Director of Public Health Annual Report 2023: Mental health matters

While the factors listed previously can promote good mental health in children and young people, there are also many things that can have a negative effect.

These include:

• traumatic events in childhood
• poor quality homes and neighbourhoods
• bullying
• caring responsibilities
• how children and young people engage with social media

Traumatic events in childhood (such as parental divorce, parental substance misuse, neglect and abuse, or domestic violence) have been found to increase the risk of poorer mental health from childhood up to midlife.

Indeed, exposure to two or more of these traumatic events can create a three times higher risk of depression or anxiety in adulthood. Fortunately, most children who experience such events appear to stay in good mental health for much of their lives and the factors listed in the previous section – such as supportive family relationships and strong friendships – can support good mental health despite these traumatic events.

The home environment and neighbourhood children and young people are raised in often influences their mental health.

The risk of multiple mental health problems rises from 1 in 20 to 1 in 4 in young people living in cold housing compared to those who live in warm homes.

Children living in households with debt are five times more likely to be unhappy than children from wealthier families. Living in poverty in childhood is also linked to mental health problems later in life. For example, research found that people exposed to persistent poverty in their childhood years had an increased risk of mental health conditions in adulthood.

Children and young people who are victims of bullying, or who bully others, are more likely to develop mental health conditions and have an increased risk of mental health disorders in adulthood.

Certain groups of children and young people are at greater risk of being bullied. This includes girls, pupils from ethnic minority groups, children with disabilities or special educational needs, and lesbian, gay, bisexual and transgender (or LGBTQ+) children.

Online bullying (or “Cyberbullying”) is also an emerging problem, affecting as many as 1 in 5 children aged 10 to 15.

In Buckinghamshire, 1 in 10 of the primary school age children who responded to the 2021 OxWell survey reported being bullied at least weekly. For secondary and sixth form age children and young people this was lower at 1 in 14. In the majority of cases (68.6% for primary, 77.8% for secondary and sixth form) the bullying was verbal, followed by physical (24.9% for primary, 21.3% in secondary and sixth form). For cyberbullying there were clear differences based on age, with higher rates for older children (13.8% in primary, 28.3% in secondary and sixth form).

Supporting children and young people to develop empathy and to support others has been shown to reduce bullying. This includes “active bystander training” which is designed to give children and young people the skills to recognise and challenge inappropriate behaviours.

The internet and social media can be a positive influence. For example, the internet allowed remote teaching and learning during the Covid-19 restrictions. Many children and young people also regularly search online for advice and information, and often say they would like to be able to access digital support for their mental health alongside traditional face to face services.

The rise of the internet has, however, led to cyberbullying and the potential for children to be exposed to inappropriate or harmful content. The amount of time that children spend using screens (including television) also has the potential to displace other activities that protect wellbeing, such as sleep and physical activity.

In the 2021 Buckinghamshire OxWell survey, 1 in 10 primary school aged children reported they had spent more than six hours the previous evening online or playing computer games. A quarter of secondary school pupils said they had posted or done something on the internet they later regretted, with this figure rising to a third in sixth form settings.

The Royal College of Paediatrics and Child Health advice to parents is that there is no “safe” cut off for screen use. They recommend that parents focus on building screen use around family activities (and not the other way round).

In the United States, the Surgeon General recommends parents and caregivers teach children and young people about responsible behaviour online and model it themselves. In England, these skills are covered in the school PSHE (Personal, Social, Health and Economic) curriculum and parents are encouraged to reinforce safety messages at home.

Children and young people who have taken on unpaid caring responsibilities for a family member (often referred to as “Young Carers”) are seven times more likely not to be in good health compared to their peers. They are also likely to have poorer mental health. An NHS survey suggested that 20% of young carers aged 16-17 years had a long-term mental health condition, compared with 7% of non-carers of the same age.

According to the 2021 census, 1,085 children aged 5 to 17 and 1,570 young people aged 18 to 24 in Buckinghamshire are unpaid carers.

Many young carers do not recognise their role as a carer. It is important to identify these children and young people so they can be provided with support.