Believe in yourself!
Fostering aspiration and mental wellbeing in young black men 

 

The majority of children from African
Caribbean communities thrive and
achieve in school and in life.
However,
for many years, national statistics have
pointed to an overrepresentation of black
boys being excluded from school and
a higher likelihood of black men being
placed in secure mental health settings
and being diagnosed with serious mental
health difficulties. Yet high quality studies
indicate that black boys appear less likely
to present with symptoms of mental ill
health than their peers up to the age of 11.
So what goes wrong?


Discussions with young men provide vital
insights for schools and other services to
bring about change.


Lorraine Khan is an Associate at the
Centre for Mental Health and the
co-author (with a number of peer
researchers) of the Centre’s 2017
report ‘Against the Odds’ about three
community projects in Birmingham
aiming to improve the resilience of young
African Caribbean men. Lorraine shared
with CWMT some of the findings from the
report.


Background – the data
First, Lorraine stressed that the data we
have in this country on Black Asian and
Minority Ethnic (BAME) child mental
health is very limited. Sample sizes have
generally been small, preventing robust
conclusions. However, our national
Millennium Cohort Study oversampled
BAME communities, allowing us to get a
more accurate picture of the journeys of
children and families.


Lorraine says: “Recent sweeps of this
long-term UK study highlight that black
boys are less likely to have a diagnosable
mental health difficulty than their peers
at the age of 11 (Gutman et al, 2015); but
when we start looking at our national
adult mental health survey, some really
quite stark shifts take place. Black men as
they move into adulthood are four times
more likely to end up in mental health
services, are more likely to end up in
highly controlling psychiatric units
(usually with presentations such as
schizophrenia) and there is a higher risk
of suicide.”

 

“They only show the bad stuff, the
media, to do with the young black
community.”
Young man, Birmingham,
Against The Odds


It’s not just men who are affected,
African Caribbean women are also more
likely to have mental health difficulties,
such as depression and anxiety, as are
South Asian women.

 

The transition from primary to
secondary school
Based on the conversations Lorraine’s
team had with young African Caribbean
men in Birmingham, their experience of
primary school was generally positive. So
what happens?


A second phase of the Centre’s work in
Birmingham is currently investigating
further what goes on during the transition
to secondary school and strategies to
strengthen young men’s resilience and
achievement. For young men, this
transition is clearly a significant shift.

“Some young men don’t feel like real
citizens. (People think) they must
be up to something. It’s seen as
negative. Many (…) internalise this
and live out a self-fulfilling prophecy.”
Peer mentor, Against The Odds

Lorraine says: “There’s something about
the importance of interactive activity,
movement and building in ‘brain
breaks’ to keep minds stimulated and
engaged. Learning from our partner The
Birmingham Repertory Company, we
often start focus groups in Birmingham
with an ice breaker that is full of
movement. It gets people’s minds really
racing and engaged, and we tended to
get really deep and considered answers
to the questions we were exploring. They
were the most productive focus groups
we’ve done.”
Lorraine told us about a project where a
community engagement organisation
in Birmingham, called First Class Legacy,
went into schools and worked for ten
weeks with boys identified as struggling
and at risk. “Activities were led by
relatable and positive role models and
community leaders who created a
safe space, and used lots of circle time
and interactive exercises, encouraging
boys to explore who they were, and
to develop social and emotional skills –
persistence, empathy and perspective.
Interactive activities helped boys better
understand themselves, and to explore
their qualities, aspirations, goals and their
teachers’ perspectives.”
Creativity plays a part too, not just in
fostering unity and teamwork but as a
coping skill in its own right. Lorraine told
me: “What engaged these young men
with the projects was often creative or
music-based activities – writing songs,
producing music in a recording studio.”
Resilience and role models
Taking an assets-based approach to
black history, rather than a deficit-based
approach, was also described as important
by community partners and young men,
as was recognising the importance,
significance and power of community
resilience in the face of adversity.
Working with partners in Birmingham,
Lorraine says she was struck by the power
for young men of the opportunities to
‘see it to be it’: contact with relatable role
models who had ‘faced and got through
the same problems’ and who had
achieved. She told us about a school in
London where the headmaster’s mission is
to bring in people who have achieved in
their career to challenge the stereotypes
that often tend to flood young men from
African Caribbean communities.
A sense of belonging
“A sense of belonging is pivotal to a child’s
mental health,” Lorraine says, “and a
sense of school belonging is critical in that
transition to secondary school and has
been proved in studies to be critical to
academic achievement too.
“If a child doesn’t feel able to talk to
teachers, it’s a huge risk factor. It’s those
children who we should be investing
extra time in to try and develop a
relationship, whether it’s with their
teacher or another member of staff.”
“(Of community mentor), they like
helped me and pushed me to do more
stuff than I used to do, so in my school
work and that.”
Young man, Against The Odds
Lorraine believes that peer mentoring
can make a significant difference in
keeping young people engaged with
school in a positive way. She says: “From
what the project leads and young
people themselves told us, having
someone who looks like you, talks like
you, is like you, who can encourage you
and foster your talents, helps with that
sense of school belonging. That kind of
intermediary can work well with young
people who might be beginning to
lose their sense of connection with the
school – and mentors can work hand
in hand with school staff to help them
understand where that young person is
coming from and problem-solve what
might help movement forward.”
What should teachers be aware of
when that sense of belonging starts
to disappear and there is risk of
disengagement? Lorraine explains
that their research shows that it is still
possible to intervene if you can provide
a credible alternative. “Even if young

