Explore MHFA England's history from 2007-2019. Mental Health First Aid training came to England in 2007. The Department of Health developed and launched the programme as part of a national approach to improve public mental health. Today we are a social enterprise that has provided expert consultancy and training to over 20,000 workplaces.
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Your manual Youth Mental Health First Aid
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MHFA England © 2024 V1
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Acknowledgements
Editor: Jasmine Pugh Editorial support: Ciaran O’Mant, Sana Shah
The following contributing Subject Matter Experts have been invaluable to the research and review of the content in this material: Suzanne Allies, Matt Barnard, Sajda Butt, Julie Castleman, Jane Cattermole MBAPC DipCouns, Sue Craney, Alice Golding, Kate Golding, Belinda Heaven RN BSc SCPHN PGc HE, Ben Lovatt, Katie Marlow, Esta Orchard, Craig de Vos (on behalf of GamCare), Janice Wright (on behalf of RNIB). The following contributing young people and adults have been invaluable to the lived experience expertise in this material: Scarlett Bolster (14 years old), Aidan Callaghan (12 years old), Tamzin Caves (16 years old), Ines Golding (11 years old), Megan Kwok (18 years old), Jamie Nyirenda-Scott (17 years old), Ciaran O’Mant, Zara Qaisar (15 years old), Marina Savva, Chantal Senya, Vaisnavy Sivakumaran (17 years old), Emily Staples (15 years old), Teddy Surgeoner (17 years old). The following contributing end-users have been invaluable to the feedback of the content in this material: Jessica Agudelo, Kerry Duffy, Ben Anderson, Alice Moore, Zaynab Noureddine, Jennie Wright. We are especially grateful to Professor Anthony Jorm and Betty Kitchener of MHFA International as the originators of the MHFA programme. Without them this course and the MHFA International would not exist. ALL RIGHTS RESERVED. Any unauthorised reprint or use of this material is prohibited. No part of this manual may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system without express written permission from the author/publisher. This Mental Health First Aid material has been adapted from MHFA International materials, under Licence from Mental Health First Aid International. For further information, contact MHFA International: www.mhfainternational.org
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Mental Health First Aid Manual. 4th ed. Melbourne: Mental Health First Aid International, which is the copyright of Mental Health First Aid International and cannot be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic or mechanical including photocopying, recording or otherwise, without the prior permission of the original copyright holders (Betty Ann Kitchener, Anthony Francis Jorm, and Claire Megan Kelly).
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Contents
About Youth MHFA
10 12 14 18 23 29 42 44 52 56 76 82 88
Foreword
Background, development, and evidence
Glossary
Why Youth MHFA matters The Youth MHFAider role
Understanding youth mental health in England
Adolescent development
The Mental Health Continuum
Factors that influence mental health in young people
Stress
Mental health stigma and discrimination
Young people’s recovery
The Youth MHFA action plan
96 98
The five actions: ALGEE
Action 1: Approach the young person, assess, and assist with any crisis Action 2: Listen and communicate non-judgementally
100
105 115
Action 3: Give support and information
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Action 4: Encourage the young person to get appropriate professional help
119
Action 5: Encourage other supports
141
Supporting young people from marginalised backgrounds 152 Supporting a young person from a racially marginalised background 155 Supporting a LGBTQIA+ young person 161 Supporting a neurodivergent young person 169 Supporting a Deaf young person 177 Supporting a blind or partially sighted young person 188 Supporting a young person with a learning disability 199
Types of poor mental health
210 212 214 222 233 243 252
Introduction Depression
Anxiety
Disordered eating
Psychosis
Addictive behaviours and substance misuse
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Mental health crises
272 274 275 279 285 297 307 311 317
Introduction Panic attacks
Self-harm
Suicide thoughts and behaviour
Traumatic events and adverse childhood events
Severe psychotic states
Severe effects from substance use
Aggressive behaviour
References
319
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About Youth MHFA
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Foreword We all have mental health and, just like our physical health, it needs looking after. This also applies to children and young people. Half of all reported poor mental health is established by the age of 14 years old (1) and over 200 school-aged young people are lost to suicide every year (2). Poor mental health that presents during childhood and adolescence can have lifelong effects that impact upon a range of adult outcomes. These include employment, the ability to establish and maintain healthy relationships, and general health and wellbeing. Due to the lack of government funding to the NHS, professional mental health help is not always available straight away. Investment in community youth services, such as youth clubs and groups, have also fallen across the country. Despite this the needs of young people have increased (3). When these sources of help are not available, those who have attended a Youth MHFA ® course have the skills and knowledge to provide person- centred first response support. They can help by assessing for any crises and safeguarding concerns, helping the young person to feel valued and listened to, and providing crucial signposting information. That is why it is so important that you have taken this step. Having taken the course, you are becoming part of an ever- growing community of over 700,000 people in England and seven million people worldwide who have been trained in MHFA, are passionate about building mental health literacy, challenging stigma, promoting positive mental health, and making sure everyone gets the support they need. It is this community which will achieve our vision of a society where all children and young people are emotionally nurtured, have the opportunity to understand their mental health, and feel confident asking for help. You will shortly be invited to join the Association of
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Mental Health First Aiders ® , the first and only membership body for mental health first aiders, free of charge. As part of the Association, you will be encouraged to attend our Youth MHFA Refresher course – a vital part of maintaining up to date skills and knowledge. Together, we will make a positive change. But to do so, we must also look after ourselves. As Audre Lorde, the civil rights activist and poet said, ‘Caring for myself is not self-indulgence, it is self- preservation.’ So please take the time and energy to look after yourself. If we aren’t well, we’re not able to safely offer support to others. From me and the MHFA England ® team, we wish you all the best in using the skills and knowledge you have learned on this Youth MHFA course, brought to you by MHFA England. Please do share any feedback at feedback@mhfaengland.org .
Sarah McIntosh Chief Executive, Mental Health First Aid England ®
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Background, development and evidence
Background The Youth Mental Health First Aid course was developed in 2000 at the Centre for Mental Health Research in the Australian National University in Canberra. It was developed by Betty Kitchener (an educator with lived experience of poor mental health) in partnership with Professor Anthony Jorm (a mental health researcher). The aim of the programme was to extend the concept of first aid training to include mental health. This would mean community members were empowered to provide better initial support to people developing poor mental health, living with a diagnosed mental health condition, or in a mental health crisis. The programme was first adopted outside Australia by the Scottish government in 2002 and then in England in 2006. Further details of the international spread of the MHFA programme can be found at the MHFA international website: www.mhfainternational.org Development and evidence The Australian Youth MHFA programme was aimed at adults working or living with young people aged 12—18 years old. The programme has been adopted in other countries, either by a mental health government agency or a non-government mental health organisation. In each case the course was adapted from the MHFA Australia course and reference materials in accordance with a given country’s own culture and health system. The English edition of the Youth MHFA course and materials has been funded and adapted by the MHFA England Community Interest Company. This has been done as part of a national approach to improving awareness of emotional and mental health issues experienced by young people in England. This edition of
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the Youth MHFA course is aimed at adults working or living with young people aged 8—18 years old. The adapted approach for pre-adolescents is in accordance with evidenced communication methods and education procedures in England. This Youth MHFA manual (version 2) is based on the fourth edition of the Australian Youth MHFA manual. The Youth MHFA actions (ALGEE ® ) recommended in this manual are in accordance with international MHFA Guidelines, which have been developed by researchers in Australia since 2005. These guidelines were developed using the consensus of expert panels with lived experience, carers, and professionals from several English- speaking countries. An important factor in the Youth MHFA programme’s international spread has been the continuous attention paid to research and evaluation. All information is as evidence-based as possible and many evaluation studies have been conducted. A range of studies, including randomised controlled trials, have shown that Youth MHFA training improves knowledge, reduces stigmatising attitudes, and increases first aid action towards people with poor mental health. Further details of the international MHFA guidelines and their development can be found under the ‘Our Guidelines’ option in the ‘Resources and Support’ menu of the MHFA Australia website, as well as the ‘Research and Evaluation’ option in the ‘About Us’ menu: www.mhfa.com.au Summaries of evaluation studies can be found by following the ‘Browse our Research’ link at the bottom of the ‘Research and Evaluation’ page, or by clicking this link: www. mhfa.com.au/about-us/research-and-evaluation/our-research As part of work to anglicise the MHFA actions and ensure that the approach is fit for purpose in the mental health landscape
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Background, development and evidence cont.
in England, significant work has been done in collaboration with Subject Matter Experts and end-users. Many of the statements referenced in this manual are from English or British sources which acknowledge the prevalence and health systems related to mental health in England. The Subject Matter Experts commissioned to collate and share findings are from a diverse pool with a wide breadth of professional and lived experience. In addition parts of this manual, as well as the Youth MHFA course and its associated materials, have been developed in co-design with a group of young people between the ages of 12-18 years old. Many quotes you will find throughout this manual have been recorded as part of the contributions, passion, and commitment of the young people involved. As part of the implementation of Youth MHFA in England, there has also been consideration of UK government policy and legislation affecting health services that we may signpost people to. This includes statutory mental health services provided by the NHS. For more information on government policy and legislation surrounding mental health in the UK, visit www.legislation.gov.uk . Disclaimer The information provided in this manual is for Youth MHFA use only and should not be used as a substitute for professional mental health advice. It has been written for people who attend the Youth MHFA course and is intended as an in-depth reference material to be used after completing the course. Readers should be aware that the discussions, activities, and skills covered in the course are essential to Youth MHFA. The contents of this manual alone can’t provide full training and it is only available to learners who attend our Youth MHFA course delivered by an approved MHFA England Instructor Member. For quality assurance purposes, and to ensure
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that this information is not taken out of context, it is not available to the general public.
