Children’s mental health

Why we focus on children’s mental health and behavioural difficulties

All children should have the same opportunities to be healthy and happy, no matter where they grow up. That applies to mental health as much as physical health. Positive mental health gives young people a sense of safety, helps them to build nurturing relationships, and enables the development of skills and coping mechanisms needed throughout life. 

Experiencing a range of emotions and behaviours throughout childhood is healthy. Feeling helpless and out of control is not. It is not unusual for young people to express their fear, sadness, frustration, or other strong emotions through their behaviours and interactions with others. This is especially true for young children who don’t have the language to communicate in any other way. 

But some behavioural difficulties are particularly distressing for children and the people around them, and can have a significant, long-term impact on their lives. Often the most distressing reactions are expressions of trauma, and besides the impact of the behaviours themselves the stigma many families experience can leave them feeling totally alone. 

As with so many health issues behavioural difficulties are strongly linked to inequality. Children growing up in inner-city areas like the London Boroughs of Lambeth and Southwark, particularly in families living with financial insecurity, are more likely to have mental health issues by the time they hit adolescence. NHS data tells us that children from families forced into poverty are over three times as likely to experience behavioural difficulties, but we know this is only half the story. Current data often focuses on the characteristics of the families themselves rather than the inequalities and discrimination that put such a huge burden on their mental and physical health.  

This inequality also means that families living in more deprived inner-city areas, especially those who are Black or from other minoritised groups, are less likely to get timely support that works for them, no matter how much they fight for it. 

Listening to children and their families has demonstrated the huge impact that behavioural difficulties can have on people’s lives. Often research and funding focuses on the impact on a child’s school attainment, future employability, and links to crime, which without the broader context reduces children to statistics and can feel extremely deterministic. 

The systems and practices we live with now were designed and can be redesigned, especially if we utilise the expertise of the people who depend on them. We want to focus our energy on reducing inequality so that the support around all families is protective, nurturing, and safe.

What do we mean when we talk about behavioural difficulties?

Some children experience persistent behavioural difficulties that are hugely distressing for both them and those around them. These young people may be diagnosed with a ‘conduct disorder’ which is a clinical term used to describe severe and repeated difficulties, for example breaking things around the house, hitting themselves and others, etc. The language around behavioural difficulties can be hard to navigate. If we think about behaviour as processing and communicating, we move away from the concept of behaviours that are ‘good’ and behaviours that are ‘bad’. We see them as indicators for how a child feels and a response to the world around them. 

Formal diagnoses and the language they use can be a point of contention among academics, clinicians, and families. Because some behaviours are an expression of distress or trauma, a ‘diagnosis’ can be seen as pathologising a natural emotional response – especially for those who experience racism and classism. It also puts a disproportionate amount of focus and responsibility on the child and their family rather than addressing the external and systemic factors contributing to their distress. For some however a diagnosis can be a relief, a formal acknowledgment of their child’s mental health and the first step to getting support.  

How we are addressing support for behavioural difficulties

Overview of the programme

It is vital that young people, families, and community-based networks lead the way in our understanding of this issue. During the first 18 months of the programme we have spoken to and partnered with Community Researchers, peer support groups, local families, schools, and advocates, who are sharing their expertise and helping shape the next 10 years of this work.  

What is clear from speaking to families in Lambeth and Southwark is that supportive, nurturing and safe environments are not equally accessible to all. We all need to play a part in addressing this inequality so that every child has the same opportunities to thrive

We know that early support is vital and can prevent difficulties from becoming more distressing as children get older, so we will also focus on early intervention and the support available to families with younger children. 

This is a complex issue that isn’t often talked about, and when it is the message is one of judgement. This creates stigma and isolates children and families from support. Reducing the stigma and improving understanding is crucial to any lasting change. We know putting the voices of families most affected by behavioural difficulties front and centre is the only way. 

The more we can build understanding of behavioural difficulties, not only as an issue of mental health but also of social and economic justice, the more we can start to shift the prejudices that leave some children and families without the support or protection they need. 

This work sits within the context of the cost of living crisis, systemic racism and other forms of oppression. The programme will look at ways to lighten the heavy load on so many families – from safe play areas to parent advocacy groups – and contribute to research we are leading across the organisation on the social and financial determinants of health. 

As an organisation that aims to tackle health inequality in inner city areas we believe every family should have equal opportunities to be heard and get the same access to services that work for them as early as possible. Some of the key questions we are looking to answer at this early stage of the programme are: 

• How do we increase understanding of, and reduce stigma around behavioural difficulties? 
• How can we ensure that all families get the support that they need when their children start to experience behavioural difficulties (including support for parents’ mental health)? 
• How do we make sure parents and communities play enough of a role in designing and providing support? 

Partnering with others

Families and young people who have been affected by behavioural difficulties are experts in what they need, but rarely get a seat at the table when it comes to shaping what needs to change. We are working closely with families, especially those in the local boroughs of Lambeth and Southwark, as well as the community and peer-led organisations who are already out there providing resources, advocacy and hope.  

Alongside looking at the support available for parents and families whose children experience behavioural difficulties, we will also work closely with primary schools and early years settings to get a better understanding of how they can provide as nurturing and protective environments for children as possible. We understand that many schools and school staff are already pushed to their limits, with huge amounts of pressure and competing priorities. But we also know that schools care deeply about the mental health of their pupils, so we want to understand how we can support them without creating a further burden on limited time and resources. 

This area of work used to be referred to as the Adolescent Mental Health Programme but is now the Children’s Mental Health Programme, to better reflect our focus on early intervention.