Elephant in the room

1. The Youth Mental Health Committee
2. Why did we do this research?
3. Our aims
4. Mental health - the facts
5. How did we do our research?
6. What did we find out?
7. Stigma
8. Safe spaces
9. Schools and information
10. Our recommendations for Government
11. Thank you
12. Join the Elephant in the Room campaign
13. References

October 2018

The Youth Mental Health Committee

We’re a group of nine young people made from the Belfast Youth Forum, Northern Ireland Youth Forum (NIYF) (link opens in new window) and Youth@clc (link opens in new window) and we came together in 2017 to explore issues connected to mental health and young people.

But we don’t just want to explore these issues; we want to take action on them and make change happen.

We want to make sure that as many young people as possible have a meaningful say in shaping the future of mental health education and support services.

We hope that young people use their voices to talk about mental health, to challenge the stigma and to push for change from our decision makers.

We will use this research to help make all of this happen.

Why did we do this research?

In July 2016 the United Nations Committee on the Rights of the Child recommended that the NI Government invest heavily in children and young people’s mental health services.

At a follow up youth event in October 2016 organised by youth@clc, NIYF and the Belfast Youth Forum, over 100 young people expressed their frustrations at the lack of mental health education and support services available here and called for the UN’s recommendation to be fully implemented by our government.

To help make this happen, young people at the event asked us to begin work on creating a mental health campaign.

Our aims

We wanted to find out what young people in NI thought and knew about mental health, in particular:

• where young people get their information about mental health and how do they rate this,
• what actions they think our government should take to promote positive mental health and wellbeing in society,
• how young people view mental health and how does this impact on their ability to speak about it,
• where would young people like to go to receive mental health information and support.

Mental health - the facts

• Mental illness is the largest cause of ill health in NI.[Reference 1]
• It is estimated that approximately 45,000 children and young people in Northern Ireland have a mental health problem.[Reference 2]
• More than 20 per cent of young people here are suffering ‘significant mental health problems’ by the time they reach 18.[Reference 3]
• Childhood experiences like poverty, addiction in families and trauma experienced within families are linked to the emergence of mental health issues at a young age.[Reference 4]
• There is a relationship between ill mental health rates and the legacy of the conflict, which continues to impact young people through trans-generational trauma.[Reference 5]
• NI has the highest rates of suicide in the United Kingdom.[Reference 6]
• Suicide rates in the most deprived areas of NI are three times higher than in the least deprived.[Reference 7]

How did we do our research?

From the start, we knew that we wanted our research project to be youth led. It had to be a piece of work done by young people for young people.

We asked a local researcher with lots of experience to help us, we knew this would help make our work valid and produce a stronger report.

They helped us to:

• develop our online survey and focus groups,
• get trained in research skills,
• analyse our findings,
• create our research report.

Our research timeline

1. Our research was carried out from January- April 2018.
2. Young people who took part were aged 14-17.
3. We used an online survey and youth led focus groups to gather our information.
4. We sent the online survey to all post-primary schools in NI through the C2K network and we promoted it widely through social media.
5. The young people on our Forums also took hard copies of the survey into their schools and youth groups to complete.
6. A total of 1,117 young people completed our survey.
7. We then used the survey findings to develop our focus group session and ask young people more qualitative questions about mental health.
8. In total, four focus group sessions took place; these were in Belfast, Newry, Ballymena and Derry.
9. At the focus groups, we asked young people to design their own elephant with their messages about mental health.
10. A total of 151 young people participated in our focus groups.
11. From May to August 2018 we analysed the findings of our research and created our report.
12. We used these messages and the research findings to create our recommendations for government at the end of this report.

What did we find out?

Out of the 1,117 young people who took part in our survey, 91 per cent of them told us that mental health is a huge issue for young people in NI.

The focus groups showed us there is an appetite amongst young people to talk about mental health, access information and challenge the negative stigma.

The findings of our research can be broken down into three broad themes which all connect with one another:

1. Stigma
2. Safe Spaces
3. Schools and information

Stigma

Overwhelmingly, young people told us there is a huge negative stigma attached to mental health which in turn leads to a culture of silence.

A key issue for young people is that there is little to no positive mental health language; they told us that society frames mental health in a negative way and this makes young people associate it with negative thoughts.

40 per cent of young people in our survey had negative thoughts when they heard the term mental health.

Within each of the focus groups young people described the term mental health using these same sets of words and phrases:

• depression
• suicide
• drinking
• self-harm
• bullying
• frightened
• alone
• silence.

Young people said they want to talk about mental health, but this negative stigma and the culture of silence stops them doing so.

“ People are afraid of being judged, being treated differently.”

“ People think if they say they are suffering, they will be put in an asylum.”

“ There is a huge stigma linked to seeing the counsellor, people feel ashamed and embarrassed.”
 

Young people also said that the legacy of the conflict means often people here didn’t open up about their problems and preferred to ‘smile and carry on’:

“ You just have to keep going, people don’t want to admit they need help, isn’t that always been the case around here.”