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Glossary “A lot of adults seem to be scared of saying the actual words like ‘anxiety’, ‘depression’, and giving feelings a name, but if you don’t use or explain the proper words it can come across as patronising and belittle how you are feeling.” Emily, 15 years old You will find the following terms used throughout this manual in relation to young people and mental health. Young people Young people, Youth It should be stated that there is no universally agreed international definition of the term ‘youth.’ The United Nations defines a youth as a person roughly between the ages of 15–24 years old (4). This is reflected in recent mental health research in England. For the purposes of this manual, the aims of Youth MHFA course, and its associated materials we define ‘young people’ broadly as those aged 8–18 years old. Adolescent(s) According to the World Health Organization an adolescent is a person in the phase of life between childhood and adulthood — roughly between the ages 10–19 years old (5). We also use this definition throughout this manual, the Youth MHFA course, and its associated materials. We also refer to an adolescent in the mid to later stages as a ‘teenager’ at times. Pre-adolescent(s) Pre-adolescents – those in middle-childhood preceding the onset of puberty – are commonly defined as those aged 8–12 years old. Stages of adolescence can occur before the age of 12 years old (6),
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however. We use this definition throughout this manual, the Youth MHFA course, and its associated materials. We also refer to a pre-adolescent as a ‘child’ at times. As a Youth MHFAider® you may sometimes want to use some of the guidance for pre-adolescents with young people over 12 years old, depending on the level of their emotional needs. Mental health Mental health The World Health Organization (WHO) defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (7).” Mental health encompasses all types of health relating to the way we think, feel, and behave. We all have mental health, just as we all have physical health. We can have good mental health or experience poor mental health just as we can have good physical health or poor physical health. Positive mental health Positive or good mental health has been defined as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community (8).” Poor mental health Poor mental health is a state of mind that has a negative impact on the way we think, feel, and behave. Poor mental health can cause distress or inability in education, work, and social or community settings. It can impact daily living, including how we relate and interact with those around us. For example, a young person might experience a leg injury due to a sports accident or excessive play. They might also experience a period of depression due to increased stress or life pressures.
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Glossary cont.
Just like experiencing poor physical health the severity and longevity of the signs of poor mental health varies from person to person. Some young people may experience only one episode of poor mental health in their lifetime, while others may experience multiple episodes with periods of wellness in between. Only a small minority have diagnosable long-term poor mental health (mental ill health) and even then they can still live meaningful and satisfying lives. Emotional distress Whilst Youth MHFAiders provide support to young people who are developing poor mental health, they also provide support to young people with generally positive mental health who are experiencing a difficult time in that particular moment. For example, a student who hasn’t slept well and is finding schoolwork particularly difficult that week may find themselves unable to cope and in need of someone to talk to. It is important to recognise that Youth MHFA support is just as important for those who are generally well, but are feeling distressed in the moment. This is done in order to prevent them developing a pattern or period of poor mental health. We must neither trivialise nor pathologize their experiences. Mental ill health The difference between poor mental health and mental ill health is generally the length of time that the challenges are experienced, as well as the length of time that the challenges experienced impact upon a person’s wellbeing and functioning. Mental ill health is when poor mental health has impacted a person to the point where it could be diagnosable as a mental health condition, however it doesn’t mean that a diagnosis is
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always sought. Mental ill health generally has more of a significant and detrimental impact on a person’s life than periods of poor mental health, which may be situation specific or time limited. There is support and treatment available for mental ill health and mental health conditions, just like there is for a long-term medical condition such as diabetes. As Youth MHFAiders we talk about ‘poor mental health’ as opposed to ‘mental ill health’. This is because our role is not to There are different types of mental health conditions. Some of these are common, such as depression and anxiety disorders, and some of them are not common, such as schizophrenia and bipolar disorder. However, mental health conditions, as with any health difficulty, can cause disability. This is not always well understood by people who have never experienced living with a mental health condition. Note: mental health conditions are different to neurological disorders, but sometimes they can display similarly. Neurological disorders are described as a physical malfunction of or damage to the brain and nervous system. Suicide speculate or to diagnose. Mental health conditions We use the terms ‘suicide thoughts’ and ‘suicide behaviour’ in replacement of outdated language that has been found to increase stigma. Suicide thoughts We define suicide thoughts as the thoughts someone may have when they no longer feel they can continue to live.
