Improving maternal mental health
More than one in ten mothers experience mental illness such as anxiety and depression during pregnancy or the first prenatal year. Left untreated, this can have damaging impacts on children and families, including impaired parent-child bonding and increased risks of children developing poor mental health and behavioural problems. Midwives, health visitors and GPs are ideally placed to identify and intervene with mothers experiencing mental health issues.
Home visiting programmes
England has universal midwifery and health visiting programmes that provide a valuable resource in offering parenting support to all new mothers. More intensive home visiting programmes can be effective in supporting vulnerable mothers. The Family Nurse Partnership (FNP) programme runs in many areas in England, offering regular home visits by nurses to new teenage mothers from early in pregnancy until the child is two.
Parent training programmes
Parenting programmes aim to strengthen relationships between parents and children and improve parents' skills, knowledge and confidence to support their child's development and manage their behaviour. Programmes can be delivered universally, but are often provided to high risk families and the parents of children at risk of conduct disorders.
Preschool programmes provide social and academic development to children before they start school, often combined with family and health services. In England, all three and four year old children are entitled to 15 hours free early education per week, while Sure Start Children's Centres offer services including child education, childcare, health services, outreach and parental support.
Social and emotional development programmes
Social and emotional development programmes are typically delivered in schools and aim to develop children's self-confidence, self-respect and relationship skills. They cover areas such as empathy, problem solving, personal values, assertiveness and conflict resolution. Effective programmes can increase children's social competence and academic attainment and reduce disruptive behaviours such as aggression and hyperactivity.
Classroom behaviour management programmes
Classroom behaviour management strategies help teachers address disruptive and aggressive child behaviour and develop productive school communities. In the Good Behaviour Game (GBG), developed in the US, teachers set out the rules of proper student behaviour to children and divide their classrooms into teams, with a team being rewarded when all of its members behave well.
Bullying prevention programmes
Children who are bullied at school can suffer emotional problems and social isolation, both of which can contribute to poor school achievement and attraction to gangs. All schools in England are required to implement measures to prevent bullying. An example of a programme that has shown benefits in reducing bullying is the Olweus Bullying Prevention Programme, which adopts a whole school approach including: clear school rules and management structures for bullying; training for staff; a classroom curriculum for students; parental awareness-raising; and improvements to the school environment.
Dating and relationship programmes
Dating and relationship programmes aim to prevent intimate partner and sexual violence by developing young people's relationship skills and promoting healthy gender norms. An example of a teen dating abuse programme is the Face Off resource, part of the It's Not OK! suite of educational resources addressing violence and alcohol currently being evaluated across several local authority areas.
Improving mental health in vulnerable and gang-affiliated young people
Cognitive behavioural approaches
Cognitive behaviour therapy (CBT) helps individuals manage their problems by changing the way they think and behave. It is a brief, problem-oriented talking therapy in which therapists help people to identify and address negative thought patterns that contribute to problem behaviours. CBT can be delivered in one-to-one or group sessions in a range of settings and is an effective treatment for many common mental health conditions. It is recommended by NICE for the treatment of depression, conduct disorder, ADHD, PTSD and alcohol dependence in children and young people.
Trauma-focused cognitive behavioural therapy (TF-CBT) is a structured programme that includes both skills -based and trauma-specific components for children and their caregivers. Clients are taught relaxation skills, coping strategies and how to manage their emotions before trauma-specific components are addressed. Initially developed to address the psychological trauma associated with child sexual abuse Trauma-focused cognitive behavioural therapy has been adapted for a wide range of traumatic experiences and has demonstrated positive effects in reducing symptoms of PTSD.
Multisystemic therapy (MST)
Multisystemic therapy (MST) is an intensive family therapy for 11 to 17-year olds at high risk of placement in custody or care due to persistent offending or severe behaviour problems. Therapists use strength-based and cognitive behavioural therapeutic approaches with young people and their families.
Multidimensional treatment foster care (MTFC)
Multidimensional treatment foster care (MTFC) is an intensive intervention that provides treatment and substitutive care for young people with chronic behaviour problems. Through placements with specialist foster carers (typically lasting 9 to 12 months), young people are provided with support in all areas of life, from developing better relationships to solving problems and coping with adversity.
Interventions targeting gang-affiliated young people, or those at risk of gang-affiliation, can incorporate a variety of psychosocial approaches in broader programmes to support young people. Community approaches to supporting mental health and addressing the behavioural problems and multiple needs of vulnerable youth often involve the use of a key worker to act as a single point of contact for young people and, where appropriate, their families. With many gang-affiliated youth having a deep mistrust of statutory agencies, a dedicated key worker can limit the number of services that young people and their families have to deal with and help them access appropriate services.
Mentoring programmes provide trained mentors to work with young people either at home, at school, or in the community. Typically targeting disadvantaged youths, mentors provide non-familial adult role models that are able to share knowledge and skills with young people and offer psychosocial support.
The role of schools in promoting mental health
Schools have a key role to play in supporting the mental health needs of vulnerable children and young people, including those at risk of, or affiliated to gangs. Mental health directly impacts on learning and development and children who are facing mental health difficulties may struggle in school. Failure to support the mental health needs of pupils may contribute to absenteeism and risk of school failure, which have been associated with longer-term problems such as unemployment, involvement with the criminal justice system and gang membership The Department for Education has published advice for primary and secondary school staff on supporting pupils with mental health needs.
While mental health services are delivered by a range of agencies, the comprehensive CAMHS system provides a framework for collaborative work to support mental health in children and young people. Comprehensive CAMHS are delivered by a whole system four-tiered approach starting with the universal promotion of emotional wellbeing through to the treatment of complex cases with evidence-based specialist services. CAMHS are important partners in work to support the emotional and mental health needs of gang-affiliated young people.