Insight, help-seeking and family well-being

“Seldom, very seldom does complete truth belong to any human disclosure, seldom can it happen that something is not a little disguised, or a little mistaken”

From “Emma” by Jane Austen 1816

Below, the Johari window explains four quadrants of consciousness, dividing experience into that which is known and unknown, seen and unseen (Halpern, 2015). For example, awareness of a physical illness is generally familiar. A fever, pain, exhaustion. Outward signs are seen, as well as felt and noticed by others with empathy, not stigma. Such visible issues sit in the Arena and Façade quadrant of the Johari window; either everyone knows, or an individual knows but chooses to conceal it. But social emotional and mental needs are more obscure and my task here is to backpedal and question how families might recognise they need support.

To my mind, my life is perfectly normal. Is that because it was the right way? Or simply that it seems right to me, because it is verified by those around me? We repeat the ways in which our families have operated over generations through systemic functions (Dallos & Draper, 2015), barely noticing what makes them unique. Bruner (1986; 1991) suggests that identity emerges as we process and display our understandings of our world. Our reality is subjective, woven by strands of experience which create a complicated and endlessly evolving story of self.

In the Blind Spot of the Johari window, an outsider has noticed a characteristic which the individual has not. Perhaps this is what Hayden & Jenkins (2014) meant by asking troubled to who? when they considered the “Troubled families” of the Conservative government’s flagship social policy. The idea that some lives are “normal” and that others are “troubled” permeates the children and families sector; it is a critical benchmark against which professional agencies assess need and justify essential action to protect children. The final quadrant is the Unknown, where issues are concealed from everyone. This is the point where experiences are so shrouded that individuals cannot see they need help, and the need is obscured from those that could offer it. Think here of the woman who has experienced so much control in her relationship she cannot see it as abuse, and her child who accepts this because she does, and continues to accept it throughout her life. The question is, how can people get help when distress has become so normal that it is unnoticed?

Both these latter quadrants orientate around a question of “insight”, crucial in both mental health and children’s services. Insight is crucial in a patient’s ability to manage their illness; to know when they need help signifies the ability to stay well and lead a normal, functioning life. In children’s services, it is seen as the bedrock of parenting capacity (Oppenheim & Koren-Karie, 2002; Donald & Jureidini, 2004; Tucker & Trotman, 2010). Parents who are insightful are considered able to prioritise their child’s needs, because they understand them. My doctoral research suggests that finding that insight is an intricate task of reflection and learning, in ways which resonate with individuals and families (Bruner,1986; 1991). In order to do this we need to access the intricate web of lived experience encountering subjective reality, normality, and stigma, and to normalise vulnerability in all our lives. It seems to me that we need to create a calm and non-threatening space in which adults and children can reshape their reality, and continue their story of self to enhance their social, emotional, and mental health.

Blog post by Emma Maynard (Twitter: @maynard_emma), Senior Lecturer and MICE Hub Deputy at the University of Portsmouth (School of Education and Sociology).

Reference list

Bruner, J. (1986) Actual Minds, Possible Worlds. London: Harvard University Press.

Bruner, J. (1991) The Narrative Construction of Reality. Critical Inquiry. 18 (1) 1-21

Campbell, S.M., & Roland, M.O. (1996). Why do people consult the doctor? Family Practice, 13 (1), 75-83. doi: 10.1093/fampra/13.1.75

Dallos, R., & Draper, R. (2015) An Introduction to family therapy: systemic theory and practice. Maidenhead. Open University Press.

Donald, T. & Jureidini. J. (2004) Parenting Capacity. Child Abuse Review 13 (1), 5-7. doi:10.1002/car.827

Hayden, C., & Jenkins, C. (2014) ‘Troubled Families’ programme in England: ‘Wicked problems’ and policy –based evidence. Policy Studies, 35(6), 631-649. doi: 10.1080/01442872.2014.971732

Oppenheim, D., & Koren-Karie, N. (2002) Mother’s insightfulness regarding their children’s worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23 (6), 593-605. doi: 10.1002/imhj.10035

Tucker, S & Trotman, D  (2010) Interpreting Risk; factors , fears & judgement. ch in G. Brotherton, H. Davies, & McGillivray Working with Children Young People and Families. London; Sage.

The Healthy Minds programme in schools

Evidence suggests that half of mental health conditions start before the age of 14, and up to three quarters by the mid-twenties. Schools may be well placed to improve the wellbeing of their pupils, and to improve their quality of life, through delivery of effective Personal, Social, and Health Economic (PSHE) education. Researchers at the London School of Economics, in partnership with Bounce Forward, and the Education Endowment Foundation, secured funding to develop a model to improve the quality of life of pupils.

What were CYP taught in the Healthy Minds Curriculum?

The Healthy Minds curriculum was a four-year course consisting of one hour weekly lessons (113 over four years), designed for children and young people aged between 11- 15 (Years 7 – 10 in English Secondary Schools). Fourteen core modules were taught to students, and covered important general life skills such as resilience, mental health, and social and emotional learning. Each lesson was structured, with teaching materials, support, and training available per module (a total of 19 training days for the curriculum).

How was the Healthy Minds curriculum trailed?

Study recruitment in the intent-to-treat trial began in 2013-2014 and was phased over two years, with involvement of 34 schools, and 39 school-cohorts. Schools were recruited into in the treatment arm (3,021 students involved) or in the control (1,613 students involved). The study team were interested in evaluating whether the curriculum had an impact on CYP health-related quality of life outcomes (e.g., emotional wellbeing), and utilised the Child Health Questionnaire-CF87, as well as the Short Mood and Feelings Questionnaires, Life satisfaction ladder (0-10), and the Child Anxiety Related Disorders Questionnaire, to assess their aims. Data was collected at three points during the trial – at the beginning of the CYP school involvement (2013-2014), two years later (2015-2016) and at the end of their involvement (2017-2018).

What did the research find?

The initial analysis focusses on five outcomes – global health, life satisfaction, physical health, emotional health, and behaviour. Key outcomes from the preliminary analysis were:

  • Students who completed the programme had higher attainment in global health (by 10 percentiles, out of 100), compared to children in the control group, with improvements noted after two years of teaching the curriculum.
    • Similar results were observed for physical health, and life satisfaction.
  • An improvement in child anxiety-related disorders was noted for scores of pain disorder, separation anxiety, and school avoidance.
What was the impact of the trail?

The authors hail the Healthy Minds curriculum as an effective, evidence-based approach to teaching life skills in secondary schools. Moreover, the approach is described as low cost to schools, at £23.50 per pupil, per year. The full interim report for Healthy Minds, from researchers based within the London School of Economics, can be viewed here. The impact of the Healthy Minds curriculum on education outcomes (e.g., GCSE grades) will be published in 2020.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associated on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology).