on defining unusual behaviour

Sombody jumping up and “down wi’ mad clothes .... sombody walking about wi’ slippers on” on counselling

I would nae get a “counsellor they’d give you pills an’ all that then put you in a mental home” on depression

Really sad and like “everything is so awful and it will never get better, but it always does” on feelings of sadness LISTENING Well, I think most folk have “a little wee place to go, like outside or in a cupboard, to CHILDREN probably just go there to think about it or cry or something like that, but just to think about it mainly ” Clare Armstrong, Malcolm Hill & Jenny Secker on feeling mentally healthy Centre for the Child & Society you need to tell people “your problems and not just University of Glasgow keep them all... yeah because it would drive you mad if you had problems and you couldn’t tell any one” on anorexia

I don’t think she’s mentally “ill but she’s got a psychological problem with the way she feels about herself and the way she looks BRIGHT FUTURES ” Promoting Children and Young People’s Mental Health Acknowledgements

We would like to thank all those who were involved with this study, particularly the young people, their parents and the staff at the various schools and projects we visited.

We would also like to thank the advisory group for their words of wisdom at the different stages of the study.

Finally, thanks to Elaine Cross and Lyn Hilley for helping with the transcribing.

The Mental Health Foundation is very grateful to all those who have generously supported the Bright Futures Initiative in particular the Baily Thomas Charitable Fund. LISTENING TO CHILDREN

Contents

Executive Summary ...... 1 Chapter 6 ...... 45

Positive mental health and mental illness: Chapter 1 ...... 7 the views of young people living with a mentally ill adult Introduction Feelings The young people’s understanding of positive mental health Chapter 2 ...... 10 Promoting positive mental health Dealing with negative feelings Research design Perceived differences between adults and young people The research methods Unusual behaviour Recruitment of research participants The young people’s understanding of mental illness The research process Attitudes towards mental illness Methodological issues Helping with mental health problems Data analysis and presentation of the research findings

Chapter 7 ...... 53 Chapter 3 ...... 17 Conclusions and recommendations Positive mental health and its promotion: the views of young people from the mainstream References ...... 59 Feelings The young people’s understanding of positive mental health Factors which contribute to young people feeling mentally Bibliography ...... 62 healthy and unhealthy Promoting positive mental health Dealing with negative feelings Appendix 1 ...... 63 Perceived differences between adults and young people Project Outline

Chapter 4 ...... 27 Appendix 2 ...... 64

Perceptions of mental illness: Consent form and letter to parent/guardian the views of young people from the mainstream sample Appendix 3 ...... 66 Unusual behaviour The young people’s understanding of mental illness Semi-structured interview schedule Attitudes towards mental illness Helping with mental health problems Sources of information about mental illness Appendix 4 ...... 70

Vignettes Chapter 5 ...... 38

Positive mental health and mental illness: Appendix 5 ...... 71 the views of young people with identified problems Self-completion forms

Feelings Young people’s understanding of positive mental health Appendix 6 ...... 72 Promoting positive mental health Dealing with negative feelings Codes of practice Perceived differences between adults and young people Unusual behaviour Young people’s understanding of mental illness Attitudes towards mental illness Helping with mental health problems Sources of information about mental health problems LISTENING TO CHILDREN

Executive summary

Listening to Children is a qualitative study exploring the Recruitment of research participants attitudes and perceptions of young people aged 12-14 years about mental health and mental illness. A sample of 169 The mainstream sample was recruited through schools young people was drawn from a range of social and ethnic and minority ethnic community groups. In order to backgrounds across Scotland - mainstream schools, youth approach individual schools permission from each projects, residential schools, community groups and young education department was sought and in some instances carers groups. Respondents took part in either a focus they also suggested schools which we could approach. group discussion or an individual interview which were all Community groups were approached directly as a result recorded with their permission. A semi-structured interview of previous contacts through other research projects. schedule was used in both cases covering issues concerned The “special” sample was recruited via a number of with positive mental health and mental illness. The means: young people with identified problems were computer software package NU*DIST was used to analyse largely recruited from two schools that the Centre had all the data. worked with in the past. Additionally one rural youth The research team was based at The Centre for the Child project participated but only yielded a small number of and Society at Glasgow University and closely liaised with interviewees and a community based school funded by members of staff at the relevant schools and projects. the Catholic church which the Centre had also worked with previously. Young people living with a mentally ill parent were recruited through young carers projects and Research design user groups.

The mainstream sample consisted of 145 young people from a variety of social and ethnic backgrounds who attended mainstream schools in rural, suburban and inner city areas of Scotland. The two smaller sub-samples consisted of: 16 young people with an identified psychological, emotional and/or psychiatric problem; and 8 young people living with a mentally ill adult.

The research methods

A semi-structured interview schedule was developed based on the original themes identified at the proposal stage, and a series of changes and modifications made after piloting. The final tool allowed the young people to discuss a wide range of issues which were of particular importance to them and ensured a degree of systematic data collection in each interview. In addition to the semi- structured interview schedule, brainstorming and vignettes were used as additional methods for collecting data.

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Main findings

1.0 Positive mental health 3.0 Dealing with negative feelings

Definitions were mixed. Some respondents focused on Two distinct mechanisms: mechanisms for coping with the terms mentally and healthy. Those who understood sad feelings and mechanisms for coping with angry the term viewed it in terms of either the absence of feelings. Both were reactionary strategies. In contrast to illness or in more positive terms. responses to anger they spoke of internalising reactions when they felt sad or depressed. Boys appeared to resort Factors which caused positive mental health were: to this more than girls. family; friends; personal achievement; feeling good about yourself; having people to talk to; pets; presents and Surprisingly perhaps, young people did not see the use having fun. of drugs or alcohol as a particularly effective means of coping with negative feelings, although they Mentally unhealthy was defined by words such as: sad; acknowledged that young people participated in such depressed; bored; worried; troubled; lonely; angry; activities. scared; rejected and confused.

Factors which caused people to feel mentally unhealthy were identified as: death of a family member, friends or 4.0 Perceived differences between pets; stress of exams; break up of relationships; peer adults and children pressure; falling out with friends; divorce or parents fighting and boredom. There were a number of similar factors which influenced the mental health of adults and children. However, additional ones which only affected adults were: job 2.0 Promotion of positive mental health insecurity; financial worries and worries about children.

It was generally assumed by the young people that their Boredom was a major factor in contributing to some of problems were more trivial than adults and it was more the negative feelings already discussed. Therefore more expected for young people to have “teenage problems”. activities were seen as an important way of attaining positive mental health. Like young people, adults were thought to talk and bottle up their feelings. The main differences were: who adults Adult intervention was seen as important. Although there talk to and their use of alcohol as opposed to drugs. were different mechanisms all amounted to making young people feel safe both physically and emotionally.

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Perceptions of mental illness

5.0 Understanding of mental illness 8.0 Helping with mental health problems

An eating disorder was widely recognised and labelled as Formal and informal types of intervention were identified anorexia, but in a number of cases respondents were depending on the type of illness and the age of the unsure as to whether it was a mental illness. A large individual. Informal types were seen as more appropriate number preferred to refer to it as a mental or for young people even if they were equally as unwell as psychological problem. an adult.

Most did not identify depression as a mental illness and More formal types of intervention were identified as saw it as a normal feeling, although some felt the degree hospital, medication and talking to professionals. of severity and chronicity could determine whether it Medication was said to be a way of calming people down was a mental illness. and controlling them. Anti-depressants were referred to several times but they were seen as a universal cure-all rather than a drug to treat depression. 6.0 Attitudes towards mental illness Professionals were identified as: doctors (GPs); Fear was the predominant emotion in respect of those psychiatrists; psychologists; counsellors; social workers who displayed unpredictable, aggressive or psychotic and teachers. type behaviour.

Sympathy was displayed towards anyone with an eating 9.0 Sources and ideas about mental disorder and less severe mental illness which the illness respondents did not feel threatened by. Girls were more sympathetic than boys towards some problems. Knowledge the respondents had about mental health and All respondents identified psychotic behaviour as mental illness appeared to be the result of images and illness and used words such as: loony; schizo; mad; sick; information they had gained from the media, especially weird; maniac; schizophrenic and split personality. television. School and parents did not seem to have played any formal role in developing young people’s attitudes, although it is likely they had a more subliminal 7.0 Views about who might experience affect. mental illness

Initially respondents did not think there was a particular type of person who experienced mental health problems. However, environmental and social factors such as poverty were seen as contributing factors.

Some respondents said women were more likely to suffer from particular illnesses such as anorexia, phobias and anxiety, but men were more likely to experience depression as they lead more stressful lives as the main breadwinners.

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Differences between mainstream sample and special sub-samples

Young people with identified problems

1.0 Feelings Unlike the mainstream group respondents from this group identified social workers, key workers and Only a small number of feelings were identified and teachers as people they would talk to as opposed to these were mostly positive in nature. Most of the friends or family. respondents were unable to identify negative emotions.

4.0 Promotion of positive mental health 2.0 Positive mental health Unlike the mainstream sample this sub-sample identified Little difference was displayed in the way this sub-sample a much smaller number of factors which could promote and the mainstream sample responded to questions positive mental health. At times what they said was quite about positive mental health. contradictory, as the factors which they felt needed to be addressed in order to promote their mental health were Young people in this group associated positive feelings the factors which some identified as making them feel with instant gratification. Happiness and feeling good happy. appeared to be a short term feeling that could only be attained through immediate actions, which as one For example: they wanted more activities to prevent respondent said gave you a “buzz”. On the whole factors them from becoming bored and turning to crime and that this group associated with making people feel good drugs, but they had already identified both of these as or mentally healthy were reactive strategies to negative pleasurable activities. feelings.

5.0 Perceived differences between 3.0 Dealing with negative feelings adults and children

Ways of coping were largely reactive as opposed to The major issue highlighted by this group was the affect proactive. of children’s behaviour on their parents’ mental health. They saw themselves as responsible for the way their A large number of respondents from both sexes parents felt. identified cutting themselves as a means of coping with feelings of anger and sadness. It appeared to act as a Unlike the mainstream group, respondents only diversionary tactic taking the focus away from one thing associated adulthood with the parental role. There was and putting it onto another that they had more control no mention of financial, employment or personal issues. over. Some said it also gave them a “buzz”.

Alcohol and drug use featured much more in this group 6.0 Defining unusual behaviour and were used to cope mainly with feelings of sadness, whereas “cutting” was said to be mainly a response to Unlike the mainstream sample this group made no anger. reference to behaviour which may be unusual for people A small number of the boys said they would go and steal they knew as deviating from personal patterns. They cars when they had negative feelings, which made them only discussed behaviour which they thought was feel better and gave them a “buzz”. socially unacceptable.

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7.0 Understanding of Mental Illness

The understanding of mental illness in this sub-sample did not differ greatly from the mainstream sample and discussions about the vignettes were similar. However, this sub-sample appeared to identify more with certain behaviour, particularly those with behavioural problems.

8.0 Attitudes towards mental illness

Respondents in this group had much more punitive attitudes towards those who displayed psychotic behaviour and were much more inclined to ridicule them and use pejorative terms.

9.0 Helping with mental health problems

Informal intervention was not discussed as a means of helping people with a variety of mental health problems.

Their knowledge of the professional role was limited to what they had experienced as opposed to having any additional knowledge gained from other sources. Most were familiar with the role of social workers. Some were able to identify the role of psychologists because either they or one of their friends had seen one, and most thought psychiatrists “helped people sort out their head”, although there were mixed feelings about whether they were medically qualified.

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Young people living with a mentally ill parent

1.0 Positive mental health 4.0 Attitudes towards mental illness

Respondents were far more familiar with the terms The respondents in this sub-sample appeared to keep a mentally healthy and unhealthy. Therefore they did not very strong distinction between what occurs at home confuse them with more physical aspects of health. and outside the home.

Positive mental health was viewed as a more long term The primary attitude towards psychotic behaviour was issue and as a mechanism which allowed people to cope one of fear, which was similar to the mainstream with the stresses of everyday living. respondents. However, young people in this group expressed much more sympathy. Mentally unhealthy was defined in similar terms, but several felt that quite often people did not know why they had negative emotions and there was no obvious 5.0 Helping with mental health problems cause.

As expected respondents were more aware of particular professionals who they and their parents had come into 2.0 Promotion of positive mental health contact with.

A small number of respondents who attended a young In contrast to the mainstream sample all respondents carers project identified this as particularly important in referred to psychiatrists as doctors. promoting the mental health of young people who lived Medication was viewed more as a treatment than a way with a mentally ill parent. of calming people down.

3.0 Understanding of mental illness

More detailed insight of some conditions was displayed than in the other groups.

Respondents made reference to episodes and phases of mental illness, especially with regard to psychotic symptoms.

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Chapter 1 Introduction

This is a report on a study undertaken to assess young features which seemed common to most or all young people’s understandings and views about mental health and people, as well as those which were held only by some mental illness. individuals or sub-groups. It was also important to speak with some young people who had personal experiences of The study formed part of the Bright Futures initiative, a serious mental health problems, since research on physical three year programme of work undertaken by the Mental health and disability indicates that knowledge and attitudes Health Foundation which aimed to: are as much related to exposure to relevant conditions as to improve services and care for young people with age, intelligence or educational level (Bluebond-Langner mental health problems 1991; Hockenbury-Eaton and Minich 1994). A combination of group and individual interviews were used in order to raise professional and public awareness and gain access to both interactive and more private understanding about young people’s mental health communication about mental health issues.

improve the integration of aims, policies and services across the full range of people and agencies involved. The report

The more specific objectives of this research were to The main purpose of this report is to share with the reader examine and assess: the main findings of the contacts with young people. We have how young people think about and describe positive included many verbatim quotes so that as much as possible mental health and mental health problems - what their own ideas and views are directly communicated. At the language do they use and what attitudes are held? same time, a context is provided for understanding how and why the young people said what they did. young people’s understandings of people affected by The rest of this chapter will indicate why the research was mental distress needed and briefly summarise related issues and previous their ideas about help-seeking and relevant studies. This will be followed in the next chapter by an account of the ways in which access was gained to a sample professionals. of young people - not an easy task, given the sensitive and The findings would, it was hoped, enable professionals, stigmatised nature of the subject matter. Details of the teachers, parents and others to communicate better with research approach and methods are then briefly outlined. young people about mental health issues and respond in The main part of the report provides an account of the ways which take more account of how they themselves children’s views. This is presented in a similar order to that frame relevant issues. The study was thus part of a wider of the interviews and discussions: trend supporting the idea that education, health promotion and service delivery should be rooted in lay understandings understanding of positive mental health of the public and of service users. ideas about what might make young people feel The methods used for the study were qualitative. In other mentally healthy and unhealthy words, the intention was to enable young people to express views on how they might promote young people’s themselves as freely as possible, using their own words. A mental health broad range of young people aged 12-14 were to be included in the study, plus smaller numbers of a) young their own response to negative feelings people with a ‘mentally ill’ parent, and b) young people ideas about odd or unusual behaviour identified by professionals as having some kind of emotional understanding of mental illness or psychological problem. Young people of varied social attitudes to the people with mental illness and ethnic backgrounds were included both to ensure good coverage of different perspectives and to note those sources of information

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Next, the perspectives of those with a particular experience underpin them (Sartorius, 1992; Harris, 1992). of mental health problems are compared with the When research has been carried out on lay views of mental ‘mainstream’ sample in order to identify both similarities health, this has been largely confined to surveys of public and differences. attitudes to mental illness which have relied primarily on Finally, key points are summarised and implications drawn quantitative methods (e.g. Brockington et al., 1993; DoH, out for policy and practice. 1993). For example, it has been found that schizophrenia is generally viewed as threatening or worrying, having bio- genetic causes and difficult to cure, while depression is Background to the research viewed more sympathetically and optimistically as a product more of stress (Colombo 1997). Such studies give a broad impression of public attitudes but are able to shed Young people and mental health little light on the important questions of how attitudes and Over the past decade, increasing emphasis has been placed beliefs are formed or how they might influence behaviour in health care policy and practice on health promotion, (Secker and Platt, 1996). Two studies commissioned by the which aims to empower people to gain greater control over Health Education Authority and the Health Education Board their own health (Downie et al., 1990). Alongside this for Scotland have, however, broken new ground in using development, there is a growing acknowledgement, in qualitative methods to explore adults’ views on mental theory if not always in practice, of the importance both of health issues (Rogers et al., 1996; Pavis et al., 1996). These lay understandings of health, and of lay participation in studies provide a useful illustration of the importance of identifying salient health issues and ways of addressing understanding lay perspectives, in that their findings them (WHO, 1986; Ashton and Seymour, 1988, RUHBC, challenge received professional wisdom about mental 1989). Traditional approaches to health education have health and its maintenance. For example, both studies been the focus of considerable criticism for their suggest that health promotion messages based on received assumption that simply imparting accurate information will wisdom about the benefits of talking through worries and lead to changes in people’s attitudes and behaviour (Tones problems may be ineffective, since from one lay point of et al., 1990). In contrast, health promotion recognises that view dwelling on problems is perceived to be detrimental initiatives are likely to meet with little success unless to mental health. Further, the timing and context of people’s own understandings, beliefs and concerns are personal disclosure is regarded as something to be handled taken into account. To date, however, research has focused with extreme caution. mainly on adults’ perspectives on physical health issues While studies of adults’ perspectives have, until recently, such as coronary heart disease (Davison et al., 1991) and focused largely on physical health issues, children’s cancer (Gifford, 1986). In comparison, both mental health perspectives have rarely been explored in relation to either and the perspectives of children are relatively under- physical or mental health (Kalnins et al., 1992). Some explored. recent studies have explored children’s beliefs and views Where mental health is concerned, there is little consensus about their emotional and mental well-being and/or amongst the different professional and other interest groups physical health (Williams et al., 1989; Mayall, 1993; Hill et involved about the meaning of the term (Tudor, 1992; al., 1995; Gordon and Grant 1997). These have not dealt MacDonald, 1993). Those definitions which are put forward centrally with severe mental distress or illness. tend to reflect psychological and psychiatric perspectives. Young people’s perspectives on mental health are, however, Hence, more fundamentally, they also reflect the important on a number of grounds. To some extent, their predominant ideology of the western societies within importance lies in the foundations which may be laid in which psychology itself is located. Thus the image of the childhood, and particularly in early adolescence, for future ‘mentally healthy person’ which emerges is of an beliefs and attitudes. Such ideas are likely to have a autonomous, self-actualising individual, in line with the significant influence on the success of community care increasing emphasis placed on these qualities in the United policies, since negative attitudes have been shown to States and Britain since the second world war (Rose, 1989). impact both on service development, and on the quality of In contrast with health promotion’s emphasis on respect for life of people experiencing mental distress (Scottish Mental diverse cultures and beliefs, little attention has been paid to Health Forum, 1992; Forrest, 1992). In addition, lay perspectives or to the diverse cultures and beliefs which embarrassment and stigma may prevent people

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experiencing mental distress from seeking help (Royal Young People as research subjects College of Psychiatrists, 1995). The growth of the children’s rights movement which has However, young people’s perspectives are not important recently led to policy and legislative changes (Franklin, simply because they are the adults of the future. They are 1995) has been accompanied by increasing recognition of equally important in their own right. In the first place, data the validity of children’s perspectives. Young people are recently collated by the Office of Population Censuses and belatedly but increasingly being identified as competent Surveys indicate that the prevalence of mental health service users and so potential beneficiaries of problems in childhood and adolescence is far greater than empowerment approaches. ‘Whatever the young person’s often assumed. For example, between 14% and 20% of age and ability, a mental health professional who meets with young people experience mental health problems in them might be expected to gain an awareness of their views childhood or adolescence and suicide rates for young men and be able to communicate this awareness to the child so aged 15-19 increased by almost 45% between the late 1970s as to enable the child to feel heard and validated’ (Glaser and the late 1980s (Rutter and Rutter 1993; Maughan, 1996: 87-8). In the social sciences increasing 1995). Many young people with such difficulties are acknowledgement is being given to young people’s reluctant to make use of specialist services or quickly cease perspectives, especially as tapped through qualitative contact (Triseliotis et al., 1995; McKay et al., 1996; Gough research rather than embedded or even lost in quantified 1998). This data indicates the importance of developing data gathered in response to adults concerns (Qvortrup et appropriate sources of help and of enabling children to al., 1994; James and Prout 1997). help themselves and each other. Understanding young The young people who took part in the study were in their people’s perceptions of mental distress, and mental health early teens. Legally and ethically some of the additional and their perceptions of sources of informal and formal considerations which relate to young people were therefore help will provide valuable information in this respect. applicable (e.g. as regards the need for legal consent, Young people can be affected in major ways when parents concern about safety and vulnerability) (See Alderson 1995; or other significant adults experience mental health Morrow and Richards 1996; Hill 1997). However, they were difficulties (e.g. Sheppard, 1994; Robertson, 1996). In old enough that some of the communication techniques addition, the role of young people in caring for adult family which younger children enjoy and respond to, particularly members is receiving increasing recognition (Aldridge and those with dramatic and pictorial elements, might be seen Becker, 1994). Again, the focus to date has been on young as patronising or unnecessary (Garbarino et al., 1992). For people who care for adults with a physical disability and example, younger children may be asked by researchers or little is known about the different, and possibly additional, educators to make annotated drawings (Weare 1995; Hill needs of children who care for someone experiencing 1996), but this was thought to be less appropriate for mental distress. A study of young people with a parent who teenagers. Group discussions can be a useful means of misused alcohol suggested that considerable distress and enabling children and teenagers to speak more openly and social difficulties could result, though personal coping and debate with each other (Freeman et al., 1996; Hill et al. social support might be strengthened too (Laybourn et al., 1996), so it was planned to arrange group meetings as well 1996). Further research is therefore required to begin to as individual interviews. explore young people’s needs when they experience and Although most in this age group can handle some degree of encounter mental distress, and to identify how they can be abstract discussion, many are more comfortable with talking supported. about specific, concrete situations. With adolescents it is Finally and perhaps most important, young people’s vital to convey respect and ensure complete confidentiality. expressed views should be seen as inherently valuable. Even At times it can be helpful to combine serious intent with those who are not directly affected by serious mental health some light-heartedness and humour (Buchanan, 1995; problems are entitled to have their knowledge and views Williamson and Butler, 1996). considered. Not only does this mean that they may then In the next chapter, we explain how we went about gaining receive health education in a form which they are more access to a suitable selection of young people and the likely to take notice of and benefit from. Also their attitudes methods used to tap their ideas about mental health. may be critically important in affecting the degree of support, understanding or stigma which those with problems will encounter.

