. We often lie to ourselves about how much we drink and about how much we eat. We deceive ourselves as to whether we really are attracted to someone or not or whether we are enjoying what we tell other people we truly are. We lie to ourselves about bigger choices – careers, partners, becoming parents.
Why do we do this? Partly its because we fear the truth – we don’t want to deal with the consequences that facing reality will generate. Self-acceptance is a funny thing. We need it and yet we shy away from it. Better to either avoid or denigrate our selves than accept the truth, since we need to preserve our ‘ideal self’ and to some extent our ‘ideal world.’
However much wool we may draw over our eyes, we live our reality. Our truth is part of how we think, behave and relate. Grieving for an ideal is part of life and sad as it is, it needs to happen. It’s time to face the truth and accept responsibility for oneself. Self-acceptance and self-compassion enable living a far more content life, in the present and for the future.
The 4th February was ‘Time to Talk’ day. It seems strange at a time when the mobile phone is almost everyone’s accessory that we need to be reminded to talk. And yet of course, what’s been referred to here, is the good old-fashioned way of talking, using words, face to face, expressing our thoughts, our emotions, our intentions, of being listened to and of being heard. Do we really need to talk or has our speedy modern communication through social media, through text and email surpassed what can only be but seen by some as a time consuming and sometimes painful process, especially if talking isn’t practiced or words are not your forte?
Robert Frost in his poem ‘Time to Talk’ says
‘When a friend calls me from the road
And slows his horse to a meaning walk,
I don’t stand still and look around
On all the hills I hadn’t hoed,..’
Talking is probably one of the most under rated human abilities and the most often practiced one. Mothers talk to their babies from the time they are born (and even when they are in utero) initiating the process of bonding through creating a pathway through words to emotional connection. It is one of our oldest forms of love.
Talking helps to clarify your thoughts, to pay attention to things and to get a different perspective or to get a handle on what may be churning inside. It substantiates our experiences and memories. It helps you to connect to others and to sometimes release an internal pressure such as anger or sadness.
William Blake in ‘A Poison Tree’ says
‘I was angry with my friend:
I told my wrath, my wrath did end.‘
Talking forms the basis of psychological treatment and at a time when children and young people’s mental ill health is at an all time high, how do we encourage them to talk, particularly boys?
The statistics on mental health problems indicate a heavier bias towards boys. In children aged 5-10 years, 5.10% boys present with mental health problems in comparison with girls; and in children aged 11-15 years, 12.8% comprise of boys whilst 9.5% are girls (National Statistics online, 2004).
The types of difficulties boys present with include a higher rate of behavioural and developmental problems such as conduct disorders and autistic spectrum disorders and in the older group, a higher proportion of alcohol and drug misuse, bipolar disorder and schizophrenia. Statistics also indicate that suicide in more common in young men under the age of 35.
And yet, far less boys admit to experiencing emotional difficulties and attendance figures to G.P’s indicate that more girls and women seek help. In a ‘man-up’ culture, where expressing vulnerability is seen to be negative, encouraging boys and young men to admit to mental health difficulties remains a challenge. Education plays a huge role in enabling discussion, discouraging ‘banter’ and bringing about an attitude change. Talking at school is a good start, together with promoting and supporting fathers to instigate discussion about concerns and worries.
In an age when self-harm predominates as way in which 1 in 12 children in the UK non verbally communicate their stress and distress, surely we need to provide them with verbal tools which will enable them to begin a process of change and healing?
It’s natural to feel anxious before an exam and we all know that a moderate degree of anxiety boosts performance. However, some students report severe levels of crippling anxiety. In 2011 Child Line confirmed increasingly levels of stress in children and young people trying to cope with the pressures that accompany exams.
There are many Problem Focused strategies that you can access which focus on managing your behaviour whether it be to have breaks, be organized or a variety of other techniques.
However, Emotion Focused strategies help us to deal with exams positively and well through helpful thinking and helpful ways of being with friends and others.
Helpful thinking –
‘I can do’ is a good way to think. To help you with this
- Remind yourself of what you find interesting in your work and what you have got right
- Make it about doing it to better yourself rather than being better than others – its not about being the best, its about doing your best
- Catch negative thoughts such as ‘I’m going to fail’ and balance them with a positive such as ‘I am capable of success’
- If you’ve got things wrong see them as things you can learn from
- Try not to build scary future scenarios in your mind, focus on what’s working now
Helpful emotions –
Do you give yourself time to notice your emotions? Now would be a good time to do this.
Stop for a moment, keep your feet firmly on the ground, breathe out and notice what you are feeling. Just observe what the feelings are. Imagine lots of clouds drifting over you. Place each feeling in a cloud. Just watch them as they float above you. They may drift back but you can let them drift away again.
Putting away emotions and choosing whether to interact with them or not is a helpful strategy to manage your emotions during exams. Some emotions such as anxiety or unhappiness can take up valuable space in your head.
The impact of having a sibling or a friend who has a mental health issue can be draining
Some possible strategies to help siblings and friends cope with the situation:
- Give them opportunities to talk – about themselves as well as the person they are concerned about. Within a family context this may be with other siblings or parents, while at school it may be with pastoral staff.
- Give them access to factual information about the condition, as well as support. Recommended websites, discussions with a care team, suitable leaflets or books or talking to a school nurse can all be useful.
- Be prepared to listen, but in a supportive and non-judgmental manner. You may find training on this subject useful if you are a parent, teacher, peer mentor etc who’s trying to help.
- Help them learn to accept the changes they notice in their sibling or friend and to accept the impact it has on them as well.
- Encourage them to let the person who is unwell to be as independent as possible and to manage not being over-involved.
- Help them to avoid placing blame or guilt on themselves
- Help them learn to prioritise themselves.
- Encourage them to gain control over their own lives and take regular time out for themselves, using spare time for things like keeping fit and healthy.
- Show them how to seek help if they have their own mental health problems.
The impact of mental illness on siblings and friends often goes undetected and yet it can have far-reaching effects – sometimes what is caused is a ripple, but at other times siblings and friends can be caught up in a torrent of emotions, which they may find difficult to deal with, thereby having a knock-on effect on their own mental wellbeing.
Many teenagers are vulnerable to some form of addiction. Although addiction to drugs is most commonly reported, there are also activities that are addictive. Common teenage addictions include gaming, Internet gambling, pornography, exercise, the Internet and other technology.
Addiction has a clear craving component; it is compulsive with increasing tolerance to what the original effect was; it affects the individual in a negative way and the person feels out of control of the behaviour and is unable to stop even with effort. Withdrawal is noted if the behaviour is discontinued for even a short period of time.