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Glossary cont.
Suicide behaviour Making plans and acting on suicide thoughts is called suicide behaviour, whether the outcome is life or death. Acting on thoughts is also referred to as a ‘suicide attempt’. Dies/died by suicide When a person dies this way we say they ‘died by suicide’ or ‘took their own life.’ We use theses terms over other phrases such as ‘committed suicide’ or ‘completed suicide’. Suicide attempt We never say that a suicide attempt was ‘successful’ or ‘unsuccessful’.Instead, we say that the outcome of suicide behaviour is ‘life’ or ‘death’. It is common for people to use the term ‘commit suicide’. This dates back to when suicide and suicide attempts were against the law and a person who died by suicide ‘committed’ a crime. As suicide is no longer a crime this language is inappropriate and can perpetuate stigma and shame.
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Why Youth MHFA matters “Learning to be a Youth MHFAider is like becoming a kangaroo – creating a warm and safe space and carrying around different sets
of skills and resources in their pocket.” Jessica, Youth MHFA Instructor Member Aims and outcomes
Youth MHFA is the first response support offered to a young person who is showing emotional distress, developing poor mental health, experiencing a worsening of an existing mental health condition, or is in a mental health crisis. This might be in a work, home, or community setting. The aims of Youth MHFA are to: – Preserve life where a person may be at risk of harm to themselves or others – Provide help to prevent poor mental health from becoming more serious – Promote recovery from poor mental health – Provide comfort to a person displaying emotional distress or developing poor mental health Youth MHFA will typically be offered by someone who is not a mental health professional, but rather by someone in the young person’s social network (such as a family member or member of the community). It may also be offered by someone working in a public facing role (such as a teacher, police officer, or apprenticeship staff). This person is called a Youth MHFAider. This stands for Mental Health First Aider and is MHFA England’s official and registered trademark title.
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Why Youth MHFA matters cont.
The Youth MHFA course teaches people how to spot the early signs of poor mental health, including warning signs of common mental health crises. It also teaches people how to respond and provide initial support, as well as how to encourage a person to seek appropriate professional treatment and other sources of support. The Youth MHFA course does not teach people to diagnose mental health conditions or to provide therapy. MHFA is the first response support given to someone experiencing poor mental health before any required professional help is obtained. The wider aims of Youth MHFA are to: – Raise awareness of mental health in the community
– Reduce stigma and discrimination Reasons to train in Youth MHFA
Poor mental health is common and can have long-lasting effects Poor mental health is unfortunately common in young people. This is especially true of mental health conditions such as depression and anxiety. Half of all reported poor mental health is established by the age of 14 years old (1). Recent research by NHS Digital showed that in 2022 18% of children aged 7–16 years old and 22% of young people aged 17–24 years old were experiencing a probable mental health condition (9). Additionally, suicide is the main cause of death in young people under the age of 35 in the UK. Over 200 school-aged young people are lost to suicide every year (2). Poor mental health that presents during childhood and adolescence can have lifelong effects impacting a range of adult outcomes. These include employment, the ability to establish and maintain healthy relationships, and general health and wellbeing.
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Schools, workplaces employing those under 18 years old, and applicable community settings are in a unique position to offer first response support to all young people. Youth MHFA has been designed to empower adults who work with young people in these settings to offer that support. There is a stigma associated with poor mental health Stigma can have several detrimental effects. These include creating barriers to seeking help, exclusion from employment, difficulty accessing housing or social activities, difficulty maintaining healthy relationships, and internalised stigma leading to shame and low self-esteem. Young people may feel ashamed to discuss their mental health with professionals because of their concerns about what others will think of them (10). Better understanding and acceptance of the experiences of young people can help to reduce stigma and discrimination across communities. Many people are not well informed Understanding of how to recognise poor mental health and what effective treatments are available is not widespread. There are many myths and misunderstandings about poor mental health. Common myths include the idea that people with mental health conditions are dangerous, that it is better to avoid psychiatric treatment, that people can pull themselves out of poor mental health through willpower, and that only people who are weak develop poor mental health. Lack of knowledge may result in people avoiding or not responding to a young person with poor mental health, not knowing where to seek help, or not being able to signpost to help that might be useful. Similarly, the rise of self-diagnosis in young people may affect how they perceive any poor mental health they experience. It may cause them to have strong but incorrect ideas about mental health conditions. Youth MHFAiders can help to dispel myths and provide accurate and well sourced information.