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Chapter 2 Research design

As indicated in the previous chapter, the research reported exploring each topic were therefore largely open ended so here was a qualitative study designed to explore young that participants could pursue issues of importance to people’s perceptions of mental health and illness from their them. In addition, space was allowed for brainstorming own perspective. In this chapter, five aspects of the sessions during the group discussions. The schedule was research design are examined in more detail: divided into two parts, the first focusing on positive mental health and the second on mental illness. the methods chosen to carry out the research Where positive mental health was concerned, the schedule the way in which young people were recruited to the included questions about feelings which had salience for study young people; their understanding of mental health and how it could be promoted; how young people themselves the research process, in terms of the interview coped with difficult feelings; and perceived differences dynamics which shaped the process of data collection between young people and adults.

methodological issues which have a bearing on the The second part of the schedule covered young people’s research findings attitudes towards unusual behaviour; their knowledge about mental illness; their perceptions of people with mental the analysis of the data and presentation of the health problems; and their sources of information, including findings. any relevant personal experience. Rather than asking abstract questions about mental illness, however, we decided to ground our questions in vignettes describing the 2.1 The research methods behaviour associated with particular mental health problems (Appendix 4). This technique has been A combination of focus group discussions, individual extensively used in research with both adults and young interviews and brief self-completion exercises were chosen people and is regarded as a reliable, valid approach to to carry out the research. Together, it was thought these assessing beliefs and attitudes about mental illness (Rezler, methods would yield an interesting range of information. 1983). While group discussions would both provide an opportunity to explore a breadth of views, and enable A series of five vignettes was developed, each portraying a participants to comment on and develop each other’s ideas, character experiencing a particular mental health problem individual interviews would allow us to explore more (whose formal diagnostic label was not included): personal experiences and attitudes in greater privacy. As a James, a 13 year old boy showing signs of a complement to these less structured methods, self- behavioural problem completion exercises would enable us to obtain more standardised information from each of the research John, a 34 year old man with chronic schizophrenia participants. Angela, a young woman of 17 experiencing anorexia A semi-structured interview schedule covering themes related to different aspects of mental health and illness was David, 40 years old and experiencing depression designed to guide the discussions and interviews (Appendix Peter, a 15 year old boy with early onset 3). In developing the schedule we were concerned to ensure that key themes were covered in all the interviews. schizophrenia. Specific topic areas to be addressed in each interview were Three of the vignettes were written specifically for the therefore identified, together with prompts around each project by a psychiatrist drawing on her own experience. topic to stimulate in-depth discussion. However, we were The other two were taken, from another study carried out also concerned to ensure that the young people who at the University of Glasgow, with the researcher’s participated in the research were able to set their own permission. agenda within the identified topic areas. The questions

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Copies of the vignettes were made for each participant so 2.2 Recruitment of research participants that they could be read through in turn at group discussions, either by each individual alone or as a group. Three groups of young people were recruited to take part For individual interviews or where a group preferred it, the in the research: researcher read the vignettes while participants followed 1. A main sample of young people from both urban and the text. After reading each vignette, questions were asked rural areas and from a cross section of social class and about participants’ reactions to the character’s behaviour; ethnic backgrounds. whether they knew of a name for the way he/she was acting; how they would feel if they lived next door to the 2. A smaller sample of young people who had been character; whether they thought the person needed help; if identified as having some kind of emotional, so, who could help and what their role would be; and psychological or psychiatric problem. whether they themselves had ever known someone like the 3. A further small sample of young people with a parent person portrayed. who had experienced mental health problems. The self-completion exercises (Appendix 5) were designed Details are provided below of the way in which the main to be filled out at the end of each discussion or interview. sample and the two smaller special samples were recruited. These asked participants to describe their ‘best’ and ‘worst’ day, and the feelings they had on each of those days. Main sample In order to assess how useful and appropriate they were, all In order to gain access to the main sample, we sought the research instruments were piloted with three groups of permission to approach individual schools from four young people at mainstream schools and one group with Scottish local authority departments of education, each of identified problems. As a result of the information obtained, which was asked to identify one or two schools likely to be a number of changes were made: willing to participate in the study. All four authorities agreed some repetitious questions were dropped to help and identified two high schools we could approach, although it was made clear that the final decision about the wording of the questions was simplified for participation could only be made by the individual school. young people with identified problems When approached directly, some of the identified schools did decline to participate because of pressure of work or the first half of the interview was shortened as it involvement in other research. However, four others were focused too heavily on emotions and feelings in willing to take part: one inner city school, two suburban isolation, rather than on the more general concepts of schools and one rural school. In the suburban areas, the positive mental health selection was made on the basis of a difference in geographical location. the self-completion exercises were dropped for young people with identified problems as some had Once each school had agreed to participate, a project outline (Appendix 1) was sent to the head teacher together limited literacy skills; for other interviews they were with a letter explaining how many interviews would take redesigned to be more structured and it was made place and how much time they were likely to require. In clear that participants could find a private space to fill three schools, this was passed to the guidance teacher who them out then took responsibility for further negotiations.

the second half of the interview was also restructured Since none of the education departments involved had a to focus on attitudes towards unusual behaviour standard parental consent form, a form was designed before exploring personal experiences of mental specifically for the study. In accordance with recognised codes of practice (Appendix 6), the form sought the illness consent of both parents and young people, allowing them role play was dropped as most young people found to opt either in or out of the study. It was accompanied by a this difficult and it did not appear to generate new letter providing a brief outline of the project and an information. explanation of what would be involved in the group and individual interviews. The letter and consent form can be found in Appendix 2.

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About half the young people who were invited to Table 2.2: Gender balance in the main sample participate agreed to do so, although there was RECRUITMENT SOURCE NO. OF BOYS NO. OF GIRLS considerable variation between schools. The consent form covered both group discussions and individual interviews, Mainstream schools 43 77 but some parents only gave consent for participation in a Minority ethnic groups 12 13 group discussion. Overall, 120 young people participated in Total 55 90 17 group discussions and 18 individual interviews. Interestingly, almost twice as many girls as boys agreed to take part, perhaps as a result of girls’ greater willingness to The special samples talk about issues relating to feelings. It was anticipated that both young people with identified While we anticipated that a number of young people from problems and young people with a mentally ill parent might Scotland’s minority ethnic groups would participate in the have particular needs and perspectives in relation to mental school-based interviews, we were concerned to ensure that health and illness. In order to recruit young people with an the views of these groups were fully represented. Four identified problem to the study, a local mental healthcare further groups from Chinese and Muslim Pakistani trust and a number of residential schools and specialist backgrounds were therefore recruited with the assistance of projects were approached for assistance. Similar steps to community agencies with which the Centre had previously those taken with the main sample were taken to obtain the worked. The letter to parents and the consent form were consent of young people and their parents, although the translated for the Chinese community. However, workers at trust adapted the consent form to feature their own logo the Muslim Pakistani agency did not feel translation was since this was a requirement of the medical ethics necessary in their case. committee.

25 young people from the two ethnic groups agreed to Despite the willingness of all the organisations approached participate in the research. Two mixed-sex group to help, the response rate was lower than expected. No discussions and five individual interviews were carried out participants were recruited from the healthcare trust and with young people from the Chinese community, while two the sample of 16 young people recruited from other single sex group discussions were carried out with boys and sources probably over-represents those with more severe girls from the Muslim Pakistani community. In both groups, problems which have caused them to be taken out of the gender balance was more equal than in the sample mainstream education. As Table 2.3 illustrates, boys were recruited from mainstream schools. also over-represented in comparison with girls.

In total, then, the main sample included 145 young people. Table 2.3: Young people with identified problems Table 2.1 provides summary information about this sample SOURCE OF NO. OF NO. OF TYPE OF while Table 2.2 examines the gender balance in each of the RECRUITMENT GIRLS BOYS INTERVIEW groups. Boys’ school 0 10 individual Table 2.1: Summary information: main sample Girls’ school 3 0 group Youth project 2 1 group SCHOOL/ A B C D MUSLIM

GROUP PAKISTANI CHINESE School size Where young people with a mentally ill parent were (approx.) 1000 1100 800 850 N/A N/A concerned, an advertisement seeking participants was School Inner Suburban placed in a newsletter published by the Scottish Users location city Rural N/A N/A Network. However, this met with no response and local No. of group user and young carer groups were therefore approached for discussions 5 5 3 4 2 2 assistance. This proved more successful and three boys and No. of five girls agreed to take part, again with their parents’ individual consent. Table 2.4 summarises the sources of recruitment, interviews 4 4 5 5 0 5 while Table 2.5 draws together information about all three samples recruited to take part in the research.

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Table 2.4: Young people living with adults who For this purpose it was decided that it would be helpful for have a mental health problem minority ethnic children to be interviewed by people from similar backgrounds and, when in groups, with other SOURCE OF NO. OF NO. OF TYPE OF children of the same background in a familiar setting. Some RECRUITMENT GIRLS BOYS INTERVIEW previous research studies have been criticised for producing Adult user group 4 2 individual findings which were biased as a result of white interviewers Young carers project 1 1 individual seeing black children. This point has been made particularly in relation to research on transracial adoption and the Table 2.5: Summary information: placements of black children in care (Triseliotis et al., 1997; main and special samples Barn et al., 1997; Hill and Shaw 1998). It is argued that

PARTICIPATING NO. IN NO. OF NO. NO. TOTAL white interviewers are, perhaps unwittingly, likely to invite GROUP GROUP INDIVIDUAL OF OF and interpret responses which fit with their preconceptions DISCUSSIONS INTERVIEWS GIRLS BOYS (Small 1991). There is also evidence that children are more Young people likely to be honest and forthcoming when communicating from mainstream with people who they feel are likely to understand their schools 102 18 77 43 120 style of speaking and viewpoints (Labov 1969; Garborino et Minority ethnic al., 1992). This necessitates taking a differentiated view groups 20 5 13 12 25 (Ahmad 1989), so that different interviewers were used for Young people with children with Chinese and Muslim Pakistani backgrounds, identified problems 6 10 5 11 16 findings were checked with the interviewers and Young people with recognition was given to variations within each group. a mentally ill parent 0 8 5 3 8 At the beginning of each interview, the purpose of the Total 128 41 100 69 169 project was explained and an opportunity was provided for participants to raise any questions they had. A commitment 2.3 The research process to confidentiality was then given and explained, with the proviso that information might have to be passed on if the The majority of the research interviews were carried out by researcher was concerned about a participant’s safety. It the research fellow appointed to the project. However, it was emphasised that unless such concerns arose, parents was anticipated that young people from the minority ethnic and teachers would not have access to anything discussed groups might feel more comfortable talking to a researcher in the course of the interviews. Equally, the young people from their own community. A worker from each of the two who took part in group discussions were asked not to community agencies which had assisted with recruitment discuss any sensitive issues outside the group that could be therefore carried out these interviews. directly related to anyone involved in the interviews. Particular issues relating to each setting and type of Whilst recognising that some children from minority ethnic interview are discussed below. backgrounds would be included in our mainstream school samples, the numbers were likely to be so small that their Young people in the mainstream schools experiences would simply be absorbed into generalisations which might or might not be applicable - a process Gambe It had been estimated that two lesson periods would be et al., (1993) refer to as ‘universalising of white experience’ needed to give enough time to carry out the group (p.22). Within the limitations of the research time scale, it discussions and two schools agreed for us to do this over a was important to try to assess how far and in what ways double lesson period. Young people in these groups were ethnicity and racism impinged on the children’s offered a break between periods. The other two schools perceptions, as they expressed them. In keeping with the preferred to split the time between two single periods and broader ethos of the research to minimise implanting ideas, these interviews were therefore carried out over two the aim was to ask a sub-sample of children from minority consecutive weeks. As was seen earlier, the interview backgrounds the same questions as others, but within a schedule was already divided into two parts, focusing first context which would facilitate openness about issues on mental health and then on mental illness. However, the which were key for them. second part was more time consuming than the first and was less easy to encompass in one lesson period. As a

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result, some groups ran slightly over the allocated time. On tasks at hand and began arguing and threatening each other. the whole, though, the time allocated was sufficient, and Although this was difficult to manage, it did not feel some interviews finished with time to spare. threatening, and it appeared that the girls’ behaviour was as much about frustration than anything else. There were Although some groups were inevitably more talkative than issues they clearly found difficult, either because they others, the focus groups appeared to work well, with involved difficult feelings, or because they could not discussion flowing between group members as well as articulate what they felt. Nevertheless, they were able to between the interviewer and individual participants. express their feelings about some issues which concerned Despite some initial concern about the length of the them. In particular, they expressed considerable anger interview, the young people appeared interested and when talking about their experiences of negative feelings. focused throughout. This was confirmed by positive feedback from teachers. The other group interview took place at a rural youth project for young people with identified emotional The mixed gender groups were sometimes rather problems. This group worked well, although the gender dominated by the girls, but overall the interaction between balance was less than ideal in that only one boy was male and female participants was good. However, in the involved. At times the girls appeared to be influenced by one instance where there was only one boy in a group, the the boy’s presence, changing their responses to agree with girls definitely dominated the discussion, despite the what he was saying. researcher’s attempts to elicit the boy’s point of view. The individual interviews carried out at the boys’ school In each group one participant tended to lead the discussion were quite different from these two groups. On the whole, and at times this may have inhibited the other participants, the boys were quiet and reserved, although a few were again despite the researcher’s attempts to ensure equal more talkative and animated. Some appeared to be testing involvement. Certainly, responses to the self-completion out the researcher at the beginning of the interview, using forms suggested some young people had issues to discuss frequent swear words and referring to drugs and criminal which did not always emerge in the groups as clearly as acts. However, in most cases this stage did not last long and they did on paper. the interviews worked reasonably well. In comparison with the group discussions, some individual interviews were more reserved, perhaps because the young Young people with a mentally ill parent people felt less certain about talking to a strange adult The interviews carried out with these young people were without peer support. The school setting and being unused very similar in tone to those carried out at the suburban to one-to-one discussions with an adult may also have schools, perhaps because of similarities in social class. Six contributed. Partly for this reason, all the individual participants were interviewed in their homes, either interviews were shorter than the group discussions. individually or with a sibling. In this setting they appeared Nevertheless, they served their purpose of enabling the relaxed, articulate and willing to talk. A further two young young people to talk about more personal issues in relative people were interviewed at a support group they attended. privacy. This seemed to be particularly helpful for the boys, In comparison, they seemed slightly nervous to begin with. who not infrequently prefaced what they were about to say However, they clearly relaxed as the interview progressed with comments like ‘I shouldn’t really tell you this but as and were again articulate and willing to contribute their no-one will hear...... ’ views.

Young people with identified problems

Only two focus group discussions were carried out with young people with identified problems. This was partly due to the small sample size, but also partly because workers at the boys’ school which participated in the study felt the boys would respond better to individual interviews.

One of the two focus group discussions was carried out at the girls’ school and this group proved quite difficult to control at times. The girls frequently digressed from the

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2.4 Methodological issues from families where attitudes to the discussion of mental health issues differ from those of other families. As a result, A number of methodological issues need to be taken into their perceptions and views may not be representative of all consideration when considering the findings of the study. young people aged 12-14 from similar schools. These are discussed here first in relation to the main Finally, as indicated earlier, there was a clear gender sample, and then in relation to the two special samples. imbalance in the sample. As a result, the views of girls tended to dominate at times and this may be reflected in The main sample the research findings. On most issues there did not appear Although overall levels of recruitment to the main sample to be significant gender differences, but where these were were good, given the potential sensitivity of the subject observed they have been noted as points of interest. matter, there were significant differences between the four participating schools. In particular, more young people took The special samples part from School A than from the other three schools. This As was seen earlier, recruitment rates to the two special may be because the school catchment area has a high samples were relatively low. Where young people with incidence of mental health problems, with the result that identified problems were concerned, this appears to be young people at the school had a particular interest in this partly because the professionals and service providers subject. (According to the Community Police Officer, one in involved in the recruitment process were protective of the five women in the area are prescribed major tranquillisers.) young people and felt some were not emotionally robust In addition, the guidance teacher with whom we liaised had enough to participate in the interviews. In addition, parents a particular interest in mental health issues and was of young people in this group may have been concerned therefore very enthusiastic about the study. However, she about the extent to which family problems would be was also clear that young people at the school were eager discussed, or about the possibility of repercussions from to participate themselves. social services or other professionals. Overall, as has been Conversely, young people at the other three schools may seen, the young people who did participate tended to have have had less personal experience of mental health issues, more severe problems which meant they had been taken and may therefore have been less keen to take part. In out of mainstream education. In addition, more boys than addition, the level of interest, knowledge and enthusiasm girls took part in these interviews and this gender bias may expressed by the teachers involved in the recruitment again be reflected in the findings. On both counts, the process may have played a part. Certainly, evidence from findings cannot be regarded as representative of all young School B suggests that enthusiasm on the part of the head people with identified problems. teacher may explain why a higher recruitment rate was Similarly, only a small number of young people with a achieved there than in Schools C and D. mentally ill parent were recruited to the study, partly As a result of the relatively low recruitment rates at Schools because we were concerned to do this through the user B, C and D, it was not necessary to select a sample from movement, where there is considerable interest in the amongst the young people who agreed to take part. Instead, needs of young people, rather than through health and all those who agreed to participate were included. In social work agencies. Because those young people who did School A, a sample was selected by the teachers concerned, take part came predominately from middle class families, with the result that both potentially disruptive and their views, too, cannot be regarded as representative of particularly shy young people were not included. those of all young people in this situation. Otherwise, a cross section of pupils was selected from those who had agreed to participate.

While the main sample size and spread is sufficient to draw general conclusions from the overall findings, more caution is needed with regard to comparisons between the individual schools. Where they were apparent, any differences are highlighted as points of interest rather than as definite conclusions. It should also be borne in mind that the young people who agreed to participate may come

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2.5 Data analysis and presentation Summary of the research findings A combination of focus group discussions, individual Each group and individual interview was fully transcribed interviews and self-completion exercises were used to for analysis using the NU*DIST software package. The explore young people’s perceptions. Three groups of young themes and issues which emerged from them were very people took part in the research: a main sample of young similar so have been reported on together in the following people from Scottish schools and minority ethnic chapters. The data from the self-completion forms was community groups; a smaller sample of young people with analysed separately also using NU*DIST. When this data identified problems; and a further small sample of young reflected issues also discussed in the interviews, the results people with a mentally ill parent. A total of 100 girls and 69 were incorporated into the main body of the findings. boys took part. Three quarters of these young people However, a small amount of new or particularly salient participated in 21 focus groups, while the remainder were issues emerged from the self-completion forms and these interviewed individually. In the following four chapters the were identified in the text. research findings are presented and discussed. Although these cannot be regarded as representative of the The process of analysis began with developing a framework perspectives of all young people in similar situations, they which was initially based on a number of the main topics do give a valuable insight into the ways in which the young used in the interview schedule. However, as we became people who took part in the research understand mental more familiar with the data and examined it more closely health and illness. further themes developed which enabled us to construct a more detailed framework which was transposed into NU*DIST and became the “tree” used to index all the data. Once the framework or “tree” as it is referred to in NU*DIST was developed it was systematically applied to the data. When all the data had been indexed an individual report on each index was produced, illustrating all the relevant data. This was then analysed further by the research team to establish patterns and associations. However, piecing together an overall picture was not simply a question of aggregating patterns and associations, but of weighing up the salience and dynamics of issues, and searching for underlying structures rather than a multiplicity of evidence.

Because a large amount of data was obtained from the main sample, it is examined in two chapters which follow the division in the interview schedule between mental health and illness. The views of young people with identified problems and those of young people with a mentally ill parent are then discussed in two further chapters.

The report is intended to reflect the views, perceptions and attitudes of the young people who took part in the research, and substantial extracts from the data have therefore been included. In order to protect participants’ identity, any names used in the quotations have been changed. Place names have also been altered to preserve anonymity. In extracts from the group discussions, a change of speaker is indicated by the use of a slash ( / ). Where the interviewer’s questions are included, these are enclosed in round brackets ( ), while words and phrases inserted to make meanings clear are enclosed in square brackets [ ].

