1. Can Sport improve Mental Health and Wellbeing of young people?
Stephen McLeod
Head of Specialist Children’s Services
NHS Greater Glasgow and Clyde

2. Contents
Definitions & Determinants Glasgow’s School Children – active and healthy? Young People’s development – what is normal? Distress V Disorder Resilience Actions

3. Definition of health
“A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (WHO 1948)
We need to reframe a definition for our time to reflect the population age and the pattern of illness changes
“The ability to adapt and self manage” in the face of social, physical and emotional challenges. (Huber et al BMJ 2011)
Need to reframe the definition in light of demographic changes and the pattern of illness the 1948 definition offered a move away from medical model necessary but arguably no longer sufficient

4. Positive mental health can be promoted through
Physical activity-incorporating exercise into everyday activities
Labour market activity-having meaningful work and a daily routine
Social activity-being connected to family, friends and our communities

5. The social determinants of mental health
Growing social and economic inequalities contribute to levels of anxiety, depression and stress. It is therefore unsurprising that mental health patterns in NHSGGC are very closely aligned with other social inequalities. Societies with greater inequality have a greater prevalence of a range of mental health problems and even relatively small levels of inequality can have significant effects on health. Several reports have described patterns and trends in mental health across NHSGGC and in smaller neighbourhoods, further described below.
The importance of natural environment in preserving and promoting human health is now being increasingly recognised. Research indicates that green spaces improve mental health and overall quality of life. Opportunities to be outdoors, in fresh air and to be in contact with plants and animals have a profound impact on wellbeing. Green spaces provide a place to exercise. The more time people spend in outdoor green spaces, the less stressed they feel. This is true regardless of their age, gender, and socio-economic status.
GCHP’s The Shape of Primary Care report predicted that patients attending practices serving predominantly deprived areas were more than twice as likely to present with mental health problems as those from one of the least deprived areas. Depression was also documented more frequently as a co-morbid condition among patients with coronary heart disease in more deprived practices. There are profound socioeconomic and geographic variations in mental health problems across NHSGGC, for example, in rates of suicide and psychiatric admissions to hospital.

6. ‘Recovery capital.’… the things, the people, their resources, their understanding and concern for the individual which can help them have a sense of belonging and connection which helps them to firstly help them consider, and then initiate change in their lives. Sometimes this change is slow, but it can be sustainable change, change that’s supported by others in a meaningful and very personal way.
My vision for a healthy Glasgow is one where people have a common sense of hope and purpose in their lives”
Neil Hunter, Chief Reporter to the Children’s Panel

7. “Many folk in Glasgow spend five or more hours a day watching television – particularly commercial channels. My vision for a mentally flourishing Greater Glasgow and Clyde is one where people spend less time watching television and more on activities, which support them socially and emotionally. Carol Craig, Director, Centre for Confidence and Wellbeing.

8. Screen time – computer games, surfing the net, social networking, smart phone and TV 25% of secondary school pupils 12 or more hours of screen time
One in four (25% 1,166 pupils) spent more than 12 hours a day on screen-based activities on school days

9. Arts, culture and mental health
Contribute to effective health education
Contribute to therapeutic and relaxed environments in health services
Develop creativity
Improve quality of life
Raise expectations of what is possible and desirable
…plausible link to mental health outcomes but more research required
Arts and culture
Art, dance, and music therapy are well established in mental healthcare. They are also widely advocated for promotion of positive mental health. However, the evidence base for any measurable benefits on health status per se is currently inadequate and needs to be improved. There is some limited observational and descriptive research

10. Benefits of Physical Activity
Social
Encourages family/community connectedness
Improves social skills/networks
Prolongs independent living for older people
Reduces isolation, loneliness
Enhances self-esteem, confidence
Environmental
Reduces traffic congestion
Reduces air pollution
Reduces greenhouse emissions
Reduces noise pollution
Creates safer places with people out and about
Physical
Activity
Benefits
Physical & mental
Improves quality of life
Manages weight
Reduces risk of chronic diseases
Improves sleep
Reduces stress, depression
Develops motor skills
Improves concentration, memory & learning
Economic
Creates employment
Draws tourism
Means of transport
Supports local businesses
Reduces absenteeism
Reduces crime
Reduces health savings
Physical activity benefits mental as well as physical health. The new UK physical activity guidelines recommend a renewed focus on being active every day.
Adults (19-64 years old) and older people (65 plus): should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more.
Importance of the natural environment and value of green space and we should build on the positive work already commenced on auditing green space in NHS Greater Glasgow and Clyde estates to maximize opportunities for utilizing green space in NHS grounds to promote physical activity for staff, patients and local communities.
Even in times of austerity, we must continue to advocate active transport, walking groups, good signage, cycle lane schemes and cycling proficiency in schools. 10

11. Glasgow Schools Survey

12. Sport, exercise and travel
4/5 report taking part in a sports club out of school
Swimming, football, dance are most popular
51% used active travel methods to journey to school
¾ report owning a bicycle
Exercise target
Boys were more likely to meet the physical activity target than girls
Young people from an Asian background were least likely to meet the physical activity target
Active travel
48% of pupils walked or cycled to school. While 22% - a fifth were transported to school in a car. Children from an Asian background were most likely to use the car to get to school and least likely to use public transport
Sport
The most common sports participated in school were badminton, swimming and basketball. The most common sports in pupils out of school were swimming and football.
Boys, lower school pupils and children from an Asian ethnic background were least likely to participate in sports
Those who did not participate in sports clubs at school were asked why. The most common response was “do not like them/not interested”; followed by prefer to do other things/too busy. A small minority of pupils were not aware of clubs, unsure how to join them or faced transport barriers.

