Children's mental health

Growing stronger together: insights into children’s healthy social development

A review of national data, academic research, and families’ experiences to understand how the policy landscape around children’s mental health and social development can be more equitable and impactful

Introduction

In 2022, our children’s mental health programme commissioned Centre for Mental Health to help us better understand the policy and commissioning landscape around children’s mental health, social development, and behaviour. We wanted more insight into what existing, traditional research says about child social development, how this informs policymakers’ decisions, and how the experiences and expertise of families might shift which policy ‘solutions’ are prioritised.

In our child and family ethnography No Timeouts, which we published in 2021, we heard from lots of young people and parents how existing methods of support were either inaccessible or ineffective. We also learned about the huge impact social and environmental factors have on children’s physical and mental health, from the stress of temporary housing to the trauma of racism. The ultimate aim of this new research is to identify new or existing policy areas that could more adequately address the inequalities and social injustices that cause so much distress to children and lead to much higher rates of mental health and behavioural issues. We focused on learning as much as we could about our local boroughs of Lambeth and Southwark, with the understanding that much of the insight is relevant to any inner-city area and therefore to national as well and local policy.

For this research Centre for Mental health brought together:

publicly available data for relevant local risk and prevalence information
a literature review on general risk and protective factors and evidence of the efficacy of various existing interventions
a series of interviews and focus groups with children, parents and carers and relevant professionals in Lambeth and Southwark
a summary of possible policy opportunities to encourage improvements in these boroughs and beyond

On this page, we have pulled out key parts of the research that are most relevant to our areas of focus as a programme. These mostly centre on the external causes of distress that stem from financial inequality – how an unfair distribution of resources means some children do not have access to the things we all need to be healthy and hopeful. You can download the full report for all findings and recommendations.

Download the report

Read 'Growing Stronger Together'

Key insights

Centre for Mental Health conducted focus groups with

16 parents and carers from Southwark
Six parents and carers from Lambeth
Eight children aged 10-13 years from Lambeth

The group was a broadly representative ethnic mix with a majority from Black, Latin American, and Middle Eastern backgrounds, as well as several white British parents and carers.

There were also semi-structured individual interviews with thirteen professional stakeholders. These stakeholders were responsible for political oversight, commissioning and delivery of maternity, early years, primary and secondary school, substance misuse, psychiatry, psychological counselling, mentoring, criminal justice diversion, sports, arts and other services for children and young people in both Lambeth and Southwark.

There are some common themes that both families and professional stakeholders spoke to in their discussions with the researchers. Some of these insights are also reflected in the data and studies gathered during Centre for Mental Health’s literature review. We know from other projects, speaking to families and professionals about the evidence base around these issues, that traditional academic evidence can be at times limited and at its worst stigmatising, if it does not incorporate the lived experience and expertise of the children and families it ‘studies’. For this reason we have pulled out the academic findings that are echoed and/or affirmed by families and local stakeholders.

The distress of poverty

Families talked about or were described as not having enough money for the basics like quality food or heating. Many talked about families being stressed and in ‘survival mode’ – having to work double shifts in various jobs and getting very little time to be at home with children.

“Child and parent poverty definitely play an important role. When families do not have the money and time to be together, doing constructive activities, eating healthily in a warm and secure home that has a big impact on their relationships and how they learn, interact, and get on in the world.” (Professional stakeholder)

“All of these nine young men [we worked with] knew their dads and they lived at home but their dads worked all hours, cleaning and things like this. But they were absent because of work. I can remember mums getting night buses for work and eight-year-olds having to get their siblings ready for schools.” (Professional stakeholder)

“We had one little girl who was clearly having a really hard time controlling her behaviour recently. So, we pulled her out of her class and talked to her and she told us that there was no one at home to ask her how her day was. Basic needs like that were not being met because her parents were out at work all the time.” (Professional stakeholder)

Parents, carers and many professional stakeholders described pressures of swimming against the tide as they tried to adequately support children’s healthy social, emotional, and educational development in face of wider systemic and structural risks such as low pay, insufficient benefits, and crippling childcare costs.