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Chapter 3 Positive mental health and its promotion: the views of young people from the mainstream sample

This chapter examines the main themes that emerged from Table 1: Commonly identified feelings the focus group and individual interviews with young (n =145) people from the mainstream sample in relation to positive TYPE OF FEELINGS % OF RESPONDENTS mental health. Much of the discussion in the interviews concerned emotions, their causes and the way in which happy, sad, angry 100 young people coped with them, particularly negative hurt, scared, nervous, lonely 50 emotions. The first section of the chapter summarises the excited, frightened, bored, feelings the young people identified at the beginning of annoyed, frustrated 40 each interview and the following sections then focus on worried, sorry, proud four key themes: tired, joyful, hate 25 embarrassed, upset, smug, the young people’s understanding of positive mental calm, depressed, jealous, 17 health stupid,shameful, ashamed

their ideas about what might make young people feel mentally healthy and unhealthy 3.2 The young people’s understanding of positive mental health their views about how other people might promote young people’s mental health When the young people were asked what they thought it meant to be mentally healthy, their responses were mixed. their own response to negative feelings. Some found it difficult to focus on the term “mentally In conclusion, the young people’s views about differences healthy” and concentrated on only one of these words, between themselves and adults are considered. which resulted in an answer which either defined what they thought “healthy” meant, or what they thought “mentally” meant. Those who focused on the term 3.1 Feelings “healthy” discussed factors such as diet and exercise, for example: In the focus groups, brainstorming was used to encourage “You get mentally healthy when you eat food an’ participants to identify as many feelings as they could. that / and like exercise.” (School A group) Similarly, participants in the individual interviews were asked to identify as many feelings as possible, and these “When you drink water and exercise / and stuff were noted by the interviewer. Each approach enabled the that’s good for your heart.” (Minority ethnic group young people to identify a large number of salient feelings, girl) although, unsurprisingly, the groups identified more than individuals. Those who focused on the term “mentally” clearly defined this in relation to mental ill-health. This response from one A total of 62 feelings were identified. However, several of group was fairly typical: these were synonymous, in that different words were used to describe the same feeling, while 37 feelings were only “Mentally healthy is when you’re like disturbed mentioned once. As Table 1 illustrates, the most commonly / they feel confused so that if something happens mentioned feelings were mostly those with negative they don’t know how to react to it / they cry connotations, such as sadness, anger, fear and loneliness. / lash out and hit people / and get upset over the silliest wee things.” (School D group)

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“You wouldn’t be depressed / but everyone gets a case normality was defined as not being “different”: bit depressed sometimes / maybe you’d be “Like when everyone acts the same as everyone unhappy sometimes but you’d have enough good else and they don’t frighten anybody else or act things to cope with the bad things.” differently.” (School D group) (School B group)

For other young people, “mentally healthy” meant not 3.3 Factors which contribute to young being disabled, although this was not a common response: people feeling mentally healthy and “You’re not like disabled or you haven’t got unhealthy something like cerebral palsy or something.” (School D girl) A key theme to emerge from the young people’s responses to questions about what might make them feel mentally Interestingly, it was mainly young people from Schools A healthy or unhealthy was the importance of family and and D who experienced these difficulties with the term friends. This theme is explored here alongside the other “mentally healthy”. It would be difficult and perhaps factors the young people identified as important. unwise to speculate as to why these differences occurred due to the small number of respondents from each school. Feeling mentally healthy In contrast, young people from Schools B and C and the The young people who took part in the research all minority ethnic groups had less difficulty, defining the term identified four main factors as contributing to mental and referred to it either as the absence of illness, or more health: family and friends; having people to talk to; personal positively in terms such as happiness and confidence. The achievements and feeling good about yourself. Pets, following extracts from the data illustrate these two presents, and having fun were also mentioned by some of perspectives: the groups. “Sane / not lost it / nothing wrong with your As these extracts from the data illustrate, friends and family brain.” (School C group) were seen as making young people feel secure, supported “Like if you feel self confident.” (School D boy) and wanted, and conversely as preventing feelings of isolation. Young people from Muslim Pakistani backgrounds “Happy with yourself / aye if you don’t like identified the family as particularly important sources of yourself no-one else will / and then you’ll just support . feel miserable and lonely.” (School B group) “Friends and family / well if you’ve got them they “You’re happy with yourself / feel good / not make you feel comfortable / they give you feeling scared.” (Minority ethnic group) support / feeling safe makes you feel mentally healthy.” (School C group) For some young people, the notion of mental health was closely linked with the idea of normality, a theme which “Good family and lots of friends around you.” will emerge strongly in the next chapter. In this context, (Minority ethnic boy) however, there was no consensus about what normality “Having lots of family to talk to. I go to my auntie a meant. In one group, for example, normality was initially lot.” (Minority ethnic girl) identified as having a range of feelings similar to those listed at the start of the interview, but this later sparked “Friends are important / and family / aye to give vociferous discussion within the group. One girl, in you a bit more confidence / you know there’s particular, felt strongly that being “normal” had no somebody there to care / you know you’re influence on whether someone could feel the emotions wanted.” (School D group) listed at the beginning of the interview and that there was “Friends and family ‘cause like you don’t feel no such thing as being “normal” because “everyone’s got lonely. You wouldn’t have anyone to do things something wrong with them, nobody’s perfect.” with or talk to without them. I think I’d feel In another group from the same school, participants also isolated without them.” (School B girl) equated being mentally healthy with normality, but in this

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“Friends and family make me feel happy because In contrast with this view expressed by the girls in the my family like to include me in the family and not group, the boys did not feel there was any connection just leave me to do things on my own. It makes me between being or feeling fat and being mentally healthy: feel wanted.” (School D boy) “The way your body is has nae got anything to do with your mind.” Sharing problems, and hence having someone to talk to, was also seen as important for mental health, and here too Again, recognition was important, but in this case from friends and family emerged as centrally significant. Young peers, especially boys, rather than from parents: people from Muslim Pakistani backgrounds referred more often to extended family such as uncles and aunts as “Like if someone pays you a compliment and says particularly important in times of difficulty. like oh you look nice an’ that / aye like your pal or that / aye or one of the boys tells you his pal “You need to tell people your problems and not likes you.” (School D group). just keep them all / yeah because it would just drive you mad if you had problems and you Feeling mentally unhealthy couldn’t tell anyone.” (School C group) In comparison with the difficulties experienced in defining “I can go to my aunties if I have any problems, mentally healthy, the young people found talking about ‘cause they’re like near my age” (Minority ethnic feeling mentally unhealthy relatively unproblematic, girl) perhaps because of the previous discussions about being “People that care for you and stuff like that / got mentally healthy. pals and people to talk to.” (School B group) The words used to describe feeling mentally unhealthy included: sad, depressed, worried, troubled, lonely, angry, Where personal achievement was concerned, the data scared, rejected and confused. For some young people, suggests that this was more important for boys than for girls boredom was a significant contributing factor in relation to as a source of confidence and feeling good. This response, some of these feelings. However, there were differences for example, was fairly typical of those given by many of the here between the four schools. Whereas all the young boys: people in Schools A and D quickly identified boredom as a “I feel good and confident and stuff when I’m major influence, this did not emerge as strongly in Schools playing football and I know I’m playing well.” B and C, and there were mixed responses from young (School B boy) people from minority ethnic groups, which possibly reflected the mix in socio-economic background. Here too, however, recognition from family and friends, Although some young people in Schools B and C did raise particularly parents, was seen as important: the issue, it was not the first subject which they discussed. “If you’ve done really well in a test or something It seems likely that this was because most of the young and then your parents say oh yeah that’s really people in these schools appeared to belong to clubs or good and you did really well. I like that it makes were involved in activities outside school. In turn, this me feel like sort of happy and like they’re pleased might reflect differences in location and class between the with me.” (School D boy) schools, or it may be that the young people who participated in the research at these schools were those “Like you might not have won, but your mum or who were also more likely to take part in organised that says you did really well. Like at the swimming activities. or something.” (School D boy) Setting aside this difference, family and friends again For girls, feeling fit, especially in relation to body image, emerged as particularly significant for all the young people appeared to be more important than personal achievement. in relation to feeling mentally unhealthy. The following extracts illustrate the range of responses they gave: “If you were physically fit you’d feel better about yourself instead of being fat.” (School A group)

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Parental problems “If you get bullied or slagged and then you feel really down inside and like nobody likes you.” If your parents don’t really appreciate you when (School D boy) you’ve done well.” (School B girl) “Say like someone gets picked on and bullied and “Family pressure. Minority ethnic people want you that.” (School A girl) to be in education and all that. They try and make you learn more an’ that they think you have to be “When kids get bullied at school that causes stress reading books all the time and they say like oh that and can lead to other things.” (Minority ethnic group) person’s kid does this so why don’t you and all that.” (Minority ethnic group) 3.4 Promoting positive mental health Bereavement Having identified the feelings and contributing factors they “When somebody dies in your family / associated with mental health, the young people were somebody’s not well / when your pet dies.” asked what could be done to achieve and maintain these (School A group) feelings for young people. All the research participants saw “If someone dies / aye when my gran died my adults as having a direct part to play and their views about dad was really upset and so was all the family.” how adults could help are therefore examined here first. (Minority ethnic group) Some improvements to their local neighbourhoods were suggested particularly by young people from Schools A “My uncle was killed in Pakistan and we all felt and D. really sad and it was really bad for my dad ‘cause it was his brother.” (Minority ethnic group) The role of adults “When my gran died I felt like it was the worst day A key theme to emerge from the interviews in relation to in my life.” (Minority ethnic group) the role of adults was the need to make young people feel “When a relative dies and it upsets your whole safe, both physically and emotionally. At the very least, as family, even if you didn’t know them very well.” these extracts illustrate, this meant being looked after and (Minority ethnic boy) cared for:

“Family or someone who can look after you.” Peer rejection (School B group) “If you’re not very popular / if you’ve not got a “If children live in a home you’ve got to make sure proper stable family.” (School B group) you can really trust people and the child’s going to “If you think people are your friend and they go be cared for.” (School B group) off with other people.” (School D girl) Over and above being looked after, the young people also “Peer pressure / yeah like if you’ve not done felt it was important to be able to talk to an adult, and that something that your friends are doing / but I parents were not always the right people with whom to think sometimes in the end it makes you feel discuss some issues. However, they highlighted a number of stronger if you don’t do it and like you can stand difficulties in identifying other adults who could fulfil this up for yourself / like if you don’t smoke or you role. There were no professionals they felt they could really haven’t done very well in school.” (School D group) trust, and in their view adults did not appreciate this dilemma. One suggestion was that schools could employ Bullying someone, perhaps a nurse or a social worker, specifically to fulfil this role. In contrast to this view a number of young Bullying was also viewed as a particularly important factor people from Muslim Pakistani backgrounds did not feel it in feeling mentally unhealthy. It was an issue raised by all was appropriate to discuss issues outside the family, but the groups and individuals interviewed. This extract from identified extended family such as aunts and uncles as one interview was typical of the young people’s feelings: appropriate people to talk to as quite often they were of a similar age.

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Assuming an appropriate adult was available, however, In addition to the need for a trustworthy adult to talk to, the confidentiality was a further issue for the young people. young people wanted adults to provide information about While they accepted, at least to some extent, that teachers issues that worried them, such as sex, drugs and careers. and other professionals had a duty to pass on information if However, the quality of information, and hence the they thought it necessary, they were concerned that this expertise of the adult providing it, was seen as crucial if was not always made clear to begin with. In their young people were to take any notice of what they were experience, professionals sometimes indicated that a told: conversation would be confidential, when in fact it wasn’t. “Children have a right to know about things that As this group made clear, young people want to make will affect them when they’re older / people who informed choices about who they talk to, and to do so they know what they’re going on about should explain need to be aware of all the implications: things more / aye not just like teachers.” “There’s no-one you can go to and it won’t go any (School A group) further / yeah people say go to your guidance teacher but you can’t do that if you don’t want it As a second extract illustrates, some young people also out / the teacher has a responsibility to go and wanted to be involved in identifying issues of importance, tell someone else / but they tell you in the first rather than simply being passive recipients of information place it’s confidential and it’s not.” (School C group) adults viewed as important:

“The teachers in social education don’t really have In the course of these discussions about having an adult to enough knowledge to tell us about certain things / talk to, the pros and cons of Childline were widely debated. I think we should have people to talk to us who Although none of the young people who took part in the are more experienced / may be we could give research acknowledged using the service, the depth of them our ideas rather than the teachers choosing discussion suggests that some may have done so, and that what we talk about.” (School C group) others may have considered it but decided not to. As these two extracts illustrate, debate revolved largely around the Local improvements advantages or otherwise of an unseen and unknown confidant, and around the problem of access to a Unsurprisingly, the young people from Schools A and D sufficiently private telephone: who took part in the research were particularly concerned with addressing the problem of boredom they had “No [I wouldn’t use it] ‘cause you can’t see the identified: person on the other end / that’s the whole idea / yeah I think a lot of people would use it because “More sports centres / build stuff like a club or you couldn’t tell a teacher because there’s stuff you something / bring something into lowtown as couldn’t tell them.” (School C group) there’s nothing to do / we should have a park or shows or something, that would help keep us off “I think stuff like Childline is really good ‘cause the streets.” (School A group) people think oh I can’t tell them that ‘cause they’ll think something, so Childline they don’t know “If there was more to do it would stop young anything about you, they don’t know where you people from thinking and worrying.” live, you don’t even need to give your name / so (School D group) it’s really totally confidential? / it’s a bit worrying “Keep kids off the street and introduce more clubs though / yeah they’re probably sitting in the / more activities and sports centres / ask them other end of the phone laughing / you don’t what they want.” (Minority ethnic group girl) really know what their feelings are, they might not even be interested so it’s not really that good / if “More stuff to do like the Islamic summer school you phoned at home it may be will show up on but longer for about 3 to 4 weeks.” (Minority ethnic your phone bill or if you used a phone box group boy) somebody you know might pass by and step in or somebody might be waiting for the phone and However, while they wanted to see more activities think you’re mucking about / you might run out provided, these young people were keen to preserve their of money.” (School D group) individual freedom to do as they pleased. In effect, as this

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boy made clear, they did not want any prescriptive advice “Normally just throw something or do something about how to occupy their time, but options from which silly like that.” (School B girl) they could choose: “Get pencils and scribble over books / take it out “Give young people lots of options but do not rule on other people / get angry like a volcano waiting their lives.” (School D boy) to explode / take all your tantrums and sadness out on other people.” (School A group) In addition to the provision of activities, participants from “Take it out on other people if they’re angry about School A identified better housing as something which something / wreck your bedroom.” could improve young people’s mental health. Poor housing (School C group) was seen as causing young people to become angry and depressed as a result of lack of space and privacy. “I’ll take it out on other people especially my brother / I slam the door / fight when people Two groups from this school also identified drugs as an annoy you / if you’ve got something in your issue which affected the mental health of young people. system you need to take it out.” (School D group) They worried not only that they and their peers would become addicted to drugs, which they saw as directly “See like if I got really angry then I’d just gi’ them detrimental to their mental health, but also about the a slap.” (School A girl) indirect effect of drug use in their neighbourhood: “Go and wreck something like a bus stop or that.” “I’d make nicer places, make people more (School A girl) friendlier / aye like ban drugs ‘cause that just “Smash something an’ that.” (School C boy) makes people go into gangs an’ that and fight and steal / aye get rid o’ all the bad guys in lowtown / “Take anger out on their parents / start lying and see my street it’s a pure dump ‘cause like they’re fighting.” (Minority ethnic group boy) all into drugs an’ that.” (School A group) Perhaps surprisingly, there appears to be little difference here between girls and boys, in that both described 3.5 Dealing with negative feelings similarly aggressive responses, including fighting. However, for the boys this appeared to be regarded as a normal way In addition to exploring their views about how adults and of behaving which they discussed openly in the groups and others might promote mental health, the young people interviews. In contrast, the girls rarely talked about were asked what they themselves did to feel better when behaving aggressively in the interviews, but instead wrote they experienced negative feelings. The reactions they about such behaviour in the self-completion forms. One described fell into two main categories: responses to angry girl, in particular, expressed considerable feelings of feelings and responses to feelings of sadness; they also remorse about injuring another girl severely enough for her talked of a variety of ways they dealt with negative feelings to require hospital treatment. This more private form of in general. disclosure suggests that social norms governing what is regarded as acceptable behaviour for girls and boys have an Anger impact less on the behaviour itself than on its aftermath in terms of the feelings with which young people are left. The most common way in which the young people described dealing with feelings of anger or frustration was Sadness to take it out on inanimate objects, on siblings or, less commonly, on other young people. These extracts were In contrast with their reactions to angry feelings, the young very typical: people described their reaction to feelings of sadness and depression as one of internalisation. For some young “Mostly trash the place up like when I go into my people, this appeared to be part of a process of coming to room like punching the wall and shout and bawl terms with a problem before it could be resolved, and in and everything and take it all out on everyone this context being alone was often important: else.” (School D boy)

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“Well I think most folk have a little wee place to go, schools. While all those interviewed in Schools A, B and C like outside or in a cupboard, probably just go there said they would go to their friends with relationship and and just think about it or cry or something like that, personal problems, one group at School D said they would but just think about it mainly.” (School B girl) go to their parents. They did qualify this view by indicating that it would depend on the relationship young people had “Sometimes you might just stay on your own and with their parents: think about it and then sort it out.” (School D boy) “If you’ve got quite a close relationship with your “They [adults] try and help you but sometimes you parents you’d probably talk about more personal don’t want any help at all / you know they’re things than you would with your friends / aye if doing good but it just gets on your nerves / you were talking to your friends about more maybe something’s happened and you don’t want personal things you’d probably make a joke out of to tell them straight away / you need to adjust to it / I think your parents know the real you but it yourself.” (School D group) your friends only know one side of you / if you’re at school you don’t talk about secrets but if it’s the For others, however, it seemed that best way to deal with a sort of friend that stays over then you talk about problem was to bottle it up in the hope it would go away: secrets.” (School D group) “Don’t talk to anyone or do anything just keep it inside and hope it goes away.” (School B boy) Other young people felt they would be more likely to talk to friends about relationships, and trustworthiness was an “Might lock yourself up in a room and turn the important factor here: music up until you feel better.” (Minority ethnic boy) “Best friends really ‘cause you feel you can trust “You just want to go away and hide / yeah you them / yeah they’re not like patronising / yeah just want to curl up.” (School D group) like parents sometimes are / you feel sometimes that your parents wouldn’t understand it so you go This response to sad feelings appeared to be more common to someone in your own age group and you feel amongst boys than girls, but the small number of boys who you can trust them a bit more.” (School D group) took part in the study makes it difficult to draw firm conclusions about this. “You might talk to your mum and dad. It depends what it is. If it was like about boys and stuff I talk In the context of these discussions of sadness and depression, to my best friend.” (School B girl) suicide was discussed only by one group in school D. As this extract suggests, the group felt young people resorted to Despite the general feeling that they did not have access to suicide partly as a means of escape, but also as a cry for help professionals to whom they could talk, teachers were seen when people did not realise how desperate they felt: by some young people as the most appropriate adults to “ ‘cause they’ve got nothing else they can do / talk to about school-related issues, particularly bullying. In they feel it’s a way of escaping / some people addition, there was some discussion about the role of don’t really want to die but they want people to counsellors. However, this was uncommon, and the views know how depressed they are.” (School D group) expressed seemed to depend on individual experience. For example, this boy felt that counselling was appropriate for Negative feelings in general young people on the basis of his personal experience:

In keeping with their earlier emphasis on the need for “Young people can go to counsellors. I’ve been to a adults to whom they could talk, all the young people who counsellor it was after something. I’m not saying took part in the research identified talking as an effective what it was”. (School A boy) means of coping with negative feelings. Also in keeping with their earlier concern about making an informed choice In contrast, another boy in the same school associated of confidant, they indicated that they would select different counselling with the stigma of mental illness: people to talk to, depending on what the problem was. “I would nae get a counsellor they’d gi’ you pills For reasons which are difficult to discern, there was some an’ all that and then put you in a mental home”. variation here between young people from different (School A boy)

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While talking problems through was commonly discussed “When they’re finished they all [problems] come as an active way of coping with negative feelings, a few back again.” (School D group) young people proposed avoidance tactics such as sleeping and eating, for example: 3.6 Perceived differences between “If you sleep you don’t need to worry about adults and young people anything they just go away.” (School D group)

“Some people just go and eat when they’re not The young people’s perceptions of differences between feeling good about themselves / yeah ‘cause it’s themselves and adults are considered here firstly in relation comfort to them / a bit like smoking / aye it to the factors thought to affect mental health, and secondly relaxes them.” (School D group) in relation to the coping strategies employed by adults and young people. However, these were not commonly proposed solutions and talking to carefully selected confidants was clearly the Factors affecting mental health preferred way of coping for the majority of young people. All the research participants felt there were a number of Before turning to examine the differences young people similar factors which influenced the mental health of both perceived between themselves and adults, it is worth noting adults and young people, for example the death of friends here that the young people who took part in this research and relatives; falling out with people and stress. However, did not describe either drugs or alcohol as a means of they also identified additional factors which affected adults coping with negative feelings, although they did but which had less impact on young people. These acknowledge that young people participated in such included job insecurity, financial worries and concerns activities. It may be that drug and alcohol use is not as about children. Perhaps unsurprisingly, money problems widespread as some reports would suggest, at least amongst were more commonly identified by young people from this age group. Alternatively, participants may not have school A than by participants from other schools. For wanted to acknowledge drug and alcohol use to the example: researcher, particularly in the school setting. Or they might “Adults get depressed when they need to buy have viewed drug and alcohol use purely as a recreational things and they have nae got any money / aye, activity, as opposed to a coping mechanism. when they need to pay their debt up when they’ve Although certain groups and individuals, particularly in bought stuff out of the catalogue.” (School A group) School A, did discuss the issue of drugs more freely and seemed to have a wider knowledge than other participants, In general, as these extracts indicate, it was assumed that they still did not describe drugs as something which could young people’s own worries and problems were trivial in make you feel good or help combat negative feelings. The comparison with such adult problems: general view seemed to be that drugs might work to begin “It’s probably more noticeable for adults. When with, but that this was only an illusion: you’re our age people kind of expect you to be this “When they wear off you feel sad and then you moody person / when it’s an adult that’s like that need more / then you get addicted and then you you just don’t know, it seems more serious because die.” (School A group) they have a much more sensible kind of way of thinking about it.” (School C group) “Some people turn to drugs and try to get themselves a little pep up but I don’t think that “Adults problems are stronger ‘cause they’re older works, ‘cause as soon as the effects worn off it’s / they get the same sort of problems but worse.” just like all the problems are still there waiting for (School A group) them.” (School B girl) “Adults have like their job to worry about / yeah “Some people take drugs and stuff / they think it young people worry about stuff like what colour will help them and make them feel better / then nail polish they’ve got on and if they’re popular.” when they try it they like sort of can’t stop it.” (Minority ethnic girl) (School C group)

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These views raise the question of why young people think was an effective solution to problems and a number of young in these terms. From one perspective, it may seem people thought it made things worse in the longer term: admirably realistic and objective for young people to “If they’re like younger adults they might take recognise the relative seriousness of adult problems. On the drugs and stuff but if they’re older they’ll probably other hand, our previous research suggests that even quite be more mature / adults are more likely to turn to young children are deeply upset by the things that worry alcohol.” (School B group) them, and would like these to be taken more seriously by adults (Hill et al., 1995, Secker 1997). It may therefore be “They drink ‘cause they say it makes them feel that the young people who took part in this research had better / it makes them feel worse the next day.” internalised an adult perspective which trivialises and (School D group) devalues young people and their problems. “They might drink alcohol quite a lot and get Nor were the young people themselves totally immune to drunk and try and get rid of it all, but I don’t think adults’ worries. In particular, where worries about children that works either. I think you actually need to face were concerned, many of the young people appeared to the problem and get it over with.” (School D boy) feel responsible for these, and this in turn seemed to be a “They keep drinking and keep drinking and they source of worry and stress for them: end up getting steaming / they end up pure drunk “It’s just greater in adults more strain on them / and they don’t know what’s happened / and that ‘cause they’re working and they’ve got to make just makes everything worse man.” (School A group) money / they’ve got more responsibility for kids “It might help to begin with, but then the next and stuff, they’ve got work, they’ve got morning you wake up with a sore head / it makes everything.” (School D group) you sick if you drink too much.” (School B group) “Like say you’ve got kids that are quite like a rebel and they keep getting into trouble that makes adults really stressed, ‘cause they’ve got to deal Summary with it.” (School D boy) It was interesting to note there were very few differences Coping strategies among young people from minority ethnic backgrounds compared with the white respondents we interviewed. As As with the factors affecting mental health, the young might be expected young people from Muslim Pakistani people identified both similarities and differences in the backgrounds identified the family as particularly important ways they and adults coped with negative feelings. Like sources of support and friendship especially in times of young people, adults were thought to both talk about and difficulty. However, the pressure of the family was also bottle up their feelings. The main differences concerned the identified as causing some young people additional stress people to whom adults might talk and the use of alcohol. especially in terms of academic achievement. Interestingly Where talking about problems was concerned, a number of the self-completion forms also revealed a stronger emphasis groups in Schools A and D felt adults would be more likely on family life as young people often cited meeting up with to talk to a professional: family members in other countries as the best day of their life. They also referred more to the death of family members “Talk to their boyfriend or their husband / go to a as contributing to stress and other negative feelings, psychiatrist / doctor / talk it out with a social whereas the other young people in the sample talked of this worker / talk with a counsellor, get them to come less frequently and discussed a range of other issues. to the house.” (School A group) Chinese young people did not appear to have such strong “I don’t think they’ve (adults) really got anyone to emotional ties to their families and did not rely on them to turn to unless they go and see a psychiatrist or such a great extent for support. Factors which made them someone like that.” (School D boy) happy and sad were more akin to the rest of the sample than the Muslim Pakistani group and like the other While only one group associated drug taking with adults, all respondents they identified friends as also providing the young people involved in the research identified alcohol important sources of support at particular times of crisis. as a way in which adults coped. However, nobody felt this

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This chapter illustrated the main themes which emerged A number of similar factors were thought to influence from the focus group discussions and individual interviews the mental health of adults and young people. with young people in the mainstream sample. To However, several additional factors were also summarise, the main issues to emerge were: identified such as job insecurity, financial worries and Four main factors contributed to positive mental worries about children. Adults’ problems were health, although the importance of family and friends thought to be more serious than young people’s and were seen as the most salient factor. some respondents trivialised worries and problems experienced by young people. Factors which contributed to feeling mentally unhealthy included; the absence of family and As with factors affecting mental health, respondents friends; boredom; bullying and stress. identified similarities and differences in the ways adults and young people coped with negative In response to questions about how positive mental feelings. The main differences concerned the people health could be achieved and maintained, the to whom adults would be more likely to talk to and following issues were raised: the need for young their use of alcohol which young people were not people to feel safe, both physically and emotionally; thought to do. being able to talk to an adult of their choice in confidence; the provision of relevant information by informed adults. A minority also identified the provision of more clubs to prevent boredom and keep people off the streets and improvements to the local environment to tackle the affects of drugs on the community.

