Analysis

Child support services often miss clues from past trauma, say mental health experts

Many mental health problems are linked to adverse childhood experiences, but young people are too often misunderstood by services that should be supporting them

One in three lifetime mental health problems are linked to adverse childhood experiences, but young people who display ‘difficult’ behaviour are too often misunderstood by services that should be supporting them

  • Children who experience adversity are statistically more likely to have mental health problems, become suicidal and die young
  • Challenging behaviour is often a normal response to what they have been through
  • At least 10% of children and young people are affected by poor mental health

Picture: iStock

Nurses and other professionals who work with children need a framework to understand when a child’s behaviour is a response to trauma, according to a new collection of papers published by the charity YoungMinds and Health Education England (HEE).

The papers, published under the title Addressing Adversity: Prioritising Adversity and Trauma-informed Care for Children and Young People in England, says young people who display ‘difficult’ behaviour due to trauma are too often misunderstood by services that should be supporting them.

There is evidence that children who grow up in difficult and complex circumstances are more likely to develop mental health problems, become suicidal and die young, the collection Addressing Adversity states.

Childhood events

The collection, funded by HEE, demonstrates the impact of so-called adverse childhood experiences (ACEs) and trauma on the developing brain.

1 in 3

diagnosed mental health conditions in adulthood directly relate to adverse childhood experiences.

ACEs are highly stressful and potentially traumatic events or situations that occur during childhood or adolescence, which require significant social, emotional, neurobiological, psychological or behavioural adaptation.

The authors say one in three lifetime mental health problems are directly linked to ACEs, which include abuse, domestic violence, bereavement, prejudice, poverty and inhumane treatment.

Judged and excluded

Young people who have experienced four or more ACEs are four times more likely to have low levels of mental well-being and life satisfaction, according to the report.

‘It’s important that clear information is in place to guide nurses and nursing staff when they are working with young people affected by trauma’

Fiona Smith

When these children display challenging behaviour, it is often a normal response to what they have been through. But they are often judged on it and are more likely to be criminalised or excluded from school, and less likely to receive the support they need, the reports say.

RCN professional lead for children and young people Fiona Smith says at least 10% of children and young people are affected by poor mental health, one of the biggest health problems in the UK.

Fiona_Smith©NC
Fiona Smith: Traumatic events can
severely impact a child’s well-being
Picture: Nathan Clarke

‘Traumatic events can severely impact on a child’s well-being, and children affected should have access to the right staff, such as children’s mental health nurses and school nurses, so they can address any potential or resulting mental health issues,’ she says.

Guide for nurses

She says that Addressing Adversity builds on a body of evidence that details the impact of adverse childhood experiences. ‘It’s important that clear information is in place to guide nurses and nursing staff when they are working with young people affected by trauma.’

YoungMinds head of policy Marc Bush says childhood adversity and trauma must be made a public health priority by the government.

He says all professionals who work with children, including NHS workers, teachers, social workers and the police, should receive training about the impact of trauma on behaviour.

The charity also wants to see local health commissioners introduce trauma-informed models of care, so that services can give effective support to young people who have been through traumatic experiences, without re-traumatising them or making them feel in danger.

Dr Bush says: ‘As a society we need to get much better at identifying when seemingly “difficult” behaviour may be a reaction to a traumatic event or a sign of emotional distress.

‘Professionals need a framework so they know how to look at what’s causing different behaviours and feel confident identifying when a young person may be reacting to trauma.’

‘As a society we need to get much better at identifying when seemingly “difficult” behaviour may be a reaction to a traumatic event or a sign of emotional distress’

Marc Bush

‘If a child becomes aggressive with a school nurse who is trying to give them an injection, that could be a response to violence or drug misuse in their family – but the nurse needs clear guidance on how to identify this,’ Dr Bush says.

Trauma-informed care involves listening to young people and understanding their situation and their needs, she says.

50%

One in two adults experienced at least one form of adversity in their childhood or adolescence.

This could mean working with gang members on the street, rather than expecting them to come to a counselling appointment at a GP surgery, or making it possible for a child who is self-harming to go to a quiet drop-in centre rather than a potentially triggering environment such as an emergency department.

Consistent new approach

‘Many professionals are already doing excellent work, but we urgently need a consistent new approach across the country,’ Dr Bush says.

‘If the government means what it says about prioritising mental health, it needs to face up to the fact that children in the most difficult and complex situations need far better support.’

CHUMS, the child and young people’s mental health and emotional well-being service, is a community investment company offering psychological support to thousands of bereaved children and those with mild to moderate mental health problems in Bedfordshire.

It offers interventions, including group workshops, telephone support, residential weekends, memorial services, a crisis response service, training for professionals and specialist traumatic loss interventions.

‘If the government means what it says about prioritising mental health, it needs to face up to the fact that children in the most difficult and complex situations need far better support’

Marc Bush

CHUMS chief executive Dawn Hewitt, a former nurse, says mental health nurses could also take the initiative to find out what support there is for bereaved or traumatised children in their areas.

‘Mental health nurses could do some research on the Childhood Bereavement Network website. There is a lot of provision across the UK.

‘If you can’t find anything, escalate your concerns up to managers, find the key people in your area and lobby them.

‘If there is no support for young people go and find some, or a get a group and do training together. Remember the voice of the young person, and ask what they would want or need.’

1.5

It is 1.5 times more likely that a bereaved child will be diagnosed with a mental health condition than their peers.

Corinne Harvey, a public health consultant in health and well-being at Public Health England (PHE), says she would like to see the concept of trauma-informed care become more commonplace.

Training programmes

Ms Harvey, who is a mental health nurse, says: ‘Introducing this care early in nurse training programmes would be a proactive thing to do. Undertaking continuing professional development in this area would ensure staff feel better-equipped to deal with people who have a range of life experiences.’

Ms Harvey co-authored a paper for Addressing Adversity looking at PHE’s ‘whole system approach’ to young people’s healthcare, and the range of things that might affect people’s development.

‘There is an increasing evidence base around the impact of adversity on the mental health of children and young people. Hopefully, this collection will raise awareness and help us feel more confident and knowledgeable in our work.’

Identifying adverse childhood experiences

Addressing Adversity gives examples of adverse childhood experiences such as:

  • Maltreatment, including physical, sexual, emotional and financial abuse or neglect
  • Violence and coercion, including experiencing or witnessing domestic abuse, assault, harassment or violence, sexual exploitation, sexually harmful behaviour, being the victim of crime or terrorism, experience of armed conflict, gang or cult membership and bullying
  • Prejudice, including discrimination, victimisation, hate incidents and crime, LGBT+ (lesbian, gay, bisexual, transgender/transsexual plus) prejudice, sexism, racism or ‘disablism’
  • Bereavement and survivorship, such as the death of a caregiver or sibling, including through suicide or homicide, miscarriage, acquiring or surviving an illness or injury, and surviving a natural disaster, terrorism or accident
  • Inhumane treatment including torture, forcible imprisonment, confinement or institutionalisation, non-consensual and coercive scarification (scratching, cutting etc.) and genital mutilation
  • Household/family adversity, such as living in poverty or care, or in a household with substance misusers, with those engaged in criminal activities, with those who are not supported to manage their mental ill health, and making sense of intergenerational trauma (such as experiences of genocide)
  • Adjustment, including moving to a new area where there are no social bonds, migrating, seeking and gaining refuge or asylum, and the ending of a socially significant or emotionally important relationship
  • Adult responsibilities, such as being the primary carer of adults or siblings in the family, taking on financial responsibility for adults in the household and engaging in child labour

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