School aged children and young people
Importance of focussing on school aged children and young people
The importance of a focus on childhood and adolescence as part of a life-course approach to mental health and wellbeing is widely recognised, often citing a large study of English-speaking Americans which found that three quarters of lifetime cases of mental illness began before 24 years of age and half before 14 years [31]. The most recent data from England, suggests that one in eight children aged 5-19 years has a mental health disorder, with rates rising with increasing age of young people [32]. The proportion of children affected by a mental health disorder is rising over time, with the proportion affected by emotional disorders including anxiety increasing over time.
Adverse Childhood Experiences
Children’s health and wellbeing, including their mental health and wellbeing, needs to be seen in their social context, especially the family environment. Recent work in Scotland and elsewhere on the childhood stress caused by Adverse Childhood Experiences (ACEs) has highlighted the impact of ACEs on adolescent behaviour [33] and subsequent adult mental health and wellbeing [34]. ACEs include abuse (physical, sexual and emotional), neglect (physical and emotional) and household adversity (including domestic abuse, criminality, household alcohol and drug misuse, household mental ill health, separation of parents and being in care). ACEs can have a lifelong impact on physical and mental wellbeing and behaviour, with those who experience multiple ACEs more likely to develop mental and physical ill-health and have health harming behaviours. Whilst ACEs can happen to all children, there is increased risk of ACEs in children living in poverty or high levels of social deprivation [35].
Mental wellbeing of adolescents
The mental wellbeing of adolescents appears to have been deteriorating in recent years, with a particular decline in the wellbeing of adolescent girls [36]. The causes of this decline appear to be myriad and may include aspects of school-related pressures, bullying, social media use, disrupted sleep, body image concerns, increase in self-harm, increase in exposure to pornography and shaming. The difference in trajectory between girls and boys should be seen in the context of systemic societal gender inequity.
Interventions
Mandatory attendance at school to the age of 16 years in the UK offers the opportunity to develop emotional literacy amongst children and young people. This aims for understanding and developing the ability to recognise mental ill health, know how to support wellbeing (including mental wellbeing) and how to develop resilience. To this end, school programmes now contain health and wellbeing topics including mental, emotional, social and physical wellbeing, substance misuse, sexual health, food and health and physical exercise [37]. Specific mental health interventions can be used in schools to address anxiety, depression and conduct disorder. However, the evaluation of these interventions is limited and further work is needed to demonstrate effectiveness [38].