Samantha Chapman Hello, I’m Sam Chapman and  I’m going to be presenting some information   for you today on a concept analysis that I’ve  developed. The concept analysis, I developed   this to try and help us understand what good  mental health is and how we can, kind of,   view this in other people when we’re particularly  working with children and young people. My area of interest is really trying to, kind  of, understand and research how we promote   good mental health in children and young people.  So, in order to do that, I wanted to be able to   really get to understand what exactly good mental  health is. I’m a Registered Mental Health Nurse,   a Specialist Practitioner in Mental Health and I  have a master’s in public health. I’m also doing   my doctorate studies at the moment and for my  doctoral studies, I’m researching how schools   can enable children to have good mental health.  I’m also a Teaching Fellow at Aston University. Just an overview of what to expect over  the next, sort of, rough 30 minutes. So,   I’ll be providing a brief overview of the  systematic approach that I’ve taken to   collecting the data for the concept analysis. I’ll  be exploring very briefly the relationship between   good mental health and mental illness. This is  just to contextualise where this presentation   is coming from, so that you can, kind of,  fit it within that. I’m going to explore   the characteristics of good mental health  and what came out of the concept analysis,   demonstrate the characteristics of that, of  good mental health, through different scenarios,   and I’m going to explore the many ways in  which we can promote good mental health. So, when developing the concept analysis,  I followed the framework of Walker & Avant.   They’ve got eight steps to their framework.  I won’t be talking through all of the steps   within this presentation. Really, the next  couple of slides are just to give you the   knowledge that this was done in a systematic  way. I did a full literature search using   all of the different Boolean operators. I  didn’t limit my literature search to any   particular date because from my own observation,  I recognise that the phrase “good mental health”   didn’t really appear in literature until more  recent times, and so, I didn’t want to exclude   any years. I just really wanted to capture the  historical dates, really, of where that appears. I had an inclusion and an exclusion criteria.  So, I focused, in the end, on only looking at   UK papers, as I wanted to understand how good  mental health is understood within the UK,   and I limited the literature search to  the children between the ages of five to   18-years-old. And I searched a wide range of  different databases. In particular, I made a   conscious effort to include databases outside of  the health domains. So, I really wanted to include   things from art and sport. Interestingly,  I didn’t find anything in either of those   databases that I searched, but I did want to  include them to really try and capture the   different ways in which we might be understanding  good mental health in other disciplines. This is just a flow diagram to show  you that systematic approach. So,   I started off with 489 articles and through  the scrutiny of the papers, I ended up with a   final count of 12 papers. Originally, there was 14  for the UK when I included the UK ones that had,   kind of, co-authorship from different countries,  but they ended up – when I looked more closely,   they were out of the age range for what I  was covering. So, I ended up with UK-only,   no international collaboration on  those papers, and 12 papers in total. So, what does good mental health look like? So,  for this piece of work, I’m really interested   in exploring good mental health. As a Mental  Health Nurse, I’m very much often focus on   people who are not very well and thinking about  how we can work with people to develop their   strengths and their hobbies and interests.  But if you’d have asked me five years ago,   before I started my doctorate, what good  mental health was and what it looked like,   I would’ve had a rough guess but really  would’ve struggled to pinpoint exactly   what it is in an objective way. And so, this  concept analysis was really there to inform a,   kind of, a foundation to my doctoral research  and to help me as a Mental Health Clinician   to understand what exactly good mental  health is and how we can promote that. So, I’m interested in a field of health called  salutogenic health. So, this is recognising   that we all can have good mental health. Even  if we’ve got a diagnosis of mental illness,   we can still have good mental health within that,  in the same way that somebody can have diabetes   but have good health. And so, good mental health  is really, if we look at the spectrum of mental   health and illness, good mental health covers  pretty much all of it, unless we’re not very   well at that moment in time. But this work around  good mental health, I’m trying to explore how do   we move people who have poor mental health towards  having more good mental health? How do we enable   people who have good mental health to develop  even more robust and strong good mental health,   or how do we encourage people to grow and  develop good mental health in general? And just   remembering that all of the literature was focused  around children and young people ages five to 18. So, the findings I’m going to put onto the next  slide, and I’ll talk through these in more detail   as we go along. The findings identified areas on  the left, here, that promoted good mental health.   