Mental Health and Wellbeing
WHAT IS MENTAL HEALTH?
Your mental health affects how you feel, think and act. It refers to your emotional, psychological and social wellbeing. Your mental health can change and fluctuate on a daily basis and over time, and can be affected by a range of factors.
Just as it’s important to look after your physical health, the same is true for your mental health. Your state of wellbeing affects how you cope with stress, relate to others, make choices, and play a part in your family, community, workplace and among your friends.
Good mental health among children
When children have good levels of wellbeing it helps them to:
- learn and explore the world
- feel, express and manage positive and negative emotions
- form and maintain good relationships with others
- cope with, and manage, change, setbacks and uncertainty
- develop and thrive.
When children look after their mental health and develop their coping skills it can help them to boost their resilience, self-esteem and confidence. It can also help them learn to settle themselves, feel calm, and engage positively with their education - which can, in turn, improve their academic attainment.
What affects children’s mental health?
A child’s mental health will be influenced by many things over time and, because children have different personalities, they will react and cope with challenging situations in different ways.
|Risk factors||Protective factors|
Children present with and will be exposed to a range of factors in their homes and communities that can affect their mental health – this is what we call “risk factors”. Some children experience multiple risks, which means their mental health is more likely to be affected.
These risks come in many forms and may be the result of:
However, not all children who are exposed to risks will develop mental health difficulties.
There are lots of things that schools can do to help “protect” and support children so that they can cope better with any challenges that they may face.
These include important social and emotional skills to help child cope, such as being more resilient, knowing how to calm themselves, and feel confident.
Schools also need to make sure that they reduce school-based risk factors, such as bullying, and put in place support that helps children to feel that they belong and have positive relationships with their teachers and school staff, as well as other children.
It’s quite natural for children to worry and to be anxious at various stages of school and home life.
Most children will learn how to manage their thoughts, feelings and emotions, but some may need extra support.
Anxiety can become a problem when:
- there isn’t a clear reason for it
- it disrupts a young person’s life at home or school on a regular basis
- the problem has gone but the feeling of fear or panic hasn’t
- it interferes with their ability to take part in activities
- they struggle to complete tasks that other children do easily
- their fear or worry seems out of proportion to the problem
- they become anxious or fearful more easily, or more often, or more intensely than other children
- it leads to unhelpful and unrealistic thoughts about themselves and others
Spotting the signs
A child with an anxiety disorder may display physical and emotional symptoms including:
- headaches and stomach aches or just feeling unwell
- dizziness/faintness/palpitations/ breathlessness /sweating
- not sleeping
- not eating properly
- being clingy/feeling panicky/tearful
- seeming to be worried or anxious and needing lots of reassurance
- feeling down or depressed
- having difficulty concentrating
- wanting things to be perfect and getting frustrated if they’re not
- lashing out at others
- hyper-alertness and difficulty keeping still
Using the Mentally Healthy Schools website has provided me with crucial learning, information and strategies to support children [with panic or anxiety attacks].
– Learning mentor, primary school
Find out more about common anxiety disorders in children
MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. The following sessions aim to help staff better understand how anxiety affects children:
- The worried child: describes anxiety and worry in children and teens and discusses how to react to them.
- Anxiety disorders: outlines how common anxieties present in children and young people, and how to assess and treat them.
Please note: Although resources may reference secondary school children, information is still of use to those in primary settings.
ATTACHMENT AND CHILD DEVELOPMENT
Attachment refers to a relationship bond between a child or young person and their primary caregiver which is formed in the early years and has a long-term impact on a child’s sense of self, development, growth and future relationships with others.
It is a complex psychological concept, which originated with the work of John Bowlby, who highlighted the importance of a child’s relationship with their primary caregiver (usually their mother) in terms of their social, emotional development and their ability to learn.
From the moment a baby is born, the baby communicates emotional and physical needs to their primary carer.
Good attachments rely on the extent to which parents have the physical and emotional proximity and resources to be dependable, respond reliably and sensitively to a child’s basic needs making them feel safe and giving infants a stable base for exploring the world. The infant knows that they are safe to venture out and explore and that the caregiver will always be there to welcome them back and provide comfort in times of stress or anxiety. These relationship bonds can form a blueprint which can be transferred to teachers and other members of staff in the school.
