Why Does Child Well-being Matter?
A central aim of any society should be that its children enjoy their lives and acquire the skills necessary to become happy, functioning adults. For this, they need to develop emotional buoyancy, coping skills, resilience and the ability to form constructive social relationships. Social and emotional capacity is a built-in response to experience. The main drivers of children’s experiences are parents, teachers, health workers and the community in general. These relationships form the focus of this report. How can these relationships be supported and improved to maximize good outcomes for children? And how can this be achieved given the different challenges posed in low-, middle- and high-income countries? 109
Some 31% of the world’s population is aged under 18.11 Of them, around 10% have a diagnosable mental disorder (mainly anxiety, depression or conduct disorder).12, 13 That means some 220 million children and young people…
(Excerpt from the World Happiness Report 2015, Chapter 6)
HEALTHY YOUNG MINDS: TRANSFORMING THE MENTAL HEALTH OF CHILDREN
RICHARD LAYARD AND ANN HAGELL
Children matter vitally–both as people and as tomorrow’s adults. Altogether, 31% of the world’s population is aged under 18,1 representing one-third of all human experience. This is the group we focus on in this report, and for convenience we shall refer to them as “children.”
What matters most about children is their subjective well-being – how they feel about their lives. This reflects a new shift of emphasis among policy makers worldwide. Increasingly people feel that the success of a society cannot be judged mainly by its level of wealth but rather by how satisfied people are with their lives.2 Nearly all Organisation for Economic Co-operation and Development (OECD) countries now measure adult life satisfaction as a routine statistic,3 and many are considering new forms of policy analysis with this as the objective.
Children differ hugely in their subjective well-being (or “well-being” for short). There is a very wide spectrum. For much of our report we focus on those with mental disorders, who lie at the bottom end of the spectrum. But we also look at the whole spectrum because a general upward shift in well-being can be an excellent way to reduce the numbers at the lowest levels. More fundamentally, there is increasing evidence that nurturing the positive aspects of all young lives is the most effective way of preventing mental disorders.
Children’s mental well-being is affected by every aspect of their lives – by their physical health and quality of nutrition, by their wealth and poverty, by discrimination, by war and conflict– and a whole range of other social and economic factors. But it is also affected by more personal factors. First is the family – the stability it offers, the stimulus it provides and the values it nurtures. Then there is the psychological support of the wider community, including the healthcare system, but also a whole range of local social organizations. And finally there is the school, which leaves its mark on the character of every child. In this report we cannot discuss all the factors that affect children. Instead we concentrate on the role of these more personal factors, and above all on how they can be improved.
Our central focus is on how to reduce mental illness by directly addressing the personal factors that have caused or are sustaining it. This means ensuring that mental disorders are treated when they arise, but also doing our best to prevent them in the first place. Prevention requires a wide approach because there is no reliable way of predicting which children will develop mental health problems. So, when thinking about prevention, we have to think about how to improve the well-being of all children – a task for everyone in our society.
We need a completely new priority to be given to the well-being of children and we make major recommendations about what this would imply – suggestions affecting communities, healthcare systems and schools. We start with three main points.
1. First, the scale of the issue. This is a massive problem. Around 10% of the world’s children today are suffering from diagnosable mental health problems.4 Roughly half of these are suffering from anxiety disorders (or, less commonly, depression) and a half from conduct disorder or attention deficit and hyperactivity disorder (ADHD). Approximately 1% of all children suffer from developmental disorders such as autism. Where evidence exists over time, it shows that these problems have increased over the last half century.5 These children are unhappy and disturbed – the quality of their experience 107 is very poor. And the majority of them will also become unhappy adults. The best predictor of whether a child will become a satisfied adult is not their academic achievement but their emotional health in childhood.6 The cost of child mental illness is borne by all of us. Crime is increased, educational achievement is thwarted and productivity is diminished. Improving children’s mental health is a critical issue across the globe, and the messages of this report are as relevant to high-income countries as to low- or middle- income countries.
