Mental & Emotional Health

According to Bristol’s Emotional Health and Wellbeing Strategy for Children and Young People 2009-14, poor emotional health is at the root of many different kinds of problems. If we can improve the emotional health of Bristol’s children, we will also improve their physical health, prevent them becoming overweight, smoking, and misusing alcohol and drugs, improve their educational achievement and future satisfaction in employment, relationships and parenting, and reduce crime. In 2004, according to a survey by the Office for National Statistics[1], one in ten children and young people aged 5-16 had a clinically recognisable mental disorder. Extrapolating, this suggests as many as 8,000 of Bristol’s children fit this category. Whilst it is dangerous to make this induction, the Quality of Life survey[2] conducted in Bristol in 2009 measured levels of happiness and concluded that 9% of people are unhappy. This survey also revealed that that levels of unhappiness are highest in high deprivation areas of the city.

An extremely comprehensive Needs Assessment in Bristol (see footnote 1) suggested the following:

  • Children from households with lower gross weekly incomes were more likely than those from households with higher incomes to display a mental disorder of some kind.
  • Other groups of children with a greater susceptibility to emotional and mental issues include those from broken homes, children in care, refugees and asylum seekers and young offenders.
  • There is also known to be a higher prevalence among disabled children, teenage parents, children who are obese, and children of parents who have mental health problems.
  • Boys are more vulnerable than girls to most types of mental disorder.
  • Research and good practice in schools demonstrate that when staff and pupils feel good about themselves, they perform better

To address these issues Bristol has a comprehensive Emotional Health and Wellbeing Strategy for Children and Young People covering the period from 2009 to 2014[3].

There is a national indicator that is used to measure emotional health: NI 50 The quality of relationships with parents, friends and other trusted adults.

Figure 1: The Quality of Relationships with Parents, Friends and Other Trusted Adults

Source: Office for National Statistics

The Bristol Suicide Prevention Strategy 2007 – 2010, produced by the Bristol Suicide and Prevention Audit Group draws heavily from national data – local figures for children committing or attempting suicide or self-harm are not available. The strategy states that suicide rates fluctuate but have generally shown a downward trend since the early 1980s. Overall, around three-quarters of suicides are men; the majority occurring in young adult men under 40 years old. In 2005-2006, there were 70 apparently self-inflicted deaths in English prisons. This was a reduction of 17% in comparison to the previous year. A recent report in Children and Young People Now[4] exposed the fact that there have been at least 96 suicides, attempted suicides or accidental deaths of young people looked after by YOTs in the first eight months of this year.

As stated above, looked after children are more vulnerable to emotional health problems. According to National Indicators for Local Authorities and Local Authority Partnerships: Handbook of Definitions[5] “looked after children experience significantly worse mental health than all children” and “an estimated 45% of looked after children aged 5 to 17 have mental health problems, over 4 times higher than for all children”. The only comparator available is the National Indicator 58, which measures the emotional and behavioural health of looked after children through the use of a ‘primary carer’ Strengths and Difficulties Questionnaire (SDQ). The SDQ is a short behavioural screening questionnaire. It has five sections that cover details of emotional difficulties; conduct problems; hyperactivity or inattention; friendships and peer groups; and also positive behaviour.

Figure 2: Emotional and Behavioural Health of Looked After Children.

Source: Office for National Statistics

The SDQ is a snapshot of the child’s emotional and mental well-being at a particular point in time. In one case, a child’s carer completed three SDQs within a four-month period. The scores were 13 on 7 July 2009, 23 on 19 August 2009 and 5 on 16 October 2009. Figure 3 shows the wide gulf between those that are Looked After and those that aren’t:

Figure 3: SDQ Scores – Child Population and Bristol LAC

Source: Bristol City Council and Office for National Statistics

From Table 1 below it is clear that one in ten children in the general population had an SDQ score in the abnormal range, whereas over one in three Bristol Looked After children had scores in this range. This is not a surprising finding given the poor experiences of family life Looked After children usually have before coming into the care system, and the placement moves and school moves which can occur once they are Looked After. However it does illustrate the significant needs of Looked After children and young people in relation to their emotional and mental well-being.

