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Jonathan Campion, South London and Maudsley NHS Foundation Trust, United Kingdom Presentation Transcript

  • 1. Mental health promoting schoolsProfessor Jonathan CampionProfessor of Population Mental Health (University CollegeLondon) and Director of Population Mental Health (UCLPartners)Director of Public Mental Health (South London andMaudsley NHS Foundation Trust)13thJune 2013
  • 2. Why is mental health important in schools?
  • 3. Mental health/ wellbeing• Broad range of health and other impacts relevant toeducation as well as a range of other policy areas• Large proportion of childhood and adolescencespent in school• Experience during childhood and adolescenceimpacts across life course• Variation of levels of child mental health andwellbeing across Europe (Bradshaw & Richardson,2009)
  • 4. Health impacts of mental wellbeingAssociated with reductions in and prevention of(Campion et al, 2012):• Mental disorder in children and adolescentsincluding persistence• Mental disorder and suicide in adults• Physical illness• Associated health care utilisation• Mortality
  • 5. Impacts outside health• Improved educational outcomes• Healthier lifestyle• Reduced health risk behaviour - smoking, alcohol,drug misuse, physical inactivity, diet• Reduced anti-social behaviour, crime and violence• Increased productivity at work, fewer missed daysoff work• Higher income• Social relationships
  • 6. Relationship between mental disorder andwellbeing• Improved mental wellbeing associated with reducedrisk of mental disorder• Mental disorder associated with reduced mentalwellbeing• Single largest group with poor wellbeing are thosewith mental disorder – important group to targetpromotion• Promotion of wellbeing can prevent mental disorder• Intervention for mental disorder addresses importantdriver of poor wellbeing
  • 7. Similar broad range of impacts of mentaldisorder
  • 8. During childhood and adolescence• health outcomes• self-harm and suicide• educational outcomes• antisocial behaviour and offending• social skills outcomes• health risk behaviour - smoking, alcohol and drugmisuse, sexual risk, nutrition, physical activity• teenage parenthood
  • 9. Impacts of emotional and conduct disorder in childrenand young people in UK (Green et al, 2005)Risk Behaviour EmotionalDisorder (6%)ConductDisorder (4%)No DisorderSmoke Regularly(age 11- 16)19% 30% 5%Drink at least twicea week (age 11- 16)5% 12% 3%Ever Used HardDrugs (age 11- 166% 12% 1%Have ever selfharmed (self report)21% 19% 4%Have no friends 6% 8% 1%Have ever beenexcluded fromschool12% 34% 4%
  • 10. Increased risk of poor adult outcomesPoor mental health in childhood and adolescence alsoassociated with poor adult health outcomes includingHigher rates of:• adult mental disorder• health risk behaviour• physical illness• suicide• unemployment and lower earnings• marital problems• crime and violence
  • 11. Impact of mental disorder• 23% of burden of disease in UK compared to 16% forcancer and 16% for cardiovascular disease• Size of impact due to Mental disorder being common Arising early in the life course Broad range of impacts Only 10% receive notionally adequate treatment(Wittchen et al, 2011)
  • 12. Population level of mental disorder• 10% of children and adolescents in UK have amental disorder (Green et al, 2005)• 18% of children and adolescents have sub-thresholdconduct disorder• 23% of adults in England have at least one mentaldisorder (McManus et al, 2009)• 38% of the European population experiences at leastone mental disorder each year (Wittchen et al, 2011)
  • 13. Early onset of mental disorder• Key reason for size of burden• 50% of lifetime mental illness (excluding dementia)starts by age 14 (Kim-Cohen et al. 2003; Kessler etal, 2005)• 75% by mid twenties (Kessler et al, 2007)
  • 14. School offers important opportunities• Place where children and adolescents spend largeproportion of time• Opportunity to promote wellbeing at key time in thelife course with resulting range of impacts acrossdifferent sectors and policy areas• Opportunity to prevent and detect mental disorderearly to enable early intervention preventing widerange of impacts across different policy areas
  • 15. Economics of mental health
  • 16. Cost of mental disorder• Europe cost of €798 in 2010 (Olesen et al, 2012) (37%direct healthcare cost, 23% direct non-medical cost,40% indirect cost)• To UK economy: €123 billion annual cost of mentalillness in England (CMH, 2010)• Crime: €70 billion annual cost of crime in Englandand Wales by adults who had conduct disorder andsub-threshold conduct disorder during childhoodand adolescence (SCMH, 2009)
  • 17. Economic impact of wellbeingLongitudinal studies indicate that subjective wellbeingprecedes (Lyubomirsky et al, 2005):• productive work• higher income• better mental and physical health• improved life expectancy
  • 18. Certain groups at much higher risk of mentaldisorder and low wellbeing• Higher risk groups benefit proportionately morefrom intervention to both promote wellbeing andprevent mental disorder• Need for information about numbers from higher riskgroups (Campion & Fitch, 2012)
  • 19. Children and adolescents• Looked after children (by the state) - 5 fold increasedrisk of mental disorder (Meltzer et al, 2003)• Children with learning disability - 6.5 fold increasedrisk of mental illness (Emerson and Hatton, 2007)• Special educational need (OR 3.7) (Parry-Langdon etal, 2008)• Young offenders: 18 fold increased risk of suicidefor men in custody age 15–17 (Fazel et al, 2005)
  • 20. Mental health promoting schools
  • 21. Preschool and early education programmesResult in improved:• cognitive skills• school readiness• improved academic achievement• positive effect on family outcomes including forsiblings (Anderson et al, 2003; Sylva et al, 2007)• prevention of emotional and conduct disorder(Tennant et al, 2007)Combined programmes for preschool children fromdisadvantaged areas - improved parent and familywellbeing (Nelson et al, 2003)