2. Second, treatment and prevention. In the richest countries only a quarter of disturbed children get specialist help,7 and in the poorest countries it is much less. In every country in the world, far fewer children are in treatment if they have mental health problems than if the problem is one of physical illness. This is shocking, because today there are really effective treatments available for children in distress, as well as the opportunity to make major changes in schools and commu- nities that can make the problem less likely in the first place. In treatment there has been a real revolution in the last 30 years. We now have well-researched treatments for child anxiety and depression and for conduct problems, with recovery rates of over 50%, and with effects that are observed to persist.8 We can also treat maternal depression, which blights the lives of many young children. On prevention, we can use community structures and healthcare systems to promote good parenting, as well as openness and honesty about mental illness. And our schools should become as concerned with the well-being of children as they are with their academic performance. Because any child can develop mental health problems, we need a universal approach to mental health and well- being that involves the whole of society.
3. Third, economics. For the sake of our common humanity we should use all the tools that are available. But it is also good economics; in most countries, mental illness is reducing gross domestic product (GDP) by over 5%.9 And the net cost of the changes we propose is mostly small. Reorienting schools involves training teachers differently but not training more of them. The main cost is improved healthcare and support for parents. Intensive early intervention with at-risk families is expensive, but has been shown to save as much as it costs.10 The same can be true of better treatment facilities. There should be parity of esteem between mental and physical health – children should be as likely to receive help if their problem is mental or physical. This will involve substantial gross cost. In poorer countries it will have to be done through people with less professional training than in richer countries, and with fewer of them. But the savings will be great and will often exceed the costs. We cannot afford not to do it.
In all these endeavors we have the enormous advantage of new technology – above all, the smartphone with internet access. Online programs can contribute hugely to staff training, to the mental health treatment of adolescents, and to life-skills curriculums in schools. Our single most important recommendation is that one or more major charities establish a substantial fund to design such programs that can be available for free worldwide.
This is a short report, which cannot possibly cover the whole field. So we focus on 10 specific things that can be done in every country and that would bring great benefit. These action points are:
1. Community action: Every local community should have a local child well-being strategy, including an assessment of the needs of children and families, and of the role that can be played by healthcare organizations, schools, community groups, non-government organizations (NGOs), youth and faith organizations.
2. Parity of esteem: Evidence-based healthcare for children and their parents should be equally available whether their disorder is mental
3. Universality: All health professionals should be trained to identify mental health problems in children, as well as perinatal depression in
mothers. They should be trained to provide general mental health education to parents and, unless more professional services are available, they should also be trained to treat these problems.
4. Professionals: Every country should train more professionals in evidence-based treat- ments, especially psychological therapy. To develop quality, there should be at least one center of excellence for every region.
5. Schools for well-being: The well-being of pupils should be an explicit objective of every school. Schools should have a well-being code (including mutual respect, kindness and play) to which all teachers, parents and pupils subscribe. This should stress the importance of praise rather than criticism.
6. Measurement: Schools should measure pupil well-being regularly.
7. A life-skills curriculum: Schools should use evidence-based methods to provide explicit teaching in life skills for at least an hour a week throughout school life, and more in the early years. This should mainly emphasize dos rather than dont’s.
8. Teacher training: All teachers should be trained in ways to notice and promote child well-being and mental health, and to maintain a civilized learning environment.
9. Use of mobiles: There should be a major international program to develop free smartphone-based approaches to all our recommendations. A major international charity should be asked to support this.
10. The Sustainable Development Goals: The Sustainable Development Goals should include explicit reference to physical and mental health.
There is a massive problem: 10% of our children are suffering from a mental disorder, and under a quarter of these are receiving specialist help for their problem.
We know what to do: For children with mental health problems, there are effective evidence- based psychological treatments that the healthcare system should provide. Every school should promote the well-being of its children, using evidence-based approaches.
The net cost need not be high: Mental illness already imposes high costs on the economy. Above all, hundreds of high-quality online programs should be developed and offered free to children and their caretakers throughout the world.
To continue reading this chapter and access the full 2015 World Happiness Report go to ->> http://worldhappiness.report/wp-content/uploads/sites/2/2015/04/WHR15.pdf
Acknowledgement: This chapter reproduces a report written for the World Innovation Summit for Health (WISH) held in Qatar on 17-18 February 2015. WISH is an initiative of Qatar Foundation for Education, Science and Community Development, chaired by Lord Darzi. The report received invaluable support from a WISH Forum consisting of Hamad Al Ibrahim; Helen Baker-Henningham; Chris Bonell; Zachary Brown; Mark Jordans; Vikram Patel; Linda Richter; Stephen Scott; Chiara Servili; Graham Thornicroft; and, Carolyn Webster-Stratton; and, with help from the WISH Forum team (Will Warburton, Sarah Henderson and Dominic King).