The e – the, kind of, column in the middle is  what exactly is good mental health and how do   we recognise it? And the column on the right is  talking about other terminology and phrases that   came up in the literature that I’m sure you’ll  be familiar with, such as ‘resilience’ and   ‘flourishing’. But actually, in the literature,  these came up as exceeding good mental health,   and I’m going to focus on these two areas  for the time being in this presentation. So, what exactly is good mental health? So, in  the framework of Walker & Avant, they talk about   “determining the attributes” of the concept  that we’re looking at. So, in this case,   for good mental health, the literature pulled  out these different attributes. That the person   demonstrates positive coping skills, that  they engage in health promoting ways of being,   and I’ll go into more detail with these. That the  person has hope, they have a developed formation   of self, there’s autonomy and agency within the  person, there’s social compatibility and that the   person demonstrates good interpersonal skills. And  so, those are the different attributes, but yet,   you see on the right, the word ‘resilience’, which  often, I hear and see in literature being talked   about to, kind of, instil this sense of resilience  in people, that we want people to be resilience. And actually, I’m arguing that I think what we’re  meaning when we say that is we’re wanting people   to have good mental health, because resilience,  according to the concept analysis that I’ve done,   demonstrates this is something above and beyond  having good mental health. This is exceeding good   mental health. It’s almost like a gold standard  above somebody having good mental health. And so,   I guess my worry, my concern, would be that when  we talk about people needing to have resilience,   that we’re expecting people to have  something above and beyond, you know,   a real – that’s a really high achievement to have  resilience, when really, what we’re wanting people   to have is good mental health in the moment. So,  that when they’re faced with difficult times, that   they’ve got those attributes, those strengths,  that will help them work through, manage,   and survive, for want of a better phrase, the  difficult challenges that we all face in life. And a salutogenic theoretical framework for  understanding that talks about just that,   that we – when we talk about health, we can’t  move away from the fact that life is challenging,   that there are difficulties, and I think that’s  really true for children and young people,   more so when they have less resources to draw  on in the physical world. And so, if we’re   thinking about all those difficulties that young  people face, really, what we want is for them to   have really good, strong mental health, to be  able to face those challenges and come out the   other side still being mentally well. And to  come out the other side and be mentally well,   that’s called – that is resilience, and  that’s the definition of resilience is to   be able to look back at a situation and think  wow, gosh, I came out of that the other side. And so, resilience is above and beyond and it’s  something we can only look back on and know that   we’ve had. It’s not something in the moment we  can say I’m being resilient. And I’d argue that   because, you know, thinking about even my own  personal, you know, experiences across life,   there’s been times when I think I’m being really  resilient and actually, then I crash and burn,   and that’s quite a common thing that, you  know, people do experience in life. It’s   only when you come out of it the other end,  that you can look back and go, okay, yes,   I’ve come out of that now and I’ve been resilient.  So, good mental health is having the skills to   help us reach that point of resilience further  down the line, but we need to have good mental   health first in order to work through those  difficult challenges. I hope that makes sense. So, I’m going to focus on the attributes and  give you a little bit more detail to that.   This slide is just demonstrating how each of  the attributes is broken down into different   segments based on what the lea – literature was  telling us. I’m going to go through each of these   different attributes to provide a little bit more  information. I’m not going to spend too long on   them, so if you want to pause the slide before I  move onto the next one, you might need to do that. So, the first one I’m going to look at is  that where the person is demonstrating that   they have good mental health, one of the  things in which they – the ways in which   they do this is by demonstrating  they have positive coping skills,   so the ability to problem solve, the ability to  self-regulate. And they have a lack of avoidant   coping, which means that the person isn’t  avoiding doing something because of the fear   or because of not having the skills that they  need to get through that particular obstacle. Having hope is another attribute of somebody who  has good mental health. This is so important.   