When children have a secure attachment with their parent/carer, it is an important protective factor for their mental health, while insecure attachments can be a risk factor for the development of emotional and behaviour problems.
Insecure attachments develop if early interactions between a child and their caregiver are negative, inconsistent, inappropriate, neglectful or abusive.
When a child’s care giver and home environment is a source of fear rather than a source of safety, this can be highly toxic to a child’s development. Some children facing these experiences (and with no buffer in the family to protect them) may behave in ways which are designed to promote their survival but which may be difficult for school staff to understand and manage. For example, in the classroom these children may:
- find it difficult to ask for help, manage their thoughts, emotions and behaviour, form positive relationships with staff and peers, concentrate and take part in learning
- struggle to calm themselves down
- be both demanding and rejecting at the same time
- become quickly or disproportionately angry or upset, at times with no clear triggers
- be scared of being vulnerable – but may mask this by being highly controlling of others and through unpredictable and explosive outbursts
- avoid getting close to others and appear withdrawn or disengaged from school activities
- struggle to ask for help
- show little emotional response or confused and confusing responses (such as laughing when they or others are hurt)
- day dream, be hyperactive or constantly fidget or move finding it difficult to focus and concentrate in class
All these behaviours may cause great difficulty in terms of classroom and school management.
Spotting the signs
Usually, securely attached children are able to trust and rely on school staff to meet their needs, are confident about forming relationships with others, able to make the most of learning opportunities, have the ability to problem solve and are emotionally resilient and self-aware.
Children with attachment difficulties may not display these characteristics and it may be harder for them to:
- Gain the confidence and the self-motivation that comes from exploring the world from a safe base.
- Achieve appropriate developmental milestones.
- Reach their academic and intellectual potential.
- Develop good relationships with peers and school staff (often displaying a lack of empathy).
- Cope with stress, frustration and anxiety.
- Concentrate and be able to plan ahead.
Any child can develop attachment difficulties but they are more common with children who have been looked after or who have experienced other significant trauma which has affected their parents’ ability to provide safe and secure care.
Find out more about attachment
- MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. These sessions aim to help staff better understand how children develop emotionally and the importance of attachment.
BEREAVEMENT AND LOSS
Grief is a natural response to the death or loss of someone close.
Children can experience feelings of loss due to family breakdown (e.g separation from families due to divorce, care proceedings or through parents going to prison) or due to the death of someone close to them (including extended family, siblings, parents/cares and also pets).
Some children experience multiple losses and bereavements. Everyone will experience grief in a unique and individual way.
It is, of course, a fundamental loss and adjustment for any child to lose someone or something important to them – particularly a close family member. But with the right support most children will be able to find a way to move forward. There are no limits about how long grieving should last and what it should consist of; it is a process that everyone goes through while they adjust and begin to cope with life without the person who they have lost or who has died.
But, if a bereaved child struggles to cope with the emotional impact of their grief or feels unable to move forward, they can become ‘stuck’. This is sometimes known as complicated or chronic grief. When children get stuck, this can result in them developing negative ways to cope with their thoughts and feelings about loss. It can also predispose them to mental health problems if unsupported.
Spotting the signs of complex grief
Children’s feelings of loss and grief can be complicated by a number of factors, including:
- The relationship they had with the person who has died. Complicated grief is more likely to occur if the person was the child’s parent, sibling or best friend.
- The circumstances of the death. Particularly if it is sudden and unexpected or as a result of suicide or violence.
- If they have experienced several losses in a short period of time.
- How resourceful or resilient a child is and whether they have good coping skills.
- If they have a lack of access to appropriate support systems and networks, or if a child is poor or exposed to substance abuse, domestic violence etc.
Find out more about loss and grief
MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. This session aim to help staff better understand how grief impacts on children and young people’s mental health:
- Loss and grief: looks at the loss of parents or others by death or separation/divorce.
Persistently behaving in a challenging way is often how children communicate that something is wrong - or is a sign that they may be in distress.
