How young people in Ireland influenced policy development and public awareness on teenage mental health

Presenters:
•Eibhlin Browne (17) (Dáil na nÓg - young people's parliament)
•Danny Costello (17) (Participant in national consultations - Teenage Mental Health: What Helps and What Hurts)
•Jade McNeill (16) (Office of the Minister for Children and Youth Affairs - Children and Young People's Forum)
•Anne O'Donnell (Head of Communications and Participation - Office of the Minister for Children and Youth Affairs)

The Office of the Minister for Children and Youth Affairs team will present on the following processes:

· The top recommendation from Dáil na nÓg 2008 (national youth parliament) was the need for ‘a positive mental health advertising campaign aimed at teenagers’
· A series of national consultations (October 2008) with young people on Teenage Mental Health: What Helps and What Hurts?
· The development of the advertising and on-line public awareness campaign on teenage mental health

Background to the above initiatives

The Office of the Minister for Children and Youth Affairs (OMCYA) is responsible for overseeing the development and improvement of structures that promote and enable civic participation by children and young people and funds five key structures:

· Comhairle na nÓg (local youth councils);
· Dáil na nÓg (national youth parliament);
· The Inclusion programme for seldom heard children/young people;
· The OMCYA Children and Young People’s Forum
· National consultations/dialogues with children and young people.

Throughout 2008, a number of parallel processes on teenage mental health were being overseen by the OMCYA, Dáil na nÓg (national youth parliament), , the Office for Disability and Mental Health, the Health Service Executive (HSE) and its National Office for Suicide Prevention (NOSP).

1. The Office for Disability and Mental Health and its Minister of State identified that young people had not been included in the consultation process that informed the Report of the Expert Group on the National Mental Health Policy A Vision for Change. The Minister and his Office were interested in hearing the views of young people to inform the on-going implementation of this policy.

2. In response to the above consultation gap, the Health Service Executive (HSE) and its National Office for Suicide Prevention (NOSP) made a commitment to get young people’s views on mental health services and to develop an awareness campaign aimed at young people.

3. The OMCYA agreed to organise a series of consultations with teenagers on mental health during 2008, in co-operation with the HSE, the NOSP and the Office for Disability and Mental Health. Work on developing these consultations began in December 2007.

4. By co-incidence, Dáil na nÓg (the national youth parliament for young people aged 12-18) chose 'mental health for young people' as one of the two themes for discussion at the parliament in February 2008. Topics for discussion at Dáil na nÓg are selected by young people in their Comhairle na nÓg (local youth councils) throughout the country several months ahead of the annual youth parliament.

5. In preparation for Dáil na nÓg the OMCYA, the HSE and the National Office for Suicide Prevention began to work together. Senior officials from the HSE and the National Office for Suicide Prevention were on the panel of experts for the Questions and Answers session of Dáil na nÓg 2008.

6. At Dáil na nÓg 2008, the top recommendation voted by the 200 delegates, was the need for ‘a positive mental health advertising campaign aimed at teenagers’.

7. The Dáil na nÓg Council, which is made up of one representative elected from each of the 34 Comhairle na nÓg (local youth councils), follows up on the recommendations from the Dáil and tries to make changes for young people in those areas. During 2008 and 2009, the Dáil na nÓg Council worked on researching the most important issues to be highlighted in a public awareness campaign and supported the OMCYA in conducting consultations with young people on ‘Teenage Mental Health: What Helps and What Hurts?’