In response to questions about how young people coped with negative feelings they identified a range of coping mechanisms which addressed ways of coping with angry and sad type feelings. Taking out anger on inanimate objects, siblings, and on occasion other young people, were the most common means of coping. In contrast coping with sadness was dealt with by internalising feelings or bottling them up in the hope they would go away. Ways of dealing with more general negative feelings involved talking with friends and family. Surprisingly perhaps the use of drugs and alcohol were not seen as an effective way of coping with negative feelings.

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Chapter 4 Mental Illness: The views of young people from the mainstream sample

This chapter examines the data from the second half of the 4.1 Unusual behaviour interviews conducted in the mainstream sample, where the focus was on issues surrounding mental illness. The An early indication of the ways in which the young people intention was to ascertain the young people’s response to constructed their understanding of mental illness emerged the descriptions presented in the vignettes and to explore from their responses to questions about what constituted their understanding of the labels attached to specific mental odd or unusual behaviour. In arriving at their definitions, the health problems. We were also interested in the young young people implicitly drew a distinction between deviation people’s views about what might help people with the from personal norms and deviation from social norms. As the problems discussed in the interviews, and in their sources following extracts illustrate, their understanding of deviation of information about mental illness. from personal norms was grounded in their own experience of everyday patterns of behaviour amongst people whom A main theme to emerge from the data concerns the ways they knew or might conceivably know: in which the young people appeared to construct their understanding of mental illness. As was seen in the previous “If they were doing things they wouldn’t normally chapter, for some young people the concept of positive do, like if someone is usually quiet and they were mental health was closely linked with ‘normality’. Although going about shouting at everybody.” (School D boy) there was no consensus about what this might mean for “If they did something really different and not positive mental health, a clearer consensus did emerge from normal like the things they normally did.” the second half of the interviews about what might be (School A girl) described as ‘abnormal’. “When someone always does their hair in the In essence, in defining what did or did not constitute morning and make it fancy and then they shove it mental illness, the young people drew on their own lived back. Just don’t look after theirselves / they don’t experience to separate experiences and behaviour with get washed or nothing and normally they’re like which they could identify in some way from those which really clean.” (School A group) were completely outside their experience. When experiences and behaviour could be understood in terms of In contrast, where deviation from social norms was their own experience, the young people were reluctant to concerned, the young people drew on experiences of label these mental illness. Conversely, experiences and seeing strangers behave in ways they could not understand behaviour with which they could not identify were in terms of their own everyday experience, for example: constructed as ‘abnormal’ or ‘other’ and labelled mental illness. Thus anorexia and depression, for example, were “Dancing about / talking to theirself / loudly / not generally described as mental illness because they could I saw this man and he was like shouting and be understood in terms of the young people’s own waving his arms about and there was nobody there experience. In contrast, schizophrenia and behaviour such / going up to people and talking rubbish.” as responding to voices others could not hear were labelled (School C group) mental illness, a process which was both informed by and “Somebody jumping up and down wi’ mad clothes legitimated through reference to media representations. / somebody walking about wi slippers on.” This theme is explored here first in relation to the young (School A group) people’s ideas about odd or unusual behaviour, their “Jumping about being loud and swearing / just understanding of mental illness and their attitudes to the going crazy / talking to yourself and making people depicted in the vignettes. Their ideas about what weird facial expressions / staring and making might help with different problems are then considered, funny noises / thinking too much.” before turning to examine their sources of information (Minority ethnic group) about mental illness.

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“I was in Burger King and this man was talking to mentally ill. In fact, they quickly dismissed this vignette. himself but my dada said he was talking to his From their perspective, James was simply behaving badly. imaginary friend and he was hitting himself and In other words, they made a moral rather than a health everything.” (School D group) judgement. However, they were sympathetic towards the fact that his father had left, and cited this as a reason for his As will be seen in the following sections, these ways of behaviour. They thus proposed fairly environmental defining odd behaviour in terms of ‘known’ and ‘unknown’ explanations: people foreshadowed the young people’s responses to the “He’s acting a bit out of proportion / probably vignettes. ‘cause his dad left / aye not mentally ill though / if his dad was bad maybe he’s trying to take after him / he’s taking his anger out ‘cause his father is 4.2 The young people’s understanding away.” (Minority ethnic group boy) of mental illness “He’s probably bad because his dad left him and In order to explore the young people’s understanding of he’s probably not taken it in / probably thinks it’s mental illness, they were shown each vignette in turn and his fault / ‘cause his dad left it’s probably making asked whether they thought the character depicted was him upset and he’s trying to take the anger for his mentally ill. Except in interviews where the vignette dad out on other people / probably missing his exercise indicated participants were particularly dad as well.” (School B group) knowledgeable about the terminology of mental illness, “Stupid but not mentally ill / ‘cause he’s they were also shown flash cards on which specific depressed about not seeing his dad / probably diagnostic labels were written. In this way it was possible to ‘cause his mum hasn’t got very much time to look assess how many of the named conditions they recognised after him.” (School A group) and the extent of their knowledge about them.

In some cases, where the young people did not define the Depression problems depicted in the vignettes in terms of a diagnostic label, when they were shown the relevant label on a flash The distinction the young people were making between card they recognised the term even if they did not know its experiences and behaviour with which they could identify exact meaning. In a few cases they were able to relate the in some way and those with which they could not emerged label back to a specific vignette. This suggests that the more clearly as they discussed the portrayal of depression in young people were familiar with the terms concerned, but Vignette 4 (David). Although it was not uncommon for the in most cases they had only a vague idea of their meaning young people to spontaneously describe David’s behaviour and did not connect them to particular individuals. as depression, the great majority of them did not define this as mental illness. For them, as these extracts illustrate, the The following discussion deals in turn with the young experiences and behaviour described were accessible people’s understanding of each of the mental health enough through their own experience to be regarded as problems represented in the vignettes and flash cards. ‘normal’:

Behavioural problems in adolescence “I don’t think he’s mentally ill / everybody gets depressed but not as bad as that.” (School A group) The young people’s response to James (Vignette 1) provides an illustration of the central part played by their own “No he’s not mentally ill I just think he’s got experience in distinguishing what was to be considered depression and he doesn’t care about anything but mental illness from what was not. As was seen in the I don’t think he’s mentally ill” (School D girl) previous chapter, the main way in which many of the young “No not mentally ill but like he’s got stress or some people themselves said they dealt with negative feelings other problem / he’s got nothing to live for so his was through aggression towards other people and things. mind’s sort of gone.” (Minority ethnic group) From their perspective, then, James’ behaviour was not ‘abnormal’ because it could readily be understood in terms “No not mentally ill just depressed and selfish.” of their own experience. Consequently, none of the young (School C boy) people who took part in the research regarded James as

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Since the word depression was so commonly used in experience to preclude them being classed as mental connection with this vignette, the young people’s illness, and none of the young people did so. As one group understanding of the term was explored in more detail. put it: Again, their use of their own experience in locating “I’m afraid of spiders but I’m not mentally ill.” depression within the bounds of normality became (School A group) apparent:

“Depression is not mental illness / my mum’s Similarly, the young people’s understanding of anxiety was friend used to be depressed because her boyfriend grounded in their own experience: walked out. She lost lots of weight but then she “That’s when you’re really worried about went to see the doctor and he gave her anti- everything. Like you are sure it’s going to happen depressants.” (School A group) and you’re so worried about it and just forget “Really sad and like everything is so awful and it everything else and focus on this one thing.” will never get better, but it always does.” (School D group) (School B boy) “When you’re really worried about something and you feel a lot of anxiety about that thing.” Although some young people acknowledged that (School B boy) depression might mean different things, mental illness was not included amongst them: Consequently, again, anxiety was not viewed as a mental “Depressed can be quite a lot of things. It can be illness: feeling really sad about yourself or it could be “I don’t think it’s a mental illness though, ‘cause feeling like there’s no point in life going on and like I think a lot of people get anxious and worried why should I bother. Depressed can make you feel just before a test or something.” (School C group) pretty much of a failure.” (School D boy)

“It depends what you think of depression as. You Anorexia can get depressed because somebody calls you a name / but would that be depression / not The young people’s discussion of Angela’s behaviour necessarily that might just be frustration or anger (Vignette 3) was particularly interesting in terms of how / depression might be when you feel like they were constructing their definition of mental illness. everything’s gone wrong and you just don’t want All the young people were clearly knowledgeable about to go on with it.” (School C group) anorexia and spontaneously used the term in relation to Angela. Although girls were more vocal than boys on this One girl, however, disagreed with the general consensus subject in the group discussions, the boys proved equally that depression did not constitute mental illness. Like David knowledgeable in individual interviews. in the vignette, her father had become depressed after However, the young people had more difficulty than with the being made redundant, and had been admitted to other problems discussed so far in deciding whether anorexia psychiatric hospital. On these grounds, the girl therefore could be described as mental illness. On the one hand, they defined the behaviour described in the vignette as mental appeared reluctant to say that it was, because the behaviour illness. described could be understood in terms of experiences they could relate to and understand. This group, in particular, Anxiety and phobia revealed considerable depth of understanding: Although anxiety states and phobias were not depicted in a “If she keeps on she’s just doing herself harm / vignette, they are relatively common mental health maybe she can’t stop though. She’s in a sort of problems and the young people’s understanding of them pattern and she can’t get out of it / I suppose it’s was therefore explored using flash cards alone. All the like you smoke and you get addicted / may be she young people who took part in the interviews recognised feels like she’s got some power over her. May be the term phobia and were able to define it, mainly in terms everything in her life is going wrong and that’s of being afraid of spiders, heights and small spaces. Again one thing she can control.” (School D group) these fears were accessible enough through their own

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On the other hand, the young people felt it was not which John and Peter behaved. “normal” to behave like Angela. Although a small number of The following illustrates views in response to the questions participants did unequivocally define anorexia as mental already mentioned about vignettes describing John and illness on these grounds, the majority resolved the dilemma, Peter: as this girl did, by using a third category of mental, or psychological, problems: Vignette 2 (John) “I don’t think she’s mentally ill but she’s got a Schizophrenia / it’s a bit like what Joe is out of psychological problem with the way she feels Eastenders / it’s where one person is like two about herself and the way she looks.” (School C girl) people. They can be a normal person at one time “It’s not like a mental illness / no ‘cause like it’s and then another person takes over their body and not really out of the normal it’s just like to do with makes them do things they wouldn’t normally do eating / people are skinny so it’s still normal.” / yeah like they might hurt people or hurt (Minority ethnic group) themselves / they can get like lots of different personalities / and they can change from one to the other quite quick.” (School D group) Psychotic behaviour “Schizophrenic or something ‘cause he’s hearing In contrast with their response to the other vignettes, voices and mood swings and forgets routines an’ all the young people who took part in the research that / like there’s two people doing different stuff unequivocally defined the behaviour described in Vignettes / you argue with your own head.” (School B group) 2 and 5 (John and Peter) as mental illness. For the most part, the two characters were seen as very similar and the “He can’t help it ‘cause it’s his mental condition / terms schizo or schizophrenia were used to define them paranoid as well because he hears voices and both. thinks people are trying to harm him.” (Minority ethnic group girl) “Aye mentally ill like schizophrenic or something / ‘cause he hears voices and stuff.” (School D group) Vignette 5 (Peter) “He’s just... well he’s just kind of the same as what was it, John, because of the voices inside his head. “Well he’s kind of the same as what was it John If he thinks he’s getting controlled by aliens, he’s because of the voices inside his head. He must be maybe just been watching TV programmes and a wee bit mentally ill if he’s got voices inside his stuff and seen things like that. The X-Files and head. That’s not a very good sign.” (School A girl) stuff.” (School D group) “He’s like the same as the other one [John] / “Aye mentally ill / a bit like that Joe out of aye mental / very weird and paranoid.” Eastenders / really weird man.” (Minority ethnic group boy) (Minority ethnic group) In summary, then, the young people’s responses to the five These two characters were seen as very similar by the vignettes, and to the flash cards where these were used, young people, therefore they are discussed together. The suggest that they were drawing on their own lived terms schizo and schizophrenic were identified as experience to define behaviour in one of three ways: appropriate terms for these particular characters as young behaviour with which they could identify quite closely was people believed they classified anyone who heard voices, classified as being within the bounds of normality; talked to themselves or were aggressive in any way. All behaviour with which they could identify but which could young people compared John and Peter to a television not be described as normal was classified as resulting from character; Joe from Eastenders, who had been diagnosed as mental or psychological problems, but not as mental illness; schizophrenic. and behaviour they had difficulty in identifying with was classified as mental illness. Some young people used the terms mentally handicapped, stressed, daft, weird, mentally ill, sick, psycho, loony, paranoid, mad, maniac and strange to describe the way in

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4.3 Attitudes towards mental illness “Probably try and talk to him sometimes and try and help him a little bit. Show him that somebody Research participants’ attitudes to mental illness were actually cares.” (School A girl) explored through questions about how they would feel if “I’d feel sorry for him / yeah and like try and get they lived next door to the people portrayed in the to know him and try and understand the way he vignettes and through further questions about the sort of is.” (School B group) people they thought might become mentally ill. Their responses to each line of questioning are considered here Where Angela was concerned, sympathy was expressed by in turn. all the girls in Schools A, B and C but not by the boys, again suggesting that the process of identification was important. While the first three quotations below are from girls who 4.3.1 Responses to the vignette characters took part in the research, the forth is an extract from a discussion between a boy and two girls: The young people expressed three main responses to the characters in the vignettes: sympathy, fear and, in a minority “You’d feel dead sorry for them / you’d end up of cases, embarrassment. putting in food for them / you wouldn’t feel scared or nothing just sorry for them.” Interestingly, these responses were related to the type of (School A group) behaviour illustrated and the age of the individual portrayed, but not to whether they were regarded as “I’d like just help her to eat an’ that and tell her mentally ill. As will be seen, where both anorexia and the she’s not fat. She needs a lot of help.” (School C girl) expression of fear were concerned, participants’ gender “You’d feel sorry for her ‘cause it’s important to also appeared to play a part. her what other people think she looks like.” In addition, young people in rural School D appeared less (Minority ethnic girl) tolerant and sympathetic than the other respondents. “[She’s] stupid ‘cause she’ll end up making herself Although those from School D were not condemning or really ill or damaging herself. And like it’s only intolerant, they were more likely to be indifferent to the ‘cause she wants to look like the super models / individuals in the vignettes, and were less concerned with yeah but like she can’t help it / I’d feel really helping or befriending them. Why this was is very difficult sorry for her ‘cause like she’s probably got a to determine from this study and would require a more problem like an eating disorder.” (School B group) specific study with a more representative sample. As noted above, attitudes in School D were generally less The young people’s main responses are each considered in sympathetic, and this applied to Angela as well as to the turn below. other people portrayed in the vignettes. Although the young people at this school said it would not bother them if Sympathy Angela lived next door, none of them expressed any wish to Sympathy was most commonly expressed for James make friends with her or help her and one group member (behavioural problems), Angela (anorexia) and, to a lesser was clear that she would not do so: extent, Peter (psychotic behaviour). That these three “I wouldn’t want to be friends with her ‘cause she characters were all young people themselves suggests that wouldn’t want to do the same things as you ‘cause here too the response of the young people who took part in like she’d want to go for a jog and you’d want to the research was to some extent shaped by the extent to watch telly.” (School D group) which they could identify with the person concerned. For example, despite their quick dismissal of James as ‘just The attitudes of those young people who expressed behaving badly’, they were nevertheless quite sympathetic sympathy for Peter are particularly interesting in that they to him: illustrate how an understanding could be achieved, even of “I’d probably feel sorry for him because of his behaviour classified as mentally ill, through extrapolation problem and people might like just ignore him. from personal experience. For example, one group member Maybe that’s why he’s doing that.” (School B boy) in School A equated Peter’s feelings to the feelings she experienced herself when watching a horror movie:

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“It must be scary thinking there’s aliens in your view, less threatening. The following extracts illustrate the head, like if you watch “Aliens” or something.” difference in their attitudes. (School A group) John: Another participant equated Peter’s feelings with those “I’d feel a bit scared because you don’t know if he’d commonly experienced in childhood: turn round and do anything to you. One minute “It’s like a child who thinks there are monsters you could be talking to him and the next minute under the bed, you actually begin to think it.” you could be like thrown across the room or (School B group) something like that.” (School C girl)

“If he’s verbally aggressive it’s not very safe living In contrast with their response to these three characters, next to him.” (School B boy) sympathy was only expressed in one individual interview and one focus group towards the adult vignette characters, “What if he comes in and starts shouting and stuff again regardless of whether they were regarded as mentally and he could be getting up to stuff if he’s hearing ill. Thus only one participant expressed a degree of voices.” (Minority ethnic boy) sympathy towards John (psychotic behaviour):

“I’d probably just help him out a bit. Maybe not Peter: when he was in one of these funny moods with the “Make sure people didn’t tease him / I’d go up to voices telling him to do things because you him and try and calm him down / try and get him wouldn’t know what he was going to do.” away from people staring at him in the streets.” (School B boy) (School B group)

Equally, despite the general consensus that he was not “You’d probably want to go and help him and talk mentally ill, only one member of a group in School B to him but you wouldn’t really know what to do / expressed sympathy for David (depression), and this was because he’s so shy it would be a bit hard for him because he had known someone in a similar situation. to make friends.” (School C group) However, after he had explained about the man he knew the rest of the group appeared more sympathetic. This may Although hearing voices was a key indicator of mental have been the result of a concern to make a socially illness for the young people, they were not necessarily acceptable response, but it may also suggest that the young frightened simply because someone heard voices. As these people’s attitudes could be shaped not only by their own extracts illustrate, fear was only apparent when there was a experiences, but also by the experiences of other people threat or actual evidence of violent behaviour: which had some salience for them. “If he was being really aggressive and was always fighting I’d be scared but if he was just a bit weird Fear and quiet then you know I’d probably not think Unsurprisingly, fear was most commonly expressed in anything of it.” (School B girl) relation to those characters in the vignettes whose “I’d be scared / aye he doesn’t know what he’s behaviour was portrayed as potentially aggressive or doing and thinks everybody’s gonna harm him / unpredictable. For this reason, all young people said they his voices are telling him to do stuff / the voices would be frightened of John, Peter and, to a lesser degree, could tell him something and he could walk up to James, towards whom some were quite sympathetic, as has you and stab you or something / aye” been seen. (School A group) Again, the age of the character portrayed seems to have been a mediating factor in all those interviewed apart from A further extract from one group discussion of John those in School D, where young people were equally suggests that in some cases at least, the ridicule to which frightened of Peter and John. The other respondents people with mental illness can be exposed stems more from indicated they would be less frightened of living next door the fear of others than from the behaviour associated with to Peter because he was younger and therefore, in their mental illness itself:

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“I would be frightened of him. I think that’s why 4.3.2 Views about who might experience people make a joke of it / yeah they don’t know mental illness what else to do / I would be frightened if I had this man living next door to me and I wouldn’t In response to questions about whether there was a know how to react so I’d make a joke of it.” particular type of person who suffered from mental illness, (School C Group) the majority of young people initially said they did not think there was. In particular, they rejected the suggestion that Where James was concerned, the young people’s views class, race or gender might play a part. After further were divided. While some feared that James might be discussion, most participants did suggest situations which physically aggressive towards them, given his propensity for they thought might predispose someone to mental illness or fighting, others thought he would be annoying but not make them more susceptible to it. However, they were particularly frightening. Unsurprisingly perhaps, keen to make it clear that this would be due to participants’ gender seemed to play a part here, with boys circumstances rather than individual characteristics. For being less likely to express fear of James than girls, at least example, several young people felt people would be more in the group interviews. In the individual interviews, likely to experience mental health problems if they were however, the boys did express more fear of James, and their poor, due to the stress of not having enough money: attitude in the groups may therefore have had more to do “Like if you’re poor / aye if you’re a bit middle with the need to portray a certain image than with their class you wouldn’t suffer as much / you don’t true feelings. really hear of people like that getting ill.” In contrast with their attitudes towards John, Peter and (School B group) James, none of the young people expressed any fear at the thought of living next door to David (depression) or Angela Equally some young people felt being unemployed or failing (anorexia). exams would have a detrimental affect on mental health:

