CACHE Level 2

Certificate in Understanding
Children and Young People’s Mental
Health

DUTY OF CARE

RISK FACTORS

DISCRIMINATION

SAFEGUARDING

EARLY INTERVENTION

STRESS AND ANXIETY

Workbook 2
 How to use your learning materials

This course is delivered on a flexible learning basis. This means that most of your study
will take place away from your Assessor/Tutor. It helps to carefully plan your studying so
that you get the most out of your course. We have put together some handy tips for you
below.

Study Guidance

Try to plan an outline timetable of when and where you will study.
T ry to complete your work in a quiet environment where you are unlikely to
be distracted.
Set realistic goals and deadlines for the various elements of your course.
 lan what you are going to study during each session, and try and achieve
P
this each time.
 fter each session, reflect on what you have achieved and plan what you hope to
A
complete next time.
 emember that not only do you have the support of your Assessor/Tutor, but it is
R
likely that your family, friends and work colleagues will also be willing to help.

Assessor/Tutor Support

Your Assessor/Tutor will be available to support and guide you through the programme.
They are experts in your area of study and are experienced in helping many different
types of learners.
They can help you to improve the standard of work you submit and will give
you useful feedback on areas in which you have excelled, as well as where
you can improve.
Remember to listen to, or read, their feedback carefully. Ask if you are unsure about any
of the feedback you receive as your Assessor/Tutor is there to help.
Make note of any tips they give. Refer to the learning materials as they contain the
information you need to complete the end-of-unit assessments.
Look out for areas in which you can improve, and set yourself an action plan to make
sure you complete the required work.
Take positive feedback on board; this demonstrates you are doing things right and have
a good understanding of the subject area.
Use the feedback to avoid repeating any mistakes you may have made.

Enjoy your studies!

2 © LCG 2018
 CACHE Level 2 Certificate in Understanding
Children and Young People’s Mental Health

Workbook 2
Workbook Contents

This workbook will develop your knowledge of the mental health concerns and
conditions affecting children and young people. You will learn about the behaviours
that may indicate concerns and conditions. You will explore the support that is available
for children and young people’s mental health, including the services and treatments
available.

Contents
This workbook contains three sections: Page
Section 1: Understand children and young people’s mental
health concerns 4
Section 2: Understand how to support children and young people
with mental health concerns 36
Section 3: Extension activities 65

Each section has a corresponding assessment that must be

CACHE Level 2 Certificate in Understanding
completed in order to achieve this part of the programme. Children and Young People’s Mental Health

Assessment 2

The assessments for this workbook can be found in: Learner contact details

Name:

Assessment 2 Contact address:

Postcode: Contact number:

Email:

Learner declaration

When you have completed this workbook, you should

I confirm that the answers in Assessment 2 were completed by me, represent my own
ideas and are my own work.
Learner signature: Assessment date:

attempt the assessment. Your Assessor/Tutor will then give If you need any help in completing these Assessments, refer to the
relevant section within Workbook 2, or contact your Assessor/Tutor.

you detailed written feedback on your progress. Please tick one of the boxes below to show what your status will be when you complete this course.
 EMP 1 In paid employment for 16 hours or more
per week
 EMP 2 In paid employment for less than 16 hours
 GAP 1 Gap year before
starting HE
 EDU 1 Traineeship
per week  EDU 2 Apprenticeship

Remember that your assessment answers should be written

 EMP 4 Self-employed for 16 hours or more per week  EDU 3 Supported Internship
 EMP 5 Self-employed for less than 16 hours per week  EDU 4 Other FE* (Full-time)
 NPE 1 Not in paid employment, looking for work and
 EDU 5 Other FE* (Part-time)
available to start work
 NPE 2 Not in paid employment, not looking for work  EDU 6 HE

in your own words. You should not copy answers directly

and/or not available to start work (including retired)  OTH # (please state)
 VOL 1 Voluntary work ………………………………

from the workbooks. Assessment 1

Upon successful completion of this qualification, learners will be awarded the NCFE
CACHE Level 2 Certificate in Understanding Children and Young People’s Mental
Health: 603/2813/7. This CACHE branded qualification is certificated by the Awarding
Organisation NCFE.

Workbook 2 3
 Section 1: Understand children and young people’s mental
health concerns

In this section, you will learn about the behaviours displayed by children and young
people that may indicate a mental health concern. You will also explore common mental
health conditions that may affect children and young people.

Behaviour associated with mental health concerns

Please read the following as it will help you to answer question 1.

Often, the most obvious signs of mental health problems in children and young people
are behavioural ones. This does not mean that all unwanted behaviour is a sign of
mental illness and only medical professionals are qualified to make a formal diagnosis.
However, anyone working with children or young people needs to be aware that certain
behaviours could indicate a mental health concern.
There are a range of behaviours that may give cause for concern and we will look at the
main ones here.

Distress

It can be difficult to identify signs of distress in children and young people as these
can often present as physical symptoms, such as stomach ache, headaches and
nausea. If these physical symptoms are frequent, it may be worth mentioning to a
parent, counsellor or medical professional as appropriate. Other signs may include:
• Sadness that is ongoing
• Being irritable all the time
• Lack of interest and motivation
• Tiredness and fatigue
• Lack of concentration
• Change in sleep patterns – not sleeping or sleeping more than usual
• Change in eating and/or weight – eating more or less than usual or losing or gaining
weight
• Being indecisive
• Lack of confidence
• Tense, unable to relax and/or constant fidgeting
• Disruptive behaviour in school or other group situations

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Withdrawal

Withdrawal may be a sign of mental distress or illness. This will usually be indicated
by a lack of interaction with others, and the individual may become quieter and may
spend large amounts of time alone.

Truanting

Not attending school regularly should always be a cause for concern but may indicate
a mental health issue. Particular care needs to be taken to monitor young people who
are in college or apprenticeship situations where patterns of attendance may not be as
easy to identify.

Avoidance of specific situations

Where stress or anxiety is caused by specific situations, the child or young person may
try to avoid these. These may include situations where the child or young person is
being bullied, or any social situations if they suffer anxiety about social situations.

Substance misuse

Children and young people may turn to drugs and/or alcohol to counteract their feelings
of depression, anxiety or stress. Signs of drug or alcohol use may include:
• Lying and being secretive
• Looking ill, lacking energy, being tired and/or appearing dopey
• Changes in eating habits – eating more or less can indicate effects of drug use
• Lack of interest in activities and people that used to be important to them
• New friendship groups
• Stealing to fund alcohol/drugs
• Smell of alcohol or cannabis or use of mints, strong perfumes, etc. to try and hide
smells
• Becoming more talkative or quieter than usual

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 Section 1: Understand children and young people’s mental
health concerns

• Appearance and behaviour, e.g. dilated pupils may indicate drug use, sores around
the mouth can indicate solvent abuse, and slurring words and being unsteady on
their feet may indicate drunkenness
• Finding cigarette papers, bits of tin foil, bags with drug residue or empty alcohol
bottles

Violence

Changes in behaviour that involve the child or young person becoming violent or
aggressive may indicate concerns with mental health. This can range from the
individual becoming more irritable to them actually hitting out at people or becoming
involved in fights at school, for example.

Self-injurious behaviour

Self-injurious behaviour or self-harm may include cutting, rubbing, scratching, burning,

hitting, pulling out hair, self-poisoning (taking substances such as alcohol, drugs, etc.
to make themselves sick) and, in the worst case, suicide. It is a response to anxiety
or stress but can become a long-term problem unless the underlying mental concern
is addressed. Signs to look out for include:
• Scars, usually on arms, legs or front of torso
• Fresh wounds or burns
• Keeping sharp objects or matches close by
• Wearing long sleeves even when it is warm
• Unwillingness to undress in front of others, e.g. when changing for PE
• Being sick frequently or other signs of taking drugs, alcohol, etc., e.g. empty packets
or bottles
• Other behavioural changes such as withdrawal, irritability, lack of interactivity, etc.

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 Section 1: Understand children and young people’s mental
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Any changes in behaviour

Whenever the behaviour of a child or young person changes suddenly, this should raise
questions as it could indicate a problem in their lives and/or a mental health concern.
Examples might be a good student becoming less conscientious, a noisy or extroverted
individual becoming very quiet and withdrawn, or a quiet individual becoming
aggressive. Where any changes in behaviour are noted, it is worth reporting these to
appropriate people, e.g. pastoral staff or tutors in schools, for further investigation.

Jamie’s story
Jamie was quite a quiet five-year-old who generally did as he was told in
school. His class teacher identified a change in his behaviour. He began
bullying some of the smaller children and became disruptive in class. Further
investigation indicated that his parents had split up and there was some
dispute over which parent would have custody of Jamie and his sister. Jamie
was experiencing anxiety and distress about his home situation and this
resulted in the change in behaviour. Once this was identified, the parents
worked with teachers and a specialist counsellor to ensure Jamie received the
support he needed.

How children and young people express feelings through

behaviour
Please read the following as it will help you to answer question 2.

Behaviour is a form of communication. Feelings such as frustration, fear, sadness,

discomfort, boredom and confusion, as well as a range of other emotions, might be
expressed through behaviour in a child or young person. This can be because they do not
have the words to express what they are feeling, they do not recognise what the feeling is
or know what to do about it, or they are afraid to talk about it, for example.
Younger children may not understand their feelings and often will not have the
vocabulary to express them. Feelings may be expressed through tantrums, throwing
things, becoming withdrawn or sometimes through play or drawing. If a child’s
imaginative play involves lots of fighting or scary situations, this may be an expression
of something they are feeling. In most children, tantrums will stop by the time they start
school because they have more language and social skills.