“Obviously central government decides things like child benefit, family tax credits and funding to services that has a big impact on child poverty and other drivers of healthy social development and behaviour.” (Professional Stakeholder)

“Child poverty reduction is a really important part of that, and [we…] were the first borough to become a Living Wage Place increasing the number of employers paying above poverty-level wages. We are also one of the few boroughs that provides universal free school meals for primary children and free gym and swim sessions in our leisure centres.” (Professional stakeholder)

“Work is a problem – childcare is so expensive that it isn’t possible to work and have young children. They stress you to work and then it stresses you to work and pay for childcare. If childcare was free, then I could work more but I just can’t afford it and then you are made to feel like a scrounger.” (Parent/carer)

Academic literature tells a very similar story. In some studies (Gutman et al., 2018) the negative impact of poverty on children’s behavioural and emotional wellbeing is visible early in life. The Scottish cohort study sees this risk becoming more pronounced throughout childhood (CYL) (Bromley at al,. 2010). Some studies have highlighted a stronger association between socio economic risks and the emergence and persistence of severe behavioural problems and hyperactivity than is the case with emotional problems (Amone-P’Olak, Burger, Huisman, Oldehinkel, & Ormel, 2011; Bolger, Patterson, Thompson, & Kupersmidt, 1995).

A 2021 European longitudinal study also highlighted a range of other risks to early healthy child social, emotional, and behavioural development. For example, longer sleep duration, healthy diet, and higher family social capital (measured in terms of how often a parent had contact with family and friends) were associated with reductions in child social, emotional and behavioural difficulties. The same was seen in another study where exposure to indoor pollution and car traffic density (during pregnancy) were associated with increases in the prevalence of distress, emotional and behavioural difficulties (Maitre et al., 2021). These are all risks that are hugely exacerbated for families who are forced into poverty, particularly those in unsafe housing.

The impact of insecure and unsafe housing

Though this is closely linked to the distress of being forced into poverty and ‘survival mode’ that many participants talked about, housing specifically came up again and again as a major risk factor.

Particular causes of fear and stress included:

limited availability of affordable social housing
the inflating rental housing market
the persistently substandard conditions in some accommodation housing children
many families living in overcrowded houses

“Housing is a major problem – we have children who share a bedroom with three or four siblings – how are you able to find yourself in that environment? People need a space to grow and find themselves.” (Professional stakeholder)

“I asked [the] council to come in and take measurements – they told me to change [my] living room to bedroom. [The living room is…] the only sanctuary we have to enjoy family time – they want us to convert it into a bedroom.” (Parent/carer)

“He doesn’t have his own space. [And he’s…] doing A levels. Studying on the bed. The living room is stuffed.” (Parent/carer)

“[ We are…] currently living in two bedrooms and there are seven of us. [I…] have done all I can to approach the council to recognise that. I have medical issues. [They…] have categorized us as needing to move but [it’s] been two years. My children [have been] impacted by mould. [I …] have an asthmatic child [who has been] in and out of hospital. These things affect the health of my children.” (Parent/carers)

“Say they have damp we signpost [families] to the environmental health team; but gone are the days that we have a big influence when we used to write letters pointing out overcrowding and damp and the council would act.” (Professional stakeholder)

“We recently worked with a 10-year-old girl with attention deficit hyperactivity disorder who was throwing things out of her bedroom window – she was sent to Divert [a criminal justice diversionary service] through the youth justice process because of her behaviour. When we asked her why she was throwing things out of her window it became clear it was a cry for help because her room was damp, mouldy, with mice running around. No authority dealt with the housing issues that was driving her to behave that way until she came to us via the criminal justice system.” (Professional stakeholder)

One meta-analysis pulled out in the literature review noted an incremental increase in the likelihood of ‘severe and persistent behavioural problems’ developing the more a child and family had to move from one property to another. Moves of more than 10 km and moving to areas of higher socioeconomic deprivation were particularly associated with increased social and emotional difficulties (Nathan et al., 2020).

No safe spaces to play or make friends

The children who took part in the focus group talked a lot about the importance of green spaces, fun activities, and making friends. Parents also talked about the importance of safe, supervised spaces for children to spend time, away from social hazards, traffic, and pollution, especially when housing was cramped or unpleasant in other ways (cold, mouldy etc).