“No. No particular type, but like if they’ve just been Embarrassment unemployed or something like that they could get Embarrassment was not a commonly assessed attitude, but really depressed and get mentally ill that way / or it was mentioned by one boy from School C in a group if university, they failed exams or something like interview, and by one boy from School D in an individual that they’d feel useless. But it’s really not a specific interview. Both were concerned that they could not be type of person / it could be anybody.” friends with someone who displayed behaviour like John, (School D group) James or Peter because they themselves would be thought of as strange for befriending these people. As these extracts For most of the young people, then, mental illness was from the two interviews indicate, a strong need to ‘fit in’ associated with stress rather than with particular individuals or appeared to lie behind these attitudes: groups. However, one group from School D and one of the minority ethnic groups did feel that, on the whole, men were “I don’t think I could be friends with them [John, more likely to experience mental health problems than James and Peter] ‘cause like you’d feel really women. In particular, they thought men were more likely to embarrassed if they started saying things like experience depression, although women were more likely to they’re talking about me and then other people suffer from phobias and anorexia. Here too, though, the young would think you were weird for hanging around people’s explanation related to the stresses they associated with him.” (School C group) with different gender roles, rather than to gender per se: “All your other friends would be saying stuff like “Because men bring in the income for the family / look at you. You’d be the odd one out then.” not so much now / yeah but they take care of all (School D boy) the bills and that / women have to cope with having children.” (School D group)

“Mainly men ‘cause like they have more to worry about / only anorexia happens to females.” (Minority ethnic group boy)

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4.4 Helping with mental health problems Peter:

“His parents could talk to him. They could calm In the course of general discussion and in response to him down and tell him people aren’t looking at specific questions about what might help the people him.” (School C girl) portrayed in the vignettes, the young people identified a range of possible interventions. These included informal sources of help such as talking with family or friends, and John: more formal interventions such as professional assistance, “He should go and talk to a counsellor about it. See hospitalisation and medication. what the voices are saying an’ that.” (School A girl) Again, the young people’s views about which of these “Like the social worker she could come and talk to might be most appropriate for each of the people portrayed him [John] an’ that / help him sort out his head in the vignettes did not necessarily depend on whether they and stuff.” (School A group) were thought to be mentally ill. Instead, their opinions appeared to be based on the age of the person concerned There was, however, an exception to the young people’s as much as on the type of problems described. Their views use of age in deciding the best source of help where Angela about the different interventions they discussed are (anorexia) was concerned. Here, the type of problem considered below, together with their ideas about the part described seemed to be the deciding factor, in that most of different professionals might play. the young people thought either a psychiatrist or a psychologist would be best placed to help Angela: Talking things through “Take her to a psychologist...... probably tell her In keeping with the young people’s earlier emphasis on that she’s not fat and get her believing that she’s talking things through as a way of dealing with problems, not fat, she’s too thin.” (School B group) this was seen as important for all the people in the vignettes, regardless of age or the problems described. “She needs to see a doctor / or you can go to However, age seemed to play a part in the young people’s special clinics for that” (School A group) opinions about who it was best to talk to. Whereas family and friends were most often suggested for the younger Hospitalisation characters, professional assistance from counsellors, social workers and psychiatrists was suggested in addition to Unsurprisingly, hospitalisation was most often suggested for informal help from family and friends for the adult the vignette characters portraying psychotic behaviour. characters. Thus informal support was identified as Here too, though, the young people’s decisions appeared to important for both James (behavioural problems) and Peter depend as much on the age of the character concerned as (psychotic behaviour), while professional assistance was on the problems described, in that hospitalisation was suggested for John (also psychotic behaviour): suggested more often for adults than for the younger characters. James: Interestingly, there was some differences between young “If someone sat down and talked to him about it people from different schools as to the purpose of may be they could find out what’s really bugging hospitalisation. For the young people in Schools A and C, him and help him through it / like his dad could hospitalisation was primarily a means of restraint and help him a bit more / talk to him and see how he protecting others in the community, as opposed to a source feels.” (School B group) of help for the individual concerned:

“Put him [John] in a hospital / aye a mental one / locked in one of those wee white rooms / there’d be nobody there he could hurt / there’d be nobody there he could take it out on.” (School A group)

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“He [John] needs to go to hospital because he’s It was only in School A that anti-depressants were referred verbally aggressive and might become aggressive / to in the course of general discussion about depression, or also to help him / put him on a restraining suggested as an appropriate treatment for David (vignette 4) order.” (School C group) “Aye gi’ him tablets for depression / my brother was depressed and he got pills from the doctor / In contrast, young people from School D discussed whether aye anti-depressants.” (School A group) hospital was the best place to help someone like John and did not seem to see hospitalisation as a means of protecting the community: Professional roles

“Hospital but I suppose that wouldn’t do much for In addition to their role as someone for adults, in particular, him if he’s in with a load of other people who have to talk to, the young people identified a number of other got mental problems / if he’s nobody else to ways in which professional assistance might play a part. The speak to like family or friends I suppose that professionals most frequently mentioned included doctors would be the only option / no but he might think (GPs), psychiatrists, psychologists, counsellors and that is the right way to act and it’s normal / it teachers. In Schools A and D, social workers were also might be better ‘cause he wouldn’t think he was mentioned. the only one that suffered from it and he wouldn’t All the young people distinguished between the role of GPs feel so left out.” (School D group) and psychiatrists. Whereas GPs were identified as people who could prescribe medication and deal with physical Medication complaints, psychiatrists were thought to be more able to talk to people and “sort out your head”. As the following Medication in the form of pills and tablets was seen by the extracts illustrate, psychiatrists were not thought to be able young people as a means of “calming people down” rather to prescribe medication, and some young people did not than as a means of resolving problems. In accordance with see psychiatrists as doctors: this view, medication was therefore regarded as appropriate for those characters, James, John and Peter, whose “A doctor could talk to people and give medication behaviour was described as aggressive: and the psychiatrist could talk to people but not give medication.” (School D group) “They could give him [John] pills to calm him down and stop him hearing the voices.” “Psychiatrists are trained to help people with like (School C girl) mental problems / more mental than physical.” (School B group) “Give him [Peter] pills the same as John. That would calm him down and make him think The young people from Schools A and D who discussed the normally and the way he used to be.” (School B girl) role of social workers identified them as being able to help “I think there’s some sort of tablet he [James] could in a variety of situations. Unlike doctors or psychiatrists, take to calm him down.” (School D boy) they were not thought to be able to prescribe pills or tablets, but were referred to in terms of sorting things out, “Give him [John] tablets to control him.” talking things through and “someone who knows what (Minority ethnic group boy) they’re talking about”. For some young people, this was not just of benefit to the adults directly concerned, but also to In addition to pills to “calm people down”, the young their children: people also referred to the use of anti-depressants. However, in schools B, C and D, these seemed to be seen as “They try and sort out any problems like talk to a universal type of drug which could be given to any of the people and stuff. They make the home characters identified as mentally ill, rather than to treat environment for the children a lot easier.” depression. (School D boy)

“Aye pills that would help him [John] / aye anti- In comparison with other professionals, psychologists were depressants that’s what you get for that type of only mentioned by a small number of the young people. In thing. They calm you down.” (School C group) one group, however, it transpired that a member of the

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group had seen a psychologist, and the rest of the group were interested to know what they did. The girl concerned “He had this thing that everyone was so dirty and explained: he always wore white and he had a bath three “They try and talk to you and calm you down and times a day, and he left school because he felt play wee games. They helped me a lot. I feel a lot everything was too dirty.” better now. They sort of sort out your head and problems you’ve got.” (School A girl) Another girl spoke at some length about her father’s experience of depression: Finally, despite the general view expressed earlier in the “My dad had depression three years ago ‘cause like interviews about the lack of access to professionals to he got made redundant from his work and it whom young people can talk in confidence, some young started off OK and then it got worse and he people did feel guidance teachers could intervene in certain wouldn’t eat or drink and he got taken to hospital. situations and help to alleviate certain problems, especially I only went to visit him a few times ‘cause I didn’t bullying and other problems at school. like it at all and he just stared at the ceiling and he was really ill and he wouldn’t even look at me...... He’s all right now.” 4.5 Sources of information about mental illness A different girl in the same group then talked about her uncle: The data from both the group and individual interviews suggest that the young people’s information about mental “My uncle was schizophrenic. He started to hear illness was derived mainly from the media, especially voices all the time and he committed suicide. He television, and that neither school nor their parents had jumped off a bridge ‘cause he couldn’t take the played any significant part as far as they were aware, but it voices.” is highly likely that they were effected by more subliminal information from family and peers. All the young people As was seen earlier, experiences like these could make a who took part in the research said their knowledge came considerable difference to the ways in which the young mainly from the television. In addition, some mentioned people responded to the characters portrayed in the magazine and newspaper articles. Although a small number vignettes. For most young people, however, the media said their parents had discussed mental illness with them seemed to be the most influential source of information. after it had been raised by a TV programme or film, all said they had received no information at school.

Interestingly, the information booklets which were made available to the young people after each interview were all taken away, perhaps indicating a desire for more formal sources of information.

For some young people, however, personal experience was a potent source of informal information. Although none of the participants in the research spoke about having been mentally ill themselves, several had experience of mental health problems amongst their friends or family. Some young people were clearly uncomfortable talking about this and they were not pressed to do so. However, others did elaborate without being pressed. For example one girl spoke about a friend whom she thought suffered from a form of phobia (extracts from these interviews have not been attributed in order to ensure anonymity):

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Summary Young people identified a number of interventions for the individuals in the vignettes. These included The responses to questions on issues about mental illness formal sources of help such as psychiatrists, demonstrated the views, attitudes and understanding young psychologists, doctors and in a minority of cases people had, and what influences played a part in shaping social workers; and informal sources of help such as their various points of view. One of the most significant family and friends. In keeping with earlier emphasis features to emerge from this chapter was the way in which young people appeared to construct their understanding of on talking, young people identified this as an mental illness. This was done by separating experiences and important method of helping all those in the behaviour they could identify with from those which were vignettes. However, age appeared to determine unfamiliar to them. Consequently behaviour that was whether formal or informal sources were most familiar tended not to be classified as mental illness, effective, family and friends seemed to be favoured whereas behaviour they had little understanding or more for the younger characters in the vignettes. Age experience of was more often thought to be a mental also appeared to be an important factor when illness. This appeared to be a theme which ran through the data. considering hospitalisation for the more psychotic types of behaviour as it was thought more Unusual behaviour was defined in terms of deviation appropriate for adults than the younger characters in from personal and social norms. The former was the vignettes. based on their own experience of behaviour among people they knew or might conceivably know. Medication was seen as a means of calming people down as opposed to treating or resolving their Understanding of mental illness was illustrated in a problems. Not surprisingly it was advocated for the number of ways as a result of vignettes and flash more aggressive and volatile types of behaviour. The cards. It was defined in one of three ways depending use of anti-depressants was mentioned on several on how closely young people identified with the occasions but the term was often used as a universal behaviour displayed. type of drug appropriate for any mental illness. Attitudes towards mental illness included sympathy, Young people identified different roles for the fear and on occasion embarrassment. These different professionals they had identified as being able to attitudes appeared to be determined more by age and help both adults and young people experiencing the type of behaviour as opposed to a diagnosis of mental health problems. Doctors were seen as being mental illness. In response to questions about who able to deal with physical complaints and prescribe might experience mental illness, young people did medicine, whereas psychiatrists were often not not initially think race, gender or class played any thought of as doctors but most appropriate to talk to significant role. However, after further consideration a and “sort out your head”. Social workers were only number of young people felt that poverty would mentioned by a small number of young people but predispose people to mental illness due to the stress they were thought to help people sort out more of not having an adequate amount of money, and general problems of everyday living. several felt men would be more likely to experience conditions such as depression due to the stress of The knowledge and understanding young people being the breadwinner, but women would be more displayed about mental health and illness was, susceptible to conditions such as anorexia, anxiety according to them, mainly derived from the media and phobias. They did make it clear that they thought especially television. Parents and schools played little mental illness was the result of circumstance and overt part in informing young people about such external pressures rather than individual issues. characteristics.

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Chapter 5 Positive mental health and mental illness: the views of young people with identified problems

The following two chapters examine the responses from with issues discussed in the interviews and had no more the “special” subsamples which consisted of children with knowledge about specific mental illnesses than young identified emotional, psychological and/or psychiatric people in the mainstream group. They were far less likely to problems (special A); and children living with a mentally ill admit or even to acknowledge negative feelings, but did not parent (special B). The data from these two sub-samples appear to be covering them up, they simply did not seem to was examined separately as there were some significant associate their feelings or behaviour with negative emotions. differences. We felt it was most appropriate to comment on The following presents the views of this group on the issues the differences in the attitudes and perceptions of the two raised and highlights contrasts with the mainstream group. special groups in comparison with those from the mainstream sample. Consequently we have not provided commentary on all the data as some of the responses from 5.1 Feelings these two groups were very similar to those of the mainstream group. The findings in this chapter and the next Unlike the interviews with young people from the only reflect the most salient differences which add to the mainstream sample, respondents from this sub-sample did wide range of views already obtained. not identify a large number of feelings. Those they did As indicated in Chapter 2 there were a number of problems identify were mostly positive feelings, and when asked if in recruiting this sample so the numbers were small. they could think of negative feelings they either remained Consequently the data, although interesting cannot be used silent or said they did not have any. Initially the interviewer to form any concrete conclusions about how particular thought they might not have understood the question so groups of young people perceive mental health and illness, examples of negative feelings were given to assist them. but give some indication from a small number. However, it became obvious that they did understand when various individuals gave replies such as: The first chapter examines the data from interviews with young people who have identified problems and the second “No I never feel sad I’m a very happy boy.” examines data from interviews with young people living with a mentally ill parent. The themes used in the earlier Even when the interviewer acknowledged this statement by chapters which reflect the interview schedule have also saying, “OK. but what about other young people? What sort been used to identify important differences or to discuss of bad feelings do they have?” The respondents could only issues that have not been raised already by the mainstream identify a few negative feelings and some identified sad as sample. the only negative feeling they knew, but were keen to add that they never usually felt sad. For those who could Before reporting there are noticeable differences between identify negative feelings sad, angry and bored were the the data produced by this sub-sample and the mainstream most common. sample, it is relevant to note additional contrasts which arose between the dynamics of the interviews. Not surprisingly children in the special sub-sample were much 5.2 Young people’s understanding more difficult to interview. They were less expressive and of positive mental health articulate, and they became bored and restless quite easily therefore the responses were not always easy to interpret. There was little difference in the way this sample This reflected the fact these were mostly a group of responded to questions about positive mental health emotionally turbulent young people some of whom had compared with the mainstream sample. Again the responses suffered from very traumatic experiences. Despite this they to questions about the meanings of mentally healthy were were very co-operative and had some interesting views. mixed and the answers were similar to the mainstream They did not explicitly link any of their personal problems group.

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“Mentally healthy is like when you’re pure, pure The problem of being mentally unhealthy was also healthy, like not schizo.” (Boy) addressed. Unlike the mainstream group this was not described in terms of feelings but as a functional defect of “Feeling good in your mind.” (Boy) the brain. “Feeling happy.” (Boy) “Your brain doesn’t work properly and you’re like “Fit/you can run and exercise your body.” (Girl) a cabbage.” (Girl)

“Fit you can run an’ that.” (Boy) “You’re just like a vegetable.” (Boy)

As in the mainstream interviews respondents were asked to In contrast to the mainstream group it was difficult to identify factors which made young people feel mentally follow this discussion by asking what causes young people healthy. In general this sample identified similar factors to feel mentally unhealthy as specific feelings were not although in some instances the context was different. For identified to describe mentally unhealthy. Therefore feelings example when asked what makes young people feel good identified in previous interviews with the mainstream or mentally healthy both groups identified friends and sample were used as examples and respondents were asked family, but young people in this sub-sample said they felt if they thought these meant young people were mentally good when they had made up with their parents after unhealthy and if so what caused them to feel this way. arguing with them, or they had behaved well and their Similar causes to the mainstream group were identified, but parents were pleased with them. In contrast respondents in again there were subtle differences in context and language. the mainstream sample identified family and friends as For example bullying was identified by the mainstream making them feel good in more general and unconditional sample as a negative factor affecting mental health, and terms as they provided support mechanisms and although the word “bullying” was not used by this sub- companionship. sample they indicated such actions (which could be termed as bullying) affected their mental health. They referred to Personal achievement was also mentioned but only by a people “noising them up” instead of saying they were small number of respondents. Factors mentioned which bullied. This phrase appeared to mean anything from verbal were not identified by the mainstream sample were: drugs, to physical abuse, and had the same consequences for them alcohol, stealing cars and women (boy response). Young as bullying did for the other group; they felt stressed, people in this group appeared to associate positive feelings annoyed and miserable. This was a term used by a number with instant gratification. Happiness and feeling good of male and female respondents in this sub-sample. appeared to be a short term feeling that could be attained through immediate actions, which as one respondent said The following provide responses to the question: “what gave a “buzz”. It appeared that on the whole the factors makes young people have negative feelings?” (examples of that this group associated with making young people feel negative feelings were given to begin with). good or mentally healthy were reactive strategies to “Somebody annoys you like the older ones noise negative feelings, rather than factors which were simply you up too far and you go daft and you get enjoyable or made young people feel good in their own problems you can’t cope with and you get stressed right. out.” (Boy) The following illustrate some of the responses to the “Folk noising me up ‘cause of the colour of my question “what makes you feel good or mentally healthy?” hair and stuff like that.” (Boy) “Women. When I behave because folk are pleased with me and that makes me feel good. Christmas, Those in this sub-sample who spent significant periods my birthday.” (Boy) away from home discussed the disappointment experienced when parents promised to do something such as visit them “Smoking dope, getting a buzz, doing motors, and then they did not follow it through. This was only drinking.” (Boy) relevant for those who were resident at the schools. This “When you’ve fallen out wi’ your ma and you fall seemed to produce outward signs of anger and frustration. back in wi’ her.” (Girl) One of the girls said that she felt it was all her fault when this happened and it made her feel like committing suicide.

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“When your ma promises she’ll come up and she “Dancing and keeping people off the streets and does nae. You feel as if you might kill yourself and drinking at weekends. Clubs an that so you weren’t it’s all your fault.” (Girl) walking the streets all the time turning cars and doing drugs an stuff like that.” (Girl) This was an issue which was only discussed by one group in the mainstream sample and was not mentioned in reference One boy said legalising cannabis would help to promote to themselves but other young people. positive mental health as it would keep young people away from using hard drugs:

“Legalise hash. If you legalised hash it would stop 5.3 Promoting positive mental health people from being so hyper and calm them down and then maybe get a job. People are hyper ‘cause The respondents in this sub-sample were asked what could they take stuff like smack and jellies an’ that and be done to make young people feel better and have more they get hyper when they can nae get them. positive feelings. Unlike the mainstream sample they Smoking hash is better for you.” (Boy) identified a much smaller number of factors which could promote positive mental health. At times what they said Again this statement gives the impression of minimising risk was quite contradictory as the factors which they felt but still getting some degree of pleasure. needed to be addressed in order to promote their mental health were the factors which some identified as making A small number mentioned more mainstream activities such them feel happy. as swimming, basketball and clubs as helping to promote young people’s mental health, but these were in the They wanted more activities for young people to prevent minority. On the whole the comments of this group them becoming bored and as a result turning to drugs and reflected the involvement of many in behaviour crime. This was an interesting point as a number of the disapproved of by the law and adult authorities. respondents had already identified these two activities as making them have positive emotions. One answer to this dichotomy could be that they were putting on some kind of 5.4 Dealing with negative feelings bravado, when in fact they were aware that such behaviour was a means of escape, be it from boredom or more Considering respondents in this group were unable to list negative feelings. Perhaps this type of behaviour was their many negative feelings and some said they never only chance of taking control and “doing something” as experienced any, responses to questions about coping with opposed to having “something done” to them. They may such feelings provided some interesting insights into the also have been responding to presumed social expectations negative feelings these young people do in fact experience. learned from professionals and others. It is possible that these feelings have come to be One boy said that young people stole cars because there experienced so frequently that they are unable to was nothing else for them. He also gave the impression that distinguish them as specifically negative and just presume there was very little to lose so the risks associated with they are normal. stealing cars were worth taking. Nonetheless programmes Again negative feelings were identified by the respondents or activities were still thought to be beneficial as they as sadness and anger, and different mechanisms were would provide a purpose to life but take away any risk of identified to cope with them. Discussions were not as being put in prison or having a criminal record. expansive as the mainstream group and respondents only “Young people need places to do up motors and referred to their feelings as angry or sad, whereas smash them up and drive them about and get a respondents in the other sample elaborated and described good laugh. Young people take motors and stuff specific feelings which came under these broader headings. ‘cause it’s a buzz and there’s nothing else for them. As in the mainstream sample, ways of coping with such If there were other things that gave you a buzz feelings were largely reactive as opposed to proactive. One then you wouldn’t do it.” (Boy) respondent really summed up the different coping mechanisms used by this group which are very different from the mainstream group:

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“When you feel like sad an’ that? Take drugs, drink, “See when I used to get pissed off I’d go out and steal motors. Some people they like cut take a motor and get a good laugh and a buzz and themselves. Aye a lot of young people cut then I’d be alright. It made me feel better and themselves.” (Boy) happy, but I didn’t like being caught.” (Boy)

A large number of respondents of both sexes identified It was interesting to see these boys talking about stealing cutting themselves as a way of coping with feelings of anger cars as they became very animated and excited when and sadness. The results of this were evident as some of the discussing it and this activity obviously gave them much respondents had scars which were clearly visible. This was enjoyment. However, should young people have to go to not mentioned by any respondents in the mainstream such lengths in order to gain enjoyment and pleasure? group. Respondents said that cutting or slashing themselves The respondents in this group as in the mainstream group helped them forget about issues that were making them feel said that they talked to people they could trust if they sad and helped them to feel less angry. It appeared to act as needed help with problems. A number however did say a diversionary tactic taking the focus away from one thing they would not talk to anyone if they felt sad, only if they and putting it onto another that they had more control over. had a specific problem. Some said it also gave them a “buzz” when they were doing it and made them feel physically better. “I go to people if I’ve got any problems, but I don’t talk to anyone if I’m sad.” (Girl) “When you feel angry, like really angry you slash your arm. It makes you feel better.” (Girl) This group had more contact with specialist professionals “Some people when they feel sad they cut and so they identified social workers, key workers and staff themselves, harm themselves and try and think as central figures who they would seek help and advice about something else. I had a pal whose mum and from, where as respondents in the mainstream group dad just had a divorce and he kept on cutting identified family and friends. himself so he could think of something else like “Sometimes I talk to my keyworker, they’re the pain. A lot of young people cut themselves, brilliant. I can nae really talk to my ma, no I don’t ‘cause like it makes you feel good after, but then talk to my friends.” (Boy) sometimes it hurts.” (Boy) “Sometimes you feel like your mum and dad won’t Alcohol and drug use featured much more among this sub- understand so you just leave it and try and get sample than the mainstream group and were used to cope through it yourself, but like I can talk to my social mainly with feelings of sadness, whereas wrist slashing was worker or the staff here.” (Girl) said to be mainly a response to anger. The respondents did not elaborate as to why they took drugs or drank but just said it made them feel better or made them forget their 5.5 Perceived differences between problems. One boy who indulged in such behaviour did not adults and young people condone taking drugs and warned that care was needed.