Many children go through phases when they don't behave. Often this is nothing to worry about, and most children will move out of this phase as school staff and parents help them settle into school routines.
But some children get stuck in patterns of challenging behaviour and struggle to develop strategies they can use to calm themselves down.
This behaviour is more serious than a child being rebellious or mischievous, and is often a way for a child to communicate hidden difficulties, distress or trauma they may be experiencing.
When a child’s behavioural problem becomes severe and persistent they may be diagnosed with conduct disorder, which is a mental health condition. Conduct disorder can not only affect a child’s ability to function, but it can also cause distress to others.
It’s important for school staff to consider what a child is attempting to tell them through their behaviour.
Spotting the signs
A child with early, persistent behavioural problems may:
- be argumentative, angry, uncooperative or irritable
- have frequent tantrums and angry outbursts
- be aggressive, provoke or bully others
- be constantly defiant
- blame others for things that go wrong
- tell lies regularly
- appear cruel and lack empathy for other children
- seek out risky experiences without thinking about the consequences
- as they get older, become involved in antisocial behaviour
- be at risk of self-harm or suicide.
Around 5% of children aged five to 10 have conduct disorders.
These children tend to present with repetitive and persistent antisocial, aggressive and defiant behaviour - and are often drawn towards risky activities. They may also struggle to calm and soothe themselves when they are faced with day-to-day stresses.
Conduct disorder is the most common diagnosable mental health problem among children. Children as young as two can present with this; for children to be diagnosed, symptoms must be present for over six months.
It is also more likely for children with conduct disorders to have been exposed to other challenges early on in their life, including poverty, housing insecurity, parents with mental health problems, and development delays, including language difficulties, for example.
Persistent behavioural problems can have a big impact on a child’s life outcomes, especially if they emerge before secondary school years.
The most common reason for children being excluded from school, either permanently or for a fixed period of time, is for persistent disruptive behaviour.
Interventions to address persistent poor behaviour before it becomes entrenched are often not used early enough to prevent exclusion. It is important for school staff to understand what is likely to be driving poor behaviour in school, so that they can identify the best action to take.
The most effective interventions to address severe and persistent behavioural problems are those that help parents develop strategies to settle children’s behaviour, such as the Triple P and Incredible Years programmes.
Children with severe and persistent behavioural problems are at a greater risk of getting involved, and staying, in gangs.
Boys from disadvantaged backgrounds are disproportionality affected. These children may also struggle with sleep or eating problems. They are also at greater risk of suicide or self-harm.
LOW MOOD OR DEPRESSION
Feeling sad is a normal reaction; everyone feels low or down at times and children (just like adults) can be upset by many things: an incident or a break-up/argument with a friend, a disagreement at home, or just not doing as well at school as they expected.
But if the feeling is more than just sad or it persists for a longer time, then everyday sadness or low mood may move into something more serious such as depression – where children may see themselves and the future in a negative way, or they no longer feel or seem themselves.
Spotting the signs
Symptoms can include:
- being moody and irritable
- not being interested in things they used to enjoy
- not wanting to go to school or go out
- often feeling tired or exhausted
- becoming withdrawn and isolating self from others
- feeling unhappy and miserable or becoming tearful
- sleep problems or sleeping a lot
- changes in appetite
- being self-critical
- feeling hopeless and/or worthless
Find out more about low mood
MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. This session aims to help staff better understand how anxiety affects children and supports them to recognise the difference between clinical depression and normal emotional experiences of sadness:
- Sad, bored or isolated: recognising the difference between clinical depression and normal emotional experiences of sadness
Children with obsessive compulsive behaviour (commonly known as OCD, obsessive-compulsive disorder) have repeating thoughts, images or feelings that are distressing. They also carry out rituals or habits (compulsions) to temporarily feel better.
OCD is a type of anxiety disorder. Sometimes these behaviours can become a coping mechanism to manage other stressful life events. OCD rituals can be obvious to others (like checking door locks or washing hands) or they can manifest themselves as mental rituals such as persistent and uncontrollable thoughts, impulses, worries and fears.
