Integrated Approach to Children's Health

COVID-19 has disrupted the lives of everyone, including children and young people, beyond recognition. So much so, that the proportion of children aged six to 16 with probable mental health disorders has increased from one in nine in 2017 to one in six in both 2020 and 2021. In this episode, we talked with Professor of Child and Adolescent Psychiatry, Tamsin Ford, Professor of Health Neuroscience Paul Fletcher and behavioural epidemiologist Dr Esther van Sluijs about growing concern over the recent and widespread deterioration of adolescent mental health and what can be done about it. 

We cover everything from the prevalence of mental health problems and eating disorders, sedentary behaviour and mentally passive activities, to how mental illness is represented in video games and how video games can be used to engage the public with mental illness in the right way. Along the way, we hear about mental health before and during the Covid-19 pandemic.

This episode was produced by Nick Saffell, James Dolan, Naomi Clements-Brod and Annie Thwaite. 

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Timestamps: 

[00:00] - Introductions

[01:05] - A bit about the guests’ research

[02:10] - How do we define and classify mental illness

[06:40] - Seeing mental health as a spectrum with wellbeing at one end and illness at the other

[09:00] - The criticism of the diagnostic process in psychiatry

[11:15] - The scale of the problem. How much mental ill-health is out there?

[12:10] - Concern around the fact that 1 in 6 people report experiencing a common mental health problem 

[13:40] - This deterioration spreads across groups, gender, and ethnicity. Children from families facing financial or food insecurity or poor parental mental health reported worse mental health. 

[14:50] - The role of the pandemic and the “medicalisation” of a normal reaction to a stressful and anxious situation.

[16:00] - Is it because more people are developing mental illnesses? Or is it because available services to help people have been reduced in recent years

[19:00] - Time for a recap! 

[25:30] - The role of sedentary behaviour, physical activity and screen-based activity and how all of this interacts with mental health

[27:00] - The effect of sedentary behaviours and screen-based activities that are mentally passive. 

[28:00] - The relationship between sedentary behaviour and eating behaviour

[29:50] - How has the pandemic affected physicality levels? 

[34:45] - The role of physical activity in mental health and wellbeing? 

[35:50] -  Interventions. Treating depression through behavioural activation, which is a form of cognitive behavioural therapy. 

[38:00] -  We are social animals. The active part of social media, keeping in touch and interacting with friends and family can be a good thing. 

[39:00] - Videogames, including Hellblade! And the representation of mental illness in video games. Paul’s experience of working with Ninja Theory and working with creative industries. 

[42:15] - Impact - the feedback from the community who played the game and the response to the representation of psychosis in the game. 

[44:20] - Mental health is stigmatised. What this game did is fantastic for sparking a debate around the subject of mental health

[45:05] - Time for another recap. 

[52:25] - How do young people talk about their mental health? 

[53:25] - The insidious nature of cyberbullying. The attention schools pay to mental health. 

[54:40] - How we communicate the importance of mental health to adolescents and how to change their behaviour.

[57:40] - Working with creative industries and how they can inspire academic studies. Is it possible to use video game design and big video game producers in mental health research? 

[1:00:00] - The limitations of research-based games designed by academics

[1:01:00] - Creative industries - the potential to create an immersive space that is safe to explore mental health issues.

[1:01:50] - Using VR in future studies and how pedometers or Wii fit can be easily cheated because of our natural tendencies. 

[1:04:00] - Plans for the Cambridge Children’s Hospital - integrating physical and mental health

[1:06:30] - How this would work for eating disorders. Eating disorders are some of the mental health disorders with the highest mortality rates, and by the time people are in hospital, they are often already really ill.

[1:08:00] - How this plays out on the wards. How physical health get separated from mental health. 

[1:10:30] - There is a lot of of attention on childhood obesity and eating behaviours and not enough focus on adolescent behaviour and the role of physical activity. 

[1:12:10] - Is physical activity high enough on the agenda? 

[1:09:20] - Physical activity got an elevation because of the pandemic and lockdown rules. We need to see how that impacts our future.   

[1:14:10] - Did the population recognise the benefits to both physical and mental health of the physical activity during lockdown? 

[1:15:20] - Let's break this episode down and close this thing out.

Guests

Professor Tamsin Ford  @Tamsin_J_Ford

Tamsin Ford is Professor of Child and Adolescent Psychiatry at the University of Cambridge. She is an internationally renowned Child Psychiatric Epidemiologist who researches the organisation, delivery, and effectiveness of services and interventions for children and young people’s mental health.

Professor Paul Fletcher @PaulPcf22

He is the Bernard Wolfe Professor of Health Neuroscience at the University of Cambridge and a Wellcome Trust Investigator as well as an honorary consultant psychiatrist with Cambridgeshire and Peterborough NHS Foundation Trust. Paul is very interested in how the mind can create a world in the setting of some mental illnesses and this has led him to a deeper consideration of perception and belief and a growing conviction that, even under normal circumstances, much of what we experience as objective reality has actually been processed, shaped and even fabricated by the mind. He’s also excited about the potential impact of games on cognitive neuroscience and psychiatry. Paul has worked with the Cambridge video game studio, Ninja Theory Ltd, in the development of Hellblade: Senua’s Sacrifice and continues to collaborate with them in exploring a scientific basis for using games to enhance mental health.

Dr Esther van Sluijs @EvanSluijs 

Esther leads the Behavioural Epidemiology and Interventions in Young People programme in the MRC Epidemiology Unit. This programme aims to develop and evaluate interventions to promote physical activity and dietary behaviour in young people, and use observational research to further understand where, when and how health promotion interventions in young people may be targeted. Guided by the ecological model of behaviour, various domains of influence are considered in both observational and intervention research. This includes psychological influences, as well as socio-cultural and environmental influences.

Is there any ‘further reading’ you can suggest to listeners?

NHS Mental Health of Children and Young People Surveys

https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england - this is the link to the national surveys of mental health – including the 2021 and 2020 follow up of 2017.

Child mental health in England before and during the COVID-19 lockdown

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30570-8/fulltext - here is an 800 word summary for those who don’t want to dig deep.

The health impacts of screen time - a guide for clinicians and parents

https://www.rcpch.ac.uk/resources/health-impacts-screen-time-guide-clinicians-parents