“Take drugs, depends on what type of drugs you Respondents in this group felt a major factor which affected take as to how it makes you feel. Young people the mental health of adults was the way in which their take drugs to get a laugh and a buzz or get away children behaved. This was also an issue raised by some from stuff that pisses them off. Aye it makes them children in the mainstream sample. In a number of cases feel better, but it’s bad taking drugs. You’ve got to respondents in this sample saw themselves as responsible watch what you’re doing.” (Boy) for the way their parents felt. This may have been due to the parents telling them that their behaviour made them A small number of the boys interviewed said when they had feel stressed or annoyed, or it may have come from negative feelings they would go out and steal cars and discussions with professionals. smash them up, which made them feel better as it gave Unlike the mainstream sample young people in this group them a “buzz” which boosted their mood and also took did not mention any other factors which could affect adults their mind off their problems. mental health. They appeared to be unable to associate

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adulthood with anything else apart from the parental role. 5.7 Young people’s understanding There was no mention of issues raised by the mainstream of mental illness group such as financial or employment worries. They also appeared only to associate adults negative emotions with The same methods (vignettes and flash cards) were used to anger, where as the mainstream sample also talked about elicit the respondents understandings of mental illness as in adults feeling sad or depressed. the mainstream sample. Views did not differ greatly from respondents in the mainstream sample and discussions This was also evident when they were asked how adults about the vignettes were similar. However, some slight cope with negative feelings. Coping mechanisms appeared differences did emerge. to be a way of either taking out their anger or calming it down. Behavioural problems in adolescence “They batter their weans ‘cause like they get that A number of respondents were not as quick to dismiss angry.” (Girl) James behaviour as the mainstream sample had been. This “Smoke dope ‘cause that like calms you down/get appeared to be because they were more able to identify drunk and runaway.” (Girl group) with the way he was acting.

“See the way he behaves I behaved like that in my Respondents felt most adults were more able to cope with primary school. My temper’s cooled down a bit negative feelings than young people, but some now. I just hold my breath and count to ten.” (Boy) acknowledged that not all adults were able to do this. “He’s in the same situation as I’m in...... it’s “Adults are like old enough to handle it. Adults are personal”. (Boy) wiser but we’re a lot more stupider so we do crazy things. Some adults don’t have their heads together though so like they do crazy stuff too.” (Boy) Depression

Respondents views about the depression vignette were very In contrast to the mainstream sample this group did not similar to the mainstream sample, but they did not engage in illustrate any striking differences between adults and young any in-depth discussions about depression. The majority felt people, apart from the comment above. Unlike the the man was not depressed but just lazy, whilst a few felt he mainstream sample there was no sense that adults had was mentally ill as he had stopped doing the things he enjoyed. greater responsibilities and worries than children. The young people in this sample appeared to find it difficult to “Maybe a wee bit [mentally ill] but not like really conceptualise the feelings, causes and coping mechanisms like the other one.” (Boy) adults had. Therefore their responses to these questions “Na just lazy. He needs to get off his arse.” (Boy) were somewhat limited.

Anorexia 5.6 Unusual behaviour As in the mainstream sample all respondents in the special A group labelled Angela’s behaviour as anorexia. However, Unlike the mainstream sample this group made no it was not discussed in such detail. On the whole reference to behaviour which may be unusual for people respondents were not as sympathetic to this problem as the they knew as deviating from personal patterns. They only mainstream sample and only two respondents thought she discussed behaviour which they considered to be socially could be mentally ill. Respondents in this group thought unacceptable behaviour in society. she was either mentally ill or not, whereas responses in the “People who talk to themselves, walking about mainstream sample were not so clear cut. doing stupid things.” (Boy) “Anorexia. In a way it’s mental illness. It’s not her “They’d look like weird and wear weird clothes an’ fault she doesn’t know she’s lost weight, aye that. Talking to themselves and that.” (Boy) mental illness.” (Boy)

“Talking to yourself/walking about with no clothes “She cannae cope with being fat. She’s mentally on.” (Girl) ill.” (Boy)

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A number in the mainstream sample who felt she was not There were a couple of boys who said they would sort mentally ill said they thought she did have some sort of anyone out if they started acting strangely, but this was psychological problem. probably said for the benefit of the interviewer and for shock value. Psychotic behaviour Sympathy As in the mainstream group it was the two vignettes which illustrated psychotic behaviour that were definitely viewed As already indicated this group were less sympathetic than as mental illness. Similar terms to those used by the the mainstream group. None of the respondents expressed mainstream sample were also used by this group to label any problem about living next door to Angela, but unlike such behaviour. the mainstream group did not want to go and help or befriend her. “Nut case, straight jackets for him. Definitely mentally ill.” (Girl) Unlike the mainstream sample who felt sorry for James and wanted to help, this group did not see a problem in the way “Aye mental illness, he needs to go to a psychiatric he behaved and viewed it as acceptable behaviour. Most ward ‘cause he’s seeing aliens and stuff.” (Boy) said they would be quite happy to befriend James. The “He’s mentally ill ‘cause he thinks people are following illustrates a typical response to the question; talking to him an’ that.” (Boy) “how would you feel if James lived next door to you.”

“Would nae bother me. I’d probably go and make pals with him.” (Boy) 5.8 Attitudes towards mental illness

Attitudes towards the different types of mental illness were 5.8.1 Views about who might experience similar in this group compared with the mainstream sample, mental illness except for sympathy. This was not readily expressed by the respondents in response to any of the vignettes, although Like the mainstream sample most of the respondents they were tolerant of the less unpredictable conditions. thought anyone could experience mental health problems. However, unlike the first sample they did not consider the Responses to the vignettes question further (was there a particular type of person who suffered from mental illness). Several respondents said they Fear did not know as they had never met anyone with mental As in the mainstream sample fear was expressed in response illness and a small number thought adults would be more to the vignettes which illustrated psychotic behaviour. likely than young people to experience mental illness. However, respondents in this sub-sample were more ready However, it appeared that some confused mental illness to have them locked up or put into straight jackets, whereas with criminal acts and compared the severity of being in this was not expressed by the mainstream sample. prison with being in care, and therefore came to the conclusion that if an adult was in prison the crime was “Get the council to move him and put him in the more serious than something a young person had done to loony bin.” (Boy) end up in care. Therefore the adult was mentally ill. “He needs to go to the psychiatric ward.” (Girl)

“He’s pure mad. Put him in one o’ they straight jacket things so he can’t get away and stab anyone.” (Boy)

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“More in grown ups ‘cause some of them are in jail Summary and general comments for psychopaths, it’s just like kids are in care and it’s not all that serious, well it is serious but not In some respects the participants in this sub-sample held really crazy like shooting people an’ that.” (Boy) views and attitudes in common with the mainstream sample. However, from the data provided it is clear that there are a number of salient differences:

5.9 Helping with mental health an inability or reluctance to acknowledge or admit to problems negative feelings in themselves or other young people Like the mainstream sample the special A group discussed formal interventions such as medication, hospitalisation and a need to have instant gratification in order to consultation with professionals. However, there was very experience positive feelings little discussion about informal sources of help such as talking to family or friends. This was only mentioned by two a tendency to cope with problems by using escape boys who said that James and Peter could talk to their mechanisms such as drugs, self abuse and crime mums. rather than addressing the problem itself

If we consider the experiences some of these young people a reliance on people outside the family as sources of have had, particularly in relation to their families and their support familiarity with professionals it is not surprising they hold these views. However, although they have had considerably the association of adults problems with the affects of more contact with certain professionals than the delinquent or disturbed children as opposed to the mainstream sample their knowledge of the professionals’ affects of problems adults might experience as role’s was limited to what they had experienced as opposed individuals to having any additional knowledge gained from other sources apart from personal experience. Most were very more familiarity with professionals. familiar with the role of social workers. Some were able to identify the role of psychologists because either they or one of their friends had one, and most acknowledged that Most of the differences portrayed by the special group can psychiatrists “helped people with their heads”, although be easily linked to the circumstances and experiences of they was mixed feelings about whether they were doctors these young people. It is also important to note that the or not. Therefore their comments were similar to those of majority of the sample were male from working class the mainstream sample if we look at professionals that backgrounds who had lower than average levels of neither group have had contact with. educational achievement which may have affected the responses they gave.

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Chapter 6 Positive mental health and mental illness: the views of young people living with a mentally ill adult

Despite the small number of young people in this sample, their perceptions of differences between adults and their contribution is valuable in beginning to illuminate the young people. ways in which their particular experiences can shape perceptions of mental health and illness. At first sight, there seemed to be few differences between the views of this 6.2 The young people’s understanding sub-sample and those of the mainstream sample. However, of positive mental health detailed analysis of the data suggests that there were some significant, though subtle, differences. As in the previous A number of differences between these young people and chapter, the main differences are examined although those in the main sample emerged from their responses to reference is also made to some of the salient similarities. questions about positive mental health. Unlike many of the young people in the main sample, none of these young people found the concept of mental health problematic. 6.1 Feelings Rather than focusing either on aspects of physical health, or on mental ill-health, they unequivocally defined mental As in the mainstream group respondents were asked to health in terms of positive feelings and attributes. identify as many feelings as possible at the beginning of the In some respects, these definitions were similar to those interview. Not surprisingly the number of feelings identified of the minority of young people in the mainstream sample were substantially fewer and reflected those identified by who also found the concept unproblematic. For example, participants in the individual interviews. However, those feeling happy, good and self-confident were mentioned by that were identified were largely similar to those in the both groups as important for mental health. Additionally, mainstream sample and Table 6.1 illustrates the most however, the young people in this group identified an common. Interestingly most respondents identified similar ability to cope as important. For them, mental health was feelings. not simply about feeling good, but about being able to live Table 6.1: Commonly identified feelings a ‘normal’ life with all its inevitable ups and downs. The following extracts illustrate their responses: (n =8) TYPE OF FEELINGS % PARTICIPANTS “You can cope / you feel good / cope with stress happy, sad, angry 100 / you know what you’re saying.” (Two sisters) excited, scared, nervous, lonely 80 “Having good feelings about yourself and just upset, depressed, worried 50 being able to live a normal life.” (Boy)

“Probably have a good outlook on life and a In order to compare their views with those of the main healthy attitude about yourself. Like you’re able to sample, the young people’s responses to questions about overcome the problems.” (Girl) positive mental health and illness are again considered here in relation to the topics explored in the research interviews: “I think it’s to feel right about yourself.” (Girl)

their understanding of mental health Feeling mentally healthy their views about what might make young people feel Despite the young people’s greater emphasis on the ability mentally healthy or unhealthy to cope with life’s problems, their views about what might

their ideas about how young people’s mental health make young people feel mentally healthy were very similar to those of the mainstream sample. As these extracts from can be promoted the data indicate, family and friends again emerged as their own responses to negative feelings centrally important:

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“When other people appreciate you like friends 6.3 Promoting positive mental health and family and you’ve got people to talk to.” (Girl) On the whole, these participants’ ideas about how young “My sister makes me feel happy ‘cause I know I people’s mental health could be promoted were very can go to her.” (Boy) similar to those in Schools B and C. Like the respondents in “Friends and family as well as you feel you are not these schools the need for more clubs or local alone and you feel as if you don’t have to carry all improvements were not paramount but other issues related of the burden of something, you know, whether to support were mentioned. A particular issue concerned it’s to do with school or just something happening the extent to which they were able to seek support in at home or something.” (Girl) relation to their parent’s mental illness. Of the eight participants, six indicated that they would not discuss this “If you have your friends to talk to.” (Boy) with anyone, either because it was too complex to explain, or because they felt it was not something that should be Feeling mentally unhealthy discussed outside the family. As these extracts illustrate, they viewed their parent’s illness, and particularly As with mental health, these young people defined feeling admission to hospital, as a very private matter: mentally unhealthy somewhat differently from the mainstream sample. Like the mainstream sample, they “It was you know very, very difficult to explain to associated negative emotions such as sadness and anyone at school / even our closest friends didn’t unhappiness with feeling mentally unhealthy. Equally, they know / I suppose we could have told them but we identified similar causes, such as problems with friends and didn’t really need to.” (Two sisters). feeling isolated. However, several of these young people “When mum was in hospital we just sort of went to added that quite often people may not know why they felt school and stuff and dad did all the house type like this, and that there may be no obvious cause, for stuff, but nobody else knew.” (Girl) example:

“To be unhappy and not really sure why you are Two other participants, a brother and sister, shared the unhappy. It means confusion. It’s hard to explain. view that people at school would not understand their Like when nothing really bad has happened but situation. However, they had been able to join a young you feel like it has and you don’t know why and carers support group and had found this extremely helpful, sometimes you don’t realise you feel really bad / both in enabling them to talk to other people who would Yes when you are really confused and you can’t understand, and in allowing them time away from their control your emotions.” (Sister and brother). mentally ill parent. While they did not think it necessary to establish groups specifically for young people with a “Like lots of things make you feel sad or depressed. mentally ill parent, they felt strongly that the wider Like when you feel left out and stuff or you fall out availability of groups for any young person with a physically with your friends, but sometimes people just feel or mentally disabled parent would make a significant bad. You just feel like that.” (Girl) contribution to the promotion of the young person’s mental health: Despite their parents’ experience of mental illness, none of the young people equated feeling mentally unhealthy with “More clubs like this so you can do your mental illness, or referred to any specific conditions. homework and talk to people / when you’re at However, their emphasis on feeling bad for no obvious school you can’t really talk to any of your friends reason suggests that they may have been drawing an ‘cause they can’t understand it but here you can implicit distinction between the more everyday experience talk to other people and they can understand and of feeling down or sad, and feeling mentally unwell. agree with you and they can say I know what that’s like / I’d set up a club like this.”

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6.4 Dealing with negative feelings the worry of illness in the family as a factor which affected adults mental health. They did not explicitly say that the Responses to questions about how young people cope with other parent would be under added pressure due to their negative feelings were very similar to the mainstream partners mental illness but used examples of physical illness group. However, it was more difficult to separate their to illustrate the point. negative feelings into explicit categories as they talked more “Like if things are going bad in the family or if generally of feeling unhappy as opposed to specific feelings there are things to worry about like illnesses and of sadness or anger. However, some coping mechanisms did stuff like cancer and all that.” (Two sisters) emerge but appeared to be used when they felt generally down or fed up. As in Chapter 3 coping mechanisms Strategies identified to cope with negative feelings were included venting anger, bottling up feelings in the hope again similar to the mainstream sample and included talking they would go away and talking things through with friends to friends and family. Interestingly talking to professionals and family. Unlike the mainstream group there were some was only mentioned by one respondent who said they instances where young people obviously wanted to discuss would talk to a psychiatrist if they felt “really bad” which issues with their parent but this was not a realistic option appeared to be directly related to their parent. One salient due to their illness, so they ended up internalising their factor which did emerge was summed up by the following problems. The following give some indication of what they quote: thought young people did, and what they did themselves when they had negative feelings: “They could do something to take their minds off it. Like we would go out or something like that but “If I’m feeling like really pissed off I go for a run if you’re not feeling too good about things then ‘cause I’m really into sport and that and when I get may be that doesn’t really give you the motivation back I feel OK and ready to deal with it. Otherwise to go out and do something else. Sometimes it I’d hit someone or something.” (Girl) stops you from doing things.” (Girl). “Go swimming or use the squeezy stress thing. I don’t really know how it works.” (Girl) So, a difference between what adults and young people would do was identified but specifically related to an adult “I take it out on something. Sometimes fight with experiencing mental health problems. my sister.” (Girl) It was seen in Chapter 4 that the young people in the “Wreck my room and smash things, go for a run, mainstream sample constructed their understanding of play football stuff like that.” (Boy) mental illness by drawing on their own experience to “Talk to their friends. Yes if you can talk to your separate behaviours and experiences with which they mum and dad you can do that too.” (Girl) could identify in some way from those which were outside their experience. On this basis, it might be thought that the “I could never talk to my mum ‘cause I was always responses of the young people in this sample would be very the one she talked to so I just bottle things up and different from those of the mainstream sample, given their try and sort them out.” (Boy) direct experience of mental illness in their families. On the “If there was a really nice sympathetic teacher I whole, however, their perceptions were very similar to might go to her. Like, you are supposed to be able those of the mainstream sample. In effect, they appeared to to go to your guidance teacher at the school.” (Girl) make a strong distinction between what occurs at home and outside the home, with the result that they did not associate the two in considering the behaviour of strangers 6.5 Perceived differences between in the wider community. adults and young people This theme, together with some subtle differences which did emerge from the data, is explored here in relation to Perceptions about the different factors affecting adults and each of the main research topics: young people’s mental health, and the strategies employed to deal with problems were largely similar to the the young people’s views about what constitutes mainstream sample. However, one factor not identified by unusual behaviour the mainstream group, but mentioned by two sisters was

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their attitudes towards mental illness 6.7 The young people’s understanding of mental illness their ideas about how people experiencing mental

illness might be helped As with their approach to defining unusual behaviour, in the majority of cases the young people’s understanding of their sources of information about mental illness. mental illness was not significantly different from that of the mainstream sample. However, there were some slight 6.6 Unusual behaviour differences and these differences are examined in more detail as the young people’s responses to each of the five vignettes are considered in turn below and compared to Like the mainstream sample, the majority of these young those of the mainstream sample. people defined unusual behaviour in relation to deviations from personal norms amongst people they knew or might Behavioural problems conceivably know, and deviations from social norms on the part of strangers. With the exception of one participant, Like the mainstream sample, the young people in this group they made no reference to their own parents when discussed James, the boy depicted as having behavioural discussing unusual behaviour. problems, in terms of whether his behaviour was simply bad, or indicative of unhappiness. As these extracts In relation to people deviating from personal norms the illustrate, they reached the same conclusion that he was not following quotes illustrate the respondents views: mentally ill: “You might like say hi to someone you know and “Maybe if he didn’t used to be like that and is like they like just seem off and they’re not willing to all of a sudden or as a result of his dad leaving communicate. It’s also odd when people do stuff then like maybe he has got a problem but some that they don’t normally do.” (Boy) people are just like that and really naughty and “Like not doing stuff you normally that, but I don’t think he is actually mentally ill.” do...... normally someone does things everyday (Girl) like washes their hair and puts on nice clothes and “Angry ‘cause his dad left him and he’s taking it then they don’t bother. That’s weird.” (Boy) out on other people in the school. He’s not mentally ill just stressed by all the stuff that’s Where deviation from social norms was concerned, this happened to him.” (Boy) was clearly associated with abstract or unknown strangers rather than with their own parents: “Na he’s not ill, he ‘s just got a bad family life. He needs a role model to turn to. He hasn’t got “People walking around a room with a pair of anyone to turn to so he takes it out on his friends. pants stuck on their head. That would be odd.” He doesn’t want to talk to his mum so he bottles it (Girl) up.” (Girl) “Somebody talking mumbo jumbo things that didn’t make sense. Somebody whose mannerisms Depression were different.” (Boy) “He sounds a bit depressed. Stopped going to work “There’s a lady in ...... and she talks to herself not wanting to do anything.” (Girl) down the street and wears slippers. I think that’s really weird.” (Girl) “He [David] could have mental health problems but then again he could just be a lazy git.” (Girl) As this last extract suggests, in general the young people’s “It’s hard to tell maybe if it’s been going on for own experience did not lead to greater understanding or ages he’s depressed or may be he just can’t be sympathy for unusual behaviour. bothered.” (Boy).

Most respondents thought that depression was only a mental illness if it was prolonged and the symptoms became extreme.

