Guest editorial

Citation

Macintyre, A. (2016), "Guest editorial", Journal of Public Mental Health, Vol. 15 No. 1. https://doi.org/10.1108/JPMH-02-2016-0010

Guest editorial

Article Type: Guest editorial From: Journal of Public Mental Health, Volume 15, Issue 1.

Anna Macintyre

Anna Macintyre is Editorial Assistant at the Journal of Public Mental Health and Research Associate at the Centre for Health Policy, University of Strathclyde, Glasgow, UK.

Welcome to this curated special issue of the Journal of Public Mental Health. For this themed issue “Childhood, parenting, families and young people”, we are pleased to have invited specific papers from a range of perspectives on the mental health and wellbeing of children and young people. With an intention to move beyond an exclusive focus on mental health disorders and clinical care, we hope that the articles we have invited might stimulate wider debates about the role of public mental health in this area.

We wish to highlight the importance of prevention (Patel et al., 2007; Kieling et al., 2011; Lewis et al., 2014), with the caveat that this can be constructed in diverse ways and related to different stages in the life course. This might include focus on intervening very early in life, pre-conception and pre-natally (World Health Organisation, 2014; Lewis et al., 2014). To provide a perspective on these issues we invited Sue Gerhardt, author of “Why Love Matters” and “The Selfish Society” (Gerhardt, 2004, 2010), to offer a personal viewpoint on the early years and the consequences of this critical period for later emotional health. Gerdhart’s viewpoint provides readers with an overview of some the literature from neuroscience relevant to understanding the developing brain, and integrates this with her reflections on the implications for policy decisions about support for parents and the early years. This offers a thought provoking angle on preventative approaches, and adds to our understanding of the importance of very early childhood development for public mental health.

Socioeconomic inequalities in child and adolescent mental health and wellbeing form a key theme of this edition. There are clear inequities in child and adolescent mental health (World Health Organisation, 2014), yet these social inequalities are arguably not given sufficient attention, or addressed by interventions (Collinshaw, 2015; Welsh et al., 2015). In this issue, an extended invited guest editorial by Roberts et al., at the Institute of Health Equity, provides a comprehensive overview of socioeconomic inequalities in child mental health, with a particular focus on the UK. The authors emphasise that it is those children who are most socially and structurally disadvantaged who are most at risk of poor mental health, and suggest possible pathways, which might explain this vulnerability. Crucially, Roberts et al. propose key targets for action including tackling income inequality, and intervening very early in life.

Incorporating an epidemiological focus, the significance of adequate data on the mental health and wellbeing of children and young people cannot be underestimated (Public Health England, 2015; Health Select Committee, 2015). This comes into stark relief at a global level when grappling with whether or not there is an increasing worldwide prevalence of child and adolescent mental health problems (Collinshaw, 2015; Bor et al., 2014). In one of our research papers Neilsen et al. consider the measurement of positive mental health, and the extent to which socioeconomic inequalities in high and low levels of positive wellbeing are evidenced in a sample of Danish young people. The authors argue that the socioeconomic distribution of high levels of positive mental health is different from that of low levels of positive mental health. This may stimulate interesting debates regarding the impact of inequality on child wellbeing.

What may be indisputable is that there is considerable unmet need (Health Select Committee, 2015; CentreForum, 2014; Patel et al., 2007). Indeed in the UK there is concern that Child and Adolescent Mental Health Services are under significant pressure (Health Select Committee, 2015; Anonymous, 2015). Furthermore the recent ADOCARE consortium highlighted the limitations of the provision of mental health services for adolescents across Europe (Coppens et al., 2015). This urgency for increased resource is complicated by the lack of a sound evidence base for interventions on which clinicians can draw (Patel et al., 2007; Kennedy, 2015). Poor mental health in young people can be understood as a response to stressful circumstances, disadvantage or trauma, rather than a medical disorder (World Health Organisation, 2014; Anonymous, 2015). At the same time it is exactly these experiences which are risk factors for the development of mental health problems later in life (World Health Organisation, 2014; Patel et al., 2007). The reality of clinical practice must negotiate such tensions.

Responding to these challenges includes the development, and evaluation, of non-clinical approaches which promote and support child and adolescent wellbeing (Lewis et al., 2014; National Institute for Health and Care Excellence, 2013) and which can offer protection against the impact of negative experiences. Contributing to this literature, in one of our research papers, we invited Harkins et al., to report on their evaluation of “The Big Noise”, a community based orchestral programme, and to consider the implications of this intervention for child and adolescent wellbeing specifically. This provides readers with an example of an innovative programme, and an account of a wide range of methodologies employed to study the impacts of this complex public health intervention. In our final invited research paper, Parchment et al. describe a youth development intervention. In this exploratory study, the authors argue that the number of sessions attended, and the young person’s attainment prior to the intervention are predictive of educational outcomes afterwards. The authors make a case for the link between attainment in high school, and health outcomes, and describe an example of a preventative intervention for adolescents who may experience particular disadvantage.

We conclude with a viewpoint on policy. In the context of the recently launched Sustainable Development Goals we invited Baltag et al. to offer policy analysis from a global perspective. The authors draw upon a range of recent global policy initiatives, particularly the global strategy for women’s, children’s and adolescents’ health, and pick out those aspects of particular relevance for adolescent mental health. For example, they highlight a World Health Organisation review of policy documents and identify countries which have included specific aims relevant to adolescent mental health in their policies, such as the provision of “child and adolescent friendly” services or appropriate transition to adult services. However, the extent to which these objectives have been adequately tackled in reality may be debated.

In the realm of “childhood, families, parenting and young people” there are clearly diverse roles for public mental health, including recognising the social and structural sources of distress in childhood, as well as responding to these determinants in preventative ways. Several of the papers we have included in this issue highlight that considerable challenges lie therein. However, the value of a coordinated public health response, for future generations of children, is beyond doubt.

Acknowledgements

The author would like to thank Professor Woody Caan and Lee Knifton for their feedback on earlier drafts of this manuscript.

References

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