  • 22. School based mental health promotion programmes• Improved wellbeing, impacts on academicperformance, social and emotional skills, andclassroom misbehaviour (NICE, 2008; NICE, 2009)• Reduced conduct problems and emotional distress(Stewart-Brown, 2006; Adi et al, 2007)• More effective approaches were long term, wholeschool, including teacher training and parentalparticipation (Durlak et al, 2011; Weare & Nind, 2011)• Interventions for children sub-threshold disorderresult in improved mental health, behaviour andsocial skills (Reddy et al, 2009)
  • 23. Social and emotional learning programmesMeta-analysis of 270,000 students from US social andemotional programme (Durlak et al, 2011)• reduced conduct problems and emotional distress• improved social and emotional skills, attitude aboutself• improved social behaviour• 11% improved academic performance• cost savings of reduced conduct disorder are £84 foreach £ invested (Knapp et al, 2011)
  • 24. • Peer mediation effective in promoting pro-social andbehavioural skills in the long term (Blank et al, 2009)• Secondary school curriculum approaches topromote pro-social behaviours and skills can alsoprevent development of anxiety and depression(NICE, 2009)
  • 25. School based prevention of mental disorderduring childhoodPrevention of conduct and emotional disorder• Pre-school programmes (Tennant et al, 2007)• Universal and targeted school programmes(Horowitz and Garber, 2006; Merry et al, 2004)• Penn Resiliency programme (Brunwasser andGilham, 2008)
  • 26. School based prevention of violence and abuse• Violence and abuse are important risk factors formental disorder and poor wellbeing• Interventions to address violence and abuse canpromote wellbeing and prevent mental disorder• School based violence prevention programmes(Mytton et al, 2006)• School based sexual abuse prevention programmes(Zwi et al, 2009)• School based bullying prevention programmes (Ttofiet al, 2008)
  • 27. Early recognition/ intervention for mental disorder• Half of lifetime mental disorder has arisen by age 14• Early recognition/ intervention of mental disorderthrough improved mental health literacy in schools• Results in improved wellbeing and outcomes• Can prevent significant proportion of adult mentaldisorder (Kim-Cohen et al, 2003)
  • 28. Proportionate universal approach• Certain groups at higher risk of mental disorder andpoor wellbeing• To ensure groups receive proportionately greaterlevels of public mental health intervention, needinformation about (Campion & Fitch, 2012):Local numbers from such groupsLevels of increased risk of different mentaldisorderLevel of coverage of interventions
  • 29. London Family School proposalTargeted approach for pupils with mental andbehavioural disorder under negotiation with UK’s DfE:• Addresses mental and behavioural disorder in bothindividual and family context• Promotes psychological and emotional well-beingTo:• Gain resilience• Progress academically• Remain in full-time education and return tomainstream education
  • 30. Improved range of health and other outcomesReflects broad impacts of mental disorder andwellbeing• Improved educational outcomes• Reduced antisocial behaviour/ crime• Improved employment outcomes• Reduced range of health risk behaviours• Reduced physical illness• Improved quality of life• Reduced burden and costs of mental ill-health• Economic savings
  • 31. Economic impacts of interventions
  • 32. Impact of promotion, prevention and treatment• Evidence from LSE highlights such interventionsalso result in considerable economic savings evenin short term (Knapp/ DH, 2011)• Significant proportion of savings accrue in areasoutside health reflecting broad impacts of mentalhealth• Local economic savings from interventions andcosts of not providing interventions can becalculated (Campion and Fitch, 2012)
  • 33. Savings per £ invested (Knapp et al, 2011)• Parenting interventions for families with conductdisorder £8• School-based interventions to reduce bullying £14• Prevention of conduct disorder through social andemotional learning programmes £84
  • 34. Intervention gap• In Europe, 10% of people with mental disorderreceive notionally adequate treatment (Wittchen etal, 2011)• In UK, minority of children/ adolescents with mentaldisorder receive any intervention (Green et al, 2005)• Lack of implementation of evidence based schoolbased mental health promotion and mental disorderprevention programmes• Lack of intervention has significant impact and costacross broad range of sectors – local size, impactand cost of unmet need can be estimated (Campion& Fitch, 2012)
  • 35. Summary• Mental wellbeing and disorder have broad range ofimpacts across different sectors and policy areas• Majority of mental disorder and poor wellbeingarises before adulthood• School based interventions improve mental healththrough wellbeing promotion, mental disorderprevention and early intervention for mental disorder• Result in broad range of short and long term impactsacross a range of sectors/ policies with associatedeconomic savings• Lack of implementation of such interventions resultin long term impacts and costs in different sectors
  • 36. Summary• Mental health - key part of any policy• Taking account of mental health improves outcomesof every policy• EU Joint Action on Mental Health includes workpackage ‘Mental health in all policy’ and ‘Mentalhealth in schools’• Effective promotion and prevention requiresinterventions targeted in a universallyproportionate waytaking account of needdelivered through a sustained and coordinatedapproach
  • 37. References and contact• Campion J, Bhui K, Bhugra D (2012). EuropeanPsychiatric Association guidance on prevention ofmental disorder. European Psychiatry 27: 68-80.• Campion J, Fitch C (2012) Guidance for thecommissioning of public mental health services.Joint Commissioning Panel for Mental Health.www.jcpmh.info• Weare K, Nind M (2011). Promoting mental health ofchildren and adolescents through schools andschool based interventions: report of workpackagethree of the DataPrev Project. DataPrev.• Email: jonathan_campion@yahoo.co.uk