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“It’s [depression] only a mental illness sometimes vignette (John) as depicting mental illness, but were unable / if it gets really bad. If you catch it in the early to name the condition, all these young people identified stages then not really.” (Sisters) him as suffering from schizophrenia. The mainstream sample did use the terms schizo and schizophrenic but it “Yes I think depression is a mental illness, ‘cause appeared they were just terms banded about that had no you can’t do the things you want to and it affects real meaning to them, and they did not appear to be used as your life.” (Girl) a diagnostic label but more as a pejorative term they had heard in the media. The difference was that those in his Anxiety and phobia sub-sample actually knew what the term meant and used it accordingly. “It’s like when you’re really uptight.” (Girl) There was one respondent in particular who appeared to “You get a bit paranoid. No not a mental illness have a greater understanding than any of the others ‘cause like sometimes you get really stressed out interviewed in the whole sample. This person gave detailed about stuff but you’re not mentally ill” (Girl) descriptions about how you might be able to tell if “When you’re scared of something like spiders and someone was experiencing mental health problems and the small spaces. Not really a mental illness.” (Girl) sort of help they might have received. She was also particularly knowledgeable about the vignettes. The “Like arachnophobia that’s when you’re like following quotes provide some examples: scared of spiders, but I think you can be scared of other things like heights and stuff. Na not a mental Response to Vignette 2 (John) illness.” (Boy) “He definitely needs help. He’s like Joe out of Again these responses are very similar to those of Eastenders. He’ll need to admit he needs help and respondents in the mainstream sample. then go to hospital and take medication for the voices. Maybe injections.” Anorexia Researcher: “Is there a name for the way he’s Again like the mainstream sample, these young people behaving?” quickly identified Angela, the young woman in this vignette, “Schizophrenia.” as suffering from anorexia and debated the question of whether this meant she was mentally ill in similar terms:

“Obviously she’s got a problem if she’s stopped 6.8 Attitudes towards mental illness eating but I don’t know is that considered a mental illness / I would say so. Yes because it’s all in your For the most part, when they were asked how they would brain, thinking you need to lose weight when feel if they lived next door to the people in the vignettes, you’re not fat.” (Sisters) these young people’s responses were again very similar to “It’s only a mental illness if it gets really bad and those of the main sample especially in relation to James, you have to go to hospital and have drips and all David and Angela. For example: that.” (Girl) James “She’s not exactly mentally ill but she must have a problem if she’s not eating and she’s not fat. A bit “It would be alright. I’d feel a bit sorry for him, just stupid really.” (Boy) try and talk to him.” (Girl)

“I wouldn’t really care as long as he didn’t bother Psychotic behaviour me I’d just ignore him.” (Boy)

Where these vignettes were concerned, there were clearer differences between the perceptions of this group of young people and the mainstream sample. For example, whereas the majority of the mainstream sample identified the second

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David “He’d probably be okay when he was like well.” (Boy) “You’d probably never see him. That would be OK.” (Girl) “It sounds like when he was fine he’d be OK to talk to and everything.” (Girl) “Not bothered he seems harmless. A bit sad really.” (Girl) “Yes when he’s not hearing the voices he’d be OK, but he could still be a bit scary.” (Girl)

Angela

“I’d feel worried about her and sorry for her but 6.8.1 Views about who might experience it’s nothing to do with you. I mean it doesn’t affect mental illness you in any way not like the guy who hears voices and is violent. You’d just feel quite sorry for her As in the mainstream sample gender race and class did not wouldn’t you.” (Girl) appear to be significant factors which affected who “Na, it wouldn’t bother me she’s a bit stupid experienced mental illness. However, two respondents really.” (Boy) identified poverty as a contributing factor, two felt it could be the result of a bad childhood and the remainder felt it Where psychotic behaviour was concerned, however, there was just something that happened, a bit like getting the flu were differences between the views of some of the young or any other physical illness. people in this group and those of the mainstream sample. “Poor people ‘cause they’ve got more stress like As with the mainstream sample, the two characters financially and that might get them a bit stressed.” depicted in these vignettes were seen as frightening, with (Girl) the younger character, Peter, again viewed as less threatening than the older character, John: “I don’t know. You hear a lot on TV about people who’ve had troubled childhoods.” (Girl) “You would probably feel sorry for him [Peter] if he was quite shy. You wouldn’t necessarily see his “It’s just like having the flu or something or just paranoia. I mean the worst thing that he would do like some other disease that’s sort of physical or like in public would be sort of looking at people as you get a rash.” (Boy) if they were looking at him.” (Boy) “I think anyone can get it. I’m sure nobody chooses paranoia or anything else.” (Girl) However, unlike the mainstream sample, though, some of these young people also expressed sympathy towards John, despite finding him more threatening than Peter. For example, they said they would feel sorry for him because 6.9 Helping with mental health problems he heard voices and probably felt confused and lonely. This more sympathetic attitude appears to have been linked to a In some respects the young people’s views about how the perception of mental illness which was unique to this characters in the vignettes might be helped were not group. Whereas the other young people who took part in dissimilar to those of the mainstream sample. However, the research appeared to view mental illness in all or unlike the respondents in the mainstream group there was nothing terms, as something you either did or did not have, not such a strong emphasis placed on talking things these young people were clearly more aware that it could through with informal sources, although talking with be transitory and that the behaviour of the person professionals especially psychiatrists was mentioned for the concerned could be different in phases of remission. These less acute conditions. extracts provide an illustration: James “If he was like not violent and taking medication he’d probably be OK, but I might still be a bit “Talk to a psychiatrist to make him feel better, frightened.” (Girl) ‘cause he won’t be able to tell anyone what he tells the psychiatrist” (Boy)

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“A counsellor could talk things through with him 6.10 Sources of information about and help him understand what’s going on.” (Boy) mental health problems

“A counsellor could talk to him and get the true A further surprising aspect of these young people’s deep meaning of his emotions and find out what responses was that they did not identify any different was in his head.” (Girl) sources of information about mental health problems from those identified by the mainstream sample. For these young Peter people, like the mainstream sample, the media were the most commonly mentioned source, while schools, “Talk to a psychologist or a psychiatrist and they professionals and parents appeared to play little part. Where can help him see what’s bothering him.” (Girl) parents in particular were concerned, it may again be that what happened at home was not regarded as relevant to the Unsurprisingly, however, the young people in this group external world, with the result that information gained from demonstrated greater knowledge than the other research experiences at home contributed to a tacit knowledge. participants both about the role of psychiatrists, and about the purpose of medication. Thus, all the young people in this group were aware that psychiatrists were doctors who Summary specialised in mental illness and who could prescribe medication, not simply ‘sort out your head’, as a number of The data reviewed in this chapter suggest that the young people in the main sample put it. perceptions of the eight young people concerned were Equally, as these extracts illustrate, the young people saw quite similar in some respects to those of many of the main medication as form of treatment and not simply as a means sample. Where mental health is concerned, this may reflect of ‘calming people down’: similarities in their social backgrounds. Where mental illness is concerned, however, it appears to reflect a strong “Give him [Peter] some sort of medication. The distinction drawn by the young people between their medication just controls how you’re feeling like if private experiences at home and the external world they you’re having a bad spell. Like if you’re feeling a were asked to consider in the course of the research certain way the drug can numb you, make the interviews. The main themes to emerge from the data are feelings less and then you get better. But like some summarised below: people they always have to take their medication otherwise they get ill, but I think if he just took These young people unequivocally defined mental some when he felt like that he wouldn’t have to health in positive terms, with an emphasis on the take it all the time.” (Girl) ability to cope with the ups and downs of life. “If he [John] like hears voices he can take For the two young people who had access to a young medication to stop him hearing them and then he’ll feel better. My mum gets spots when she takes carers group this was a valuable source of support the medication though.” (Girl) which was lacking for the other young people.

Most of the young people defined unusual behaviour A more surprising difference between these young people in the same terms as the main sample, with no and the mainstream sample was that they did not suggest hospitalisation as an intervention for any of the characters reference to their own parents. in the vignettes, despite the fact that in some cases they had In general, their attitudes to mental illness were already discussed times when their own parent had been similar to those of the main sample, but these young hospitalised. It is difficult to ascertain the reasons for this. This may be a further example of the distinction they drew people expressed more sympathy for characters between what occurs at home and what happens elsewhere depicting psychotic behaviour and were aware that to other people. this could be part of a transitory pattern of illness and remission.

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These young people were more aware of the role of psychiatrists and the purpose of medication, but did not suggest hospitalisation as a way of helping the vignette characters.

Despite their personal experience of mental illness at home, the sources of information the young people cited were no different from those of the main sample.

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Chapter 7 Conclusions and recommendations

This study set out to: explore young people’s perceptions of respondents within each interview setting, besides the use of positive mental health and mental illness; examine their open ended questions. Firstly: brainstorming which was a encounters with mental illness; and identify and describe their particularly good way of starting the interview as it put the use of language when discussing these topics. This was done participants at their ease and encouraged them to be less in an attempt to: improve services and care for young people inhibited. Self-completion forms were used at the end of the with mental health problems; raise professional and public first half of the interview in an attempt to obtain more awareness; and understanding about young people’s mental standardised information from each of the respondents. They health; and improve the integration of aims, policies and proved very useful as some young people did not express services across the full range of people and agencies involved. many views in the interview itself but were able to express how they felt in this written exercise. Finally vignettes were In response this report presented the findings of a 16 month used in the second part of the interview which yielded a qualitative study exploring the attitudes and perceptions of a large amount of data and were particularly popular amongst broad range of young people aged 12-14 towards positive all the respondents, especially in the group settings. mental health and mental illness. The main sample consisted of 145 young people from a variety of social and minority In an attempt to ensure a large enough sample of young ethnic backgrounds who attended mainstream schools in people from minority ethnic backgrounds were included in rural, suburban and inner city areas of Scotland, of which the study a sub-sample were recruited from community 122 were interviewed in focus group discussions and 23 groups. Whilst recognising that some young people in the individually. The two smaller sub-samples consisted of: 16 mainstream group would be from minority ethnic young people with an identified psychological, emotional backgrounds it was thought the numbers would be and/or psychiatric problem; and 8 young people living with insufficient and their experiences would simply be a mentally ill adult. In the first sub-sample the majority of the absorbed into generalisations which might or might not be interviews were conducted individually (10) and only 6 applicable. The same questions and methods were used to young people participated in focus group discussions. In the elicit information from the young people, but within a latter group all participants were interviewed individually. context which would facilitate openness about issues There was a slight shortfall in the planned numbers of the which were of key importance to them. special sub-sample especially those living with a mentally ill In the light of previous research which indicated that parent but the target numbers were achieved for the findings were biased where white interviewers interviewed mainstream sample. Altogether a total of 169 young people black children we decided it would be most effective to use were interviewed, 100 girls and 69 boys. Overall the number interviewers from similar minority ethnic backgrounds to of girls in the study outweighed the number of boys but in interview the young people. Findings were checked with the sub-sample of young people with identified problems the interviewer and recognition was given to variations boys out numbered the girls by 2:1. within each group. The interview consisted of two parts. The first addressed The views and attitudes of young people from minority issues surrounding positive mental health and was largely ethnic backgrounds were very similar to the mainstream concerned with feelings and emotions, and then progressed sample. There was some indication from the Muslim to explore: young peoples understanding of positive mental Pakistani group that close family relationships brings with it health and how it could be promoted; how young people added support in the form of close relationships with coped with negative feelings; and the perceived differences extended family, but also added pressure in some between young people and adults. The second part of the circumstances particularly in relation to academic interview was concerned with attitudes towards unusual achievement. There was no mention of racism as a specific behaviour; knowledge about mental illness; perceptions of factor affecting the mental health of young people, but this people with a mental illness and sources of information. was not surprising considering the discussions were only With regard to the original aims of the study we used a held as a one off contact where possibly deeper issues did number of specific techniques to elicit information from the not have the chance to emerge.

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7.1 Positive mental health and its They identified a number of reactions that helped them to promotion cope with such feelings and these tended to fall into two categories: reactions to anger, and reactions to sadness. The term mental health was not salient and understandings When discussing reactions to anger it emerged that both of it were often uncertain. Some simply focused on the boys and girls often vented their frustration and anger word "mentally" which they identified with strangeness or through aggression towards inanimate objects, siblings and illness. Others simply thought in terms of physical health less commonly on their peers, but there were subtle and illness. Terms which were of more salience included differences in the way they reported their behaviour. Boys happy, sad and confident which also reflects findings from were much more open about fighting and more general studies which explored adult perceptions of mental health aggressive behaviour, whereas girls were much less candid (Pavis et al., 1996). and preferred to reveal incidents of fighting in the self- completion forms as opposed to open discussions in the Respondents identified a number of factors which they interviews. Another gender difference that emerged in the associated with positive mental health, but the importance data from these questions was the way in which boys of family and friends was a recurring theme both in terms of tended to bottle up their emotions in the hope they would positive and negative emotions. Support and security go away, whereas girls appeared much more willing to talk especially from parents were identified as promoting to friends, family or teachers. This fits with other findings positive emotions. This helped to engender happiness and a that behaviour and communication about emotions is often good sense of self. The availability of family and friends were strongly differentiated by gender (McGurk 1992). also seen as especially important when difficult times arose. Rejection by them or their absence was largely to blame for An important finding emerged from questions relating to more negative feelings particularly for those with identified the differences between adults and young people’s problems who reported negative family experiences more problems. It appeared that the majority of respondents often than the mainstream group and consequently sought regarded their worries and problems as far less important support from people outside the family. than those of adults, particularly their parents. This may have a detrimental affect on young people’s well being Confidentiality was an important issue for all young people since they are likely to keep worries to themselves when discussing the role adults played in helping them with believing them not to be important enough to trouble problems and worries. This was illustrated when they spoke others with. This may prevent them getting help at an early about ChildLine which was an important potential source of stage so their problems may get worse before help is help. This was mentioned in a number of the interviews, sought. However, as mentioned already young people will which suggested that even if young people had not used the only consider discussing their worries or problems with service (which they said they had not), they had considered people they can trust who will adhere to issues of the pros and cons of using it. It does seem likely that some confidentiality. Other studies also found this to be an had more first hand knowledge of this service than they important issue when young people provided feedback admitted to judging from the very considered discussions about communication and trust in relation to adults that evolved. For those who had reservations about the (Farnfield & Kaszap 1997). service there were two main issues: firstly concern their parents might find out, secondly the person answering their call would undervalue their worries. This highlights young 7.2 Perceptions of mental illness people’s fears that their concerns may be trivialised. Others however, appeared more informed about the dynamics of Young people appeared to have more definite ideas about the service and thought it was a good provision for young mental health problems and were more able to discuss the people. Some advocated more money for such services. In term, although their discussions tended to be specific to view of the ignorance some young people had about the their own experiences whether these were direct or indirect service it is possible that teachers and others working with particularly through the media. The idea that young people’s young people need to inform them more about the views were very much shaped by their own experiences, of confidentiality aspect of the service. whatever kind, was very strong throughout the data In connection with the promotion of positive mental health especially from the second half of the interview. This respondents were asked how they coped with negative appeared to result in the development of several implicit feelings and what they did to make themselves feel better. criteria which helped them to determine whether they

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thought certain conditions and behaviour could be classified experienced or were familiar with they were as a mental illness, acceptable or understandable behaviour, understandably much more knowledgeable. Overall they weird or frightening. These criteria included: whether or not were more sympathetic which was not surprising as they the young person had previous experience of the behaviour had more specific and personal comprehension of how or condition; whether it was familiar; whether it was the mental illness affects people and their families. The way in type of condition or behaviour that was stigmatised; and which attitudes were constructed appeared very similar but whether the condition or behaviour was fear provoking. had different consequences because of different In addition to these criteria they identified a continuum of experience. The fact that young people living with a feelings with normal at one end and abnormal at the other mentally ill parent had additional knowledge in some as a way of establishing what was and what was not mental aspects reinforces the view that young people classify illness. For example, depression was not necessarily thought conditions and behaviour according to criteria which are to be a mental illness as it was within the boundaries of constructed from the knowledge and experience they have normal feelings, and was familiar in some form to most gained in daily living rather than from formal education. respondents. In some instances more serious depressive Not only did the attitudes of young people towards mental feelings had been experienced either personally, within the health and illness appear to be constructed from personal family or by close friends. Mental illness was largely confined experiences, but their views about the professionals to the most extreme end of the continuum where behaviour involved with the treatment of mental illness and the was abnormal and the associated feelings unfamiliar. In some promotion of mental health. All were familiar with the role instances depression was placed at this end of the scale of the GP and some who had come into contact with social when severity and chronicity were thought to be outside the workers, counsellors or psychologists were able to describe bounds of normality. Those conditions in the middle of the the type of role they played. Apart from this, their continuum were those such as anorexia which the young knowledge was quite sparse, which reflects the fact that people found hard to class as mental illness but were most young people have no direct and little indirect unwilling to suggest it was "normal". Behaviour which was acquaintance with health specialists. seen as familiar, or readily extrapolated from familiar behaviour was more explicable and understandable, so also Causes of mental health problems were seen as being tended to evoke more empathy and sympathy. These mainly a result of social or environmental problems and the definitions were less developed to some extent than participants did not appear to recognise biological or professional definitions but do reflect the standard spectrum lifestyle choice explanations as playing a significant role. In of neuroses and psychoses. other words young people tended not to pathologise milder forms of mental health problems such as neuroses, but saw In conjunction with this way of classing different behaviour these as largely an understandable response to familiar or and conditions, the use of pejorative language was socio-economic stresses. Interestingly this view is commonplace to describe behaviour that was at the most compatible with the apparent recent shift in government extreme end of the spectrum (e.g. psycho, loony, weird, policy to acknowledge the role of poverty and inequality in sick, schizo, maniac). These terms expressed both the generation of mental health problems. stigmatising and moralising judgements which doubtless draw on attitudes embedded in wider society. This use of Finally it was clear that media representations of mental negative shorthand also served to emphasise the distance health issues had an important influence on all the young between "normal" people and those with mental health people in the study. TV (especially soaps) and tabloid problems. Whereas views of some conditions like reports were mentioned most frequently as sources of depression and anorexia were inclusive views of behaviour, images and ideas. Responses from the young people those associated with schizophrenia were exclusive. Those indicated that there was a definite lack of formal with identified problems themselves were particularly information available to them from school or any other dismissive. source, although it is highly likely that certain ideas have been subliminally absorbed from the family and peers Interestingly these views were reinforced by the sub-sample judging by the use of common vocabulary. of young people living with a mentally ill parent whose responses were very similar to the mainstream group In the light of this report the following section provides especially in terms of their attitudes towards mental illness. some recommendations to professionals and lay people However, when speaking about issues they had working with young people.

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7.3 Recommendations d. Finding

The young people in the study were not specifically asked Many of the people and situations which young people to make policy recommendations, but a number of referred to in discussions of mental health came from implications were drawn out by the research team the media, particularly TV soaps and newspaper reflecting on what young people said and discussing the headlines and reports. resulting issues with members of the consultative group. Recommendation Below we list recommendations based on this process, indicating in summary form beforehand the key theme The media need to be responsible in the way they arising from the data on which each is based. portray mental illness as they appear to be the main influence in the way attitudes towards mental illness are a. Finding constructed. They should avoid pejorative and discriminatory language. Health promotion agencies and Young people were unfamiliar with the notion of professionals should collaborate with the media to ‘positive mental health’ and mainly used lay terms to promote more positive images of mental illness. Soaps describe mental health conditions. increasingly seek to deal with serious social issues and Recommendation indeed sometimes feel excessive demands are made on them in this respect, but it would nevertheless be good if Positive mental health needs to be discussed in a they were supported to tackle mental health issues language that is familiar to young people, as the informatively and sympathetically. professional and medical terminology has little salience and therefore will not attract the interest of young people. e. Finding

Written, visual and computer-based information about Young people’s understandings and attitudes were much influences on well-being and the nature of mental health influenced by the extent to which they could relate other should be provided which takes account of language people’s feelings, moods, behaviour and communication used by young people. to experiences they were themselves familiar with. Negative terms and stereotypes were common.

b. Finding Recommendation

The main supports in most young people’s lives are Health education and promotion strategies should family and friends. engage young people by making connections with the Recommendation ways they identify with and are sympathetic towards mental health problems when they can link these to Professional interventions need to be rooted in an familiar experiences. It is also important to help young understanding of the informal networks of young people people question stigmatising language and attitudes and work in partnership with significant carers and through greater understanding of how atypical supporters. behaviour may develop.

c. Finding

Where a parent had mental health difficulties, their children valued meeting in a group with others in a similar position.

Recommendation

More support should be available for those living with a mentally ill parent especially in the form of young carers groups.

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f. Finding i. Finding

Knowledge about mental health difficulties was often The most common reasons for anxiety and/or limited but varied considerably. Understandably depression in young people were connected with awareness tended to be greater in families where a conflicts or loss in their family or peer relationships. parent had received psychiatric services. Recommendation Recommendation Those working with young people should be more aware More information should be made available in schools of the factors that cause young people to experience about mental health issues. This should include written negative emotions, notably bereavement, family tension information and verbal discussions between pupils and and peer related anxiety. people who have specific knowledge and experience in the area. Health professionals, voluntary organisations and social work services may be able to assist schools in j. Finding this social education role. Boredom was a significant complaint and explanation of emotional difficulties.

g. Finding Recommendation

The study indicated that greater comprehension tends to More opportunities and facilities are needed which are lead to more sympathy and that those in close contact attractive to young people. with a person who has mental health problems had a deeper understanding of the day-to-day implications. k. Finding Recommendation Young people’s reported mechanisms for dealing with Users can play a vital role in helping young people strong negative feelings were often unsophisticated, i.e. contextualise mental health problems and so seeing either keep it in (don’t talk about it or do something else) them as understandable. or act out aggressively.

Recommendation h. Finding Parents and professionals in touch with young people Young people thought their own worries were can assist them in learning a wider repertoire of ways of sometimes not recognised or valued by adults. coping with sad or angry feelings.

Recommendation

Parents and other adults working with young people l. Finding need to take young people’s problems seriously and The support service which seemed to be best known was should not only view them from an adult perspective. ChildLine. This was valued by some for being child- They need to be sensitive to young people’s concerns centred and confidential, though others expressed about trivialisation and confidentiality. doubts that the service could be trusted.

Recommendation

Services such as ChildLine should be advertised as widely as possible and their importance to young people should not be underestimated. More reassurance is needed about the respect given to confidences by help line services.

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m. Finding

Although most young people seemed reasonably well supported, some wanted or appeared to need guidance on an accessible and confidential basis.

Recommendation

A professional person such as a nurse, social worker or teacher (who is not part of the teaching staff at the school) should be made available at certain times in schools to provide counselling and support for young people. This person should be someone the young people can easily relate to.

n. Finding

Many young people had limited awareness and understanding of the roles of mental health professionals.

Recommendation

Health professionals need to convey their own roles better and adjust to lay understandings as much as “educate” young people about the "real" way to view mental illness. It is the responsibility of the professionals to provide information and explanations in language which makes sense to young people.

This study was part of a wider project concerning young people and mental health. Those interviewed highlighted that listening and support is one of their main mental health needs. They are also likely to learn more about mental health and illness when adults enter into dialogue with individuals and groups which attend to young people’s understandings as well as imparting formal knowledge.

The data suggests that young people are more accepting, tolerant and sympathetic about behaviour they are familiar with. Not all young people are going to be familiar with the more extreme and acute mental health problems, therefore they must be given the opportunities to enable them to understand what people with mental health problems experience and the behaviour they may display. This can only help to dispel the myths and stigma that surround mental illness.

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Kitzinger, J. (1994) ‘The methodology of focus groups: the Rogers, A. and Pilgrim, D. with Latham, M. (1996) importance of interaction between research participants’, Understanding and Promoting Mental Health, Health Sociology of Health and Illness, 16, 1, 103-120. Education Authority, London.

Labov, W. (1969) ‘The logic of nonstandard English’, Rose, N. (1989) Governing the Soul, Routledge, London. Georgetown Monographs on Language and Royal College of Psychiatrists (1995) Attitudes Towards Linguistics, 22, 1-31. Depression, Royal College of Psychiatrists, London. Laybourn, A., Brown, J. and Hill, M. (1996) Hurting on the RUHBC (1989) Changing the Public Health, John Wiley Inside: Children, Families and Alcohol, Aldershot: & Sons, Chichester. Avebury. Rutter, M. and Rutter, D. (1993) Developing Minds, MacDonald, G. (1993) ‘Defining the goals and raising the Penguin, Harmondsworth. issues in mental health promotion’, in D. Trent and C. Reed (eds.) Promoting Mental Health Volume 2, Avebury Ryan, T. and Walker, R. (1993) Life Story Work, BAAF, Aldershot. London.

Maughan, B. (1995) ‘Mental health’, in B. Botting (ed.) The Sartorius, N (1992) ‘The promotion of mental health: Health of Our Children, Office of Population Censuses meaning and tasks’, in D. Trent (ed.) Promoting Mental and Surveys Series DS no. 11, HMSO, London. Health Volume 1, Avebury Aldershot.