“We live in a small flat with no green space and here we get access to the garden, the sports facilities and it is safe with a fence and supervision”. (Parent)

“We need safe, free, well-resourced places to go, secure green spaces, youth clubs, trips away and enrichment opportunities”. (Parent)

“Sometimes people try to talk to me on the way to tutoring, there’s lots of boys in gangs close to school – I keep my distance as I’m scared they would do something. It worries me a lot”. (Child)

“As well as not having access to basic outdoor spaces, lack of any disposable income also means not all children get access to the same fun or developmental activities. [The] economic aspect of it is really important because sometimes […] we don’t have the money or the means to give them good holidays. We don’t have the means to take them to the cinema etc. Then you see other kids that they do that and that affects you as well.” (Parent/carer)

“We can’t afford leisure centres because even though the child price isn’t too bad you have to play full price to accompany them”. (Parent/carer)

One review paper found that interventions in underprivileged neighbourhoods could reduce health risks to children, especially in families that did not have access to vital resources (Sellstrom et al., 2006).

The trauma of racism

Racial injustice and racial trauma came up repeatedly as impacting children’s healthy social and behavioural development during the researcher’s discussions with professionals.

Day-to-day microaggressions and concerns about a pervasive lack of racial justice were seen as an ‘additional layer of discrimination’ or an unacknowledged adverse childhood experience that could wear away at children’s, parent’s and carer’s well-being over time. One academic the researchers interviewed, who specialised in the impact of racial trauma, talked about the psychological pressure and distress felt by Black and Brown parents who needed to routinely ‘upskill’ their children to navigate racism. This includes preparing them for day-to-day encounters that are likely to involve multi-layered experiences of racism, fear, threat and being treated differently or unfairly. For some children, this preparation started as young as age five.

“It’s what parents are doing and have been doing for many generations.” (Professional stakeholder)

“When we’re talking to families you can’t disentangle what parents saw, how they experience racism, and on the other hand children’s experiences – both parents and children raised racism as an issue and both parties are affected by each other’s experience of racism. You can’t really disentangle it. It’s about the whole family living in that system…” (Professional stakeholder)

“It is racist. Why does our mental health system disproportionately confine so many Black people? Why is SEND diagnosis so disproportionately heavy for Black people? Black people get followed round shops, stopped, and searched, excluded, locked up – no wonder there is a greater a number who feel paranoid.” (Professional stakeholder)

There was a lot of concern among those interviewed that ‘evidence-based interventions’ tended to be those designed by white professionals and academics and evaluated mainly with white families. It was also recognised that Black and Brown people are underrepresented in the professionals who work in statutory services.

“It shows that because of systemic racism, and the poor experiences it creates for some groups, they are, understandably, more reluctant to engage with official services, go into official buildings, structures, and bureaucracies. Our Black families often have heard negative stories of care, they feel they don’t have the right to speak up or complain, they sometimes feel dismissed and not hav[ing] their concerns listened to.” (Professional stakeholder)

“There’s a real energy to talk about this. Because it’s not talked about within privileged white systems. […] There’s one queue for them and another queue for us [leading to Black people] not bothering to access help when you don’t really believe that they’re going to help you.” (Professional stakeholder)

“A lot of people delivering interventions have their biases.” (Professional stakeholder)

The pile-on of distress that comes from intersecting experiences of discrimination was a recurring theme, particularly in relation to the way racism intersects with being forced into poverty.

“Our Black children are disproportionately more affected than others – they are more likely to live in poverty, more likely to be homeless or in temporary housing, more likely to be stopped and searched and criminalised, more likely to be labelled with a SEND or other diagnosis. All of this effects their behaviour and their trajectory, they are more likely to be excluded, end up in the criminal justice system and be hurt than any other group because of racism.” (Professional stakeholder)

“Conscious and unconscious bias means that Black girls in particular are subject to adultification, where they are treated as if they are grown ups not the children they are, Black children are feared and treated as if they are a threat, they are over-disciplined and under nurtured, they are sent on a path of being (mis)diagnosed, treated unfairly, excluded, imprisoned and medicated. The history of their ancestors is neglected and talked down whilst the Empire, built on Black slavery, is celebrated. Class intersects with race and these Black children are, not coincidentally, far more likely to live in deprived circumstances. Not only is the UK systemically racist, but it is also systemically classist, and these things intersect. Poverty is what drives these poor outcomes and wealth is deliberately unfairly distributed. All we can do is raise awareness of these issues and try, with the small levers we have, to show that you can make a difference if you take a different approach.” (Professional stakeholder)

In 2023, Global Black Maternal Health drew together further evidence of the particular impact of pollution in the context of health inequalities affecting Black mothers during pregnancy, and as a result their children.

