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10-year strategy needs to reform approach to mental health and wellbeing

This opinion piece is about 7 years old

Tam Baillie, children and young people's commissioner in Scotland, says getting the balance right between universal and targeted service provision is key

The mental health and wellbeing of children and young people has been in the news a great deal recently.

The Scottish Government has already trailed announcements of an additional £150 million for mental health services, including children and young people.

I’m looking forward to the launch of their 10-year strategy to reform our approach to mental health and wellbeing. Getting the balance right between universal and targeted service provision is going to be critical.

The concept of resilience is worth considering in deciding how best to invest resources to improve mental health services.

Resilience is the ability of people to bounce back from adverse experiences – the inner strength that sees them through difficult times. Resilience in children is based on them having a positive view of themselves and having confidence to exert control and influence over their life and circumstances. While it is easy to describe, it’s more difficult to quantify the precise combination of the experiences which will develop resilience in children. Resilience is a notoriously slippery concept because sometimes the elements which develop resilience can also hinder it. A good example is to consider young carers and the impact of responsibility at a young age.

My office has just published research into the mental wellbeing of young carers called “Coping is difficult, but I feel proud”. The study is the first of its kind in Scotland to match young carers and their perceptions of their health and wellbeing, against a comparable sample of young people without caring responsibilities.

One of the – perhaps more surprising - findings was that some young carers had greater feelings of self-worth than their counterparts who do not have caring responsibilities. From that point of view, it looks like having some caring responsibilities is good for their mental health. On the other hand, those with the most demanding caring responsibilities are negatively affected; they are generally less happy, more stressed and are more likely to have difficulties with sleep.

Taken together it is possible to interpret the results as confirmation that a measured amount of challenge develops resilience, but too much, depletes it. We need to respond to our young carers in the way that best supports them. To do that we need to know if they have caring responsibilities, and also something about the nature and extent of those responsibilities in order to assess the potential impacts on the young person.

The illustration of resilience in young carers usefully informs approaches in providing for their mental health requirements. We need universal screening to identify which young people have caring responsibilities and we also need specific services to assist those with the heaviest caring responsibilities. Getting the balance right is the challenge of using the additional resources wisely.