We talk about this in mental health  services all the time and it’s really   embedded within a salutogenic approach to  promoting mental health. So, having hope   is important. People have got to know there’s  something worth living for, there’s something   worth fighting for and there’s something worth  reaching on the other side of the challenges. And then, the next one is developed formation  of self. This is really key in children and   young people. Having all of the opportunities to  develop that sense of who they are is a big part   of having good mental health. So, a young person  who has good mental health will know who they are,   will have an idea of their identity and those  different strands of their personality and   will have the opportunity to nourish them, to  practice them, to develop them or to immerse   themselves in those different elements  of who they are. So, the photograph here,   for example, is a young person who looks  like they might be interested in music,   so that’s part of our identity formation, if  that’s what we’re interested in. And having   those different opportunities really helps to  formulate the sense of self in individuals. Things   like having confidence and self-esteem all come  under this idea of developed formation of self. Autonomy and agency, this is again, another  key one for children and young people,   because they perhaps live in a world that has  less autonomy and agency for them. And so,   a child and a young person that has good  mental health will be able to practice   and implement their autonomy and agency and  is able to seek out help when they need it,   because they’ve got the autonomy and agency  to access the things that they need. And they   know they’ve got a voice, a powerful voice to be  able to reach for the resources that they need. A young person with good mental health also  engages in health promoting ways of being. So,   these are the things that we know promote good  mental health, such as exercise and physical   activity, eating particular foods or staying away  from particular foods if they exacerbate anxiety,   for example. Having good sleep is integral,  I think we’d all agree on that. Being able   to talk about feelings and then, physical,  emotional and spiritual growth. Interestingly,   in the research that I’ve been doing, when I was  speaking with children and young people, some of   them said that spirituality or a god was a really  important part of their health and wellbeing, but   a large propar – proportion of children and young  people said that spirituality was not something   that they considered relevant, at all. So, I just  thought that was a really interesting outcome. Social connectedness. So, for having good mental  health, this is reflected by having this sense   of belonging, good friendships and a sense  of right and wrong. And then, the last one,   the young person is able to demonstrate good  interpersonal skills, so good communication   skills, but feels they have the ability to  express themselves clearly. And we can see   that some of these overlap with the other areas.  So, to be able to express ourselves clearly,   we also need to feel that we’ve got autonomy  and agency to do that. And under this heading   is about being reflective, to look back at  some of our experiences and exposures and   think about what worked well and what  we would’ve done differently, perhaps. I’m going to present three case scenarios now,   just to demonstrate how these are reflected  in somebody who has good mental health.   So, the scenario is the same for all three, but  I’ll show you the differences as I go along. I’ll   read out this model case scenario for you. If you  want to read it yourself, you might want to mute   me and then pick it back up in a minute. “A bell  sounds to signify the end of the school break.   During lunch, a girl has experienced a friendship  fallout and name calling at school. The girl   recognises she’s feeling anxious, she’s worried  and sad about the experience. Before the girl goes   back to class, she seeks to discuss it with school  staff. The girl demonstrates an understanding   that what is happening to her is wrong and that  the name calling isn’t a true reflection of who   she is as a person. The girl asks if she can  have time out to engage in a practical skill   that she finds helpful to manage her emotions.  Following this, the girl is able to return back   to class and is asked by the Teacher to join  in a group activity, which she is able to do.” So, that’s the model scenario. So, in the Walker  & Avant framework, they talk about designing a   series of different scenarios to test out the  antecedents, to see if they fit and to help shape   the antecedents as we’re working through that  concept. So, this is the scenario that I created.   The next slide shows in red text where all of  those different antecedents fit within this   scenario. You can pause the video now if you want  to look at this in more detail. As you can see,   the girl is demonstrating all of the  different attributes and the breakdown   of the different attributes in lots of  different ways throughout this scenario. The next scenario is a contrary case, it’s the  opposite. What would happen in the opposite   situation, where there was no evidence of the  antecedents? I’ll read this out for you, so again,   mute me if you prefer to read it yourself. “A  bell sounds to signify the end of the school   break. During lunch, a girl has experienced  a friendship falling [means fallout] and name   calling. The girl is feeling anxious and worried  and sad about the experience. As everyone returns   to their afternoon teaching rooms, the girl is  crying in the corridor and shouting. School staff   approach the girl and try to talk to her, but she  continues to cry and shout and starts to panic as   she runs up the corridor, away from the staff.  