Conditions for mental health in education

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Tom Billington critically examines theoretical and empirical data on youth mental and emotional health worldwide.

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Institution: University of Sheffield

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There are concerns globally about the emotional wellbeing and mental health of young people and in this paper a critical orientation comprises both theoretical and empirical data sources. The case is made that (1) the medical model of mental health – that of problem identification, diagnosis and medical treatment at the level of the individual – is not appropriate for the vast majority of children and young people in schools and (2) relational approaches would be more sensitive in responding to the complexity of the ‘conditions’ in the schools, homes and communities in which young people live.

Image courtesy of interviewee. January 31, 2024

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The speaker, based in Liverpool, discusses the perspectives and experiences of a group of authors composed of practitioner psychologists, researchers, and teachers. They argue against the individual-focused medical model of mental health, suggesting it is inappropriate for most young people in schools. Instead, they advocate for relational approaches, which acknowledge the complexities of young people's lives and the social construction of their experiences.

The authors emphasize the importance of considering various human differences, such as disability, ethnicity, and child welfare, in understanding young people's well-being. They criticize the medicalized narrative that often frames mental health issues as individual deficits, which can lead to social exclusion and a focus on pathology instead of context.

Supporting their stance, they call for a paradigm shift towards a dynamic, relational understanding of mental health that incorporates social constructionism. They highlight the need for schools to recognize the interconnectedness of feelings, thoughts, and school culture, and stress the importance of family and social contexts in influencing mental health.

The findings from their research identified key factors affecting young people's well-being, including family circumstances, parental mental health, safeguarding issues, and school culture, all underscoring relational dynamics rather than individual diagnoses. The authors conclude with three principles for future research and practice: acknowledging the complexity of mental health, addressing links between mental health and poverty, and ensuring that young people's voices are heard, particularly those from marginalized communities. They propose that schools should serve as environments fostering relational experiences rather than isolating individuals through clinical labels. The next phase of their research aims to involve young people directly in the exploration of their mental health narratives.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

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I'm speaking here to, to you today from my home in

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Liverpool, quite in, for those of you that are Beatles fans,

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quite near to Penny Lane.

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Okay. So, as a group of authors,

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we're practitioner psychologists, researchers

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and teachers, who over the years have developed a lot

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of practices around that have drawn on social

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constructionism and forms of critical psychology.

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And in our experience, there are two broad conclusions.

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Firstly, that the medical model of mental health, that is

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to say problem identification, diagnosis,

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and treatment at the level of the individual

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is inappropriate for the vast majority

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of young people in schools.

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Secondly, one of our conclusions is

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that relational approaches offer a more nuanced

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and subtle, insight onto the complexity

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of the conditions in which young people live their lives in

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their schools, homes, and communities.

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Um, the word conditions in the paper title,

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has a very kind of specific set of, well,

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it's got its own history really, from page one

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of William James's Principles of Psychology in 1890.

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And we're giving a kind of refreshing that concept.

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We would say that our particular paper is distinctive in

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that it, this puts together,

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it juxtaposes critical theorization,

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with empirical research.

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So that's what we feel is distinctive.

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In the last 35 years or so, there's been global

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and national policy changes primarily in, in respect of,

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rights issues, children, d disability diversity.

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And in particular for our work,

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what's becoming important is

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listening to the voice of the child.

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More recently, there's been a wellbeing

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and mental health agenda in respect of young people.

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Um, there's a con there's a kind of an idea

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that there's a generation of young people whom are afflicted

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by a mental health crisis.

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We found that as practitioners

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and researchers, that young people's wellbeing intersects

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with a range of human differences in schools across

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communities such as disability, ethnicity, gender,

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sexual orientation, child poverty and welfare.

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But all the time, there seems

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to be a prevailing within child medicalized model

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of mental health, which places limitations on the ways in

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which we can meet the young person's complex needs.

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Not least because that medical model circulates

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what almost a language of deficit,

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which can be problematic since it fixes

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and oppresses service users,

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young people in discursive practices that often invoke forms

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of social exclusion from which

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it's very different to escape.

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And so we began to rely on what Ken Gergen in 2009, 2010,

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referred to as a concept of

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Relational beings.

