In recent years, children’s mental health has become an area of discussion and debate in Australia. This has often centred on the roles of families, education settings and communities in children’s development and their impact on children’s mental health outcomes. Debates have focused on a range of areas, including the challenges associated with parenting, indicators that mental health problems are increasing in children, the lack of early intervention and support for children exhibiting signs of mental health difficulties, schools’ responses to bullying and the impact of technology on children’s development. Recent surveys have highlighted the need for further research and interventions to ensure that children’s mental health is prioritised from an early intervention perspective, and adults responsible for their care are effectively supported. Psychologists can play a critical role in this area through their direct work with children and families as well as within the systems in which children engage, particularly education settings.
Theoretical frameworks relating to children’s mental health
Theoretical frameworks such as the socio-ecological model have been utilised to highlight the dynamic nature of interactions between children and their various environments (Bronfenbrenner, 1989). Similarly, the risk and protective factors framework has been utilised to identify those significant factors which serve to increase or reduce risk in children’s mental health. This is a complex population-level theory which can help to identify where efforts in education settings and within communities can be directed to enable the promotion of positive mental health and prevent the likelihood of mental health difficulties occurring. These factors relate to social supports and networks, communication styles and family interactions, social and emotional skills of children, and access to culturally appropriate evidence-based interventions to provide support if concerns arise (Commonwealth Department of Health and Aged Care, 2000).
Australian research about children’s mental health
The second Australian Child and Adolescent Survey of Mental Health and Wellbeing, conducted in 2013-14 by the Telethon Kids Institute at The University of Western Australia in partnership with Roy Morgan Research, provided a long-awaited snapshot of the mental health of children and young people. As was found in this survey, the research confirmed that most children have positive mental health and show no signs of mental health difficulties. However, for children aged 4-11, the survey found that almost one in seven Australian children had a mental disorder, with anxiety (6.9%) and ADHD (8.2%) being the most common. This overall statistic is consistent with the results of the survey conducted in 1998, although there were a couple of important distinctions. Children from the age of six were included in the first survey and anxiety was not specifically included (Telethon Kids Institute & Roy Morgan Research, 2015).
The survey authors outlined one particularly obvious change in the 15 years between the first and second surveys was in the use of technology and the development of social media. This has created new environments in which socialisation, and issues such as bullying with its negative impact, take place. They noted that this presented both challenges and opportunities (Telethon Kids Institute & Roy Morgan Research, 2015).
There was a promising finding in relation to service use by children and their families between the two surveys, with a significant increase in service use by children with mental disorders (31.2% in 1998 compared with 68.3% in 2013-14 for children with major depressive disorders, ADHD or conduct disorders). This finding highlights the importance of raising awareness of the signs of mental health disorders in children and promoting early help-seeking strategies. Interestingly, three key barriers to seeking help or receiving more help in the previous 12-month period for children with mental problems were identified as: families not being sure where to get help (40%); families not being sure if the child needed help (33%) and problems getting to a service that could help (32%) (Telethon Kids Institute & Roy Morgan Research, 2015).
Raising parents’ awareness of signs of mental health problems
A recent poll report conducted by the Royal Children’s Hospital Melbourne focused on parents’ role in spotting the signs of mental health problems in children. The poll, conducted in July 2017 with a sample of 2,032 nationally representative Australian parents of children from toddlers to adolescents, found that only one-third of Australian parents felt confident that they were able to recognise signs of a mental health problem in their child. One-third of parents also thought that problems might be best left alone to work themselves out over time. In addition, one-quarter of parents were not aware that ongoing physical complaints may be a sign of social or emotional problems in children and teenagers. One-third of parents, did not recognise that persistent sadness and frequent tearfulness and crying is not normal in children. Parents who reported connecting with their children most days of the week were more likely to feel confident of recognising a mental health problem in their child, however, one in three parents stated that it was difficult to find time to connect with their children. Forty-four per cent of parents reported being confident that they would know where to go for help if their child was experiencing social, emotional or behavioural difficulties (Royal Children’s Hospital, 2017).
The authors noted that parents and carers play a critical role in the identification of children’s potential mental health problems and the access of support. If they are not aware of the signs of mental health concerns or know when and where to access support, problems are more likely to become entrenched, resulting in difficulties in treatment. They suggested that education and support for parents to increase their confidence in recognising the early signs of a problem as well as assistance in navigating the pathways to support are necessary. General practitioners, teachers, school counsellors and psychologists were identified by the parents as sources of help for addressing their concerns about their children’s mental health. Schools were identified as a critical source of support for families in relation to children’s mental health.
Roles for psychologists in supporting children and families
Psychologists have a longstanding history of providing a range of interventions and supports to children and families in a variety of settings. These interventions may be typically targeted towards those children experiencing or at risk of mental health difficulties. However, from a proactive and preventative point of view, this could also include support for children and families in relation to identification of early signs that a mental health difficulty may be occurring and psychoeducation in relation to parenting and the development of positive family relationships.