We keep blaming the children

Although there was broad acknowledgement that the risk factors around children’s mental health and behaviour are complex, many participants noted that the main focus was too often on the factors centred within the child, or within their family. It was agreed that actions supposedly designed to promote children’s healthy social development usually placed the blame with them, ignoring the ‘toxic’ impact of inequality and environmental stressors.

“An excessively biological understanding of what is going on is unhelpful in my view. It obscures the social and environmental factors.[…] We trap people in a diagnosis and system, and we lie to them – we tell people at the age of 12 they have a diagnosis that it is biological and therefore difficult to change. All of this stuff is down to the environment people are in and what they have experienced.” (Professional stakeholder)

“We must always remember that these children and young people do not exist in a vacuum their behaviour is largely determined by the circumstances at home, in their communities and families. If children live in poverty, in poor housing conditions, witnessing or being subjected to domestic or community violence and other traumas then that very often does come out in their behaviour in schools and other settings.” (Professional stakeholder).

There is now a wealth of academic evidence that children who present with so-called ‘severe and persistent behavioural problems’ are more likely to have been exposed at an early age and over a prolonged timescale, to many more risk factors, developmental traumas, or adversities (Deatewr-Deckhard et al., 1998; Murray and Farrington, 2010; Gutman et al, 2018; Gutman, 2019.)

What’s next?

It is both illuminating and upsetting that we see the same themes come up again and again when speaking to children, families, and professionals about young people’s mental health. As we enter an election year it’s crucial that we all focus our efforts on addressing the systemic inequities that cause so much harm to children in our local boroughs and across the country.

We are pleased to see so many of Centre for Mental Health’s policy recommendations focusing on these socio-economic health inequities like poverty and housing. You can see their full list of recommendations in the report. We need policy makers to understand that without a commitment to anti-poverty any children’s mental health intervention will be a sticking plaster at best.

We have identified four key focus areas from this research that will continue to inform our work:

1. A focus on prevention by prioritising anti-poverty

Centre for Mental Health’s report highlights the significant impact of poverty on children’s mental health and social development. Families and professionals spoke about limited access to quality food, heating, and developmental activities. These findings strengthen our belief that at the core of any strategy to tackle poor mental health in children we need ambitious policies that address child poverty – both locally in Lambeth and Southwark, and nationally.

We are committed to funding work that moves us towards a fairer distribution of wealth and resources for families most impacted by inequality.

2. A focus on healthy and secure homes for children

In addition to poverty, the report highlights the negative impact of insecure and unsafe housing on children’s development. Issues such as limited availability of affordable housing, substandard living conditions, overcrowding, and the psychological distress caused by housing-related challenges all contribute to poor mental health in children.

Understanding that a child’s home is one of the most important factors in promoting good mental health, we will be working with partners and institutions to find more ways for families to thrive in suitable, affordable, and safe housing.

3. A focus on changing the story

We often see that professionals, institutions and interventions aiming to support children’s mental health locate the ‘problem’, for example ‘behavioural difficulties’, in the child themself. However the report by Centre for Mental Health, and much of the lived-evidence we have gathered from families over the last two years, shines a light on the effect of environmental

factors, such as the trauma of racism and racial injustice as a significant factor affecting children’s healthy social and behavioural development.

Impact on Urban Health will continue to prioritise changing the way we talk about, and as a consequence understand, children’s mental health. This includes repeatedly bringing the conversation back to social inequities and systemic racism, and supporting community-led organisations and families to tell their own stories.

4. A focus on co-design and listening

Whenever we listen to people most affected by structural inequities, we find that they are the ones who understand the challenges best and are therefore uniquely equipped to be the source of the solution.

We will continue to honour this lived evidence and embed it in our work, whether through our Partner Group or upcoming Parent Panel, or in future work where we are determined to centre the voices that matter the most – that of children.

Find out more

If you would like to find out more about our children’s mental health programme or get involved in any projects please contact our Programme Director.

Contact Kamna