13. Travel to School
Level of walking remains high but trend towards greater car use and less walking over past 20 years
Some examples of schools with high levels of active travel despite pupils travelling longer that average distances
No difference by whether or not school has a travel plan
Cycling levels low – just over 2%- but ten times as many secondary pupils would like to cycle than do currently

14. Best practice in planning for physical activity (NICE)
Identify groups of children and young people least likely to exercise at least 1 hour a day
Understand the factors that help or prevent them getting involved
Involve them in design, planning and delivery

15. Mental health is important too
Widen awareness of mental health issues Mental health promotion considered in all plans and service designs Promote value of positive environments and activities Stronger focus and leadership on physical activity even in these times of austerity
The promotion of good mental health must be a priority area for action by all public sector agencies and part of all plans and strategies.
We need a much stronger focus and leadership to get our population more physically active. This will involve some high profile campaigns as well as an understanding in all services on the importance of physical activity to promote good mental health and access to services to support and motivate behaviour change. Even in times of austerity, we must continue to advocate active transport, walking groups, good signage, cycle lane schemes and cycling proficiency in schools.
Importance of the natural environment and value of green space and we should build on the positive work already commenced on auditing green space in NHS Greater Glasgow and Clyde estates to maximize opportunities for utilizing green space in NHS grounds to promote physical activity for staff, patients and local communities.
While there is limited evidence these events deliver a legacy for physical activity, we must aspire to a different outcome for the 2014 Commonwealth Games. Must actively support efforts to use the Games to motivate and support activity and wellbeing and must make every effort to use their resources to plan activities, events and approaches that will encourage people to be physically active and involved in arts and cultural activities facilitated by the facilities and culture of the Games.

16. The challenges to mental health and wellbeing
High levels of child and family poverty
More likely to be admitted to hospital through assault
More likely to be reported to the Children’s Panel through violence
Higher rates of looked after and accommodated children
Lower rates of referral to social services as a result of concerns (public or professionals)
Worse school attendance
Higher proportion of 16-19s not in education, employment or training
Previous reports did not say much about mental health
Poor mental health is both a consequence and cause of inequalities and social exclusion;
Mental health problems are one of our most pervasive public health challenges, estimated to contribute to a third of all illness and disability in Scotland.
By improving mental health we are also likely to be more successful in changing other health behaviours such as smoking or diet
9% of population on anti-depressants at any one time
50% of IB claimants 2000 to 2008 in GGC
Current responses – not comprehensive but a flavour of how as a Board with our partners we are addressing the issues raised

17. Erik Erickson’s Stages of Psychosocial Development
 Psychosocial Crisis Stage
Life Stage
Virtue
age range, other descriptions
 4. Industry v Inferiority
School Age
Competency
5-12 yrs, early school
 5. Identity v Role Confusion
Adolescence
Fidelity
13-18 yrs, puberty, teens*
 6. Intimacy v Isolation
Young Adult
Love
18-40, courting, early parenthood
 7. Generativity v Stagnation
Adulthood
Care
30-65, middle age, parenting
 8. Integrity v Despair
Mature Age
Wisdom
50+, old age, grandparents
Here it is recommended that you provide a summary of the base development of humans from birth to death. After a general understanding is reached by audience you can focus more on numbers 4 and 5

18. Developmental Goals (6 to 12)
Ages 6 to 12
To develop industry
Begins to learn the capacity to work
Develops imagination and creativity
Learns self-care skills
Develops a conscience
Learns to cooperate, play fairly, and follow social rules
Review what is meant by industry and what it means for a 6 to 12 year old. Consider what happens at next age level if this stage is not met or the prior stage wasn’t met

19. Normal Difficult Behavior Ages 6 to 12
Arguments/Fights with Siblings and/or Peers
Curiosity about Body Parts of males and females
Testing Limits
Limited Attention Span
Worries about being accepted
Lying
Not Taking Responsibility for Behaviour

20. Cries for Help/More Serious Issues Ages 6-12
Excessive Aggressiveness
Serious Injury to Self or Others
Excessive Fears
School Refusal/Phobia
Fire Fixation/Setting
Frequent Excessive or Extended Emotional Reactions
Inability to Focus on Activity even for Five Minutes
Patterns of Problem behaviors eg property damage
Discuss what is meant by some of these terms and try to get examples from the group