Table 1: SDQ Scores

  Child population Bristol LAC
Normal (score of 0 to 13) 82.0% 51.4%
Borderline (score of 14 to 16) 8.2% 11.4%
Abnormal (score of 17 to 40) 9.8% 37.2%

It is important to acknowledge the link between mental illness and children from deprived areas. In an October 2010 report by the Royal College of Psychiatrists[6] No Health Without Public Mental Health, the Case for Action, it is claimed that children from households with the lowest 20% of incomes have a three-fold increased risk of mental health problems than children from households with the highest 20% of incomes. The report also states that half of all lifetime cases of diagnosable mental illness begin by age 14-16 and three-quarters of lifetime mental illness arise by mid-twenties.

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2 Responses to Mental & Emotional Health

  1. Sue says:

    Hi Anne,
    Thankyou for your very helpful comments on the 2010 Needs Assessment webpage, and the additional information.
    The page was produced by the CYPS Information and Analysis team rather than either of us in Health Partnership.
    Terminology changes, but the Bristol EHWB Strategy, which was a source for some of the information on the web, uses the terms emotional and mental health and ill health and tries to avoid ‘disorder’ except where quoting research. I suspect ‘abnormal’ is also a technical national SDQ category, but see your concern.
    It’s good to know someone has read the webpage!!
    Sue

  2. Anne James says:

    I think this is helpful section on measuring emotional well being and you have used some useful stats. Again it is very medical model. There is a gender dynamic for mental and emotional distress – more boys are BESD, more boys externalise distress into difficult behaviour, more girls internalise distress into self harm/depression. I think this should be contextualised. We have only just introduced girls into BESD PRU provision – so i think it is important to aknowledge the gender dynamic.
    ‘Whilst it is dangerous to make this induction’ can you put this into plain English please
    mental disorder – this isn’t a useful term – do you mean recongnisable mental health condition? mental disorder is old fashioned and can be bviewed as offesnsive terminology but it also isn’t very descriptive, i don’t know if depression is a ‘disorder’.
    ‘broken homes’ – again need to update terminology – this is a valued laden terminology and could be viewed as offensive – you need an objective term
    There is a national indicator that is used to measure emotional health: NI 50 The quality of relationships with parents, friends and other trusted adults. – may just pop in how this is measured – is it the survey of 500 pupils?
    Possibly there is more up to date info on suicide from How Fair Is britain 2010
    http://www.equalityhumanrights.com/uploaded_files/triennial_review/how_fair_is_britain_-_complete_report.pdf. For example in this info, men are three times more likley to commit suicide, your info says four times…
    This is some additional information which could be included to add an equalities dimmension to this section
    There is some evidence to suggest that lesbian, gay and
    bisexual (LGB) and transgender people may be more likely than average to attempt
    suicide or to commit acts of self-harm.(pg 69)Evidence also suggests that people from lower socio-economic
    groups may be more susceptible to such risks to life as smoking-related cancers
    and suicide.(pg 70)The trend in suicide
    rates has been generally downwards since 1991, despite a peak in 1998. Men are
    more likely to commit suicide than women; in 2008 the suicide rate for men was
    17.7 suicides per 100,000 population compared with 5.4 per 100,000 for women.9pg 90) pg 92 has suicide rates by age.
    Under SDQs – again the language should be updated – normal, borderline and abnormal. we shouldn’t be saying children in care are abnormal, Normal means average or median range therefore abnormal would be well above average. we should not use normal and abnormal when referring to people with emotional needs. It is value laden. we don’t say under achievers are abnormal so we shouldn’t use this label for mental health issues either.

    I think a rounding off summary paragraph of the implications of this information would be useful. this is data not analysis.

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