Spotting the signs
Some common obsessions:
- fears about dirt/contamination
- worries about safety and harm – to themselves and others
- anxiety if things are not symmetrical or even
- need for perfection
Some common compulsions:
- checking things over and over again
- hoarding or collecting things that appear useless
- arranging things so they are ‘just right’
- washing and cleaning
- repeating and re-doing things
Some obsessive behaviours may also be indicative of other needs (e.g. that a child might be on the autistic spectrum) so it’s important to think about the child as a whole, how they are generally functioning, and to discuss any concerns with your pastoral/special educational needs lead.
It’s also important to remember that everyone has quirks and habits. But when they start to become stressful for the child and impact on their school/family life and relationships, then it can be a sign that something more significant is wrong.
OVERACTIVITY AND POOR CONCENTRATION
All children may experience problems with concentration and hyperactivity but when these are persistent and/or severe, children may need additional support to maximise their chances of learning and developing effectively.
Attention Deficit Disorder (ADD) and Attention Deficit and Hyperactivity Disorder (ADHD) include persistent symptoms of impulsivity, inattention and also, with ADHD, hyperactivity.
These conditions can be difficult to identify, but usually:
- Begin before the age of seven.
- Should be visible in at least two settings (e.g. home and school).
- Can sometimes negatively affect school performance and relationships with peers/school staff.
- Cannot be better explained solely by an alternative mental health or child development problem (e.g. mood, conduct problems or speech and language difficulties).
When children with early and severe behavioural problems are not properly supported it can have long-lasting effects on their ability to learn, form friendships and thrive. Studies also indicate that children are more likely to be excluded from schools without adjustments and support. More boys than girls tend to be diagnosed with ADHD. It also has a strong genetic component – so other family members may also struggle in similar ways.
Spotting the signs
Symptoms can include:
- being restless or fidgety
- talking a lot and interrupting
- difficulties taking turns in games or conversation
- becoming easily distracted
- difficulties paying attention and concentrating
- not following through on instructions or failing to finish work
- social clumsiness
- impulsive behaviour – saying or doing things without thinking
Children with ADD and ADHD have particular difficulties with the thought processes that control attention and organise memory. This means that they often experience learning difficulties at school, for example:
- Missing important details about homework or classwork or timetable.
- Starting tasks before they have understood what’s required or listened to all the instructions.
- Being unable to organise themselves and their school assignments properly.
Find out more about ADHD
MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. These sessions aim to help staff better understand ADHD and hyperactivity:
- Session on poor concentration and overactivity part 1.
- Session on poor concentration and overactivity part 2.
Children can sometimes experience or witness something traumatic such as a road accident, a serious injury, a crime, threats of violence, domestic violence, neglect, etc. This can cause a traumatic stress reaction which affects the way a child thinks, feels and behaves.
A distinction is often made between simple and complex or developmental trauma.
Types of trauma
Simple trauma is usually a one-off traumatic event whereas complex or developmental trauma can be sustained through prolonged or repeated events such as abuse, neglect, violence, poor attachments, exposure to prolonged poverty or exposure to unsafe communities etc. It may be helpful, to read this section in tandem with the section on attachment.
Sometimes a sudden traumatic event (terrorism, a natural disaster like flooding, a catastrophic accident) can cause ‘collective trauma’ – which can affect a larger group of children and their families.
Trauma can change the way children see their environment, the people in it and how they ‘fit in’. It can affect children’s emotions, memory, behaviour and ability to learn.
Spotting the signs
There will be a wide range of responses to trauma.
- There may be physical symptoms such as sleep problems, headaches/stomach pains, or going back to things they did at a younger age such as bedwetting and thumb-sucking.
- Children may become preoccupied with thoughts and memories of the event, be unable to concentrate and be irritable.
- Trauma can also be associated with problems in children’s relationships with fellow pupils and adults.
- Some children can experience symptoms of trauma through listening to stories told by children (or parents) who are directly affected by a traumatic event.
Find out more about trauma
MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. These sessions aim to help staff better understand how trauma impacts on children.
- Flashbacks, trauma, bullying: focuses on one-off traumas such as accidents and assaults (as well as bullying).
- Complex trauma and post-traumatic stress disorder