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We're all relational beings,

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and we propose as a scientific first principle

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that the young person can neither be conceptualized

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nor represented outside the conditions of shared histories,

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experiences, and relational circumstances.

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We perform research

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and practice models with an alternative lens,

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the dynamic processes envisaged by social constructionism

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and encourage solutions which we would like

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to feel are both ethical and scientific.

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Well over the years, we've come to object to

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and resist what we feel are very wasteful social exclusions.

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And we've drawn on a kind of,

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what we would say is a rich methodological palette,

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whether it's from narrative psychology, critical psychology,

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and social construction.

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And we believe that young people's wellbeing

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and mental health is framed too often through the narrative

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of psychopathology disorder.

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And that's supposed to distress.

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And this is a, this has the effect of almost blaming

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the young, the young person,

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and, focusing on the disability within the young person,

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and isolating them from the context around them.

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We can fail to acknowledge the complexity

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of the relational circumstances

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that their distress arises in specific places of,

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time and place.

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And we feel that over the years,

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the positiveness positivist methodologies have been strident

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in oversimplifying psychological processes,

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and they have ignored the social and developmental

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and environmental context for human development.

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Articulated, for example, by William James Koski de Fanon,

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post colonialist Fre Henriks, Wendy Ho, Erica Berman.

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And we see that there's long compelling,

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longstanding evidence in the literature

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that young people's mental health, wellbeing

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and learning are community activities

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and not mere deficits to be located in individual persons.

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So we argue for a paradigm shift from a medicalized

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diagnostic perspective towards a dynamic social

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constructionist and relational understanding

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of young people, their wellbeing and mental health.

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Other supporting traditions in the literature include

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critical and post-colonial approaches to human subjectivity.

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There are critical approaches in clinical

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and educational psychology, developmental psychology,

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feminist psychology, the history

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and pH philosophy of science, psych, psychosocial studies,

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and critical neuroscience.

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Uh, we believe that schools are communities, places

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of relationships, socialization

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and lived experiences shared by young people

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and school staff of every juncture of the day.

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And so, going back to William James, what in which he wrote

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the faculty, that is to say mind does not exist,

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absolutely, but works

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Under conditions.

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And the quest of the conditions becomes the psychologist's

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most interesting task, the quest

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of the conditions in which those issues around wellbeing

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and mental health arises.

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So we've asked ourselves,

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what are the conditions in which young people's wellbeing,

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mental health, either prosperous or suffers?

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We were asked to evaluate a city initiative

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in which school staff were to receive basic training

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in young people's wellbeing and mental health.

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When we looked at the initial training materials being

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proposed or being asserted, they had a kind

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of clinical language.

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They had, a, a, a kind of Mexican,

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medical lexicon in which the responsibility

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for mental health was invested

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and inserted into the young person

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as psychopathologies disorders and deficits.

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Now, our social constructionist approach

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to research suggests that, that from the very first contact

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from the information sheets

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or the consent forms, we begin

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to construct the discursive field of the research.

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Uh, what, for Cole would've said was, as soon

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as we start engaging, we, there are practices

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that systematically form the objects of which they speak.

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So, for example, in if we talk about mental health

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as a disorder, then we create mental health as a disorder.

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It's not merely about language,

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but we, in the talking about it

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and in the systems we create, we, we,

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we sort of support particular approaches.

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Social constructionist principles in the research mean

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that at each stage, research participants directed,

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the journey of the research.

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So whilst we had the medical version

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of the training materials, we decided that we would listen

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to the people who'd commissioned the ser the, the,

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the research to the service managers

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who were important in it, to the clinicians, to the senior

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teachers, to the head teachers.

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We decided we would create semi-structured interviews in

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which we would listen to the ways in which they would

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explore young people's wellbeing

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and mental health in words of their own choosing.

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We weren't going to impose our own vocabulary,

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to develop their own ways

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of talking about young people's emotional wellbeing

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and mental health in the form of

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what Michael White would've called their own

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preferred narratives.

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If we were given a free choice,

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how would we talk about this?

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Which is a kind

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of key social constructionist principle in Parkwood said,

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would've said that this allows people

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to restore their agency.

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It gives them, empowers them.

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We got, interview transcriptions from the various

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professionals, 19 of them,

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Uh, that what we will say the first phase accounts,

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and that language that was being used contrasted with the,

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the language being inserted in the training materials,

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which we found interesting.

