Alcohol misuse: tackling the UK epidemic - London

Interventions in adolescent mental health
When assessing interventions in adolescent mental health, it is important to stress the difference between
promoting ‘emotional wellbeing’ among adolescents and the treatment of mental health disorders. The
arenas and approaches to interventions in these two areas are markedly different.
Promoting ‘emotional wellbeing’
It has been suggested that school-based mental health initiatives are appropriate interventions in
adolescent mental health. These could include educating school pupils about mental health problems
and screening for those most at risk. 131
Mental health promotion focuses on public awareness and understanding of mental health to encourage
the earlier recognition of the signs of emotional and psychological distress and add to knowledge about
the help available. 94
A recent study of secondary school students revealed that adolescents use an extensive vocabulary of
270 different words and phrases to describe people with mental health problems; most of these were
derogatory. The same research showed that short education workshops can produce positive changes in
participants’ reported attitudes towards people with mental health problems. 140
In 2001 the government issued guidance on promoting children’s mental health within early years and
school settings. 141
School nurses and other school professionals may be in a key position to help
adolescents handle stressful events in their life before a crisis develops. 142
For example, the identification
by teachers of children showing sudden or gradual onset of withdrawn and depressive behaviour,
followed by the offer of counselling, may have positive effects in the prevention of depressive disorders
in early adolescence. In some areas, school nursing services, linked to primary care, have set up drop-in
clinics in or close to secondary schools to provide a first-line service for less severe problems to prevent
the development of more serious mental disorders. 127
Schools signing up to the Healthy Schools Initiative are expected to monitor progress to achieve
emotional health and well-being. Social skills training in schools and life skills training for at risk groups
may help to improve the mental health of adolescents. 143
An anti-bullying programme is now mandatory
in all schools. These offer the possibility of reducing rates of depression and suicidal behaviour which
may be associated with victimisation and bullying. However, few studies have examined the mental health
problems of adolescents who are being bullied. One study found that bullied adolescents are more
anxious. It also found that there is a relation between having a high depression score and being a bully. 144
Sport and physical activity is generally believed to be beneficial to young people’s psychosocial health. 145
Physical activity is associated with lower levels of mental health problems, and seems to promote selfesteem.
One study concluded that emotional wellbeing is positively associated with extent of
participation in sport and vigorous recreational activity among adolescents. 146
Interventions in mental health disorders
The present government has shown some initiative in interventions in mental health. It has for example
launched a national suicide prevention strategy for England. 147
Most importantly for adolescent mental
health, a children’s national service framework, including standards for mental health services, is due to
be published in 2004.
Of all the issues discussed in this review of adolescent health, mental health services for adolescents are
perhaps the least targeted. Although the government has promised to turn its attention to adolescent
mental health strategies, the current English national service framework for mental health focuses almost
exclusively on services for adults.
British Medical Association Adolescent health 31