The girl is shouting just to be left alone.” As you can see, in this contrary scenario,  there’s no evidence of positive coping skills,   and there’s examples here of avoidant coping  strategies, where she’s “running up the corridor,   panicking, shouting to be left alone.” There’s no  evidence of positive relationships and there’s no   evidence of the girl having positive self-esteem  or positive internalisation or having positive   identity formation. All of the attributes  for having good mental health are missing   from the scenario, missing from observation,  when observing how the girl is behaving. I   hope this is helpful in understanding how the  attributes of having good mental health really   help us to understand how we can promote good  mental health in children and young people. So, how do we promote these characteristics?   So, when I was putting together the concept  analysis, one of the things that it involved   is searching the literature for the antecedents  of good mental health, which really, are the   things that help promote good mental health.  You can see on the left-hand column, here,   there’s quite a lot of different antecedents.  I’m going to go through them and break them down,   because just like the previous attributes, they  could be broken down into further bullet points,   and I’ll demonstrate that for you now.  I won’t discuss them in great detail,   so if you want to read the slides, I suggest  pausing the video and taking the time to do that. So, the first one is social relationships.  This is social relationships with adults,   with children, with people around them.  What’s coming out in my research is that   children just want to know that people like  them. They just want to know that they’re   likeable people. They want intimate  friendships, and they want to be able   to trust adults and other children, and  they want to feel respected and valued. Another way of promoting good mental health  is through connection and belonging. So,   this is a community connection, a school  connection, a sense of belonging to our family,   to our home or to our school, but having that  secure base. And a sense of connection is also   coming back to that idea of self-esteem and  confidence and knowing our formation of who we   are, understanding ourself. So, for example, if we  like reading, that we’re part of a reading group,   or if we like chess, that we’re part  of a group of friends that like chess,   or we go to a chess club. Or if we like football,  that there’s a football club that we can go to   that we feel connected to that and likeminded  people. Those things are really important. The next one is having an awareness of  self, so self-awareness of our emotions,   but also self-awareness of who we are and that  those are the different characteristics that   make up us, that make up our identity,  and feeling safe to practise that. So,   things like the types of clothes that  we wear, the hairstyles that we have,   the, you know, the style of bag that we carry,  all of these things help form our identity,   but also, our awareness of ourself as we’re  developing our own understanding of who we   are at a young age. Who we are and what is it  that I like doing and what is it that I love? Mental health literacy is the next one. I’m  sure you won’t be surprised to see this one. So,   thinking about knowledge and where young  people are getting their information from,   and the obvious answers are school, family  and, you know, the internet, YouTube,   TikTok, these types of things that we’re  familiar with. But mental health literacy,   from my research, goes much further than that.  It’s about, you know, in our everyday life,   how are we teaching and demonstrating to children  and young people, “This is what this looks like”?   Here – “As an adult, this is the situation that  I’m in, and this is how it’s making me feel,   but this is how I’m going to behave in this  situation.” So, we’re also teaching young   people through our own lived experience, and  they can see that being role-modelled to them. The next one is having a balanced environment.  So, this is talking about several different   things. It’s about having a space that  has structure and boundaries, but also,   at the same time, allows the freedom and  flexibility of children to be children.   There’s a really good book, and I cannot remember  what it’s called, but it writes about ‘adultism’,   and I would recommend it if I could  remember what it’s called. Apologies,   but if you have a look for a book around adultism,  it really talks about that balance between,   you know, recognising children as people in their  own right and thinking about the boundaries that   we put on children or the rules that we put  on children in our everyday life. If we can   release some of those, so that children have got  more autonomy, and we’re back to thinking about   more agency, so that they’ve got more freedom in  their everyday life to be able to be themselves,   which then comes back to our sense of self,  our understanding of our formation of self. So, really, all of these different things that  I’m talking to you about in terms of promoting   good mental health, they all interlink and  build a strong structure for all of the   different elements that we’re looking at. So,  that structure and freedom might be things like   – might be simple things like children being  able to choose, you know, what clothes they   wear or when they want to wear a hat and a scarf  and gloves and a coat, or when they want to go   without it, or what food they choose for tea.  