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Why Youth MHFA matters cont.
Many young people don’t receive adequate treatment or delay accessing treatment Professional help is not always on hand, and many young people may wait for years before seeking help. The longer young people don’t receive help, the more difficult their recovery may be. Young people may be more likely to seek help if someone close to them suggests it and they feel they have all the information they need. Youth MHFAiders can assist the young person in understanding the routes to professional help, what treatment looks like, and explore any worries or barriers they may have.
A Black adult is explaining something to a Black boy whilst they are both sat on a couch. They are gestering their hands to as they speak and listen calmly.
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Due to the lack of government funding to the NHS professional mental health help is not always available straight away. Investment in community youth services, such as youth clubs and groups, have also fallen across the country. Despite this the needs of young people have increased (3). When these sources of help are not available Youth MHFAiders can provide first response support by assessing for any crises, helping the young person to feel valued and listened to, and providing information about how they might be feeling. Young people are subject to mental health inequalities Young people from different backgrounds with different lived experiences can have different mental health outcomes. The factors associated with different health outcomes are called social determinants of health. Studies show a clear link between poorer health outcomes and social disadvantages. Young people are subject to social disadvantages in similar ways to the rest of the population. However, there are also unique issues young people face (11). Furthermore, there are more specific social determinants that affect smaller proportions of the general population of young people. It’s vital that we understand specific factors that influence the mental health of young people in order to support them. Young people may lack the knowledge to realise that they need help or that help is available Some forms of poor mental health affect clear thinking and good decision making. Like people of any age a young person experiencing such challenges may not realise that they need help or that effective help is available. They may also be in such a state of distress that they are unable to think clearly about what they should do. In this situation Youth MHFAiders can spot signs of declining mental health and facilitate appropriate support.
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Why Youth MHFA matters cont.
Members of the public often don’t know how to respond Even in an emergency, a person wishing to give assistance at an accident may be reluctant to help for fear of doing the ‘wrong thing’. In a mental health crisis the Youth MHFAider’s actions may determine how quickly the young person gets help and/or recovers.
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The Youth MHFAider role
“The Youth MHFAider role is a like fire extinguisher...the young person might feel they are on fire. They represent hope and offer a break from everything that is going on.”
Vaisnavy, 17 years old Qualities and skills
When supporting a young person who is in emotional distress, is developing poor mental health, or living with a mental health condition all Youth MHFAiders need to be: – Approachable
– Non-judgemental – Emotionally aware – Accepting – Genuine – Empathetic – Attentive – A skilled listener – A skilled communicator – Trustworthy – Patient – Resourceful – Realistic
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The Youth MHFAider role cont.
Practicalities and responsibilities Whilst upholding the values of the role your main responsibilities as a Youth MHFAider are to: – Provide first response support to a young person who is experiencing emotional distress, poor mental health, or is living with a diagnosed mental health condition – Apply the Youth MHFA action plan (ALGEE) to guide your support – Use active listening skills throughout support, taking into consideration your own Frame of Reference and any language you use around mental health – Protect the boundaries of the role – Continuously develop your mental health awareness – Understand the importance of self-care and practise self-care regularly to manage the stress in your Stress Container – Contribute to reducing stigma and promote positive mental health – Use the MHFAider Support App to access the online national database of mental health services, Hub of Hope , to record your reflections after MHFA support and to access additional resources – Refresh your skills every three years with a Youth MHFA Refresher course Apply the Youth MHFA action plan As a Youth MHFAider you should be able to apply the Youth MHFA action plan (ALGEE) and use good judgement about the order and the relevance of these actions. You will need to be both flexible and responsive.
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You should confidently be able to: – Notice signs of poor mental health in a young person – Approach the young person responsibly – Assist safely in crisis situations and, if needed, seek immediate emergency help – Use your active listening skills throughout your support – React appropriately to signs of abuse, and when necessary report to the relevant authorities – Give the young person information about what they could expect from treatments without recommending or advising – Signpost to relevant professional resources and contacts, depending on your setting and including targeted support if appropriate e.g., financial advice or bullying hotlines – Offer practical support to prepare the young person for mental health support, if appropriate – Talk through other supports available such as self-help strategies Develop your mental health awareness You should continue to improve your knowledge about the mental health landscape for young people in England. Continue to think about what you learnt on the course and how it applies to the real life context you are in as a Youth MHFAider, for example: – Keep in mind mental health risk factors that impact young people, including how discrimination influences the mental health of marginalised groups – Think about a young person’s unique and intersecting identities, remembering every young person is different – Know that young people can and do move around the Mental Health Continuum quadrants and at different rates
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The Youth MHFAider role cont.