Within school or community settings, psychologists can be engaged as consultants in the development of children’s social and emotional competencies. There is longstanding evidence for the value of social and emotional learning as an intervention which promotes positive social relationships, reduces incidences of bullying, improves academic learning outcomes and promotes positive mental health outcomes (e.g., Taylor, Oberle, Durlak & Weissberg, 2017). Schools may benefit from support from psychologists to identify the most appropriate interventions for their community and to implement social and emotional learning programs within a whole-school model in order to ensure that all children gain the benefit from the programs (Van Velsor, 2009).
Schools may also benefit from assistance in managing access to technology, given the recent and ongoing proliferation of apps and programs available online. These now provide a range of potential interventions including, psychoeducation; screening and feedback; decision-making, problem-solving and goal setting; self-monitoring and tracking of treatment progress; homework; skills training; self-management and help-seeking. Psychologists may be able to offer support to schools and families in assessing the quality of online mental health apps and programs (Stoyanov, et al, 2015) and assist in determining their relevance, taking into account cultural and linguistic factors, accessibility and alternative options.
School psychologists and psychologists in private practice who work with schools can play critical roles in supporting schools, and the children and families within the school community, across the continuum of mental health promotion, prevention and early intervention. For psychologists working in schools, there can be value in identifying and packaging their skills in a way that makes their role clear to those seeking services. Facilitators of successful psychological practice in schools have been identified and include both system and individual factors such as models of best practice, professional community membership, role clarity, accountability, professional development, access to research, collaborative approaches and proactive initiative (Eckersley & Deppeler, 2012).
Future support for children's mental health
It is likely that children’s mental health will continue to be an area of significant interest and debate, both within the mental health arena and the public domain. It is clear from recent research that there is an ongoing need to support those adults who care for children to ensure that they feel confident and have the necessary skills to promote the positive mental health of their children as well as to recognise at the earliest possible time when their children may benefit from additional support. Psychologists are well-placed to provide a range of services and interventions to assist children, families, schools and communities in prioritising and responding to children’s mental health needs.
The author can be contacted at l.o’email@example.com
The KidsMatter initiatives were developed utilising a mental health promotion, prevention and early intervention model where early childhood services, schools, families and health and community professionals worked together to support children’s mental health outcomes. KidsMatter provides a framework for addressing children’s mental health that includes creating a positive environment, fostering children’s social and emotional skills, supporting parenting, and early intervention for children at risk of or experiencing mental health difficulties. KidsMatter recognises that children develop social and emotional skills within the context of relationships with others. The initiatives support early childhood services and schools to embed social and emotional learning within the curriculum, recommending the implementation of evidence-based programs as well as valuing the daily interactions with children to support and enable practising of skills. Working collaboratively with families is also recognised as critical to enable social and emotional competencies to be achieved (Littlefield, Cavanagh, Knapp & O’Grady, 2017).
The Australian Psychological Society (APS), led by Professor Lyn Littlefield, played a significant role in the development and implementation of the KidsMatter initiatives a decade ago, leading the mental health content and evidence-base for the initiatives, and health and community partnerships relating to children’s mental health. The APS was instrumental in the development of the KidsMatter Primary and KidsMatter Early Childhood frameworks and implementation model in schools and early childhood services with accompanying resources. These resources included implementation manuals, professional learning manuals and videos for education staff, mental health information for families and education staff, webinars on mental health topics with multidisciplinary panels, review of programs and maintenance of the Programs Guides, information for early childhood services and schools to better understand the role of Primary Health Networks in accessing services for the assessment and treatment of children’s mental health difficulties, tools to enable effective partnerships between education settings and mental health professionals and e-newsletters. The APS also played a critical role in the training and support of the state and territory KidsMatter Primary and KidsMatter Early Childhood project staff to ensure that the mental health concepts and implementation science aspects of the initiatives were well understood and built into their practice when working directly with early childhood service and school staff.
The APS’s role included developing and managing content for the families and health and community professionals’ websites and developing a range of tailored resources including Starting School, e-learning to improve communication between educators and families and Aboriginal and Torres Strait Islander animated resources to increase understandings of Aboriginal children’s social and emotional wellbeing. The KidsMatter website is a comprehensive resource for psychologists working with families and education settings (www.kidsmatter.edu.au).
In its response to the National Mental Health Commission’s Review of Mental Health Programs and Services, the Australian Government announced efforts to join up support for child mental health. This included the development of a single integrated end-to-end school-based mental health program and a national workforce support initiative to assist professionals and services who work with children. Accordingly, a new Mental Health in Education program will integrate five existing programs relating to child and adolescent mental health: KidsMatter Early Childhood, KidsMatter Primary, MindMatters, headspace School Support, ResponseAbility and Peer Support. These programs will continue to be available until mid-2018 and will then integrate with the new education program. Beyondblue will lead implementation partners, Early Childhood Australia and headspace, to continue to deliver KidsMatter Early Childhood, KidsMatter Primary and MindMatters, and the National Mental Health in Education Program.