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They were using very different words.

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Um, people were locating young people their wellbeing in

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mental health within non-medical language

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and nons psychological discourses.

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So we thought as researchers, we had a responsibility

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to look at those accounts

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and use those as the basis

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for the next, for the second phase.

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And we devised a questionnaire for the second phase

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of the research that was based on those

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semi-structured interviews.

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We went through 20 iterations of those of, of our quest,

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of our questionnaire in order that we could be sure

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that we distill the key meanings in a, in an authentic way

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from, from the professionals.

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So we can claim that whilst crafted by our team,

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the questionnaire for parents, which was to be fair

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for parents and for whole school staff

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during the second phase, what's constructed upon the words

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and themes of the first phase interview accounts.

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Um, in the end, we produced a long list of themes that we,

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that we identified as,

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being important in the creation

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of young people's wellbeing and mental health.

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We then asked our second phase respondents.

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We presented that long list in front of them,

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and we said, we asked them, which three of these

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have the most impact in your experience on a young person's

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mental health and wellbeing?

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So again, we were asking the parents

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and the school staff in, in all nearly 800,

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responded in the questionnaires from 14,

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15 different schools, 14 primary, one secondary.

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And those questionnaire respondents identified four

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in order of approximate frequency.

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The first most important aspect

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of affecting a young person's mental health

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was family circumstances.

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For example, family, finances and relationships.

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Not surprising, but we can often overlook it when we're

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looking for the origins of a mental health issue.

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Secondly, parental wellbeing

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and mental health was identified by the respondents.

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Thirdly, all safeguarding issues, for example,

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substance misuse issues,

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or child welfare issues, child protection issues,

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and fourthly, school culture including school climate,

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peer relationships, and all other

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school-based relationships.

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Now, those were identified not by us

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as supposed experts,

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but by people themselves as

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what were the most important aspects

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of young people's mental health and wellbeing.

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So those were the conclusions

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or findings produced by the commissioners

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and managers themselves.

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Again, neither young people no, or the,

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or the specific diagnosis were identified as

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Individuals, but always we felt

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that those were relational factors.

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The family, the parents, safeguarding social issues,

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school culture, that's a relational environment,

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for wellbeing.

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And those were the findings.

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We feel that as a result, not, not just of our experience,

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but of our particular research,

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that we can propose three key principles for research

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and practice in the field of young people, wellbeing,

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mental health, and schools.

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Firstly, we need to acknowledge the complex links

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between affect, cognition and school climate and culture.

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Any one of those can't stand alone.

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It's, there are complex links between the way we feel,

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the way we think and the people

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around us in the school environment.

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Secondly, we need to foreground mental health and poverty.

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Now, that's not to say that, that, that men, all people

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with mental health are poor

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or poor people get mental health issues,

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but there, there are links that are to do with political

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and sociocultural circumstances,

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which can impact on a young person's,

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wellbeing in their community, their school, or their family.

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And thirdly, we need to attend to the issue of voice.

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That is to say we need

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to provide spaces in which young people,

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especially those from marginalized communities,

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can develop their own preferred narratives.

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That will be the next piece of research, I guess,

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because we didn't do this with young people, we did it

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with professionals and we did it with parents.

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So the next phase of research would be

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to do it with young people.

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We have an alternative vision, which, which

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by seeing young children

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and people as essentially relational

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and by seeing essentially relational,

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we also need to see teaching as a relational act.

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And we need to see schools as the site

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for relational experiences, not something which isolates you

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or me with a diagnosis,

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but actually the conditions around us, the situation,

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because we feel that these will support the work

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of educational professionals, empower them,

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because many

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of pe many people in schools are already doing vital work in

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addressing young people's wellbeing

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and mental health in their

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schools, families and communities.

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We don't want to take that away from the,

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and make it a clinical issue.

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This is something that they can feel empowered

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to engage in positively.