– Stay up to date with mental health language and avoid using unhelpful words or phrases – understand that a young person may express how they are feeling using different language to what you are used to, and be prepared to find a way to talk that feels comfortable for you both Understand your Frame of Reference The Frame of Reference model shows that the ways in which we all make sense of the world, of other people, and of ourselves are unique to each one of us, and are shaped by our life experiences. This includes our feelings, beliefs, and behaviours. We all see things slightly differently, and so we treat ourselves and other people differently too. Our individual Frame of Reference is influenced by a range of factors such as our family situation, education, culture, and life experiences. Sometimes, the way we view the world – our ‘window on the world’ – is impacted by our Frame of Reference. This can lead us to make judgements about a young person’s situation, and so hinder us from truly listening non-judgementally to the young person we are supporting. By noticing and understanding where these judgements may come from we can more easily set them aside to help the young person in front of us. Take into consideration your own Frame of Reference and remember not to compare your own experiences of youth to the young people around you. To fully understand how a young person you are supporting sees the world you will need to ask them about their point of view and put yours to one side during a Youth MHFA conversation.
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Example Frame of Reference In this example of the Frame of Reference model, some parts of the person’s identity sit within the inner rings surrounding the person’s central view of the world, whilst others sit within the outer rings. Each part of our identity and experiences may have different levels of influence on our perceptions and judgements – the closer to the centre, the more impactful it has been. This will differ for each person and can change as we grow and develop throughout life.
Socio-economic background
Marital status
Gender expression
Neurodiversity
Faith
Values
Spirituality
Race
A
chievements
Likes/dislikes
Sexuality
Disability
Indigeneity
Chronic illness
Religious beliefs
Language/accent
Class
Absence of faith
Body size
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The Youth MHFAider role cont.
Practise self-care You will need to understand the importance of self-care as a Youth MHFAider, and practise self-care regularly to manage the stress in your Stress Container. Before an aeroplane takes off a flight attendant will talk flight passengers through the oxygen mask procedure. This procedure instructs passengers on a flight to ensure that they put on their own mask before helping others, because you can’t assist others if you lose consciousness. The same principle applies to the Youth MHFAider role. If we aren’t well we’re not able to safely offer support to others. After supporting a young person who is in distress you may feel worn out, upset, frustrated, or even angry.
Pure self-care Individual responsibility
Pure medical care Professional responsibility
The self-care continuum
Daily choices
Self- managed ailments
Long-term conditions
Compulsory psychiactric care
Lifestyle
Minor ailments
Acute conditions
Major trauma
Adapted from the self-care continuum graphic, property of Self Care Forum: www.selfcareforum.org/ Healthy living Minor aliments Long-term conditions In-hospital care
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Self-care is the practice of engaging in activities that take care of your health and actively manage poor mental health when it occurs. To help us understand self-care and the role it plays in maintaining positive mental health or recovery from poor mental health better, we can refer to the self-care continuum. The self-care continuum, developed by UK-based health charity Self Care Forum , illustrates the spectrum of health care in the UK. Starting with our individual responsibility to make daily choices for our health, self-care is a fundamental part of creating a healthy lifestyle. It also plays a vital role in alleviating the negative effects we experience during periods of poor health. The same could be true for long-term conditions where we may self-manage without intervention from a health professional (12). Cortisol is a naturally occurring hormone that helps to manage the body’s stress response, but too much can be bad for our health. Managing stress levels by practising self-care can reduce cortisol levels in the body – which is demonstrated by the Stress Container model. When we practice self-care, we can help to stop our container overflowing by releasing our stressors via the container’s tap. With the rise of self-care culture, there is an increasing onus on individuals to fully manage their own mental health, with many solutions having an emphasis on physical beauty or making a financial investment or purchase. The aim of practising self-care should be to carry out activities that make us feel better, not to overextend ourselves. Try to be realistic and think about any time, financial, or energy requirements a self-care activity has. Self-care differs person to person and can change over time. Some things we might do daily, and some might be once a year, like enjoying a great holiday. You may also need to deal with the feelings and reactions you set aside during the conversation. Youth MHFAiders can also access Shout’s mental health text support service via the MHFAider Support App. It can also be helpful to make reflective notes on
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The Youth MHFAider role cont.