Talking to 9,000 children and young people, and their parents

The survey was conducted by the National Centre for Social Research, the Office for

National Statistics and youthinmind, and included more than 9,000 children and young

people, who were aged between two and 19 years. Children and young people were

sampled to be as representative as possible of children and young people from GP

registers across England.

All participating children and young people underwent a standardised diagnostic assessment called the Development and Well-being Assessment (DAWBA). The DAWBA covers most common child mental health problems, from several different types of anxiety and depression, through to behavioural disorders, ADHD, autism spectrum conditions and rarer problems such as eating disorders and tics. The assessment involved face to face interviews with the parent and young people aged over the age of 11. Provided the family agreed, a questionnaire was mailed to teachers.

Asking the right questions
The assessment combined highly structured questions that had set responses with open ended questions. A team of mental health practitioners from the University of Exeter and Kings College London reviewed all the information provided by parents, young people and teachers to assign mental health diagnoses according to the World Health Organisation’s International Classification of Diseases (10th edition; ICD 10), an internationally recognised way of classifying all medical diagnoses, symptoms and procedures.

The highly structured questions provide very reliable information but there is no way to detect if the person answering them has understood the questions asked. Open ended questions produce highly varied responses from different people on different occasions so are much less reliable when used alone. However, they can show that the person answering them has misunderstood the question being asked. These descriptive answers also allowed the mental health experts to handle differences in opinion about how a child was coping in the same way as they would in the clinic.

 

What if the usual diagnoses don’t fit?
There are also a considerable number of children (and adults) who do not fit neatly into ICD 10 diagnosis but have clinically relevant problems that get in the way of their functioning. ICD 10 does allow for this and the open ended questions allowed the clinical raters to assess this and assign children a “not otherwise specified” diagnosis that the very structured questions would not.

The results: changes since 1999
Comparison with earlier surveys had to be confined to the narrowest age range studied. This was five to 15 years from the first survey, which was completed in 1999. In this age group, there has been a slight increase in the proportion of children with any mental health condition from 9.7% in 1999 and 10.1% in 2004 to 11.2% in 2017. This increase was explained by a higher number of young people with clinically impairing anxiety or depression, which increased from 3.9% in 2004 to 5.8% in 2017. The proportion of children with behavioural difficulties, ADHD and other disorders was not different from that found by the earlier surveys.


Extending the survey to 19-year-olds
The survey extended the age range studied compared to earlier surveys up to the age of 19 and among 5 to19-year-olds, one in eight (12.8%) had at least one mental health condition, while one in twenty had two or more. Overall, the proportion of boys and girls with mental health conditions was similar, although the rate of any mental health condition increased with age and was highest (23.9%) among young women aged 17-19 years. Half of the young women in this age group with a mental health condition reported that they had self-harmed at some point in their life. These findings suggest that on average a class may contain at least one child who is struggling with an emotional disorder and those working with older teenagers may face a particular challenge.