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Young people going through puberty may not understand the changes that are
happening to them and fear, plus hormonal changes, can lead to behaviours such as
irritability, aggression and defiance, for example. The self-esteem and self-confidence
issues often experienced by teenagers can mean changes in behaviour that involve
them trying to fit in with peer groups and challenging adult authority.
For children and young people with learning difficulties, learning disabilities or health
conditions, the incidence of behaviour that is challenging can be higher as they
have more issues to cope with that can lead to frustration or fear. Where there are
communication issues, it is more likely that the child or young person will communicate
strong feelings through their behaviour. They may have a lower resilience due to their
illness or disability, or the illness or disability may make the child or young person less
able to understand their own emotions.
Children and young people on the autistic spectrum often have mental health concerns
such as anxiety and these can be missed because they are unable to recognise and
express their emotions.

Han’s story
Han’s mother noticed that when four-year-old Han was playing with his toys,
he created situations where the toys were fighting and hitting one another.
She talked to Han about his games, commenting that they looked a bit scary,
and identified this was Han’s response to a difficult situation in the home.
Neither parent had realised the effect on Han of their arguments with his
teenage sister who was rebelling against her parents and their conservative
culture. Han, who was used to harmony in his home life, was upset and
anxious about the arguments which were, in fact, usual teenage behaviour.
Han was too young to understand or explain what he was feeling.

Keitaro’s story
I’m fifteen years old and I hate the way my parents treat me like a child. I get
teased at school because they’ve seen me out shopping for clothes with my
Mum and I’m worried about not fitting in. I love my parents and I don’t mean
to get angry with them but I’m feeling so frustrated with everything. It makes
me want to hit out at them and not do anything they ask me to. My school
marks have gone down and that’s given my Dad another reason to get at
me. I spend most of my time in my room when I’m at home, staying out of
their way. Mum says I’m just being a teenager, but I don’t think it’s just that. I
can’t see where my life is going at the moment and I feel very alone.

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Harmful behaviour that may be used as a way of coping

Please read the following as it will help you to answer question 3.

Harmful or destructive behaviour is generally a response to the distress or anxiety the

child or young person is feeling. When discussing such behaviour, children and young
people generally explain that it makes them feel better and describe feeling a sense of
relief when they engage in such behaviour.
Harmful and destructive behaviours can include:
• Self-injury or self-harm – children and young people describe the effects of self-harm as
being like a release from their feelings.
• Alcohol or substance abuse – alcohol and drugs change an individual’s mood so may
make them feel better or mean that they forget about their problems for a while. This
may lead to further drug and/or alcohol abuse as they try to replicate the feeling. Self-
poisoning may also lead to children or young people taking excess amounts of drugs or
alcohol to make themselves sick.
• Violent or destructive actions – harmful behaviour does not always involve direct
self-harm. Becoming violent and aggressive towards others puts the individual at
risk physically, affects inclusion at school and increases risk of criminal conviction.
Behaviour may also involve vandalism or other destructive behaviour which, again, can
isolate and lead to punishment or criminal conviction.
• Engaging in harmful behaviour – other behaviours such as reckless sexual behaviour,
stealing or shoplifting are also harmful to well-being and can have a destructive effect
on the individual’s future.
• Suicidal intent – in worst case scenarios, harmful behaviour may involve attempted
or actual suicide or death from self-injurious behaviour. Repeated threatened or
attempted suicides may be seen as a cry for help. Overdoses, cutting wrists, hanging or
stepping out in front of vehicles (cars or trains) are all ways of committing suicide.

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Knowledge Activity 1: We have already mentioned self-harm. List the

different types of self-harm.

Self-harm can lead to further problems if infection or serious injury results from the
behaviour.

Did you know?

A new analysis carried out for 2019-2020 showed that rates of self-harm had
doubled over the six years. You can read an article about this at:
https://www.theguardian.com/society/2021/feb/16/self-harm-among-
young-children-in-uk-doubles-in-six-years

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Karin’s story
I’d always had a hard time at home and making myself feel ill was my way
of coping. I knew just how much alcohol and painkillers I could take to make
me feel really ill but not make me bad enough to need hospital treatment. I
couldn’t help myself. One day, I did take too much and ended up in hospital.
They referred me to a counsellor and now, I hardly ever feel like I need to
make myself ill. When I do, I have people I can contact and talk to.

Importance of early intervention when there are

behavioural concerns
Please read the following as it will help you to answer question 4.

Where there are any concerns about the behaviour of a child or young person, these
should be addressed as soon as possible and the question of whether behaviour is a
response to emotional distress or mental illness raised. Early intervention is important to
ensure that the behaviour does not become a long-term response and in order to address
any underlying depression or anxiety. The longer behaviour goes unchecked, the more
likely it will become harmful to the child or young person by affecting their physical or
mental health or damaging their life chances, by disrupting education or resulting in
criminal conviction, for example. Self-harm in particular can lead to permanent scarring or
injury, and there is always the risk that if underlying issues are not addressed, this leads to
suicide.
Early intervention can ensure that children and young people learn more appropriate
responses to stress and anxiety or traumatic events and can be supported to build
resilience to help them to cope with difficult life phases and events. Where behaviour is
not addressed, mental health concerns may continue into adulthood and may develop
into more serious mental illness.

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Stress and anxiety

Please read the following as it will help you to answer question 5.

Much of the behaviour we have been discussing in relation to children and young
people occurs in response to stress and anxiety.

Knowledge Activity 2: Think of a time when you have experienced stress

and/or anxiety. Write down what caused it and the effect it had on you.

Stress

Stress is our physical, mental and emotional reaction to changes and demands in our
lives. It describes how people feel when faced with situations that they find difficult
to cope with. When we feel stressed, our bodies release hormones that increase the
heart rate, raise blood pressure and provide extra energy. It is often called the ‘fight
or flight’ response because our bodies make sure we can fight or escape from the
threat.

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Anxiety

Where stress is something that comes and goes depending on the factors, pressures or
threats that are causing it, anxiety is something that persists whether or not its cause
is clear to the individual. Anxiety is a prolonged symptom of stress which can affect the
quality of life for an individual. Anxiety is a nervousness, fear or apprehension. It can
cause panic attacks, feelings of impending doom and physical symptoms such as heart
palpitations, shortness of breath and chest pain. This can be very frightening for the
individual.
There are a variety of specific anxiety disorders that may affect children and young people.
These include:
• Specific phobias – these are fears of specific things such as the dark, dogs or cats, for
example, and most children will grow out of them.
• Social anxiety disorder – where the child or young person has an extreme fear of being
criticised in social situations.
• Generalised anxiety disorder – where the individual seems to worry about everything in
their lives, e.g. going to school, not going to school, etc.
• Separation anxiety – usually occurs in young children when they go to school for the
first time or when they are separated from parents or carers due to accident or illness,
etc.
• Panic disorder – recurring panic attacks that may be triggered by apparently minor
events.

Jess’ story
The first time I had a panic attack was when I had to stand up in front of
the class at school and give a presentation. I didn’t know what it was. I
thought I was having a heart attack or something. My heart was racing, I
couldn’t breathe and I had a pain in my chest. My teacher recognised what
was happening and made me take slower breaths and told me to relax.
She reassured me and said I didn’t need to worry about the presentation.
Afterwards, she explained about panic attacks and suggested I mentioned it
to my doctor.

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Did you know?

90% of school leaders have reported an increase in the number of students
experiencing anxiety or stress over the last five years.
(https://youngminds.org.uk/media/1428/wise-up-prioritising-wellbeing-in-
schools.pdf)

Relationship between resilience and stress

Please read the following as it will help you to answer question 6.

In Workbook 1, you learned that resilience is the ability to recover quickly from difficult
situations and to be able to adapt to changes in life. Some people describe it as the
ability to bounce back after a setback.
Resilience is what makes some children and young people more able to cope with
stress than others. If a child or young person is resilient, they are more likely to find
a positive way to deal with stress and overcome problems and to find ways to adapt
to new situations. If a child or young person is not resilient, they may use negative
coping strategies, such as turning to alcohol or drugs, or experience long-term anxiety
problems and poor mental health.

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Possible causes of stress and anxiety in children and

young people
Please read the following as it will help you to answer question 7.

There are many possible causes of stress and anxiety in children and young people.
Before going on to read about them, try the following activity.

Knowledge Activity 3: List some possible causes of stress and anxiety for
children and young people.

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The possible causes of stress and anxiety for children and young people can be split
into internal and external causes.
Internal causes are often related to what children or young people think they should
be doing or achieving compared to what they are actually doing or achieving and the
resulting pressure that the child or young person puts on themselves. Internal causes
include:
• Low self-esteem – where the child or young person doesn’t feel good about
themselves.
• Fear – this might be fear of specific situations or things. For example, social anxiety
might create fear of being with large groups of people or they may have a fear of
speaking in public, or fear of taking and/or failing exams.
• Uncertainty – not knowing what is going to happen. Waiting for exam results, for
example, might cause stress, especially when the exams are important for the
future. Children and young people are placed under great pressure now to achieve
in exams and assessments from an early age, and this increases the pressure on
them.
• Self-criticism – children and young people, especially in the teenage years and
through puberty, can be highly critical of themselves. They may perceive themselves
as different from others and want to fit in, or feel that they need to look or behave
differently. These are all causes of stress and anxiety.
• Jealousy – along with self-criticism, children and young people can often be envious
of their peers. This might be of the way they look or of the things they have or
achieve.