Young people were clear that mental health was associated with negativity because of:

• the media (TV and films),
• social media,
• a lack of knowledge and understanding it and the misconceptions this creates,
• can’t discuss it out of fear,
• adults not understanding how young people are affected by it.

“It’s always a bad news story when you hear mental health…and people don’t want to hear when things are not going well, so they switch off. Like think when did you ever hear a good mental health story.”

“ We know about your physical health, but young people don’t know anything about your mental health. We don’t get taught how to look after ourselves; how to balance life pressures.”

“I told them about the cuts on my arms, and they were like – here’s the number for lifeline.”

“When you are 12-18 years of age, adults and professionals often dismiss how you feel…they say it’s your hormones, you’re a teenager.”

Importantly, young people said that discussions on mental health are always led by adults and this can often narrow the discussion and stop young people from talking about it as well.

Young people told us they aren’t given the space to transform how mental health is talked about and viewed and that this needs to change.
 

Safe spaces

76 per cent of survey respondents told us that young people are afraid to talk about mental health.

A further 86 per cent told us that large numbers of young people don’t know how to talk about mental health. 

Large numbers of young people in the focus groups also that there is a lack of safe spaces to talk about mental health.

The following cycle emerged:

• afraid to talk,
• don't know how to talk,
• lack of safe spaces available to talk.

"People are afraid of being judged, being treated differently.”

"Sometimes you don’t really know how you are feeling yourself, so you find it hard to talk to people about it, because it’s hard for you to understand what it is and put it into words.”

“There are just not enough safe spaces.”

“There is a lack of awareness of where to go.”

“You are ‘afraid’ to walk in somewhere.”

The internet: a safe space?

In the focus groups, there was a lot of attention given to the role of the internet by young people, who discussed its use for receiving mental heath information.

The overall view from young people was that online was a good place to access mental health information but there were issues with being able to separate fact from fiction. This meant that at times, using the internet to get information could make mental health issues worse for them. When explaining why they felt this way, young people gave these reasons:

• Online bullying
• Loss of anonymity
• Self-diagnosis
• Myths and misinformation

“Some things can be exaggerated online.”

“Internet…YouTube…filled with negativity.”

“I just type in all my symptoms and see what comes up.”

“When I look online, I convince myself I am dying.”

Young people identified social media in particular as having a negative impact on their mental health and said it was actually making things worse.

All of the young people who took part in the focus groups felt that social media was responsible for increasing negative stigma and creating an environment which forced young people to not talk about their personal feelings:

“When young people mention mental health on social media (their own), they usually face a negative backlash from their friends or bullies or trolls… usually ‘look at them attention seeking.’ That kind of stuff.”

Although the risks about receiving inaccurate information were high, there was general agreement amongst participants that online was still the best place to reach young people and to get them to access mental health information.

The challenge highlighted by young people was how to separate fact from fiction and make sure you keep everyone safe?

“Short images and videos are a good way to raise awareness of mental health issues.”

“I like the wee positive messages (affirmations) that come up on Facebook and Instagram. They can cheer you up and be inspiring.”

Finally, the discussions looked at what young people thought a ‘safe space’ might look like in real life:

“The best place to go would be to your youth worker because you trust them and they know you, and you know them and they can help point you in the right direction.”

"An ideal service would be tailored to meet the needs of individuals, no pressure, understanding and empathetic staff; positive bright environment; welcoming; training for transgender issues. Listening ears and the right advice.”

Schools and Information

According to the young people the three most common places they would source information about mental health are:

• online (59 per cent),
• family member (48 per cent),
• friends (45 per cent).

Young people said the problem is that the quality of this information is inconsistent and that it often isn’t useful because:

• it’s usually framed in a negative way,
• it often spreads myths and rumours,
• it sometimes romanticises mental health issues,
• it encourages self-diagnosis and misinformation.

"Parents believe that children under 16 are too young to have mental health issues.”

“All the focus is on the negative.”

“You can look up your symptoms and could end up thinking you're worse than you are.”

In conversations about mental health and school they told us:

• There are some positive examples of mental health education and support for young people in schools, but this is not standard across all schools and it’s not common for the majority of young people to experience this.
• Good experiences tended to be because of individual teachers, not the result of a school policy or a common approach that all schools sign up to.
• It is difficult to access mental health information in schools; most young people we spoke to hadn’t received any information in their school.
• School staff often lack knowledge and understanding about mental health and young people, and are therefore unable to help.
• Schools should adapt more to the needs of young people when it comes to mental health education and services.

“Schools only deal with mental health in one way (counsellors) but one size does not fit all.”

“Individual teachers may be helpful but they are restricted by the school system.”

“No confidentiality in school…don’t trust teachers to talk to them.”

“Closed questions like the ones you’re asked by councillors are the wrong way to engage young people…we are not textbooks.”

“Some teachers are really good in my school, they’re sound so you feel like you could go to them for help or even just a chat, but others you wouldn’t go near. They would just tell you to wise up.”

