Sunday, 28 April 2013

Social Exclusion and Mental Health



The effects of social inequality- mental health problems affect 3x as many lower class children compared to higher class, 1 in 10 children suffer from a poverty related mental health problem, UK IS fourth from bottom of poverty league table, govt aim to abolish child poverty by 2021 has now been abandoned......

Mental health problems affect three times as many children in social class V (manual and unskilled) compared with those in social class I (professional) according to the authoritative Social Trends report (ONS 2012). It is important therefore to consider the external context of child and adolescent mental health problems and acknowledge that the impact of service provision in some families is mediated by factors such as unemployment, poor housing and poverty. They all contribute to the level of resilience and capacity for resourcefulness of children and families (Eamon 1994, Dunn 1999, Micklewright & Stewart 2000). A report on social inequalities from the Office for National Statistics revealed that one in ten children in the United Kingdom suffers from a poverty related mental health problem (HMSO 2000). According to other research the UK is fourth from the bottom of a list of relative poverty among the nineteen richest nations (UNICEF 2010).


The previous government target failed to reduce child poverty by a quarter by 2004, to halve it by 2010 and unlikely to have helped to abolish it by 2021. The calculations for defining poverty, relative poverty and absolute poverty are complex and subject to much statistical interpretation and debate. The current measure for calculating relative child poverty (defined as children living in households with incomes below 50 per cent of the national median) does not reveal anything about the depth of poverty. In other words every household below the 50 per cent threshold would be counted regardless of whether they were just below or in complete destitution. Also it fails to measure how long children have lived in poverty. This is important given the cumulative psychological effects of persistent social exclusion.

 Socially excluded children and their families


Black children- Govt inspections reveal inadequate assessment of the needs of black children and families: are your agencies following these recommendations?

Ensuring that services and staffing are monitored by ethnicity to ensure they are provided appropriately and equally

Involving ethnic minorities in planning and reviewing services

Training in anti-racist and anti-discriminatory practice

Investigating and monitoring complaints of racial discrimination or harassment

Explicit policies are in place for working with black families


Research by the NSPCC revealed (Barter 1999):

Racism and racial bullying are commonplace within the lives of ethnic minority children and young people

The most common expression of racism is through racist name-calling previously considered by adults as trivial but the impact is now known to be profound

Racial bullying frequently involves the use of violence

Violence against ethnic minority groups is persistent, patterned, and long-term in the way it affects individuals and the places where they live


Disabled children

Disabled children and those with learning difficulties are more likely to have mental health problems than other children. Disabled children and adolescents are twice as likely to have emotional and behavioural problems. There are a growing number of disabled children and young people living in the community who need high levels of support. Partly this is because more of these children are surviving infancy, and partly because there is no longer the assumption that disabled children should be cared for in hospitals or other institutions. Lone parents with disabled children, families from ethnic minorities, and families caring for the most severely disabled children have the highest levels of unmet need, and live in the poorest conditions. The mental health needs of disabled children are often masked by a narrow focus on their disability through a medical, rather than social model of disability. Behaviour causing concern can often be ascribed to the physical or intellectual disability rather than a separate psychological need.


Young Offenders

According to recent figures there were 11,500 young people aged 15 to 20 in jail in England and Wales in 2010, of those 90 per cent had a diagnosable mental health disorder, and many had substance abuse problems as well as personality disorders (Lyon et al 2010). 60 per cent had anxiety and depressive illness with 10 per cent suffering from a severe psychotic mental illness such as schizophrenia. 20 per cent of these young men and 40 per cent of young women will have attempted suicide prior to their imprisonment (Farrant 2001). Young offenders are among the most socially excluded groups in society and the evidence suggests that imprisonment simply makes matters worse not better. Within two years of release, 75 per cent will have been reconvicted and 47 per cent will be back in jail (Social Exclusion Unit 2002). If some of these young people become homeless or end up in insecure accommodation, they are between eight and 11 times more likely to develop mental health problems (Stephens 2002). Low take up of preventive mental health services among socially excluded families means that minor problems can develop into major problems. Over 90 per cent of recidivist delinquents had a conduct disorder as children


Looked After Children

Nearly 60,000 children were being looked after by local authorities for the year ending 2011. About 60 per cent of these children had been abused or neglected with a further 10 per cent coming from ‘dysfunctional families’ (DOH 2011). Abuse of this nature can lead to self-harming behaviour, severe behavioural problems and depression. Evidence confirms that the mental health needs of these children and young people are overlooked and that many have established mental health problems prior to coming into local authority care (Dimigen et al 1999). 38,400 of these children were in foster placements and 6,400 were in children’s homes, yet foster carers and residential staff are among the least qualified and supported people left to manage sometimes extreme behaviour. Specialist CAMHS services often decline to help because of the uncertain and possibly temporary nature of the child’s placement which contra-indicates successful intervention. The dilemma is that without input, placements often break down as carers cannot cope, invariably leading to more placements and further deterioration in the child’s mental health.


A recent research study emphasised the importance of a preventive approach with children in the public care system who are more likely to be excluded from school following emotional and behavioural difficulties (Fletcher-Campbell 2001). Teacher training that fails to adequately prepare newly-qualified staff to respond to the mental health needs of pupils is considered to be a factor in the increased use of school exclusions (OFSTED 1996).  Social workers using a preventive approach could be helpful to teaching staff and organise collaborative work aimed at preventing difficult behaviour escalating. Unless the mental health needs of these children and young people are addressed as part of a strategy that effectively nurtures children’s inclusion in school the risk of deterioration is high. The risk factors for looked after children are probably the most extreme of any socially excluded group, they include (Richardson & Joughin 2000):


Developmental delay

School failure

Communication difficulty

Low self esteem

Parent/carer conflict

Family breakdown



Parental mental illness

Alcohol/drug abuse




Refugee and asylum seeking children
The number of applications for asylum from unaccompanied under 18s almost trebled between 1997 and 2011 from 1,105 to 3,469. DOH figures indicate that there were 6,750 unaccompanied asylum- seeking children supported by local authorities in 2001. Further evidence shows that many of these young people were accommodated and receiving a worse service than other children in need (Audit Commission 2000). Very little research has been done to ascertain the mental health needs of this group of children. However there is some evidence of the symptoms of post traumatic stress syndrome being present before they then experience the racist xenophobic abuse of individuals and institutions incapable of demonstrating humanitarian concern for their plight. This combination can shatter the most psychologically robust personality. It has been estimated that serious mental health disorders may be present in 40-50 per cent of young refugees (Hodes 1998).