Isabella’s story
I always knew I wasn’t pretty, but it started to affect me most when all my
friends started going out with boys. I was the fat, spotty girl that no one
wanted to know. Boys did ask me out, but I knew it was just to make fun of
me, so I always said no. I don’t go out with friends now. I’d rather stay at
home in my room.

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External causes of stress and anxiety are the demands that come from outside the
individual. These include:
• Major life events – these might include death or divorce of parents, moving to
a new house, changing school, death or loss of a friend (perhaps due to them
moving), abuse, neglect or serious illness of the child or young person or someone
close to them, for example. For young children, going to school and being
separated from parents for the first time can be stressful; for young people, leaving
school and going to university or out to work is a major change in their lives.
• Lifestyle – children and young people today can be extremely busy with school or
college and extra-curricular activities. This can leave them little time to relax and
play creatively, which would help to relieve stress. Other lifestyle stresses can be
lack of exercise, unhealthy eating and alcohol or drug use, which put physical
stress on the body and can lead to low self-esteem and mental stress.
• Relationships – difficult relationships may be a cause of stress and anxiety, e.g.
where children and young people argue or do not get on with family members or
friends, or see other family members or friends arguing amongst themselves.
• School situation – stress and anxiety may occur if children or young people are
unhappy at school or college for any reason. It may be that they have not made
friends or do not enjoy their lessons, or that they are being bullied or teased.
• Exam and achievement worries – we have seen that children and young people
often put internal pressure on themselves in relation to exams, but there may also
be external pressure from parents, teachers and even peer groups, which adds to
this and makes it more serious.
• Living situation – even where family life is harmonious and the child or young
person is happy in the family, there are pressures that can affect them. These
include factors such as poor housing, poverty and uncomfortable living situations,
e.g. having to share a room with several siblings.
• Social situation – this might include racial prejudice or pressures arising from being
part of a specific culture, e.g. where cultural norms insist on a particular type of
behaviour or dress that is different from that expected from young people in wider
society.

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• World events – children, especially younger children, and young people do worry
about events they see on the news or social media that they believe might threaten
their own safety and security. Terrorist events, wars and natural disasters, even in
other countries, can worry and cause distress in children and young people.
• Media and social media – the media and social media present images of celebrities
and others who have ‘perfect body shape’, ‘perfect lives’, ‘perfect relationships’,
etc. This can place pressure on children and young people as they compare
themselves and their own lives to these unrealistic images.

Michael’s story
Michael was five when his parents split up. It wasn’t a bad split, really. His
parents just decided they didn’t want to be with each other. They sorted
things out amicably and made arrangements for Michael and his older
siblings to spend time with both parents, though they were to live with their
father most of the time as he worked from home. The problem was that no
one explained it properly to Michael. He became very clingy and stopped
wanting to go to school. He complained of tummy pains and feeling sick to
stay at home. When he did go to school, his behaviour was disruptive. It was
the doctor that suggested family counselling and then everyone realised that
Michael was frightened that other family members would leave, and he would
be left alone.

How stress can be both helpful and harmful

Please read the following as it will help you to answer question 8.

We tend to think of stress as a negative thing but actually, stress can be helpful as
well as harmful. Mental stress causes hormones to be released that generate physical
changes in the body designed to help overcome the problems we are facing. Stress
makes the body create a burst of energy which can help individuals to meet goals. It
can also help individuals to achieve tasks more effectively and can even boost focus
and memory. Researchers believe that short bursts of stress can fortify the immune
system and improve the way the heart works.
Frequently reoccurring stress or long-term stress is harmful though. The constant
release of the chemicals related to stress can have long-term negative effects on the
body and mind, causing depression, anxiety and physical problems such as high blood
pressure and heart disease.
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Bethan’s story
I don’t mind exams. I always do better in the real exams than I do in the
mocks. I do feel stressed about them but, when I know I’m well prepared,
the stress actually makes me focus more and it can be quite exhilarating.
Afterwards, I feel tired but satisfied that I’ve done my best.

Graham’s story
I hate exams. I spend the whole exam period, plus several months before,
feeling stressed out. I know it’s because I never do enough work but there’s
always something to distract me and I never seem to leave enough time
for my revision. The teachers say I could do better if I prepared myself. It
doesn’t help that I have to share a bedroom with two younger brothers who
are always arguing. By the time it gets to the exams, I’m a complete wreck. I
haven’t been sleeping so I’m tired and I can’t focus on what it is I need to do.

Knowledge Activity 4: Read Bethan and Graham’s stories and write down
what is different about their approaches to exams and the stress that they
feel.

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Signs of stress and anxiety in children and young people

Please read the following as it will help you to answer question 9.

You may already be aware of common signs of stress and anxiety in yourself, such as
feeling panicky and fearful, stomach upsets, nausea, headaches and sleeplessness.
You should be aware that though children and young people may feel these things,
they may not react in the same way as an adult and may not understand what it
is they are feeling. This means adults may misinterpret the signs or they can go
unnoticed. Young children in particular are likely to show changes in behaviour and
complain of feeling ill, and this will not necessarily be recognisable as stress or
anxiety.
Signs in young children might include:
• Becoming irritable
• Having tantrums
• Being tearful and clingy
• Having difficulty sleeping
• Waking up frightened in the night
• Starting to wet the bed
• Not eating properly
• Being tense and fidgety
• Using the toilet often
• Complaining of bad dreams
• Complaining of tummy ache and feeling ill
• Not interacting with others

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Children and young people may try to hide signs of anxiety and stress because they
don’t want people to see them as weak or because they think it is something to be
ashamed of. In addition, changes in sleeping, eating and behaviour patterns due to
development, e.g. puberty, can mask the signs of stress and anxiety. Signs of stress
and anxiety in older children and young people might include:
• Restlessness
• Fatigue
• Difficulty in concentrating
• Being tense and irritable
• Frequent colds, stomach upsets or other illnesses due to reduced immunity
• Changes in behaviour
• Behaviour that is challenging
• Increased isolation and lack of interaction
• Disrupted sleep
• Loss of appetite
• Panic attacks
• Changes in achievement at school, e.g. grades going down or work handed in late

Of course, everyone experiences stress and anxiety at some point. When looking at
signs that might indicate stress or anxiety in children or young people, it should be of
particular concern when:
• Anxiety is disproportionate to the situation causing it – this may mean that they are
over-anxious or that there is another hidden cause.
• It is disruptive – the anxiety is disrupting the child or young person’s normal quality
of life.
• They are distressed – the child or young person is distressed by the situation or by
how they feel about it.
• It is persistent – the anxiety continues over time rather than them getting over it
quickly.

These signs might indicate a longer-term issue.

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Depression
Please read the following as it will help you to answer questions 10 and 11.

Depression is a common mental problem where the individual feels sad and has a
loss of interest in everyday life and a feeling of hopelessness over an extended period
of time. Low mood is where an individual is unhappy or feels bad for a short period
but recovers from this.
Everybody has times when they are unhappy, but
depression is different to simply feeling down or sad
about something or experiencing low moods. These are
feelings that individuals feel temporarily in response
to a situation but then get over and carry on with their
lives. People who are depressed feel as if they are in
a hopeless situation and helpless to do anything about
it. They feel sad all the time and it affects the way
they live their lives. Some individuals may experience
recurring bouts of depression throughout their lives.

Andrew’s story
It was the Christmas of my last year at school that I realised something was
wrong, or rather my Mum did. I had been feeling low for a while. It felt like a
black cloud had come down on me and was smothering me. I spent most of
that Christmas sitting in my room alone and avoiding the rest of the family.
I felt stupid because I could burst into tears at the slightest thing and I tried
to hide it by getting angry with people instead. Mum talked to me about it
and suggested that I went to see the doctor. She’d had depression herself so
knew what it was like.

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Possible causes of depression in children and young

people
Please read the following as it will help you to answer question 12.

Depression won’t usually have a specific, identifiable cause but is more likely to occur
as a result of a number of things that build up over time. Triggers for depression in
children and young people might include:
• Personal experiences – family breakdown or death of a relative or friend, loss of a
loved one or friend due to them leaving or moving away, neglect or abuse, bullying
or discrimination, or physical illness of the individual or of a close relative or friend.
• Life changes – major changes or too many changes happening too quickly may
trigger depression, e.g. changes in puberty, leaving home for the first time or, in
very young children, separation anxiety when they are separated from parents for
the first time.
• Stress – if the child or young person experiences a lot of stress and has no one to
talk to about it, this may trigger depression.
• Depression can run in families, so children and young people who have a parent or
sibling who has experienced depression may be particularly at risk.
• Physical illness, especially where this is serious, can reduce mental resilience and
trigger depression.
• Depression appears to be linked with chemical changes in the brain, so young
people may be particularly at risk during development phases such as in puberty
where their bodies are changing and levels of hormones fluctuate.

Did you know?

Between 1 and 3% of children and young people will experience depression.

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health concerns

Santika’s story
My depression started when my father died. I was twelve. I went through all
the emotions you associate with bereavement – the sense of loss, anger and
sadness, together with the realisation he wouldn’t be there for me anymore
– but I never seemed to get out from under the cloud. I was going through
puberty at the time so my emotions were all over the place anyway, and I was
having problems at school with a gang of girls who were bullying me. I think
it just all added together and made me feel hopeless about life. It took me a
long time to get through it but I did and, looking back now (five years later), I
wish I’d been able to identify the signs earlier and do something about them.

Signs of depression in children and young people

Please read the following as it will help you to answer question 13.

