Emotional Wellbeing and CAMHS Rachel Gates Senior Clinical Nurse Learning Disability and Neurodevelopmental Team Greenwich CAMHS

Aims: To discuss what is CAMHS? To explain the purpose and function of the LDND Schools Service To improve knowledge about child & adolescent mental health (CAMH) and emotional well-being (EWB)

What is CAMHS? Child and Adolescent Mental Health Service Service for Children and Young People aged under 18 years old With mild to severe psychological difficulties Greenwich CAMHS provide this service to young people: registered with a GP within the Greenwich Clinical Commissioning Group area; Living within the Royal Borough of Greenwich; Attending a Greenwich school; or in the care of the Local Authority. Specialist teams – Adolescent, LAC, Generic, LDND, EIS Will discuss more about “psychological difficulties”

LDND Schools Service LDND Team - Children and young people with complex neurodevelopmental problems: Learning disability roughly equitable to an IQ below 50, and/or ASD/ADHD LDND Schools Service is an in-reach service into specialist schools in Greenwich Focus on prevention of mental health difficulties and promotion of resilience and emotional well-being Early intervention for children and young people who present with mild to moderate level mental health symptoms and are considered to be vulnerable to mental health problems. We provide Consultation and advice to professionals within school Training to schools Consultations and assessment with families and young people identified through the school as requiring support Brief evidence-based interventions for young people and their families

Consultation Process Module Maximises capacity Strengthen skills and awareness in frontline staff Improvement in integration and communication Clinical Service Consultation Training

Multi-Systemic Approach Home School young person Community

What is mental health and wellbeing?

Exercise: What does the term mental health mean to you? (6 minutes in pairs, please take three minutes each) Please could you share with your partner 3-4 thoughts, feelings, beliefs or prejudices that the phrase mental health summons up for you. On a scale of 0-10 (10 is most comfortable) please rate how much you understand and how comfortable you feel with the phrase mental health

Definition of Mental Health Mentally healthy young people are able to: Develop psychologically, emotionally intellectually and spiritually Initiate, develop and sustain mutually satisfying personal relationships Use and enjoy solitude Become aware of others and empathise with them Play and learn Develop a sense of right and wrong Resolve (face) problems and setbacks and learn from them

Well-being Emotional Well-being: This includes being happy and confident and not anxious or depressed Psychological Well-being: This includes the ability to be autonomous, problem solve, manage emotions, experience empathy, be resilient and attentive Social Well-being: Have good relationships with others and does not have behavioural problems, are not disruptive, violent or a bully. (National Institute for Care and Health Excellence: NICE 2013)

Definitions Mental health problems are relatively common and consist of a broad range of emotional and behavioural difficulties which may cause concern or distress Mental disorders are less common but are more severe and/or persistent. These are outlined in the current diagnostic categories for children and young people (World Health Organisations)

The progression of ‘Problem’ to ‘Disorder’ Change in the young person’s usual behaviour, emotions or thoughts Persistence of the problem for a significant period of time Severe enough to interfere with the young person’s everyday life Significant impact on the functioning of the young person and/or carers Taking account of Child’s developmental stage, social and cultural context (Pearce, J. 1993)

Exercise: 5 Minutes In groups, try and guess three sorts of disorders listed in the International Classification of Mental Health Disorders

Classification of Child & Adolescent Mental Health Disorders Emotional Disorders: anxiety, low mood and depression, separation problems, fears, phobias, obsessions, self harm, school refusal, fluctuating moods Disorders of Conduct: defiance, disobedience, stealing, anti-social behaviour Eating Disorders: anorexia & bulimia nervosa Somatic Disorders: e.g. persistent headaches, stomach aches with no organic cause Habit Disorders: sleeping problems, tics, wetting and soiling Psychotic Disorders: psychosis, schizophrenia, bi-polar disorder, drug induced psychosis (ICD 10)

Prevalence Diagnosable disorder in child/young people population estimated to be up to 25% in some studies 10% children/young people 5-15 years with a mental health disorder (ONS, 2000) Children with Autism are more likely to experience anxiety and depression Children with a learning disability are more likely to suffer from mental health problems than children without a learning disability, approximately 36% of children with a learning disability also reported to have a psychiatric disorder (Emerson and Hatton, 2007). Several pieces of research have specifically found elevated rates of attention difficulties, aggressive behaviour and social problems in children with a learning disability compared to their peers without a learning disability (Hackett et al. 2011; De Ruiter et al. 2007).