Quick Answers

Revising Mental Health Approaches for Youth

00:00:00 - I'm speaking here to, to you today from my home in Liverpool, quite in, for those of you that are Beatles fans, quite near to Penny Lane. Okay. So, as a group of authors, we're practitioner psychologists, researchers and teachers, who over the years have developed a lot of practices around that have drawn on social constructionism and forms of critical psychology. And in our experience, there are two broad conclusions. Firstly, that the medical model of mental health, that is
00:00:35 - and treatment at the level of the individual is inappropriate for the vast majority of young people in schools. Secondly, one of our conclusions is that relational approaches offer a more nuanced and subtle, insight onto the complexity of the conditions in which young people live their lives in their schools, homes, and communities. the word conditions in the paper title, has a very kind of specific set of, well,
00:01:08 - of William James's Principles of Psychology in 1890. And we're giving a kind of refreshing that concept. We would say that our particular paper is distinctive in that it, this puts together, it juxtaposes critical theorization, with empirical research. So that's what we feel is distinctive. In the last 35 years or so, there's been global and national policy changes primarily in, in respect of,
00:01:42 - And in particular for our work, what's becoming important is listening to the voice of the child. More recently, there's been a wellbeing and mental health agenda in respect of young people. there's a con there's a kind of an idea that there's a generation of young people whom are afflicted by a mental health crisis. We found that as practitioners and researchers, that young people's wellbeing intersects
00:02:11 - communities such as disability, ethnicity, gender, sexual orientation, child poverty and welfare. But all the time, there seems to be a prevailing within child medicalized model of mental health, which places limitations on the ways in which we can meet the young person's complex needs. Not least because that medical model circulates what almost a language of deficit,
00:02:41 - and oppresses service users, young people in discursive practices that often invoke forms of social exclusion from which it's very different to escape. And so we began to rely on what Ken Gergen in 2009, 2010, referred to as a concept of Relational beings. We're all relational beings, and we propose as a scientific first principle that the young person can neither be conceptualized nor represented outside the conditions of shared histories,

Reframing Young People's Mental Health Perspectives

00:03:13 - We perform research and practice models with an alternative lens, the dynamic processes envisaged by social constructionism and encourage solutions which we would like to feel are both ethical and scientific. Well over the years, we've come to object to and resist what we feel are very wasteful social exclusions. And we've drawn on a kind of, what we would say is a rich methodological palette, whether it's from narrative psychology, critical psychology,
00:03:45 - And we believe that young people's wellbeing and mental health is framed too often through the narrative of psychopathology disorder. And that's supposed to distress. And this is a, this has the effect of almost blaming the young, the young person, and, focusing on the disability within the young person, and isolating them from the context around them.
00:04:17 - of the relational circumstances that their distress arises in specific places of, time and place. And we feel that over the years, the positiveness positivist methodologies have been strident in oversimplifying psychological processes, and they have ignored the social and developmental and environmental context for human development. Articulated, for example, by William James Koski de Fanon, post colonialist Fre Henriks, Wendy Ho, Erica Berman.
00:04:51 - longstanding evidence in the literature that young people's mental health, wellbeing and learning are community activities and not mere deficits to be located in individual persons. So we argue for a paradigm shift from a medicalized diagnostic perspective towards a dynamic social constructionist and relational understanding of young people, their wellbeing and mental health. Other supporting traditions in the literature include
00:05:22 - There are critical approaches in clinical and educational psychology, developmental psychology, feminist psychology, the history and pH philosophy of science, psych, psychosocial studies, and critical neuroscience. we believe that schools are communities, places of relationships, socialization and lived experiences shared by young people and school staff of every juncture of the day. And so, going back to William James, what in which he wrote
00:05:55 - absolutely, but works Under conditions. And the quest of the conditions becomes the psychologist's most interesting task, the quest of the conditions in which those issues around wellbeing and mental health arises. So we've asked ourselves, what are the conditions in which young people's wellbeing, mental health, either prosperous or suffers? We were asked to evaluate a city initiative