Depression will affect different individuals in different ways but some common signs
are:
• Being generally tearful and miserable
• Not wanting to take part in activities that were previously enjoyable for them
• Isolating themselves by avoiding friends and social gatherings
• Changes in sleeping habits – sleeping more or less than normal
• Changes in eating habits – eating more or less than normal
• Being irritable
• Behaving in ways that are challenging, e.g. disruptive at school, defiant to parents,
recklessness or risk-taking in sexual behaviour, drinking or drug taking
• Feelings of helplessness and hopelessness
• Talking about wanting to die
• Self-harming or attempted suicide

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• Changes in appearance, e.g. the way they dress, use make up, etc. or lack of
personal care and hygiene
• Frequently occurring minor illnesses
• Being very self-critical
• Not wanting to get out of bed in the morning
• Falling school results
• Lack of concentration and focus

How depression may affect children and young people

Please read the following as it will help you to answer question 14.

Depression doesn’t just affect the way children and young people feel; it will have
effects on their lives, friendship groups, family and achievement at school or college.
Examples of the effects depression can have are:
• Loneliness – individuals with depression tend to isolate themselves and may also
fall out with friends, family and teachers who would normally support them. This
can leave the child or young person feeling very lonely, even if they overcome the
depression.
• Reduced opportunities – missing school, being disruptive or losing focus on their
studies may affect exam results or educational and work opportunities open to the
child or young person. Risky behaviours may lead to criminal convictions that could
affect life chances.
• Long-term mental illness – children and young people who experience depression
are more at risk from experiencing depression and other mental illnesses later in
life.
• Other physical and mental illnesses – depression may lead to other mental and
physical illnesses or complaints, e.g. eating disorders and physical self-harm, injury
or illness due to reckless behaviour.

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Szymon’s story
My depression led to me skipping school and hanging out with some older
lads who were into drinking and drugs. Because of this, I almost messed up
my whole life. I’d been doing well at school but I made a mess of my exams.
It all came to a head when I was arrested for shoplifting. I was lucky. The
shopkeeper decided not to prosecute. Later, he told me he’d been in a similar
situation when he was young and someone gave him a chance, so he wanted
to give me a chance. I had some counselling and re-did my exams, getting
much better grades. I’m hoping to go to university next year.

Other mental health conditions affecting children and

young people
Please read the following as it will help you to answer question 15.

Stress and anxiety and depression are not the only mental health conditions affecting
children and young people; often, they exist alongside other conditions. Other
conditions include:
• Eating disorders – these include anorexia nervosa, where the individual seriously
limits their food intake, and bulimia nervosa, where individuals take laxatives or
make themselves sick after eating.
• Conduct disorders – this is where the child or young person persistently engages in
anti-social behaviour, such as fighting, lying or stealing, without showing any signs of
guilt or remorse.
• Post-traumatic stress disorder (PTSD) – PTSD may occur after the child or young
person has experienced a traumatic event. This might be violence, sexual abuse or
assault, or a life-threatening situation. It can also occur after witnessing a traumatic
event, such as a bad accident. The individual finds it difficult to get over the event
and experiences flashbacks, bad dreams and upsetting thoughts about it.
• Obsessive compulsive disorder (OCD) – OCD is an anxiety disorder where the
individual has recurring thoughts or feelings that are upsetting and repeatedly
carries out rituals or habits that make them feel better. Upsetting thoughts might
be around dangerous situations, dirt or contamination, or sexuality, for example.

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• Bipolar disorder – this is where an individual experiences mood swings between

extreme highs and lows. Episodes can last for days or weeks. Bipolar disorder
usually starts between the ages of 15 to 19.
• Psychosis – psychosis is the term used to describe a loss of touch with reality.
It may occur as a result of a stressful life event, as a result of serious physical
illness such as infection or drug taking, or as part of a mental illness such as
schizophrenia. It involves the individual experiencing delusions and hallucinations.
• Attention Deficit Hyperactivity Disorder (ADHD) – ADHD is sometimes classed as a
specific learning difficulty rather than a mental disorder, but little is known about
the causes and it may be caused by chemical imbalances in the brain as with
some other mental illnesses. It is a behavioural disorder where individuals have
difficulty concentrating and may find it hard to control their speech and actions. It
usually starts at about 18 months and becomes more noticeable between the ages
of 3 and 7 years.

Did you know?

About 1 in 100 people will experience schizophrenia during their lifetime and
onset is usually in the late teenage years.

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health concerns

Signs and impacts of other mental health conditions

affecting children and young people
Please read the following as it will help you to answer questions 16 and 17.

You have learned about the range of mental health conditions that may affect children
and young people. It is important to know about the signs that indicate these conditions
and the impact of each of the conditions on the lives of individuals.

Eating disorders

Two well-known eating disorders are anorexia nervosa and bulimia nervosa. What they
have in common is an obsession with food.

Anorexia nervosa
This involves the individual restricting their food intake severely. It affects ten times
more girls than boys but is becoming more common in boys.
Signs of anorexia include:
• Eating very limited amounts of food
• Showing signs of panic if faced with a large meal
• Frequently missing meal times – often saying they have already eaten
• Avoiding eating in public or with others, or showing signs of panic about eating in
front of others
• Doing excessive amounts of exercise
• An obsession with food, e.g. calorie values of foods, cooking for other people, setting
target weights, etc.
• Concern about being overweight, even where the individual is not overweight
• Concern about body image and overcritical of own appearance compared to others
• Loss of interest in activities and events which were previously of interest
• Being down and irritable
• Losing weight very quickly
• Complaining of being cold

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• Poor sleep patterns

• Lack of concentration and focus
• Complaining of other physical conditions, e.g. periods stopping, constipation, unable
to get an erection, downy hair growth on body, etc.

Impacts on the individual include damage to physical health, such as stunting of growth,
shutdown of organs and damage to bones, including the risk of osteoporosis. In girls,
periods may stop and there is a risk of later infertility. Mental health is also affected, and
individuals may experience anxiety and depression. Illness may also lead to missing
school, poor achievement and a failure to develop independence due to involvement of
parents in treatment and in close monitoring of the individual.

Bulimia nervosa
Bulimia nervosa also involves obsession with losing weight but with this condition,
individuals overeat and then make themselves sick or take laxatives to get rid of food
and control their weight. Some of the signs are similar to those of anorexia but there
are other signs that indicate bulimia. The signs include:
• Being obsessive about weight
• Doing excessive amounts of exercise
• Appearing down or depressed
• Poor sleep patterns
• binge-eating – possibly indicated by food going missing
• Isolating themselves from others
• Not showing interest in activities or other people
• Complaining of sore throat
• Thirsty all the time due to dehydration
• Damage to teeth from vomiting
• Swollen glands
• Tiredness
• May complain of muscle spasms and cramps
• Girls may have change in periods
• Swings in weight

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Impacts on the child or young person are similar to anorexia, including osteoporosis,
infertility, the mental effects of anxiety and depression and the impacts on achievement
at school. Over the longer-term, bulimia can also cause blood pressure abnormalities,
kidney failure, heart complaints, severe headaches and seizures. Bulimia can cause fatal
heart failure.

Conduct disorders

Signs of conduct disorder are bad behaviour over the longer-term. Many children
or young people have bouts of poor behaviour; this is only the sign of conduct
disorder when it lasts months or longer. Children or young people may be defiant
and aggressive. They may lie, steal and get involved in physical fights. Behaviour will
repeatedly and seriously break the rules at home and at school. Teenagers may take
risks with their health and safety by drug taking, drinking alcohol and through reckless
sexual behaviour.
Conduct disorders may distance individuals from their peers and family who will be
alienated by their behaviour. This may lead to depression. They may damage their
academic results through not attending or being excluded from school, and reckless
behaviour may lead to injury, illness or other consequences such as criminal convictions.

Jenny’s story
I don’t really know what happened at school. The teachers said I was bright,
but I didn’t care about it. I was angry all the time and didn’t do what anyone
told me. My Mum and Dad couldn’t cope. I was skipping school, taking drugs
and having sex with anyone I could. I ended up pregnant and with a drug
conviction at 16. I did get some help and now I’m retaking exams at night
school. I’ve got a part-time job and Mum and Dad help look after James,
who’s two now. I’m starting to make friends again and I feel more in control.

Post-traumatic stress disorder (PTSD)

For younger children (up to about eight years of age), main signs will be them
re-enacting the event that caused the stress, or drawing it; becoming angry; engaging
in disruptive behaviour; and having nightmares.

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As children get older, the symptoms become more like adult PTSD symptoms
including flashbacks, anxiety attacks, continuously thinking about the event and
having physical reactions to these thoughts, such as feeling sick. Some children and
young people may experience memory loss about the event or may try to avoid people
and places that remind them of it. A lack of interest in everyday activities, feeling
angry or on edge, not being able to concentrate and not being able to sleep are also
common.
As with other mental health issues, individuals may become distanced from family
and friends. They may show little interest in social interaction; and irritability, anger
and other behavioural issues might mean that others don’t want to be around them.
If untreated over the longer term, individuals may experience depression, personality
changes and may self-harm or have suicidal thoughts.

Obsessive Compulsive Disorder (OCD)

Individuals with OCD worry that something bad will happen unless they carry out
their compulsions. These can include things like repeatedly checking that doors are
locked or things are switched off, washing hands repeatedly, tidying up, counting or
repeating words. Children may go through phases where they need to put toys in a
certain order or say goodnight a number of times, but these are normal comforting
routines in response to minor stresses. It is only when they become obsessive and
the compulsions start to interfere with everyday life that it becomes a problem.
Left untreated, OCD will interfere with daily routines and the child or young person may
suffer from anxiety and depression. The illness may interfere with achievement at school
and they may become isolated or be bullied for their behaviour.