What about very young children?
This survey also assessed two to four year- olds for the first time, and found that one in eighteen had at least one mental health condition. In this age group boys were more likely than girls to have a mental health condition, and the commonest types of problem were behavioural (1.9%) and autism spectrum disorder (1.4%). Boys of primary school age were also more likely to have a mental health condition, particularly as behavioural and neurodevelopmental problems were the most common type of difficulty in this age group. There was no difference between the numbers of boys and girls with poor mental health in the secondary school age group, emotional disorders were more common (9%),
and were more common still among older teenagers (15%).

 

Ethnicity, low income and poor general health
The survey collected a range of other information about children, young people and their families. White British children (15%) and young people and those of mixed/other heritage (12%) were considerably more likely to have a mental health condition than their Black/Black British (5.6%) or Asian/Asian British (5.2%) peers. There were also regional variations in the proportion of children with mental health conditions that might be of interest to local service commissioners and providers. Children with mental health conditions were more likely to have poor general health, live in a low income household, and have less healthy family functioning
or a parent in poor health.

Social media and poor mental health: a complex relationship
Children with a mental health condition reported spending more time on social media than their peers. In addition, they were more likely to perceive negative impacts of their social media use in terms of comparisons with others, anxiety about likes and follows, spending more time than intended or not being able to be honest about themselves. As both the mental health and background information were collected at the same time, these findings do not indicate causality. While poor family function, physical ill health or poor parental mental health may adversely influence the mental health of children, parenting a child in poor mental health may equally have a negative influence on parents’ mental health and on the way the family functions. Similarly, children with poor mental health may be less engaged in other activities so have more time to spend on social media. Equally, their poor mental health might predispose them to think negatively about their experience on social media, rather than social media necessarily explaining their poor mental health. These relationships are likely to be complex, and data gathered from the same children and families over time are essential to help us to understand how they influence each other.


Support for children with mental health difficulties

As in the previous surveys, teachers were the most commonly cited professional source of support among those with mental health conditions (48.5%), while more than a fifth (22.6%) had contacted an educational support service within the last year. The latter achieved the highest level of satisfaction (73.1%)reported for any service. Despite concerns about increases in the prescription of medication for mental health reasons among young people recently, only one in six (16.4%) children with a mental health condition was taking psychotropic medication. Only a quarter of those with a mental health condition had been in contact with a mental health professional, which included counsellors in schools and the third sector, over the preceding 12 months.

A link to special educational needs

The overlap between poor mental
health and difficulty coping with school is emphasised by the high proportion of children with a mental health condition (35.6%) with recognised special educational needs. This reached almost two thirds among those with neurodevelopmental disorders such as ADHD and autism spectrum conditions, although the survey did not establish whether these special educational needs related directly to the mental health condition detected by the DAWBA. Half of the children (49.6%) with recognised special educational needs had an  ducation, Health and Care Plan, which emphasises the extent to which they needed  support to cope in school. Children who had a mental health condition were approximately ten times more likely to have played truant or to have been excluded from school than their peers without a disorder.


Finding out more
The data from one of the largest surveys of child mental health in which all children had a standardised diagnostic assessment provides invaluable data for policy, service planning and provision, practitioners and families. Few other such surveys have covered such a large age range or provided such a large sample. I would encourage all those interested to visit the NHS Digital website where there are more detailed descriptions about all of the findings described above and how the survey was undertaken. These data were very much worth the wait from 2004.
Professor Tamsin Ford, University of Exeter College of Medicine and Health, on behalf of the survey team.
Specialist feature


References
Mental Health of Children and Young People in England, 2017, https://digital.nhs.uk/data-and-information/
publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017
Dawba.info
https://www.who.int/classifications/icd/icdonlineversions/en/
Green, H., McGinnity, A., Meltzer, H., Ford, T., Goodman, R., Mental health of children and young people in
Great Britain, 2004, National Statistics
Newlove-Delgado, T., Moore, D., Ukoumunne, O. C., Stein, K., Ford, T., Mental health related contact with
education professionals in the British Child and Adolescent Mental Health Survey 2004,
https://www.emeraldinsight.com/doi/abs/10.1108/JMHTEP-02-2015-0007

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