your experience in the MHFAider Support App or find someone to talk to about your experience, remembering to leave out identifying details. Please do remember that the purpose of the reflective notes in the Support App is to reflect on the MHFA conversation you had and how you feel about it. You should not be using it to take a direct log of the conversation, but instead use it as a tool for reflection and growth in the role. Maintain boundaries “The Youth MHFAider shouldn’t try to juggle multiple supports at once so they provide the best support. They should try to understand the fine line between fulfilling the support role and offering too much help and becoming overinvolved.” Zara, 15 years old The Youth MHFAider role is a first response role. Much like in physical first aid it is then the job of an appropriate professional to provide clinical support to the young person. Clearly communicated boundaries between the Youth MHFAider and the young person is crucial. If boundaries are not maintained, it risks a significant impact on the wellbeing of both the Youth MHFAider and the young person being supported. If you are also fulfilling another role at the same time, such as school staff, ensure that you understand how your other role may extend past the boundaries of being a Youth MHFAider. The Youth MHFAider role should not be treated distinctly to any other role you fulfil, but add additional layers of skill and knowledge to your approach when supporting young people. Your Youth MHFA skills can be applied at any time, regardless of if you are working in another capacity.
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Dependency It’s important to remember that MHFA England does not teach people to be therapists or counsellors, how to diagnose mental health conditions, nor encourage Youth MHFAiders to provide ongoing support. The Youth MHFAider role is a first response role. Waiting lists for youth mental health services can be long and so it isn’t appropriate for the Youth MHFAider to hold the relationship with the young person on a frequent long-term basis, whilst they wait for professional help. Additionally, some young people aren’t able to access professional help by themselves, for example if they are a pre-adolescent. If appropriate, the Youth MHFAider should contact a trusted adult. This might be a parent/carer in a community setting or a professional contact in an education or workplace setting. However, after you have signposted to a professional, it might feel appropriate to follow up with the young person to see how they are doing and whether they are feeling hopeful. Just like with physical first aid, it can feel important to check in on the person you have supported to show compassion. It also lets them know that you are available and can be trusted to listen again in the future. To reduce the risk of both emotional and practical dependency, the Youth MHFAider should communicate where the role begins and ends and try to empower the young person to make decisions about their wellbeing. In instances where the young person shows signs of being dependent on your support, communicate the boundaries of the role again, and help them to access appropriate help with a trusted adult. Confidentiality When discussing support you’ve given to a young person with other people (such as other Youth MHFAiders or education professionals), it is vital to respect the young person’s right to privacy. Identifiable details such as name, age, gender, and
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The Youth MHFAider role cont.
appearance should be left out of conversations. Identifying someone risks stigma and unfair treatment in the education setting or community. It is important for every Youth MHFAider to know and follow the safeguarding and data sharing policies and procedures in their setting. You may need to signpost a young person who cannot access support by themselves to another contact in the school (such as a mental health lead or pastoral team member) or workplace, or find others to assist a young person at risk of harming themselves or others. If entering reflective notes into the MHFAider Support App, all data is encrypted and stored
A White pre-teen is sat in an arm chair and speaking whilst facing the viewer. She is in front of a whiteboard. She is speaking to someone in the next image.
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securely, including names, initials, and unique identifiers. Please do remember that the purpose of the reflective notes in the Support App is to reflect on the MHFA conversation you had and how you feel about it. You should not be using it to take a direct log of the conversation, but instead use it as a tool for reflection and growth in the role. In some situations, a young person may refuse to speak to a Youth MHFAider unless they promise total confidentiality upfront. Youth MHFAiders should not promise to keep threats to a person’s safety a secret. Communicate to the young person that you are there to support them but can only do so if they let you know what’s happening for them – and that part of supporting them is to ensure they remain safe.
An adult is sat in a chair and facing away from the viewer. They are blurred and their face cannot be seen. They are listening to the pre-teen in the previous image.
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The Youth MHFAider role cont.
Inappropriate relationships The Youth MHFAider role is a position of trust. Pursuing a personal or sexual relationship with the young person breaks that position of trust. It’s against the law for someone in all official positions of trust to engage in sexual activity with a child in their care, even if that child is over the age of consent (16 or over). Regardless of the Youth MHFAider role not being a position of trust recognised by the government, pursuing a relationship with a young person of any age is outside of the role’s boundaries on moral grounds and is completely unacceptable. Even in a close emotional relationship, it isn’t always possible to see a situation objectively and you risk being judgemental. A young person seeking support may be vulnerable, which could compromise their mental health. Wellbeing Consider and communicate your availability and time commitments to the role in relation to other work or community responsibilities and your own wellbeing. Recognising when you are struggling is key. When you are experiencing poor mental health yourself, or are having a tough day, you will bring these emotions to the role and will find it harder to be empathic, which puts the person being supported at risk. You also put your own wellbeing at risk by adding to your Stress Container. If you can’t support the young person in that moment, make sure there is another trusted adult available, such as another Youth MHFAider or education professional (mental health lead, pastoral team member), if you are in an education setting.