Work of the Dáil na nÓg Council (2008) on the development of an awareness campaign

The mental health group of the Dáil na nÓg Council focussed primarily on the development of an awareness/advertising campaign aimed at teenagers.
They also analysed Young Social Innovators (YSI)* projects from 2007 and 2008 to identify the number of projects on mental health and common themes in those projects. They found that 47 projects on mental health had been entered over the two years. Of these, 16 were on suicide and 14 were on body image, with the rest being about depression, pressure and stigma. This analysis fed into the work of the Council and into the development of the awareness campaign on teenage mental health. *(Young Social Innovators (YSI) is a programme for schools to raise social awareness among 15-18 year olds in Ireland by providing social awareness education. YSI participants identify issues of social concern and engage in social action projects on their chosen issue, which are showcased at an annual event.)
The Council engaged with a number of key policy-makers who are in a position to provide advice or support change, including:
· Barry Andrews, TD, Minister for Children and Youth Affairs
· Geoff Day, Head of the National Office for Suicide Prevention
· Young Social Innovators Silver Medallists (St. Joseph’s School, Rochfortsbridge) presented their award-winning project Feeling Low, Let Someone Know
· Tony Bates and Nuala Smith (Headstrong)
· Jillian van Turnhout and Carys Thomas (Children’s Rights Alliance), who spoke about the United Nations Convention on the Rights of the Child
· Senator Mary White (Vice-chair of Oireachtas sub-committee on Suicide)
· Marina Duffy (Mental Health Commission)

Members of the Dáil na nÓg Council also spoke at the following conferences:
· World Mental Health Day in October 2008;
· Barnardo’s ‘Tomorrow’s Child’ Conference in November 2008;
· ACAMH (Association for Child/Adolescent Mental Health) conference in November 2008; and
· The UN Human Rights Convention Celebration in December 2008.

In January 2009, Dáil na nÓg Council representatives made a presentation on their work to the Ministers and politicians on the Joint Oireachtas (Parliament) Committee on Health and Children.

Round Table meetings with Ministers and policy makers
In February 2009, the Dáil na nÓg Council conducted Round Table meetings with Ministers and policy makers. The purpose of the meetings was for Dáil na nÓg Councillors to outline the work and research undertaken on mental health to seek support from policy-makers in responding to the recommendations from Dáil na nÓg 2008.

Ministers and policy makers who attended the Round Table session
Barry Andrews, TD Minister for Children and Youth Affairs, (OMCYA)
John Moloney, TD Minister for Equality, Disability and Mental Health, (DOH&C)
Tony Bates, Director, Headstrong (National Centre for Youth Mental Health)
Geoff Day Chief Executive Officer, National Office for Suicide Prevention
Brendan Doody Clinical Director, Health Service Executive
Bairbre Nic Aongusa Director, Office for Disability and Mental Health
Martin Rogan Assistant National Director, Responsibility for Mental Health, HSE

Role of the OMCYA Children and Young People’s Forum (CYPF) on mental health
The OMCYA Children and Young People’s Forum, a reference panel of 35 young people aged 12-18 that advises the Minister and the OMCYA had identified mental health as an issue of importance to teenagers and worked on the issue since 2006. The CYPF engaged with health professionals at a summer school on young people’s health in 2006 and took part in focus groups for the Health Service Executive during 2007 on the needs of young people in the delivery of health and social services.

At their annual residential meeting in July 2008, the CYPF took part in a pilot of the mental health consultations to be conducted by the OMCYA in October of the same year. This was extremely useful as it allowed the OMCYA to test the most effective methods of providing space for young people to express their views and arrive at agreed decisions. Young members of the CYPF gave very useful feedback and helped the OMCYA in planning the consultations.

Young people from the CYPF were present at all six of the national consultations. They worked with the adult staff of the OMCYA in organising and running the consultations, for which they received training on administration, note-taking and co-facilitating.

Young people from the CYPF were also involved in the reference panel established to advise on the development of a national TV advertisement and public awareness campaign on teen mental health. Indeed, some of these young people actually took part in the filming of the TV advertisement (see below).

Mental health consultations with teenagers

In December 2007, the OMCYA, the Department of Health and Children Office for Disability and Mental Health, the HSE and the NOSP began to work in partnership to plan the consultation process, which it was agreed would inform the development of the awareness campaign for young people.

In October 2008, the OMCYA conducted a series of national consultations in six locations around the country with 277 teenagers aged 12-18 years. The theme of the consultations was Mental Health: What Helps and What Hurts. Consultation participants were informed that the outcomes of the consultations would feed into the development of an advertising and public awareness campaign on mental health aimed at teenagers.