Mel’s story
When Mel’s Gran died of a heart attack shortly after a break in at her home,
Mel became very distressed. She made her Mum check every door and
window before she would go to bed and started to sleep with the light on. The
checking routine became a ritual and Mel began to check everything three
times before she would go to bed each night. She also tried to stay awake as
long as possible. She told her Mum that she was frightened someone would
break in and that another family member would die.

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Bipolar disorder

Bipolar disorder is rare in children but does begin in the teenage years or in young
adulthood. The main sign to look out for is mood swings from extreme happiness to
extreme sadness.
Signs in depressive episodes include:
• Low energy
• Not taking part in activities
• Lack of enjoyment in life
• Loss of appetite
• Poor sleep patterns
• Thoughts of suicide
• In extreme cases, psychosis

Signs in manic episodes include:

• Talking too much
• Increased activity and restlessness
• Difficulty in focusing on one thing
• Overspending or reckless behaviour
• Overconfidence in own ability

Impacts include disruption of relationships with friends and family and interference
with school work. Individuals will experience a general loss of self-confidence and self-
esteem. Reckless behaviour may result in risks to the health and safety of the individual.

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Psychosis

The signs of psychosis are:

• Unusual beliefs or delusions – where the young person thinks someone is trying to
harm them, for example, or that the world is being taken over by aliens, or that the
individual has special powers.
• Thought disorder – where the young person is not thinking straight. This is often
characterised by not being able to understand what the individual is saying, and their
ideas being jumbled.
• Hallucinations – where the young person sees, hears, smells or feels something
that is not really there. Often, this manifests as the individual hearing voices. The
hallucination will seem totally real to the person.

These thoughts will affect eating, sleeping and well-being in general. Individuals may
become anxious and suffer physical symptoms. Individuals experiencing psychosis may
go on to develop bipolar disorder or schizophrenia.
Schizophrenia is a severe form of psychosis where people lose touch with reality. They
experience the thoughts described for psychosis and their behaviour is affected. They
lose interest in everyday life and may feel like harming themselves. They may become
aggressive.
Psychosis and schizophrenia affect a young person’s ability to lead a normal life. They
may alienate friends and family and find it difficult to carry out everyday tasks.

Attention Deficit Hyperactivity Disorder (ADHD)

There are a variety of signs of ADHD and not all children and young people will display
all the signs. Attention problems include an inability to concentrate and being forgetful
and disorganised. Hyperactivity makes the individual restless and fidgety and they can
be noisy and disruptive. Individuals may also be impulsive, not wanting to wait their
turn and interrupting people.
Impacts again include isolation from peers and family members who may be alienated
by behaviour and distraction from school work, which will lead to a failure to achieve.

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Did you know?

Children and young people who experience mental illness are more likely than
other people to experience mental illness in adulthood.

Mental health crisis or emergency in children and young

people
Please read the following as it will help you to answer question 18.

If symptoms of any mental illness escalate suddenly, or there is a breakdown in the

support network for a child or young person with mental health concerns, this may be a
crisis or emergency situation. Signs of this will be extreme emotional distress or anxiety,
the child or young person appearing overwhelmed or unable to cope with day-to-day
life and/or threats of self-harm or suicide. Experiencing hallucinations and hearing voices
would also be an emergency situation. Other harmful or reckless behaviour, such as drug
taking, may also indicate a mental health crisis.

Zach’s story
Zach had been withdrawn and down for a while but his family hadn’t realised
quite how bad the situation was. Over the course of one weekend, Zach
began to behave very strangely – talking to himself, not making sense when
he talked to his family and barricading himself in his room, saying he was
frightened ‘they’ were coming for him. His parents called their GP who
referred Zach for immediate psychiatric evaluation.

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Summary

In this section, you have learned about:

• Behaviours that may indicate a mental health concern in a child or young person
• How children and young people may express feelings through behaviour
• Harmful behaviours used by children and young people to cope with their feelings
• The importance of early intervention in identifying concerns about behaviour
• What stress and anxiety are and the causes of them
• The relationship between stress and resilience
• The signs of stress and anxiety
• What depression is and the signs of depression in children and young people
• Causes of depression for children and young people
• How depression can affect children and young people
• Other mental conditions that affect children and young people, their signs and
symptoms and the impacts they have on individuals
• What constitutes a mental health crisis or emergency.

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people with mental health concerns

In this section, you will learn about the support that is available for children and young
people with mental health concerns. You will develop knowledge of the person-centred
approach and learn about how to promote good mental health. You will find out about
the services available to support mental health in children and young people and
treatments available.

Person-centred support
Please read the following as it will help you to answer question 19.

Person-centred support is where the child or young person is at the centre of any
planning, decisions and support that affects them. Person-centred support involves the
child or young person and other significant people in their lives, such as parents or carers,
in the choices made about care and support. Person-centred support aims to:
• Respect and listen to the child or young person
• Ensure that the child or young person has choices
• Ensure that the child or young person is in control of the support process
• Support the child or young person to communicate and make themselves heard in
the support process
• Support the child or young person to build their skills and confidence
• Ensure that the child or young person is made aware of all their rights and choices
• Ensure that the child or young person receives information about support choices in
ways that they can access the information and make informed choices
• Support the child or young person in what they choose to do, even where there are
risks, and support them to understand the risks and work around them

Matt’s story
I’m eight years old and I’ve been having a few problems at school because
I get bored and find it hard to concentrate. The learning support person,
my teacher, my parents and I all sat down to talk about it together. They
all listened to me about how I felt. They understand and they are all trying
to help me. I have already tried some of the ideas out. It is helping me
concentrate more in class and I’ve had less fights with people. It is helping
me do my schoolwork better and helping me to make friends too.

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Recovery model for children and young people’s mental

health
Please read the following as it will help you to answer question 20.

In mental health, the recovery model takes a holistic view of the individual that focuses
on the child or young person and not just their symptoms and mental health concerns.
The model sees recovery as a journey towards better mental health rather than an end
point where the individual is declared to be ‘cured’. This journey may suffer setbacks but
it is important that all involved in the recovery process are committed to the process
and optimistic about it. This includes the child or young person and any family, friends
and professionals supporting them. Recovery is not just about the child or young person
surviving mental illness, but about them moving forward and improving not only their
mental health, but their quality of life. The recovery process should support children and
young people to recognise their abilities and achieve their goals and aspirations.
Research shows that important factors supporting recovery include:
• Positive relationships
• Feeling safe and secure
• Personal growth and achievement
• The right living environment
• Being believed in
• Being listened to and understood
• Support to understand problems and experiences
• Social inclusion
• Developing resilience
(Mental health foundation, www.mentalhealth.org.uk/a-to-z/r/recovery)

Did you know?

Mental illness and social attitudes to mental illness can be limiting for children
and young people and can mean they are isolated. Family, friends and even
professionals may unintentionally support this by being overprotective of the
child or young person and being negative about their recovery.

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people with mental health concerns

Building resilience is particularly important for the recovery of mental health in children
and young people, as this will mean they are more able to cope with stressful situations
and experiences in the future. Children and young people who are resilient will be less
likely to have recurring mental health concerns.

Knowledge Activity 5: You learned about resilience in Workbook 1. Write

your own explanation of what resilience means here.

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Upholding the rights of children and young people with

mental health concerns
Please read the following as it will help you to answer question 21.

In supporting children and young people with mental health concerns, it is important
that their rights are upheld. Rights of children include human rights, confidentiality,
safeguarding, protection and care. (You learned about the rights of children and
legislation relating to this in Workbook 1.)

Did you know?

The United Nations Convention on the Rights of the Child sets out the rights
of children and young people under the age of eighteen. There are over 40
specific rights, including the right to life, survival and development, the right to
live in a family environment, the right to health and welfare, and the right to
education.

Knowledge Activity 6: Look at children’s rights on the UN website (http://

unchildrights.blogspot.co.uk/2009/03/summary-childrens-rights-
convention.html). Choose two of the rights listed and identify how mental
health concerns may impact on those rights.

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people with mental health concerns

Examples of how the rights of a child or young person might be upheld include:
• Ensuring that children and young people have access to education. Mental health
issues can lead to children and young people being excluded from education or not
achieving in education. Support should help children and young people identify their
aims and access the education they need to succeed in their chosen pathway.
• Supporting children and young people to live in the family environment. Wherever
possible, children and young people with mental health issues should be supported
to remain with their families or within alternative supportive environments.
• Supporting children and young people to make decisions about their care and
support and to access that care and support, e.g. medical interventions, counselling
and therapy.
• Supporting children and young people to manage their own mental health as far as
possible, e.g. supporting them to identify triggers for behaviour, including self-harm,
or emotions and ways to manage these effectively.
• Ensuring that information about the child or young person is shared only with those
who require information to ensure the safety, welfare and care of the child or young
person.
• Ensuring that children and young people are safeguarded and protected from neglect
and abuse and that they build the knowledge and confidence to identify, avoid where
possible, and talk about threatening situations and experiences.
• Supporting children and young people to communicate their wishes, preferences and
needs in relation to care, support and their lives.

Kevin’s story
I’d been excluded from school because of my behaviour but the social worker
and school counsellor worked with me to help me identify what triggered me
getting angry and fighting at school. The counsellor suggested things I could
do to control my temper and my emotions when I was feeling bad. They are
helping me get back into school so that I can continue my studies and get
some qualifications to go to college.

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Strategies to support children and young people with

mental health concerns
Please read the following as it will help you to answer question 22.

