By Dr Clare Jolly and Dr Gabriele Cammarata
Children’s mental health and wellbeing is an integral part of their overall health. The Gibraltar Young Minds (GYM) core team are part of a range of services – Schools, Allied Health Professionals, Health Visitors, Care Agency, and many other statuary and voluntary services which are increasingly working together to promote and intervene to support good mental health for our young people – together we form the Gibraltar Young Minds Network.
These universal services help young people learn about their emotional health and well-being and can guide young people to self-help and resources. For example, more and more schools now teach ‘emotional regulation’, which years ago would have been in the province of mental health specialists. When we understand ‘emotional regulation’ as ‘understanding what feelings are, and how to deal with them’, parents and professionals often feel less frightened about helping children in this way.
Half of all mental health problems emerge before the age of 14.
Half of all mental health problems emerge before the age of 14. Up to half of all difficulties experienced by young children and adolescents will resolve themselves in time, or with exercise, eco-therapy, spending more pleasurable time with caregivers and/or with peers.
Sometimes problems tend to persist and might need also professional help (Psychotherapy, CBT, Family Therapy, Drama-therapy, Psycho-education). If this is the case, support may be needed from the core GYM team, which comprises two Clinical Psychologists, a Psychiatrist and a Specialist Nurse. Usually this will be a piece of work, using techniques from Cognitive Behaviour Therapy, Systemic Family Therapy or other models, to help the young person develop skills that they can use over the course of their lifetime. Often these skills can be learned in around six sessions, and the young person feels well enough at this point to practice them at home to keep themselves well.
Once skills are learned, once again we may work with other adults around the young person (e.g. in school) who can help them practice their techniques. Occasionally, young people have more severe and/or enduring mental illness, and may need to be seen for longer. If the case is complex, or there is a need for medication, the psychiatrist may be involved.
Some older children attend on their own. Other young people may benefit from working with other members of their family present. For some young people – for example those who find it difficult to engage with a talking therapist – they might not attend at all; the work might take place solely in the form of advising the child’s primary worker and/or family, who can instigate, or continue the work.
This way of working, which has been gaining support for many years, is called ‘Empowerment’, and is now in the evidence base. There is more and more evidence for the benefits of training, parents, professionals, schools, and others in the child’s life, to be able to conduct and/or help maintain mental health interventions. One benefit is that as trusted adults who already have a relationship with the young person, they are more likely to be credible to the child. We have lots of resources, particularly online advice and exercises that we can share with families and staff, and we are also initiating a ‘books on prescription’ scheme whereby families will be able to borrow books that may help them.
We are able to reduce waiting lists and ensure those in most need can be seen quickly.
Each week the core GYM team meet to discuss which approach might be helpful for the young people referred to the service. We also work with agencies such as the Care Agency and education around support for whole family issues. By working in this way – giving the child tools to use over a lifetime, and supporting others to help the child – we are able to reduce waiting lists and ensure those in most need can be seen quickly. It also means that those who might have needed a mental health service repeatedly throughout their lives, can often learn to manage and prevent symptoms, and reverse this pattern.
We know that half of those who complete treatment with a qualified professional, recover.