Young people from the Dáil na nÓg Council and the OMCYA Children and Young People’s Forum were involved with adult staff in conducting these consultations.
The consultations were conducted using an open space methodology, which allows consultation participants to identify the issues they want to discuss. This method is particularly suitable for children and teenagers, as the agenda is set by young people themselves and not by adult organisers. Young participants were asked to identify the issues that help their mental health and the issues that hurt their mental health. Workshops on the key issues identified were conducted. A report of the outcomes of the consultations was compiled.

Launch of Teenage Mental Health: What Helps and What Hurts? A Report of consultations with teenagers
On 15^th June 2009, Barry Andrews TD, Minister for Children and Youth Affairs and John Maloney TD, Minister for Disability and Mental Health launched the findings of the consultations in a report entitled, Teenage Mental Health: What Helps and What Hurts? A Report of consultations with teenagers. Six teenagers who took part in the consultations spoke at the launch and were interviewed extensively on TV, radio and in the newspapers.

Key consultation findings identified in the report:

The eight key themes that emerged when asked what hurts teenage mental health:
1. Self-image
2. School pressures and exam system
3. Family
4. Bullying
5. Death
6. Peer Pressure
7. Relationships with boyfriends and girlfriends and
8. Isolation

While being judged for how you look and the pressures associated with school and the exam system was the two most significant areas of hurt in relation to teenage mental health, death of a close family member or friend, the lack of facilities and the effects of peer pressure were also cited as key individual negative impacts on mental health.

The six key areas that emerged when young people were asked what helps and positively impacts on their mental health:

1. School environment and the exam system
2. Facilities for Young people
3. Supports for young people
4. Relationships with boyfriends and girlfriends
5. Self-image and
6. Family

While a number of helps were considered particularly important, having a youth cafe or safe space to hang out with friends was identified as paramount. Having less homework to enable young people to use such spaces in which to socialise and relax, especially at the weekends, was also identified as key. Young people also called for a reform of the exam system and a move from sole reliance on exams to continuous assessment.

Summary of speeches at the launch:
Maggie Gethings from Dublin said, ‘at the consultations, we discovered that, unlike adults, we teenagers don’t only see mental health in a negative way, but also in a positive light’. Teenagers identified eight key areas that hurt their mental health, self-image, school pressure and exams, family problems, bullying, death, peer-pressure, relationships with boyfriends and girlfriends and isolation. The teenagers also identified many things that could help with problems in the areas of exams, facilities and supports, relationships, family and self-image. ‘Adults need to realise that teenagers can hurt as badly as adults, especially on issues such as death and relationships. Teenagers’ feelings need to be taken seriously’ concluded Maggie.

Danny Costello, also from Dublin, said that among the top issues that hurt mental health were self-image and bullying. ‘Self-image is a big part of a typical teenager’s life. It can be unbearable for any young teenager to see the attractive people on TV or in magazines, and see the way that they are not like those people. Girls especially are more influenced by the media in a negative rather than a positive way’. Danny went on to say, ‘bullying came up at every consultation venue. Bullying goes on 24/7 in all different ways. School was found to the place where the most bullying takes place. Bullying by people your own age is very hurtful. The impact from bullying can lead to a lot of different things, including self-harm and suicide. The teenagers at the consultations said that bullying can lead to depression, which makes young people feel that there is no way out and no one there for them’.
Martin Clancy from County Leitrim spoke about how school or exam pressures and family issues emerged as key hurts for teenagers’ mental health. ‘Participants said that there is too much focus on doing well in one set of exams, which potentially dictate what you do with your life. They feel that there is too much pressure to decide what you want to do for the rest of your life at just 16’ said Martin. Teachers were found to play a role in creating this stress and pressure, with some teachers ignoring non-academic talents and skills and favouring students who are high academic achievers. ‘A negative family environment emerged as one of the greatest stresses for young people. Any kind of abuse such as alcohol or drug abuse, sexual abuse or living with somebody with an eating disorder makes things worse. Fighting within the family can put huge pressure and stress on teenagers’ concluded Martin.
Claire O’Shea from Limerick spoke about how the school system could help teenager’s mental health. ‘Students at the consultations felt that there should be at least one class per week on mental health, with the issues chosen by young people and taught by teachers who understand and care,’ said Claire. Young people also favoured a move away from sole reliance on exams to continuous assessment. They want the curriculum to be more holistic and integrate sport, art and drama to cater for different abilities and skill sets. Students proposed a confidential mentor, advisor or guidance councillor in every school. ‘In my school, we have peer mentoring, where the first-year students are mentored by the fifth-year students, which creates friendship networks and builds a sense of community in the school’ concluded Claire.