When working with children and young people, you are in a position to support their
mental health and to support them to develop coping strategies and resilience. There
are a variety of strategies you can use to do this.

Educating

Children and young people with mental health concerns often feel different from
others or ashamed of their feelings and behaviour. They may not understand what is
happening to them or why they feel as they do. Educating all young people about the
signs that may indicate mental health concerns and encouraging them to talk about
feelings and behaviour should help to change attitudes to mental health. It will also
help children and young people to identify when they have a mental health problem
and to feel better about themselves.
Strategy: Make sure that children and young people have access to information
about mental health issues that is age appropriate and in a format they can access
and understand.

Stellan’s story
I’d been feeling bad for some time. I was unhappy all the time and stressed
out when I had to go to school. I tried to stay at home as much as possible.
Then this guy came into school and talked about mental health and how lots
of kids go through times when they feel bad. He described exactly how I felt
and when he asked if any of us had felt like that, loads of kids stuck their
hands up. Suddenly, I realised it wasn’t just me!

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people with mental health concerns

Listening

Children and young people may be reluctant to share information about themselves
and their feelings, but may discuss things with you if they can recognise that they are
experiencing a mental health problem and know that you are available to talk to and
willing to listen. Sometimes, talking may be all the therapy they need. You may wish
to refer them to a counsellor or professional if they have ongoing or complex issues,
and especially where cases involve abuse or self-harm.

Katherina’s story
My parents are in the armed forces and move around a lot, so when it was
time for me to start taking exams, we decided I would go to boarding school.
I found it difficult to make friends at first and I missed my family and my dog.
I spent a lot of time in my room and didn’t join in any of the after-school
activities. I was sharing a room with Cassie who is really outgoing and quite
noisy, and that made me feel even worse. The housemistress noticed and
said did I want to talk about it. She said lots of the girls felt homesick and a
bit lost at first. I was a bit unsure, but once I started to tell her about how I
felt, it all came out. I cried a bit but she made me smile by saying that’s why
she had lots of boxes of tissues around! My housemistress has been great.
She moved me to a new room with two girls who are a bit quieter like me
(Cassie didn’t mind – she says she knows she is noisy and we’re now good
friends) and she helped me set up FaceTime on my phone so I could video
call my parents. Lots of the staff have dogs and me and one of the girls I’m
sharing with have offered to take them for walks. The staff really like it and it
means we don’t miss our own pets so much. I’m feeling much better about
things and I know I have someone I can talk to any time I feel down.

Strategy: Make time to listen and encourage young people to talk. Never dismiss
their concerns or be judgemental; let them know they can trust you and know how to
refer them for further help if you need to.

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Encouraging good physical health

Good diet and taking regular exercise has a positive effect on mood, so encourage
children and young people to eat healthily and take part in activities that they enjoy
and that will provide exercise. Feeling physically well will help their mental health and
research shows that exercising releases chemicals in the brain that make individuals
feel good. Exercise also helps improve sleep patterns and taking part in activities they
enjoy means they spend less time worrying about things and have the opportunity to
make friends.
Strategy: Encourage healthy eating and exercise. Educate children and young people
about the benefits of these and find activities that they will enjoy taking part in.

Developing coping strategies

Coping strategies can be positive and negative. Negative strategies include alcohol
and substance abuse as well as self-harm, but also strategies such as ignoring the
problem or avoiding stressful situations, which can isolate the individual and cause
further anxiety. Children and young people should be encouraged to develop positive
coping strategies. These might include:
• Recognising the triggers for anxiety and stress and talking to someone or finding
ways to calm themselves, e.g. breathing exercises.
• Learning relaxation techniques, e.g. breathing
techniques and mindfulness, and making time to
relax or just doing things they enjoy, e.g. reading,
playing a game, etc.
• Making time for themselves. Children and young
people’s lives have become much busier and
more stressful than they ever were and it is
important to make them aware that they need to
have some time for themselves and that this is
OK.
• Physical exercise can help children and young
people relieve stress and relax.

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Callum’s story
I get myself into trouble at school because I get angry at people. Then I
shout at a teacher or fight with another kid. One of the teaching assistants
is helping me to identify what it is that makes me flip and get angry. She
suggested I count to ten and breathe deeply when I see what she calls a
trigger. It was hard at first but I’m getting better and it does help. I’ve also
started playing rugby each week and that helps too! All that running around
on the pitch makes me feel less stressed and not so angry.

Strategy: Help children and young people to identify triggers for their moods and
develop strategies to cope with them.

Developing self-regulation

Many of our emotional responses to situations or experiences are automatic.

Something happens, and we respond in a specific way. We do, however, learn to self-
regulate our emotions. From an early age, children learn how to manage emotions
but their ability to do this may depend on parenting skills and positive role models.
Research has identified that over-controlling parenting styles may lead to a lack of
self-regulation. Children and young people on the autistic spectrum have difficulty
regulating their emotions and this is due to difficulties in processing and expressing
emotions rather than parenting styles.
Ways to support children and young people in controlling their emotional responses
include:
• Helping them to identify the emotion and find ways to delay it, e.g. using calming
techniques, finding a safe space, taking time out, etc. in response to anger, frustration,
feeling overwhelmed or anxiety. Calming techniques might include deep breathing or
counting, for example.
• Helping them to identify a safe space. This could be a space created for them where
they can take time out in the home (especially for younger children) or at school, with
things that will help to calm them.
• Helping them understand emotions. Educate children and young people about
different emotions and what they feel like and role play appropriate emotional
responses to situations and experiences. This works especially well with older children
and young people but can be used with younger children too.

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• Developing their emotional vocabulary. Children, especially younger children, can

become frustrated and withdraw because they are unable to explain what it is
they are feeling. Teach children and young people the words they need to describe
different emotions.
• Creating consequences where the child or young person is rewarded for good
behaviours and discouraged from unwanted behaviours. Reward charts work well for
younger children.

Kayleigh’s story
Whenever things got bad at home or school, I started pulling my hair out.
It made me feel better somehow. I had bald patches where I’d pulled out
so much hair. I used to wear a woolly hat all the time to cover it up. The
counsellor at school helped me find other ways to feel better. When I start to
get stressed now, I play a little word game; I think of as many words as I can
that begin with ‘K’ (for Kayleigh). It only takes a few words now to stop me
feeling so worried about stuff.

Strategy: Support children and young people to develop self-regulation of their

emotions by helping them recognise and describe their emotions and choose
appropriate responses.

Developing resilience

We have mentioned the importance of developing resilience and this is important for
all children so that they are better able to cope with difficult situations and events in
their lives.
In early childhood (under 5 years), resilience is best developed through support of the
family to ensure the child has good nutrition, a safe living environment, the opportunity
to build positive relationships with parents and peers, and high quality care.
From ages 5 to 13, whilst positive living and family situations are still important, schools
and others can start to support the development of resilience. Resilience will be
supported through:
• Equal opportunities at school for all ages, cultures and communities
• Good home-school relationships and pupil-teacher relationships

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• Support to develop interpersonal skills and ability to develop positive relationships

• Positive achievements at school, e.g. setting high but achievable targets and
supporting individuals to achieve them
• Encouraging and developing independence
• Clear expectations and consequences for behaviour
• Support for individuals as required, e.g. counselling, additional learning support, etc.
• Supporting transition from child to young adult

These factors continue to be important in the 13 to 19 age group, together with a focus
on:
• Building strong social support networks
• Support of a mentor or tutor
• Positive experiences at school or college
• Enabling and encouraging independence
• Encouraging participation and enabling achievement
• Developing the ability to analyse and deal with difficult situations
• Encouragement to help others (which helps to build self-esteem and self-confidence)
• Promoting healthy behaviours
• Supporting transition from school to college, university or work

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Knowledge Activity 7: Sasha is twelve and is currently in local authority

care. She suffers from anxiety and depression. She comes from a disruptive
and neglectful home background, finds it difficult to maintain positive
relationships and is disruptive at school. She finds it particularly difficult
to cope with criticism from others and is likely to become aggressive.
What strategies might support Sasha to develop better mental health and
resilience?

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Creating an environment to promote well-being

Please read the following as it will help you to answer question 23.

The well-being of children and young people will be improved if they experience the
right sort of environment.

Did you know?

Creating the right environment for children and young people is about creating
the right physical environment and the right emotional environment.

Physical environment

The physical environments in which a child or young person lives and learns are
important. They should reflect the ages and stages of development of the child or
young person and should provide a safe space in which they can explore, experiment
and develop. Children and young people should have access to areas for groups,
solitary activities and reflection, learning and leisure, indoors and outdoors. They
should have opportunities to develop skills and to explore new skills and abilities.
In terms of well-being, priorities for the physical environment are:
• Comfort – areas should be warm and furnished with places to sit, play games, eat
comfortably, etc.
• Being welcoming – areas should be clean and well maintained.
• Safety – the child or young person should feel safe. What this means will depend on
the age and stage of development. For young children, safety might be ensuring they
can crawl, run and play without being physically injured. For older children and young
people, safety might be having somewhere they can talk with their friends without
others overhearing them.
• Sense of belonging – the child or young person should have space or spaces that
are theirs (either individually or as a group). This might include putting up their work
or allowing them to help decorate, depending on the environment, and having
somewhere to put their own things.
• Variety – children and young people should have a variety of different environments
they can access, e.g. somewhere to learn or do homework/study, somewhere to relax,
and somewhere to play or spend time with family and friends.