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Understanding youth mental health in England
Two young White people are playing video games together using controllers.
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One has only their hands visible, whilst the other is blurred and in the background and is wearing headphones.
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Adolescent development
“Young people who are going through a lot of different things might act strangely to adults. They can feel stress from friendships and the pressure of all the schoolwork we are given, especially when there are close due dates.” Ines, 11 years old Adolescent development and Youth MHFA How to reflect on your individual Frame of Reference An understanding of how the brain changes during adolescence can help explain the contradictions a young person experiences during this period of their life. Young people at this age are close to reaching peak physical health, strength, and mental capacity – but for some it can be a time filled with challenges. Most adolescents go through the transitional age well, but it is important to understand the risk factors involved. A changing brain and hormones, as well as genetics and childhood experience, can all shape behaviour. For many Youth MHFAiders adolescence, and the associated attitudes and behaviours, may seem far removed from their current view on the world. It’s important that anyone who is supporting an adolescent keeps in mind that the various chemical and physical changes going on for them are out of their control. It’s also important that the Youth MHFAider tries not to compare their own experiences of youth with those of the young person they are supporting. How we can separate poor mental health and adolescent development Mental health and adolescent development are interrelated, influencing each other in many ways. It can often be difficult to distinguish the signs of poor mental health from normal adolescent
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moods and behaviours. For example, many young people become more secretive as they develop their independence. Secrecy however may also indicate that they are using alcohol or substances, self-harming, or struggling with food. It may also indicate paranoia which can be a sign of psychosis. Another example is social withdrawal – withdrawing from other people can be a symptom of many mental health conditions. A young person withdrawing from family but spending more time with friends, however, tends to be a normal part of growing up . One theory of the changes in the brains of adolescents is that the parts of the brain involved in emotional responses are more active than in adults, whilst the parts of the brain involved in regulating these responses are still reaching maturity. This can cause impulsive or risk-taking behaviours. It is not yet medically possible to know to what extent a particular behaviour or ability is the result of a specific feature of brain structure or change. Changes take place in the context of many other factors such as environment, personality traits, childhood, family, friends, community, and culture. Assessing a young person’s functioning is a helpful way to distinguish between poor mental health and normal development. If a young person is struggling with school or work, avoiding social contact, or is no longer enjoying things they used to enjoy then it is likely that they are experiencing poor mental health. How poor mental health can impact healthy development There are numerous variables related to mental health that can affect adolescent development. There is evidence that: – Heavy alcohol use during adolescence can lead to changes in brain structure (13). – Lack of concentration and motivation, a sign of poor mental health, can lead to difficulties in cognitive development and educational achievement.
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Adolescent development cont.
– Withdrawal from friends, family, and school can delay social development. – Eating disorders associated with dramatic weight loss can interrupt menstruation. Despite these risks it is important to remember that most young people do pass through adolescence with relatively little difficulty. Brain development The capacity of a person to learn will never be greater than during adolescence. In terms of intellectual power the brain of an adolescent is a match for an adult, however tests suggest differences in how adolescents and adults carry out mental tasks. A clue to the degree of change taking place in the adolescent brain comes from studies in which scans of children were taken as they grew from early childhood through to their mid-twenties. Findings revealed long-held assumptions about the timing of brain maturation were incorrect and that the brain doesn’t reach maturity until around the mid-twenties (14). The pre-frontal cortex, which is responsible for planning, problem-solving, decision-making, personality development, and impulsivity, is one of the last brain areas to fully develop (15). Grey matter Grey matter is made up of the nerve cell bodies, the nerve fibres that project from them, and blood vessels. One of the features of the brain’s growth in early life is the blooming of synapses, which are the connections between brain cells. Synapses are the links by which brain cells communicate with each other and are the basis of the working circuitry of the brain. At birth our synapses are more numerous than when we
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are adults, and they multiply rapidly within the first months of life. A two-year-old has twice as many synapses as an adult. Recent scans of the brain found that grey matter volume of adolescents tended to be lower than that of children (16). As the brain develops the fibres connecting nerve cells are wrapped in a protein that greatly increases the speed with which they can transmit impulses from cell to cell. The resulting increase in connectivity shapes how well different parts of the brain work in unison. Research is ongoing, but has found that the extent of this connectivity is related to intellectual growth in areas such as memory and learning (15).
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