Rethinking Mental Health Language in Youth

00:06:24 - in young people's wellbeing and mental health. When we looked at the initial training materials being proposed or being asserted, they had a kind of clinical language. They had, a, a, a kind of Mexican, medical lexicon in which the responsibility for mental health was invested and inserted into the young person as psychopathologies disorders and deficits. Now, our social constructionist approach
00:06:57 - from the information sheets or the consent forms, we begin to construct the discursive field of the research. what, for Cole would've said was, as soon as we start engaging, we, there are practices that systematically form the objects of which they speak. So, for example, in if we talk about mental health as a disorder, then we create mental health as a disorder.
00:07:27 - but we, in the talking about it and in the systems we create, we, we, we sort of support particular approaches. Social constructionist principles in the research mean that at each stage, research participants directed, the journey of the research. So whilst we had the medical version of the training materials, we decided that we would listen
00:08:01 - the research to the service managers who were important in it, to the clinicians, to the senior teachers, to the head teachers. We decided we would create semi-structured interviews in which we would listen to the ways in which they would explore young people's wellbeing and mental health in words of their own choosing. We weren't going to impose our own vocabulary, to develop their own ways of talking about young people's emotional wellbeing
00:08:30 - what Michael White would've called their own preferred narratives. If we were given a free choice, how would we talk about this? Which is a kind of key social constructionist principle in Parkwood said, would've said that this allows people to restore their agency. It gives them, empowers them. We got, interview transcriptions from the various professionals, 19 of them, that what we will say the first phase accounts, and that language that was being used contrasted with the,
00:09:04 - which we found interesting. They were using very different words. people were locating young people their wellbeing in mental health within non-medical language and nons psychological discourses. So we thought as researchers, we had a responsibility to look at those accounts and use those as the basis for the next, for the second phase. And we devised a questionnaire for the second phase of the research that was based on those semi-structured interviews.

Identifying Key Factors in Youth Mental Health

00:09:38 - of our questionnaire in order that we could be sure that we distill the key meanings in a, in an authentic way from, from the professionals. So we can claim that whilst crafted by our team, the questionnaire for parents, which was to be fair for parents and for whole school staff during the second phase, what's constructed upon the words and themes of the first phase interview accounts. in the end, we produced a long list of themes that we,
00:10:08 - being important in the creation of young people's wellbeing and mental health. We then asked our second phase respondents. We presented that long list in front of them, and we said, we asked them, which three of these have the most impact in your experience on a young person's mental health and wellbeing? So again, we were asking the parents and the school staff in, in all nearly 800,
00:10:39 - 15 different schools, 14 primary, one secondary. And those questionnaire respondents identified four in order of approximate frequency. The first most important aspect of affecting a young person's mental health was family circumstances. For example, family, finances and relationships. Not surprising, but we can often overlook it when we're looking for the origins of a mental health issue. Secondly, parental wellbeing
00:11:11 - Thirdly, all safeguarding issues, for example, substance misuse issues, or child welfare issues, child protection issues, and fourthly, school culture including school climate, peer relationships, and all other school-based relationships. Now, those were identified not by us as supposed experts, but by people themselves as what were the most important aspects
00:11:40 - So those were the conclusions or findings produced by the commissioners and managers themselves. Again, neither young people no, or the, or the specific diagnosis were identified as Individuals, but always we felt that those were relational factors. The family, the parents, safeguarding social issues, school culture, that's a relational environment, for wellbeing. And those were the findings. We feel that as a result, not, not just of our experience,
00:12:14 - that we can propose three key principles for research and practice in the field of young people, wellbeing, mental health, and schools. Firstly, we need to acknowledge the complex links between affect, cognition and school climate and culture. Any one of those can't stand alone. It's, there are complex links between the way we feel, the way we think and the people around us in the school environment.

Empowering Young Voices in Mental Health

00:12:47 - Now, that's not to say that, that, that men, all people with mental health are poor or poor people get mental health issues, but there, there are links that are to do with political and sociocultural circumstances, which can impact on a young person's, wellbeing in their community, their school, or their family. And thirdly, we need to attend to the issue of voice. That is to say we need
00:13:15 - especially those from marginalized communities, can develop their own preferred narratives. That will be the next piece of research, I guess, because we didn't do this with young people, we did it with professionals and we did it with parents. So the next phase of research would be to do it with young people. We have an alternative vision, which, which by seeing young children and people as essentially relational and by seeing essentially relational,
00:13:51 - And we need to see schools as the site for relational experiences, not something which isolates you or me with a diagnosis, but actually the conditions around us, the situation, because we feel that these will support the work of educational professionals, empower them, because many of pe many people in schools are already doing vital work in addressing young people's wellbeing
00:14:25 - schools, families and communities. We don't want to take that away from the, and make it a clinical issue. This is something that they can feel empowered to engage in positively.

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