And I’m not suggesting – as a parent myself,   I’m not suggesting we cook different meals,  but perhaps maybe instead of plating up food,   we could put food on the table and children can  self-serve. So, we’re introducing a little bit   more freedom, a little bit more choice and  autonomy into the everydayness of children’s   lives. That also has to be done on the boundary  of caring for children and keeping children safe,   but there’s so many rules that we put in  place, rightly so, to protect children, that   actually I think it’s about reflecting on what’s  essential and what can we let go of a little bit   to open up some struc – some freedom from that  structure, so children can be more independent? And this moves us onto the next one, which  is adults with emotional intelligence.   The children that I’ve been speaking to and  interviewing in my research really identify   that sometimes it feels like the rules are a bit  one-way, that we wouldn’t ask adults to do some of   the things that we ask children to do, and they  see that as being a little bit unfair. And so,   I’m advocating here on behalf of children and  young people, for us to think about going back to   that sense of agency and autonomy, is this really  necessary? Do we need to ask children to do this,   or do we need to set these rules and regulations,  and would we ask this of an adult? And if not,   maybe we need to think do – to ourselves,  if we’re not asking this of adults,   can we not ask it of children, as well,  and give them a little bit more freedom?  There’s a few more. So, the next  one is about accessibility. So,   for children and young people, having access  to things is really important. We know the,   kind of, pressures on mental health services  at the moment for children and young people,   but having access to that mental health and  wellbeing support, whether that’s through mental   health services or through different avenues.  Whether that’s, you know, information in books,   information on YouTube channels, information  somewhere, so that children can learn and   develop the knowledge of different approaches they  can use to support their own good mental health. This moves us on really nicely  to the next one, which is having   opportunities. For young people to have the  opportunities to develop all of these skills,   so when they’re in the moment, they’ve already  practised them, they’ve already seen them   being role-modelled by other people. Or they’ve  – they’re engaging in things already that really   helps strengthen and bolster their good mental  health. So, during those difficult times,   they’ve got things that are propping them  up, that are providing that safety wall,   safety boundary, if you like, to protect  them during those difficult times. Practical skill development. So, this is, again,  about seeing those skills being role-modelled and   having the opportunity to practise those,  to develop different techniques. You know,   not just things like breathing techniques,  but things like when you’re feeling really   anxious or stressed, going for a walk or valuing  going to bed early for a good night’s sleep,   or thinking about, you know, going to our  activity groups, football, reading groups,   speaking to people that we can trust and feel  supported by. All of those different things being   woven into everyday life, so that when challenges  happen, they’re already in place and children   have been practising those skills. And more  importantly, getting a good response when those   skills are practised. So, it reinforces that this  is something positive and safe for them to do. The next one is having good physiology for  mental health, so promoting physical exercise,   good sleep and a good diet. The next one  is about developing and enabling agency,   which we’ve touched upon a little bit, but  again, just giving children and young people   that choice. And then, the last one, I’m going  to put it up. It always raises some discussion,   so I’m just giving you the heads up, when I’ve  been doing my research. But the last one that came   out of the literature was physical human contact.  So, my research is in a school, so understandably,   when I spoke to school staff about this,  they were a little bit guarded about   this being something that they could do or were  comfortable enforcing. Some people say actually,   “With consent, I would hug a child if I could see  that they were upset.” Other people would say,   “Absolutely no, there’s no way I would touch a  child at all. Just the risks are too high for me.”   That particularly came through  if it was a male member of staff. But thinking about how us, as Clinicians and  healthcare staff, how we can build that physical   human contact. And there’s example here of, you  know, being close to somebody just when we’re   having that – reading a book with somebody or  going through information. Just that, kind of,   intimate close relationship on a professional  level, thinking about how we build that in or   how we encourage our families to have that  physical – that contact. Whether that’s a   hug or snuggling up together in the evening and  reading a book or snuggling on the sofa to watch   a programme together. Just building in those small  little moments of – builds up security and trust. Thank you so much for listening. If you are  interested and would like any more information,   or you want to share what you’re doing, or you  want to have a conversation about anything,   I’m really interested. So, please do feel free,   like, you can email me, and my email  address is there for you. Thank you, bye.