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Felix’s story
For as long as I can remember, I’ve helped look after Mum. She has multiple
sclerosis and needs a wheelchair to get about. We were living in a one-
bedroomed flat and I had to sleep on the sofa. Often, the lift wasn’t working
so Mum couldn’t even go out and I’d have to do everything like the shopping.
Mum was miserable and so was I, which meant we argued all the time. The
estate we were living on wasn’t good either. There was lots of crime and I
know Mum worried if I had to go out on my own. The social worker helped us
get a bigger place and now we have a two-bedroomed bungalow in a much
nicer area, and it’s closer to school. I have my own room and I was allowed
to choose the paint for the walls and put posters up. It’s somewhere quiet I
can go when I want time to myself. Mum can get out and about much better
now too. It’s only a short way to the shops and I feel much safer going on my
own.

Emotional environment

The emotional environment is the mood or atmosphere in a setting, created by the

relationships that people have with one another. It’s about how people behave,
how inclusive the environment is, how people speak to each other and how they
treat each other. Even babies and very young children pick up on the feelings and
atmosphere around them and this will shape their own feelings and behaviour.
Environments which support mental well-being will be:
• Positive – they will be welcoming and feel happy and positive.
• Respectful – individuals in the environment, including adults, children and young
people, will show respect and consideration for one another.
• Inclusive – all children and young people in the environment should have equal
access to activities, people to talk to and make friends with, and opportunities to learn
and develop.
• Calm – all individuals should be encouraged to behave appropriately, and aggressive
or other unwanted behaviour should be challenged and discouraged.
• Empathetic – children and young people should be encouraged to understand how
others might feel and to consider others’ feelings when deciding how to behave.

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Ways to create positive emotional environments include:

• Having clear policies on behavioural expectations
• Providing a role model for children and young people by remaining calm and in
control
• Encouraging discussion of issues and feelings appropriate to the age and stage of
development of the child or young person
• Challenging any discriminatory, bullying and aggressive behaviour
• Being consistent in your response to the child or young person and, in particular, in
your responses to unwanted behaviour

Promoting interaction to develop well-being

Please read the following as it will help you to answer question 24.

You have learned that positive and supportive relationships are important for the well-
being and resilience of children and young people. Most children will learn from a
young age how to make friends and develop supportive relationships, but sometimes
this doesn’t happen, or things go wrong and the child or young person becomes
isolated. Poor relationships can have a negative impact on mental health, damaging self-
confidence and self-esteem and sometimes triggering self-harm, as well as making it
difficult for individuals to form positive relationships in the future.
When a child or young person has an existing mental health concern, this may damage
the relationship they have with others who may not understand that the individual
has a mental health issue or who become stressed themselves in trying to support the
individual.
Relationships that are important for the child or young person are relationships with
parents, siblings, other family members, peers, teachers and other adults they may come
into contact with, such as sports coaches, activity leaders, etc. They may also include
relationships with pets.

Did you know?

Relationships with pets can be important in reducing stress and bringing down
blood pressure. Pets are non-judgemental and unconditional in their affection,
which can help the individual relax and just be themselves.

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If you work with children or young people, there are a range of things you can do to help
promote interaction.

Being a role model

Children and young people learn social skills from the adults around them. If
they have developed negative social skills, this is likely to be as a result of having
observed negative behaviour in adults, such as lack of respect, lack of consideration
and aggression. If they see an adult being unkind or rude, they will assume this is
acceptable behaviour.
One of the most important things you can do to promote interaction is to provide a role
model by being friendly and approachable, treating everyone with the same level of
respect and working together with others.

Encouraging a positive attitude

People with negative attitudes to everything find it difficult to develop and maintain
relationships, so encouraging positive attitudes and helping children and young
people understand that they have a choice about whether to be positive about things
or negative will help them to become more positive and make it easier for them to
interact with others.

Amber’s story
Amber, aged seven, was having problems at school because she said no
one liked her or would play with her. She was often seen standing alone in
the corner of the playground at playtime. Other children would sometimes
approach her, but she would refuse to play unless it was something she
wanted to do. On the rare occasions she did play with others, she would
try and control them, and this put the other children off. The playground
assistant noticed what was happening and talked to Amber. She discussed
how Amber would feel if the other children tried to tell her what to do and
helped her understand that she could make friends if she was more flexible.
She suggested that Amber asked one of the groups in the playground if she
could join in and that she joined in the game without trying to take over.
Amber tried this and found that she enjoyed playing with the other children.
She developed a more positive attitude to others and now regularly plays with
a group of other girls.

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Supporting shared interests

Many friendships are built around shared interests, so encouraging a child or young
person to identify interests and to take part in activities will encourage them to
interact with others who have similar interests and to build relationships with them.

Encouraging acceptance

Children and young people should understand the importance of treating everyone
with respect, accepting others as they are and being non-judgemental. This can
partly be encouraged through being a role model but should also be discussed with
children and young people and contained within any expectations and rules for
behaviour within the setting. Individuals should understand that it is not acceptable to
exclude someone or victimise them because of their culture, ethnicity, gender, sexual
orientation, etc. and that good manners are important. Any behaviour in contradiction
to this should always be challenged.

Building confidence

Often, children and young people find it difficult to interact with others due to a lack
of confidence. You can help them build confidence by supporting them in interactions
with others, e.g. by encouraging them to work in groups and facilitating interaction, by
encouraging them to approach groups and to join in activities, and by doing role plays
of different interactive scenarios so they can practice.

Promoting engagement with social groups

Joining youth groups such as Brownies, Cubs,

Scouts or a youth club can help children and
young people socialise and improve their skills
in interacting with others.

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Knowledge Activity 8: Think about your own experience of working with

children or young people or about a work setting you would like to work in.
Describe the activities and opportunities for promoting interaction between
children and young people or between them and other adults.

As an adult interacting with children and young people, you need to be friendly, open
and non-judgemental, whilst maintaining a professional relationship. It is important for
individuals to see that you treat all individuals equally and don’t have favourites.

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Respecting self-esteem in children and young people

Please read the following as it will help you to answer question 25.

It is important to respond to the behaviour and lifestyle choices of children and young
people in ways that respect their self-esteem. It is never appropriate to put a child or
young person down, make them feel small or criticise or make fun of them in front of
others. Nor is it appropriate to show disapproval of their lifestyle choices based on your
own beliefs and values. These negative ways of dealing with individuals will damage
their self-esteem.
Responses to unwanted behaviour that respect the individual’s self-esteem include:
• Speaking to the individual calmly and at a normal level (not shouting)
• Quietly moving the individual to a more private area or moving others away from
them if they are angry, aggressive or distressed
• Waiting with them while they calm down, and asking if there is anything you can do
to help
• Discussing the behaviour with them and helping them to identify triggers and find
solutions or strategies to use in the future
• Forgiving and forgetting the behaviour by not reminding them of it constantly or
making them feel ashamed

In extreme cases, a child or young person may need to be restrained, especially where
they are placing themselves or others at risk of harm, but this should be the minimum
restraint necessary and should be discussed with them and their parents where
appropriate following the incident.
In some workplaces, it is necessary to allow the use of reasonable force in order to
protect staff and children or young people. Schools and other child or youth settings
should train staff in use of restraint if required and it should only be used whilst
observing the following principles:
• Use the least restrictive option
• Use for no longer than necessary
• Use should be proportionate to the risk of harm
• Use should consider the dignity and best interests of the child/young person
• Policies on use should be open and transparent
• Incidents should be recorded and auditable

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Your workplace may have a policy on use of force; it is good practice to do so to protect
staff and children or young people.

Knowledge Activity 9: Find your workplace policy on behaviour and see if

there is a section or a separate policy on the use of reasonable force. If you
do not yet work in a child or youth setting, see if you can find a sample policy
on the Internet. Write down what is acceptable and what is not acceptable
under the policy.

Children and young people will sometimes make lifestyle choices that you feel are
inappropriate or that conflict with your own beliefs. These may be around choices for
dress, friendships, behaviour or sexual relationships, for example, or may be in conflict
with their (and your) cultural background. As long as the individual is not engaging in
behaviour that is illegal or harmful, you should respect their choices.
Responses to the lifestyle choices of children and young people that respect their self-
esteem include:
• Being accepting and non-judgemental
• Being supportive if their choices bring them into conflict with others
• Discussing any risks relating to lifestyle choices, where appropriate, and helping
them to reduce risk; e.g. if they go out after dark, staying with a group of friends
• Encouraging others to be accepting of their lifestyle choices
• Where they do make inappropriate lifestyle choices, e.g. smoking, substance abuse or
promiscuous behaviour, talking to them about why these might be inappropriate and
the risks that are involved
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Ben’s story
I’m eighteen now and I’m having medical treatment to help me transition. I
was never comfortable as a girl, even from a very young age. My parents have
accepted my gender identity now, but I went through some very difficult years
and some of our relations still won’t accept me as a man. My first positive
experience was when a youth leader at the local youth club discussed gender
issues with a group of us and gave us leaflets on support available. I talked
to her afterwards on my own and discussed my own experiences. She was
the first person who didn’t judge me or make comments that upset me. She
helped me find a counsellor to help me and my family talk about how we
were feeling and I’m much happier now.

Supporting children and young people to express emotions

and concerns
Please read the following as it will help you to answer question 26.

Many of the strategies and approaches you have already learned about will help you
to support children and young people to express their emotions and concerns.

Knowledge Activity 10: From what you have learned so far, write down ways
to support children and young people to express emotions and concerns.