Mayall, B. (1993) ‘Keeping healthy at home and school: it’s Scottish Mental Health Forum (1992) Community Care my body so it’s my job’, Sociology of Health and Illness, and Consultation, Scottish Association for Mental Health, 15, 4, 464-487. Edinburgh.

Mayall, B. (1994) Children’s Childhoods Observed and Secker, J. and Platt, S. (forthcoming) ‘Why media images Experienced, Falmer Press, London. matter’, in G. Philo (ed.) Media and Mental Illness, Longman, Harlow. Morgan, D. L. (ed.) (1993) Successful Focus Groups, Sage, London. Silverman, D. (1993) Qualitative Research, Routledge, London. Morrow, V. and Richards, M. (1996) ‘The ethics of social research with children: An overview’, Children & Society, Small, J. (1991) ‘Ethnic and racial identity in adoption 10 (2): 90-105. within the United Kingdom’, Adoption & Fostering, 15, 4.

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Triseliotis, J., Boland, M., Hill, M. and Lambert, L. (1995) Teenagers and the Social Work Services, HMSO, London.

Triseliotis, J., Shireman, J. and Hundleby, M. (1997) Adoption: Theory, Policy and Practice, Cassell, London.

Tones, K., Tilford, S. and Robinson, Y. (1990) Health Education: Effectiveness and Efficiency, Chapman Hall, London.

Tudor, K. (1992) Community mental health promotion: a paradigm approach’, in D. Trent (ed.) Promoting Mental Health Volume 1, Avebury Aldershot.

Vasta, R. (ed.) (1982) Strategies and Techniques in Child Study, Academic Press, London.

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Williams, T., Wetton, N. and Moon, A. (1989) A Way In, Southampton: Health Education Authority/University of Southampton.

Williamson, H. and Butler, I. (1996) ‘No-one ever listens to us: Interviewing children and young people’, in C. Cloke and M. Davies (eds) Participation and Empowerment in Child Protection, Pitman, London.

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Bibliography Kaufman, K., Brown, R., Graves, K., Henderson, P., Revolinski, M. (1993). What me worry? Clinical Pediatrics Albee, G. (1993). The Fourth Revoloution, in (eds.) Trent D 32, 1, 8-14. & Reed C, in Promoting Mental Health Volume 5. Kitzinger, J. (1994) ‘The methodology of focus groups: the Avebury Aldershot. importance of interaction between research participants’, Astrop, J. (1982) My Secret File, Puffin, Harmondsworth. Sociology of Health and Illness, 16, 1, 103-120.

Bruzzone, C. and Morton, L. (1992) All About Me, Early Lopez, L. (1991). Adolescents’ attitudes towards mental Learning Centre, London. illness and percieved sources of their attitudes: an examination of pilot data. Archives of Psychiatric Coppock, C. and Dwivedi, K. (1990). Group Work in Nursing, 5, 271-280. Schools, in Kedar Nath Dwivedi (ed.) Group work with Children and Adolescents. Morgan, D. L. (ed.) (1993) Successful Focus Groups, Sage, London. Borinstein, A. (1992). Public attitudes towards persons with mental illness, Health Affairs, 11, 3, 186-196. Philo, G., Secker, J., Platt, S., Henderson, L., McGlaughlin, G., and Burnside, J. (1994) ‘The impact of the mass media Fraser, M. (1994). Educating the public about mental on public images of mental illness: media content and illness: what will it take to get the job done? audience belief’, Health Education Journal, 53, 271-281. Innovations and Research, 3, 3, 29-32. Redgrave, K. (1987) Child’s Play, Boys and Girls Welfare Greenbaum, T. L. (1987) The Practical Handbook and Society, Manchester. Guide to Focus Group Research. Lexington Books, Lexington (Mass.). Ryan, T. and Walker, R. (1993) Life Story Work, BAAF, London. Haluk Arkar and Dogan Eker (1994). Effect of psychiatric labels on attitudes toward mental illness in a Turkish Silverman, D. (1993) Qualitative Research, Routledge, sample, The International Journal of Social Psychiatry, 40, London. 3, 205-213. Spitzer, A. and Cameron, C. (1995). School age children’s Harris, J. (1992) ‘The role of health education in promoting perceptions of mental illness. Western Journal of mental health’, in D. Trent (ed.) Promoting Mental Nursing Research, 17, 4 398-415. Health Volume 1, Avebury Aldershot. Van Dalen, H., Williams, A. and Gudex, C. (1993). Lay Harris, P. L. (1992) Children and Emotion, Blackwell, people’s evaluations of health: are there variations Oxford. between different subgroups? Journal of Epidemiol ogical Community Health, 48, 248-253. Hill, M. (1992) ‘Children’s role in the domestic economy’, Journal of Consumer Studies and Home Economics, Vasta, R. (ed.) (1982) Strategies and Techniques in Child 16, 33-50. Study, Academic Press, London.

Hill, M. and Triseliotis, J. (1990), ‘Who do you think you are? Towards understanding adopted children’s sense of identity’, in J. Ross and V. Bergum (eds.) ‘Through the Looking-glass: Children and Health Promotion’, Ottawa, Canadian Public Health Association.

Huxley, P. (1993). Location and stigma: a survey of community attitudes to mental illness - Part 1. Enlightenment and stigma. Journal of Mental Health, 2, 73-80.

James, A. (1993) Childhood Identities, Edinburgh University Press.

62 APPENDIX 1

Appendix 1 Project outline

Listening to young people in order to provide appropriate information and education.

Children can be affected in major ways when parents or Outline other significant adults experience mental health difficulties. In addition, the role of children in caring for adult family The Centre for the Child and Society at Glasgow University members is receiving increasing recognition. The focus to has been granted funding from The Mental Health date has been on children who care for adults with a physical Foundation to carry out a study exploring the perceptions disability and little is known about the different, and possibly of young people aged 12-14 concerning a number of issues additional, needs of children in this position. Further research surrounding positive mental health and mental illness. The is therefore required to begin to explore these children’s intention is to explore children’s views about mental and needs and to identify how they can be supported. emotional health problems. In addition children’s perceptions of professionals concerned with mental health Finally children’s views and attitudes are not only important will be examined. It is felt that the study will provide because they are the adults of the future; they are important information for children in a language they can understand, in their own right. Recent research by the Office for Public and improve our understanding of the mental health Consensus and Surveys found that mental health problems problems children of this age group may have. The work is in childhood and adolescence are far more common than scheduled for approximately 18 months, culminating in a originally thought. It is therefore important to understand final report in March 1998. children’s experiences of mental and emotional health fully and their perceptions of the professionals who may work Project background with them, in order to ensure the most appropriate help is available. In recent years, growing importance has been placed on promoting health and well being rather than on preventing In order for the children to participate in the study written and treating ill health. Alongside this, the importance of informed consent will be sought from the understanding how lay people think about their health has parent(s)/guardian of each child, as well as from the also been recognised. To date, however, most of the children themselves. All information will be treated in the research which has been undertaken to assist with this has strictest confidence and the anonymity of all participants focused on adult’s perceptions of physical health and will be preserved. Children will be asked to take part in illness. Neither mental health, or the perceptions of either a focus group discussion or an individual interview. children have received such attention. This study has therefore been commissioned to begin to address these Sample gaps in our knowledge. Three types of sample will be recruited for the study from Children’s views about mental health are important for a different sources: number of reasons. Firstly, we know that experiences in a "typical" cross section of children with a mix of childhood and adolescence can have a significant influence on mental health in adult life. It is therefore important to social class backgrounds in urban and rural settings understand children’s own concerns and worries, which children identified as having some kind of may differ in some respect from those of adults. emotional/psychological problem In addition, there is evidence that the stigma surrounding children with a parent or other significant adult who mental ill health can prevent people from seeking help early enough, and can also make it more difficult for those who is experiencing mental health problems. do receive help to lead a full life in their community. The interviews and group discussions will be recorded on Attitudes developed in childhood and adolescence may lay audio tape if participants are in agreement. Only the the foundations for life beliefs and attitudes. It is therefore research team will have access to the tapes and anonymity important to understand how children’s attitudes are formed will be preserved at all times.

63 APPENDIX 2

Appendix 2 Letter to parent/guardian

Listening to children

I am writing to ask for your help with some research I am carrying out at The Centre for the Child and Society at the University of Glasgow. The study aims to look at what children aged 12-14 think about particular aspects of health and illness. The study will involve interviews with a cross section of children from several schools in Glasgow, Edinburgh and the Borders.

We believe it is very important to understand young peoples’ views, not only because they will be the adults of the future, but because they are equally important in their own right. This study could help to provide children with information and, it could also help to identify the needs of this age group.

We are particularly interested in young peoples’ views towards mental health and mental illness (e.g. stress, anxiety, depression), their views on people experiencing these problems and the professionals involved in helping them.

I would be very grateful if you and your child agree to take part in this study. The interview will be informal and will either be on an individual basis, or a group discussion with six other young people from your child’s class. I want young people to enjoy participating in the study, so I will use games and simple written exercises to make it easier and more fun for them. I should emphasise that children can withdraw at any stage of the study, and they will not be pressed to talk about anything they do not wish to.

All interviews will be strictly confidential and there will be no identification of the school or individual child in any publication or report that comes out of the study. Interviews will be tape recorded providing you and your child agree. Only the research team will have access to the information from these interviews.

I do hope you and your child will agree to help me. Please could you and your child complete the consent form to say whether you do or do not wish to participate in this study, and return it to your child’s head teacher.

If you would like any further information about the study, please contact me on 0141 339 8855 ext.2877.

Thank you for your help. I look forward to meeting your child.

Yours sincerely

Clare Armstrong Research Fellow

64 APPENDIX 2

Consent form

Listening to children

Could you please complete this form and return to the head teacher.

Please fill in 1 or 2.

1. We have read and fully understand the information given about the project "Listening to children" and agree to participate in the study

Parent ...... Date ......

Child ...... Date ......

2. We have read and fully understand the information given about the project "Listening to children" and do not agree to participate in the study

Parent ...... Date ......

Child ...... Date ......

65 APPENDIX 3

Appendix 3 Semi-structured interview schedule for focus group discussions and individual interviews

Group discussion format

Interview one

TOPIC METHODS

1. Producing a list of feelings Brainstorm onto a flip chart, being sure significant to the group to include all members of the group.

2. Views of what constitutes a Ask the group what they think it means mentally healthy person. to be mentally healthy (may need a simplified explanation).

What causes young people to be this way (using the terminology they have used). Prompt - social, enviromental, parental influences.

What they think it means to be mentally unhealthy and what causes this. What makes adults mentally healthy and unhealthy.

3. Assess how young people cope Ask the group to identify what young with feelings. people do when they feel good and when they feel bad (emphasis is really on sad and bad). Who or what could or does make them feel better.

If they think adults have good and bad feelings what do they do in similar situations and who can help them.

4. Feelings on the best and worst Ask them to write, draw or use day I can remember. colours to illustrate how they felt.

5. Promoting positive mental health. If you were a government minister writing a policy for young people’s well being, what would you include to ensure people of your age group have more positive feelings and better mental health. What would you want adults (parents, teachers) to do for young people.

66 APPENDIX 3

Group discussion format

Interview two

TOPIC METHODS

1. Discussion of unusual behaviour. Spontaneous discussion about what they think is odd or unusual behaviour - brainstorm.

2. Identifying attitudes towards Using constructed vignettes. unusual behaviour.

3. Words used to describe mental illness. Ask what the term mental illness makes them think of. This question need only be used as a prompt if no words have become apparent.

4. Assess knowledge about mental illness. Give them cards to look at with various types of illness on them. Ask what they think each one is and what the cause is.

Ask if adults and young people get them and are the causes the same.

5. Elaborate on thoughts about Would you be able to tell if someone was mental illness. experiencing mental health problems (may need prompting-what they look like, what they do).

Identify the type of people you think might experience mental illness (may need prompting-class, gender). Interviewer can go round room asking each group member.

6. Identify sources of ideas Ask them to identify films, TV programmes, about mental illness books that have examples of mental illness. Go round and ask them where else their ideas have come from.

67 APPENDIX 3

Individual discussion format

Interview one

TOPIC METHODS

1. Producing a list of feelings Brainstorm using flip chart or just verbally.

2. Views of what constitutes a Ask what they think it means to be mentally mentally healthy person. healthy (may need a simplified explanation).

What it means to be mentally unhealthy.

Is it the same for adults.

3. Meaning of feelings in terms Which feelings would you associate with of mental health positive and negative mental health (may need to simplify and explain positive and negative).

What causes young people to be this way (using the terminology they have used). Prompt - social, enviromental, parental influences.

What causes adults to be this way.

4. Assess how young people Ask what young people do when they feel cope with feelings. good and when they feel bad (emphasis is really on sad and bad). Who or what could or does make them feel better.

What do adults do.

5. Promoting positive mental health. If you were a government minister writing a policy for young peoples well being, what would you include to ensure people of your age group have more positive feelings and better mental health. What would you want adults (parents, teachers) to do for young people.

68 APPENDIX 3

Individual discussion format

Interview two

TOPIC METHODS

1. Discussion of unusual behaviour. Spontaneous discussion about what they think is odd or unusual behaviour - brainstorm.

2. Identifying attitudes towards Using constructed vignettes. unusual behaviour.

3. Words used to describe mental illness. Ask what the term mental illness makes them think of. This question need only be used as a prompt if no words have become apparent.

4. Elaborate on thoughts Would you be able to tell if someone was about mental illness. experiencing mental health problems (may need prompting-what they look like, what they do).

List the type of people you think might experience mental illness (may need prompting-class, gender). Interviewer can go round room asking each group member.

5. Identify sources of ideas Ask them to make a list of films, TV about mental illness. programmes, books that have examples of mental illness. Go round and ask them where else their ideas have come from.

6. Assess knowledge about mental illness. Give them cards to look at with various types of illness on them. Ask what they think each one is and what the cause is.

7. Personal experiences. have they or anyone they know experienced similar feelings to any of the ones discussed (adults or children).

8 Coping strategies of people General discussion. Can you think of, or with mental illness. do you know of anything young people do to cope with the types of feelings and behaviour we have discussed. Do adults do this as well.

69 APPENDIX 4

Appendix 4 Vignettes

1. James is 13 years old. He is always getting into trouble at school for fighting. He often gets sent out of class for bad behaviour. He does have one or two friends but most of the other people at school don’t like him much because of his bad temper. His dad left about 3 years ago and James doesn’t see much of him.

2. John is 34 years old. He first became acutely distressed when he was 17 and a student at university. He could hear voices that no-one else could and these voices told him that everyone was trying to harm him. When he feels like this his concentration is poor and he tends to forget most things, even routines like washing and eating. When John is ill he can be unpredictable. At times he is loud and verbally agressive.

3. Angela is 17 years old. About 6 months ago she and a friend decided to loose weight. Angela’s friend gave up dieting but Angela continued. Angela’s mum and her friends tell her she now looks too thin but she still feels she is fat. She sometimes pretends she has eaten but throws her food away. She tries to go the whole day without eating anything.

4. David is a 40 year old man. He got fired from his job because he stopped going to work. He stays at home all day and spends the day watching TV or sleeping. His wife tries to get him to eat, but he says he is not very hungry. David is a very good artist but he doesn’t paint or draw anymore. He says he doesn’t want to see his friends.

5. Peter is 15 years old. He has always been shy and is often teased at school. Recently he has started to worry that people are staring at him in the street. He also started to hear voices in his head which talk about him. He sometimes feels that his body is controlled by aliens and has told his mum about this. Although she told him this is impossible he still worries. He also worries that aliens are poisoning his food and doesn’t like eating. His teachers have noticed he is finding it difficult to do his school work.

Questions for each vignette

1. What do you think about the way this person is acting?

2. Is there a name for the way he/she is acting?

3. How would you feel if they lived next door to you?

4. Who could help this person. Hopefully this will lead to ideas about types of care - hospital or community and the type of professionals involved (need to probe about what they think the different types of professions can actually do).

5. How would you feel if you were friends with this person?

6. Have you ever known anyone like this person?

70 APPENDIX 5

Appendix 5 Self-completion forms

Best day of my life

Worst day of my life

71 APPENDIX 6

Appendix 6 Centre for the Child & Society University of Glasgow Code of Practice for Research Involving Children

This Code of Practice applies to all research involving any Explanations should be given both in writing and verbally, direct contact with a child undertaken under the auspices in terms which make sense to prospective participants. of the Centre for the Child & Society, University of Glasgow. These should include details of the agencies who As in the UN Convention, a child is defined as anyone under commissioned and are carrying out the research, together the age of 18 years. with a contact person, address and telephone number. Considerations should be given to making available The Code sets out minimum requirements. In many information about the research in languages other than instances, additional processes are likely to be desirable to English and in other formats (e.g. Braille) if appropriate. optimise children’s experience of participation in the Particularly with children, it is important that the researcher research. Centre staff must also abide by the regulations of checks that the explanation of what the research involves agencies with which they collaborate in research and of has been well understood. relevant ethical committees. Whenever time scales permit, research proposals should be submitted to the University In the case of children under 16, informed consent should Ethics Committee for Non-Clinical Research Involving normally be obtained from the child’s parent or guardian in Human Subjects for comment. This should apply to all addition to the child. student proposals and for any research where there is a risk All potential research participants should be told why and of harm or distress to a child. how they were chosen to take part. They must be made aware of their right to refuse participation altogether and to decline or withdraw from a particular element of a study at Aims of Research any time.

Studies should only take place if they will add to existing When access to third party information is required in which knowledge and are consistent with children’s well-being. At all an individual is identified or could be identifiable (including stages care must be taken by Centre staff and students to case records), permission must be sought from the subject avoid any harmful consequences to the children participating. of that information, including children as appropriate.

Informed Consent Confidentiality and anonymity

Any child or adult may take part in research only after they Unless there are very good reasons for identifying have given their informed consent to participate. The only respondents (see below), data should be anonymised in exceptions should occur when a child is unable to give analysis and presentation of findings. Normally staff or consent on account of very young age or learning disability. students carrying out research with children will undertake Then the agreement of the child’s parent or guardian is not to pass on to anyone, outside of the research team for usually sufficient, provided that there is no reason to that study, information which could in any way identify the believe that the research would harm the child. individual who is the source of the information. It should be explained, though, that in exceptional circumstances Before agreement is sought and obtained, the objectives, confidentiality may be breached if new information comes methods and required commitment must have been to light which indicates that a child is at risk of significant explained. Assurances should be given about confidentiality harm, is harming or has harmed others seriously. Any action and anonymity, unless exceptionally the nature of the taken in such circumstances must be discussed with the research means that participants are willing to be identified child first. The Centre Director and research colleagues and would not be adversely affected in any way by doing so. working on the study should also be consulted. Those taking part in research should be told what will happen to the information they give and who will have access to it both currently and in the future.

72 APPENDIX 6

It may occasionally be consistent with the research purpose Children’s safety, anxiety and distress and children’s wishes and interests for their identity to be revealed, in which case this will be done only after full Care must be taken to ensure that, as far as possible, discussion of the implications with all relevant parties and children are safe and feel safe in the research setting. with written agreement. Children should be informed at the start of any research When research participants meet in groups, the boundaries contact that they are entitled to pause or stop the research of confidentiality for group members should be discussed at process at any time they wish and to decline to answer a the outset. question.

Research data should be kept in a secure place, where only If if appears to a researcher that a child is anxious or upset, members of the research team may have access. this should be acknowledged and the child asked for her/his views about the best way to respond. Options include - continuing the research contact; deferring or ending the Equal Opportunities research contact; the child talking to a person on his/her choice. Researchers should not take on a counselling role, Researchers should endeavour to avoid prejudice and but may advise where information or assistance can be stereotyping in their sampling methods and reporting. obtained. Efforts should be made to ensure that particular groups of people are not excluded (e.g. because of physical disability or communications difficulties) and that allowances are Debriefing and feedback made for any extra problems or anxieties a child may have. At the end of any contact with children or adults, the researcher should ascertain and respond to any outstanding Recording issues or worries. Whenever practical, feedback about research findings should be given to participants. Consent must be sought for the use of audio or video recording, and research subjects should be made aware whenever recording equipment is in use. Any equipment Financial issues used should be visible. Explanations must be given that: the recorder will be switched off immediately on request; about Children should not be offered any material inducement to who will have access to the records and transcripts; and participate. It maybe appropriate to assist with expenses. that tapes will be cleared.

Researcher safety Staff or Students carrying out research Under no circumstances is exposure to danger ever justified Before any staff member or student carries out research by the collection of research data. Researchers must be under the auspices of the Centre, s/he must sign a declaration warned of any known risks. If a researcher suspects that which gives details of any previous convictions. The fieldwork may be hazardous, s/he must inform the grant declaration form will be treated in confidence. Anyone who holder and Centre Director. Appropriate safety measures is known to have committed an offence against a child will must then be agreed (e.g. researcher is accompanied; not be allowed to carry out research with children, unless alternative form of data gathering is undertaken). exemption is given by the University Ethics Committee for Non-Clinical Research Involving Human Subjects.

73 on defining unusual behaviour

Sombody jumping up and “down wi’ mad clothes .... sombody walking about wi’ slippers on” on counselling

I would nae get a “counsellor they’d give you pills an’ all that then put you The Mental Health Foundation is the UK’s leading charity working for the in a mental home needs of people with mental health problems and those with learning ” disabilities. We aim to improve people’s lives, to reduce stigma surrounding the issues and to promote understanding. We fund scientific research, social on depression research and community projects. We provide information on mental health issues for the general public and healthcare professionals. We aim to Really sad and like “ maximise expertise and resources by creating partnerships between everything is so awful and it ourselves and others including Government, health and social services. will never get better, but it The Mental Health Foundation always does 7th Floor, 83 Victoria Street ” London SW1H 0HW

Tel: 020 7802 0300 on feelings of sadness Fax: 020 7802 0301 Well, I think most folk have email: [email protected] “a little wee place to go, like http://www.mentalhealth.org.uk outside or in a cupboard, Registered charity number 80113 probably just go there to Price: £12.00 think about it or cry or ISBN 0 901944 602 something like that, but just © 1998 The Mental Health Foundation to think about it mainly” on feeling mentally healthy

you need to tell people “your problems and not just keep them all... yeah because it would drive you mad if BRIGHT FUTURES you had problems and you Promoting Children and Young People’s Mental Health couldn’t tell any one The Bright Futures initiative is a three year programme of work ” undertaken by the Mental Health Foundation which aims to:

• Improve services and care for young people with mental on anorexia health problems “I don’t think she’s mentally • Raise professional and public awareness and understanding ill but she’s got a about young people’s mental health psychological problem with • Improve the integration of aims, policies and services across the way she feels about the full range of people and agencies involved. herself and the way she looks”