Exercise (5 Minutes) In groups, please consider the factors that may make children and young people more vulnerable to Mental Health problems: (i) Child factor (ii) Family Factor (iii) Environmental factor

Vulnerability Factors – child/young person Genetic influences Low IQ and learning disability (specific learning difficulties) Specific developmental delay Communication difficulty Difficult temperament Physical illness, especially if chronic and/or neurological Academic failure Low self esteem

Vulnerability Factors - Family Overt parental conflict and domestic violence Family breakdown Inconsistent or unclear discipline Hostile and rejecting relationships Abuse – physical, sexual and/or emotional Parental psychiatric illness Parental criminality, alcoholism and personality disorder Death and loss – including loss of friendships

Vulnerability Factors - Environmental Socio-economic disadvantage Homelessness Disaster Discrimination Other significant life events Problems at school

So why may children with a learning disability be more likely to experience poor mental health? 1. Biology and genetics may increase vulnerability to mental health problems A learning disability is caused by the way the brain develops. This in itself may increase vulnerability to mental health problems, although the reasons for this are unclear. People with a learning disability also have an elevated risk of having some physical health problems. This can cause long-term pain which may lead to distress, irritability and anger, especially if not properly treated (Royal College of Nursing 2010). People with downs syndrome, for example, are known to have a far greater risk of developing dementia, which is in itself associated with mental health problems (RCN, 2010). 2. A higher incidence of negative life events People with a learning disability are more likely to experience deprivation, poverty and other adverse life events earlier on in life (Emerson and Hatton 2007; Main and Pople 2011). They are also at risk of experiencing other potentially traumatic events, such as moving house or residence, injury and illness, unemployment and abuse and neglect (Hastings et al. 2004).

3. Access to fewer resources and coping skills Research shows that compared to the general population, people with a learning disability are less likely to have the necessary skills and resources for coping with adverse events. Major transitions, such as leaving school or home, can be particularly stressful and anxiety provoking for people with a learning disability (Kaehne 2011). People with a learning disability often have smaller social networks and/or fewer opportunities for creating friendships. This means they have less social support, and an increased risk of social exclusion and loneliness (Stacey and Edwards 2013). Social support is an established protecting factor for mental health problems, and loneliness a precursor to various psychological difficulties (Hagerty and Williams 1999). 4. The impact of other people’s attitudes MacHale and Carey (2002) found that when a loved one of somebody with a learning disability died, support workers sometimes mistakenly saw their behavioural expressions of grief as challenging behaviour. If families, carers or professionals do not correctly identify the reason for the behaviour of a person with a learning disability, this might mean that they are not provided with appropriate support or service provision, which in turn might lead to mental health problems developing or worsening. Every individual is different, but it is an interaction of factors – in particular a vulnerability to negative life events and reduced mechanisms for coping with these – that leads to people with a learning disability having an increased risk of developing mental health problems. www.mencap.org.uk

Resilience Factors Young Person: Secure early relationships, female, higher intelligence, easy temperament, positive attitude, good communication skills, humour, religious faith, capacity to reflect, belief in control. Family: At least one good carer-child relationship, affection clear/firm/consistent discipline, support for education, supportive long-term relationship/absence of severe discord. Community: Wider supportive network, good housing and high standard of living, high morale school with positive policies for behaviour/attitudes/anti-bullying, schools with strong sense of academic and non-academic opportunities, range of positive sport/leisure activities.

Would you like further information? LDND Schools Service can provide more specific parenting sessions around mental health and children with LD, ASD and ADHD Please complete the questionnaire to let us know what topics would be found useful