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.

Priorities for Mental Health Research in Children and Young People

There has been recent focus on the state of mental health for Children and Young People (CYP), and a variety of initiatives developed to improve this, such as the CYP Improving Access to Psychological Therapies (IAPT) programme, and the developing Government Green Paper for CYP mental health. However, there has been little focus on the role mental health research can play.

The McPin Foundation, a charity focussing on mental health research, recently published a report outlining their identified top ten research priorities for CYP, with the aim of influencing policy and practice.

How was the research carried out?

The McPin Foundation set up an Advisory Group with seven young people between the ages of 14 – 23 years, and a Steering Group that included a range of individuals – from research funding organisations to parents and teachers. The Groups created a Young People’s mental health survey, and asked members of the public to put forward research questions around the topic (n = 2566). The Groups then developed the largest theme identified from their data – Intervention and Services, and with the help of a second survey (n = 753), narrowed down the questions posed to 25.  The final 10 priorities were selected in a workshop which included the advisory and steering groups, in addition to new members to the project (e.g., young people, professionals, parents).

What kind of research priorities for CYP were identified?

The top 10 research questions included early identification and screening of mental health difficulties, calls for further evidence on the effectiveness of therapies/strategies/resources/training, and exploration of how family/parental relationships contribute to treatment outcomes for CYP. Further research priorities (Top 25) were also identified and were more varied, including exploring effective methods for supporting young men in recognising symptoms of mental ill-health (Priority 15), and the impact of waiting list times on treatment and mental health outcomes (Priority 21). The full list of research priorities can be viewed here.

What next?

The McPin Foundation are keen for young people, researchers, and potential partners (e.g., individuals, organisations etc.) to get in touch:

 

 

Young people

  • Young people can sign up to the Network and receive emails about taking part in research. To do so, sign up via mcpin.org/young-people/

Researchers

  • Researchers can ask the Young People’s Network for feedback on and help shaping their research that address the priorities identified in the report. In addition, the McPin Foundation are keen for researchers to keep them up to date with their research on the identified priorities. Get in touch via contact@mcpin.org.

Partners

  • Individuals may be interested in working with the McPin Foundation on the identified priorities – get in touch via contact@mcpin.org.

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

Children of the Millennium

The Centre for Mental Health, in partnership with the Institute of Education at UCL, recently published a report outlining the current understanding of conduct problems and their course through childhood. The study team (Gutman, Joshi, Khan, & Schoon, 2018) examined longitudinal data obtained from a sample of over 19,000 children born in the United Kingdom between 2000-2002 for the Millennium Cohort Study.

What is conduct disorder?

Clinical guidance from the National Institute for Health and Care Excellence (NICE) and the Social Care Institute for Excellence (SCIE) defines conduct disorders as “repetitive and persistent patterns of antisocial, aggression or defiant behaviour that amounts to significant and persistent violations of age-appropriate social expectations”. Examples of violations of age-appropriate social expectations include angry outbursts or physical aggression towards other children between the ages of 3-7 years; violence, robbery or substance misuse between the ages  of 12 – 17 years amongst others. The scale of the conduct problems is significant as the child or young person’s daily functioning is disrupted, and distress is experienced by those around them. The prevalence of conduct problems is around 5% (for children and young people between 5 – 16 years; Green, McGinnity, Meltzer, Ford, & Goodman, 2004), and is considered the most commonly diagnosed mental health condition for children between 5- 10 years.

Key results

Pathways of childhood conduct problems by gender

  • The prevalence of conduct problems is higher in boys, compared to girls, between the ages of 3 – 11 years (e.g., at 3 years old: boys = 22% and girls = 19%; at 11 years old: boys = 14% and girls = 9%).
  • Between 3 – 11 years old, the majority of girls (78%) and around half of boys (54%) had a low risk of developing severe conduct problems.

Pathways of childhood conduct problems and the impact of multiple risks over time

  • Between the ages of 3 – 14 years, the majority of children in the sample (56%) had a low risk of severe conduct problems, whereas 8% of children had a high risk.
  • Whilst 13% of children were identified to have a low risk of severe conduct disorder from 3 – 7 years, this increased by age 14.
  • A subset of children (23%) were identified as having a moderate to high risk of developing severe conduct problems by age 3 years, but this then declined with age.

Pathways of childhood conduct problems and co-occurring mental health difficulties

  • Different groups of children were identified who also presented who co-occurring mental health conditions (conduct problems, hyperactivity/inattention, emotional problems, and problems with peer interactions) between 3 – 11 years:
    • Low problems (52%)
    • Moderate externalising, low internalising (27%)
    • Moderate internalising, low externalising (12%)
    • Persistent high problems (8%)

Recommendations (for England only)

Gutman et al. (2018) proposed 10 recommendations for key stakeholders (e.g., the Government, NHS England, NICE), based on the findings of their report. Recommendations include calls for improved cross-agency working, quality of support available, and guidance. The full report can be viewed here.

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