21. Adolescence

22. Developmental Goals
Developing Identity-the child develops self-identity and the capacity for intimacy
Continue mastery of skills
Accepting responsibility for behavior
Able to develop friendships
Able to follow social rules
Review examples of what it means to develop identity and capacity for intimacy

23. Normal Difficult Behavior
Moodiness!
Less attention and affection towards parents
Extremely self involved
Peer conflicts
Worries and stress about relationships
Testing limits
Identity Searching/Exploring
Substance use experimentation
Preoccupation with sex
Emphasize that these are all typical. Remind audience though that not all adolescents experience a challenging/bumpy ride

24. Just a joke, but good disussion

25. Cries for Help- Ages 13-18 Sexual promiscuity
Suicidal/homicidal ideation
Self-mutilation
Frequent displays of temper
Withdrawal from usual activities
Significant change in grades, attitude, hygiene, functioning, sleeping, and/or eating habits
Delinquency
Excessive fighting and/or aggression (physical/verbal)
Inability to cope with day to day activities
Lots of somatic complaints (frequent flyers)

26. Discussion
How do you make the distinction between the Concerning versus the Unconcerning?
Developmental stage, frequency, intensity, contextual factors, does it represent a change, impact on functioning, danger to self-others
Prevalence Quiz…..

27. Prevalence Quiz
One in ten children between the ages of one and 15 has a mental health disorder.
(The Office for National Statistics Mental health in children and young people in Great Britain, 2005)
Estimates vary, but research suggests that 20% of children have a mental health problem in any given year, and about 10% at any one time. 
(Lifetime Impacts: Childhood and Adolescent Mental Health, Understanding The Lifetime Impacts, Mental Health Foundation, 2005)
Rates of mental health problems among children increase as they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged
(Mental Disorder More Common In Boys, National Statistics Online, 2004)

28. Prevalence Quiz
One in two LAC children between the ages of one and 15 has a mental health disorder.
(The Office for National Statistics Mental health in children and young people in Great Britain, 2005)

29. Mental Health Distress Mental Health Disorder
Distress V Disorder
Mental Health Distress Mental Health Disorder

30. Mental Health Distress
Sadness Anger Worry

31. Common Mental Health Disorders
Behavioural Problems (e.g. ADHD)
Anxiety and/or Phobias
Depression
Suicidal Thoughts and/or Self Harm
Everything else (Psychosis, Eating Disorders etc)

32. Mental Health Distress
Distress is a normal human emotion and reaction to sadness or suffering Distress tends to disappear when the situation is relieved or the stressor goes away

33. Mental Health Distress can lead to a Disorder when:
The child has significant trouble with a stressful situation and his/her response is not appropriate Problems do not go away when the stressful situation is resolved The child cannot adapt to the stressful situation

34. Resilience
A child with a mental health disorder does not necessarily have poor mental health. When a child has strong character traits, they are able to build resiliency. Resiliency is the ability to overcome challenges and stress in a way that promotes health and wellness.

35. Community Sources of Resilience
One Good Adult –dependable, mentoring, guiding, befriending
Whole Team approach to mental health – ethos, curriculum, positive behaviour, anti-bullying
Network of Youth Services – confident, skilled and able to intervene

36. Community Sources of Resilience
Guide to the ‘Service Maze’ – a range of supports and able to find quickly
Distress, Self Harm and Suicide Prevention –staff are confident, able to help those in distress, including self harm and risk of suicide
Peer Help and Social Media – young people who share their problems enjoy better mental health; use opportunities to use peer support and social media.

37. Promote connectedness
Building Resilience
Focus on strengths
Identify what they are good at, recognise it, value it, celebrate it and build on it.
Promote connectedness
Positive impact of one supportive adult or one adult who a child knows is thinking about them even when they are not there. For most children that will be a parent or carer but for some it may be a coach or volunteer.
Become better observers
Observation is about noticing and reflecting on behaviour (the visible spectrum) in order to understand what is going on in the areas of our experience that are hidden from others. This includes, but is not confined to, observing children’s behaviour.
Model emotional regulation
The last thing you need if you are a young person who feels out of control and distressed is an adult who reacts to your high display of emotion with an equal level of anxiety and distress.

38. Remember…
You are not there to be the mental ‘disorder’ expert Your job is to support young people, not find labels You are a young person expert You can be a witness to fact – listen, observe, be the dependable adult, advocate Encourage help and support seeking

39. “Comparative studies have demonstrated
that exercise can be as effective
as medication or psychotherapy.”
Mental Health Foundation on depression (2010)
“Miracles are being achieved every day…
Football groups are saving lives.”
Participant in Time to Change focus group, for football
and mental health project attendees (2011)

40. "Working in football isn't always good for your mental health, but being physically active definitely is: that's why we're pleased to get behind SAMH's Get Active campaign". 
Danny Lennon, manager at St Mirren

41. “I worked in mental health for ten years… Out of all the
things that I did as a mental health worker, I found that the
benefits from football far outweighed anything else that I did.
I could see the progress that people made by being involved
in a physical activity.”
Rob Thomas, Mental Health Lead, Everton in the Community