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

2. 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)

3. 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”

4. 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

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

6. Multi-Systemic Approach
Home
School
young person
Community

7. What is mental health and wellbeing?

8. 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

9. 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

10. 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)

11. 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)

12. 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)

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

14. 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)

15. 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).

16. 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

17. 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

18. 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

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

20. 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).

21. 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.

22. 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.

23. 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