My experience has been telling my story over and over again, just to have it dismissed. There are only so many times that you are going to do that.”

“Teachers should be educated so they know how to deliver and help us.”

“If you’re taught how to keep your heart healthy, why are you not taught how to keep your brain healthy?”

“Over 50 per cent of us are still at school and none of us have received any information about mental health.”

To balance this, young people said schools, teachers and the curriculum have a very important part to play in developing positive mental health engagement with young people.

Young people felt that more could be done in schools to create an environment where they can talk about mental health and receive useful, consistent information.

87 per cent of young people in our survey agreed that mental health issues need to be discussed more in schools and colleges. Young people in the focus groups said overwhelmingly that mental health education should be embedded in schools via the curriculum.

“Feelings and emotions should be discussed and explained more in the curriculum.”

“More approaches like storytelling and drawing exercises.”

“Time should be taken once a week to talk about mental health.”

“Make it a subject from primary school on.”

Young people said this type of mental health education should include:

• accessing information (to help increase knowledge or for personal need),
• addressing stigma,
• raising awareness,
• provision of support for young people who need it,
• training for teachers and all school staff,
• needs to be embedded in the curriculum - one off lessons won’t work.

“There should be an open clinic approach, like a drop in.”

“There should be more of senior members of a school talking to the junior members.”

“It should be interactive…less lecture type…small groups and make them active.”

Our recommendations for Government

Young people said:

There is a huge stigma attached to mental health which stops young people talking about it and creates a culture of silence which only makes the problem worse.

We are asking our decision makers to:

• support the creation of a youth-led mental health campaign challenging the culture of silence and negative stigma,
• work with young people to develop a new and positive language around mental health by creating a mental health dictionary. This could be used as part of a potential mental health curriculum programme.

Young people said:

There is a lack of safe spaces to talk about mental health and receive useful information and support.

We are asking our decision makers to:

• engage with young people to create and fund safe digital solutions to receive mental health information and support. These digital solutions should be designed by young people for young people.

Young people said:

The quality of mental health information they receive is inconsistent and often it isn’t useful. They said there is little to no mental health education in schools and they would like to see this change by having a programme embedded into schools and colleges.

We are asking our decision makers to:

• create a compulsory curriculum programme for all schools and colleges on mental health and wellbeing that helps to raise awareness and challenge stigma and that allows young people to access consistent mental health information. This curriculum programme should be long term and embedded in schools – one off workshops won’t be effective.
• support mental health and well-being training for all teachers, school support workers and youth workers so that this programme can be delivered effectively.

Thank you

We want to say a big thank you to all of the young people who took part in our research; for sharing your stories and telling us what you think about mental health. Without your help, none of this would have been possible.

Join the Elephant in the Room campaign!

Tweet and Facebook your messages about mental health and help us call out the ‘Elephant in the Room.’

Help us to #FillTheTrunk and challenge the stereotypes, bust the myths, influence decision makers and get people talking about mental health!

Remember to include our hash-tags:
#FillTheTrunk
#EITR
Follow us on Twitter @FillTheTrunk (link opens in new window)

References

1. Thompson (2017) http://www.niassembly.gov.uk/globalassets/ documents/raise/publications/2016-2021/2017/health/0817.pdf
2. Khan (2016) https://www.crisiscareconcordat.org.uk/wp
3. Sands, Dr. L. (2017), Council member, RCGP NI, Associate Director, GP Career Development Scheme and GP Training Programme Director, NIMDTA, ‘Priorities for prevention, intervention and access to mental health services’, presentation to Policy Forum for NI Keynote Seminar: improving mental health provision in Northern Ireland; prevention, treatment and developments in care, 17 January, 2017, Stormont Hotel
4. OFMDFM (2002) “Reshape, Rebuild, Achieve” Delivering Practical Help and Services to Victims of the Conflict in Northern Ireland. Belfast: Office of the First Minister and Deputy First Minister, April; Leavey, G., Galway, K., Rondón, J. and Logan, G. (2009) A flourishing society. Aspirations for emotional health and wellbeing in Northern Ireland. Belfast: Northern Ireland Association for Mental Health (NIAMH)
5. OFMDFM (2002) “Reshape, Rebuild, Achieve” Delivering Practical Help and Services to Victims of the Conflict in Northern Ireland. Belfast: Office of the First Minister and Deputy First Minister, April; Leavey, G., Galway, K., Rondón, J. and Logan, G. (2009) A flourishing society. Aspirations for emotional health and wellbeing in Northern Ireland. Belfast: Northern Ireland Association for Mental Health (NIAMH)
6. http://www.thedetail.tv/artcles/suicide-deaths-innorthern-ireland-highest-on-record
7. Schubotz D. and McArdle E. (2014) Young People and Mental Health, Policy and Research Review, Belfast: ARK, YouthAction

This project has been kindly funded by Big Lottery Fund and Belfast City Council.