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You can support children and young people to express emotions and concerns within a
safe environment by:
• Being open and approachable so they know they can discuss things with you
• Letting them know that it is OK to express their emotions and be happy, sad, angry,
etc.
• Supporting them to understand their emotions and find ways to regulate them as
appropriate, e.g. avoiding or preventing negative behaviours
• Making sure they have the vocabulary to be able to discuss emotions and concerns
• Supporting them to understand the impact their emotions have on others
• Building self-confidence and self-esteem

Services and professionals that support children and

young people’s mental health
Please read the following as it will help you to answer question 27.

The main services to support the mental health of children and young people are the
NHS CAMHS. CAMHS stands for Child and Adolescent Mental Health Services. CAMHS
are local services based around specialist teams made up of different specialists who
can provide support. A child or young person can be referred to CAMHS through their
parents, school, GP, a social worker or, if they are old enough, they can refer themselves.
CAMHS will generally work with the child or young person and their family to ensure
proper support.
The professionals who work in CAMHS teams may include:
• Psychiatrists – doctors who specialise in mental health.
• Social workers – who support individuals in their community and can help them to
access other support and funding where appropriate.
• Nurses – help to care for people and may be able to prescribe medicines in some
cases.
• Occupational therapists – help people who have been ill to build their confidence
and skills.
• Psychologists – experts on behaviour and feelings who can help individuals
understand and cope.
• Counsellors – use talking therapies to help individuals.
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• Therapists – behavioural, family or art therapists, for example, support individuals and
their families to find ways of expressing themselves and coping with mental health
concerns.
• Primary mental health worker – a key person who works with the individual and
coordinates the other care and services they need.
• Outreach workers – professionals who work in the community to support individuals
with mental health problems in day-to-day living.

Most local CAMHS will have a website explaining the services they offer.

Knowledge Activity 11: Find the CAMHS for your local area and list the
services and professional support they offer to children and young people with
mental health concerns and their families.

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In addition to CAMHS, there are a range of other professionals and services that may be
able to offer support. These include:
• GPs – the individual’s doctor can provide advice and referral to specialists. They may
also be involved in prescribing medication.
• School counsellors or mentors – many schools have counsellors or mentors who can
support children and young people who are facing difficult experiences. They may
offer counselling and support themselves or refer individuals to other services and
professionals.
• Special educational needs coordinators (SENCOs) – SENCOs work in schools to
ensure any special educational needs of individuals are met. This may include
supporting children or young people who have behavioural or emotional difficulties.
• Charities and other organisations – there are a variety of charities and organisations
that provide advice, helplines and access to services to support young people in
relation to their mental health. Examples are Mind, the mental health charity (www.
mind.org.uk), and Young Minds, who champion the mental health and well-being
of young people (www.youngminds.org.uk).
• Local and community support groups – there may also be locally run support groups
to help children and young people and their families.

Knowledge Activity 12: Find out about any support groups relating to mental
health and well-being for children and young people in your local area and
describe them here. You could look on the Internet or for leaflets and notices
in a local health centre or doctor’s surgery.

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Importance of early intervention, support and treatment

Please read the following as it will help you to answer question 28.

The earlier the intervention for a child requiring mental health support or treatment,
the better the chance of recovery and preventing long-term mental health issues. Many
of the mental health issues experienced by adults actually began in childhood and
become longer-term, more serious or recurring problems because they have not been
appropriately identified and treated.
In addition, many mental health problems in children and young people could be
prevented if there is early enough intervention to support them and build their
resilience, self-confidence and self-esteem.

Did you know?

70% of children and young people who have experienced a mental health
problem have not had appropriate interventions at a sufficiently early age.
(Mental Health Foundation, www.mentalhealth.org.uk)

Care Programme Approach (CPA)

Please read the following as it will help you to answer question 29.

The Care Programme Approach (CPA) to mental health is a package of care to support
the recovery of individuals who have been diagnosed with a serious mental health
problem, have complex needs, e.g. may need physical as well as mental health care, have
been detained under the Mental Health Act, or are at risk of harm due to mental health
issues, for example.
The CPA involves assessment of needs, planning and coordinating care and regularly
reviewing care to ensure it meets individuals’ needs. The individual will have a care
coordinator who should coordinate their care and ensure the right professionals
are involved in care. The coordinator may be a nurse, social worker or occupational
therapist. They should keep in regular contact with the individual and ensure that they
understand their care plan.
The care plan should set out medication, therapy, any physical care needs, other support
in relation to living, education, etc., any specific risks relating to the individual and their
mental health, e.g. risk of self-harm, and the individual’s personal circumstances. Care
plans should be made with the individual, ensuring their needs and preferences are met.

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The Care Programme Approach is about coordinating all the different agencies and
professionals involved in the support of a child or young person with mental health
problems.

Therapies to treat a child or young person experiencing

mental health problems
Please read the following as it will help you to answer question 30.

The main therapies that are used to treat children and young people include:
• Art therapy – art therapy helps children and young people express their feelings
and thoughts through the use of art. It helps individuals understand more about
themselves and can lead to them making positive changes.
• Talking therapies – many therapies involve talking about feelings and thoughts with
a specially trained therapist. They can work with individuals to help them think about
the personal difficulties they are experiencing and find ways to overcome them.
• Cognitive Behavioural Therapy (CBT) – this is a talking therapy that focuses on the
link between thoughts, feelings and behaviours. It encourages individuals to question
thoughts and behaviours and find ways to manage unhelpful thoughts and behaviour
patterns. Individuals learn how to analyse their own thoughts and behaviours, which
can be of future help to them in dealing with new difficulties they face.
• Family therapy – family therapy is sometimes used to support children and young
people. This involves working with the child or young person and family members to
help them express their points of view and understand the feelings and thoughts of
others in the family. This can help families make positive changes so that everyone is
supported.

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Diana’s story
I’d been depressed for a long time and had attempted suicide twice. One
of the main problems was my sexuality. I am a lesbian and my parents just
couldn’t accept that. They thought I was too young to make decisions about
my sexuality and the relationships I wanted to have, even though I’m 17.
I’d always had a good relationship with my family before and now, when I
needed their support more than ever, I felt let down by them. The family
therapist helped us to find a way forward. He met with the whole family and
encouraged us to talk about what we thought and felt. My parents, brother
and sister began to understand what I was going through, and I understood
their point of view as well. My parents accepted that I was old enough to
make my own mind up about these things and I realised their negative
attitude was really only concern for my well-being. We’ve made some positive
changes and I’m feeling much better. Mum’s invited my girlfriend to tea for
the first time and I’m really excited about introducing her to the family.

Medication to treat children and young people

experiencing mental health problems
Please read the following as it will help you to answer question 31.

The table shows the main types of medicines used to treat mental health problems in
children and young people.

Type of medication What it is used for/what it does Examples

Antidepressants Used mainly to treat depression, Amitriptyline, Prozac,
but also for anxiety, OCD, eating Mirtazapine
disorders and insomnia. They
improve symptoms of depression
and can stop them returning.

Note: there is little research about

the use of antidepressants in under
18s and they are used with care
usually alongside talking therapies.

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Anti-anxiety medicines Used for anxiety and sleep loss. Lorazepam,

Propranolol, Sertraline
Note: again, there is little (used to treat OCD)
research and medicines will only
be prescribed to under 18s by
specialists.
Stimulants Used to treat ADHD. Methylphenidate,
Amphetamine,
Dextroamphetamine
Antipsychotics Used to manage psychosis. Often Chlorpromazine,
used in combination with other Risperidone,
medicines in the treatment of Olanzapine
ADHD, eating disorders, PTSD, OCD
and generalised anxiety disorder.
Mood stabilisers Used to treat bipolar disorder and Carbamazepine,
other illnesses such as anxiety, Lamotrigine
panic, and aggressive behaviour.

Did you know?

Many medicines for mental illnesses have not been tested for under 18s and
should only be prescribed by a specialist.

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Summary

In this section, you have learned about:

• Person-centred approaches to supporting the mental health of children and young
people
• The recovery model for children and young people
• How to uphold the rights of the child or young person with mental health problems
• Strategies to support the child or young person with mental health problems
• Promoting the well-being of children and young people through the environment
and positive interaction
• Supporting children and young people to express emotions and concerns
• The services and professionals that can support the child or young person with
mental health problems
• The importance of early intervention and treatment
• The Care Programme Approach
• Therapies and medicines used to treat the child or young person experiencing mental
health problems.

64 © LCG 2018
 Section 3: Extension activities

Further your knowledge and understanding of the topics in this workbook by completing
the following extension activities.

Understand children and young people’s mental health concerns

Extension Activity 1: Write a leaflet for parents and teachers explaining the
signs that may indicate a mental health problem in a child or young person.
You may write a general leaflet or one covering a specific age group and/or
setting.

Workbook 2 65
 Section 3: Extension activities

Extension Activity 2: Research one mental health disorder that may affect
children or young people. Write a guide that covers:
a. Signs and symptoms
b. Causes and/or risk factors
c. Treatment
d. Impacts on the individual and others

66 © LCG 2018
 Section 3: Extension activities

Understand how to support children and young people with mental

health concerns

Extension Activity 3: Research one type of therapy that might be used with
children or young people and write a guide to explain the therapy, what it
involves, the outcomes and benefits.

Workbook 2 67
 Section 3: Extension activities

Extension Activity 4: Research services available in your local area to

support children and young people and write a guide to these. You should
include NHS CAMHS and other services available.

68 © LCG 2018
Section 3: Extension activities

Extension Activity 5: Write a guide for parents and teachers on how to

support well-being and build resilience in children and young people.

Workbook 2 69
 Please use these page for additional notes

70 © LCG 2018
Please use these page for additional notes

Workbook 2 71
 DEPRESSION

SUPPORT SERVICES

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