Julie O’Shea from Bantry, County Cork highlighted how leisure facilities and other supports for young people can help mental health. ‘Young people noted the lack of facilities for teenagers and stressed the importance of setting up youth cafes or clubs, which have free teen health and counselling services. Another point made at the consultations, was that well organised discos, with proper supervision are hugely important, especially in rural areas. We also consider recreational activities hobbies and sports to be very important in maintaining positive mental health as they help you to let off steam. All these facilities need to be affordable and accessible, particularly transport,’ said Julie.

David Matthews from Ballymahon, County Longford said, ‘We teenagers chose all the topics discussed at the consultations and the report is an account of exactly what we said. We discussed the signs of poor mental health and agreed that a change in someone’s personality can be a tell tale sign - where somebody’s behaviour, character or attitude to life changes dramatically. We agreed that it can be very difficult to tell if someone has a problem because “it’s normal to be moody as a teenager”. The participants felt that suicide rates in Ireland would be a lot lower if the signs were picked up on. Young people need to be informed about the signs and symptoms of poor mental health and what to do if they are in that position. We hope that this report and awareness campaign will persuade politicians and decision makers to improve mental health services and supports for young people’.

Barry Andrews TD, Minister for Children and Youth Affairs added, ‘the findings of this report will challenge policy makers, decision makers, service providers and practitioners far and beyond those working in the field of mental health. The education system, schools, local government, the media, parents, family members and young people themselves are all identified as having an important role to play in supporting positive mental health’.

John Moloney TD, Minister for Mental Health concluded, ‘I want us to break the taboo, which still surrounds mental illness and empower people with mental health problems. The fact that our teenagers are comfortable to talk about what helps or hurts their mental health gives me considerable hope that the tide is turning on the stigma associated with mental health and mental illness. Our priority is to create an environment where young people who may have mental health difficulties feel comfortable and able to seek help from family, friends or health professionals’.

Teenage Mental Health: What Helps and What Hurts? A Report of consultations with teenagers (2009) has recently been reprinted due to public demand.

Advertising and on-line public awareness campaign on mental health aimed at teenagers

Throughout 2008 and 2009, young people from a number of organisations, including the Dáil na nÓg Council and the OMCYA Children and Young People’s Forum worked with the HSE’s National Office for Suicide Prevention in developing this campaign, using the outcomes of the mental health consultations.

During late 2008 and the first six months of 2009, concepts for the TV advertisement and awareness campaign were focus tested in several forums of young people around the country, including a group of young people who had taken part in the consultations.

In December 2008, a reference panel of 25 young people was established to become involved in the development of the awareness campaign at every stage of the process. Young people from the Dáil na nÓg Council and the OMCYA Children and Young People’s Forum were involved in this panel. The reference panel gave feedback on creative concepts and messages throughout the process of developing the TV advert and online campaign. They advised the marketing company on everything, from the ideal accent for the main character in the advert to the most appropriate clothes for the actors, to appeal to the widest possible audience of teenagers.

The teen mental health TV advertisement and on-line campaign (www.letsomeoneknow.ie) were launched on 10^th October 2009 - World Mental Health Day. Young people from the reference panel featured in the TV advertisement.