Understanding Children and Young People's Mental Health

CONTENTS

NOTES ON CONTRIBUTORS

FOREWORD

ACKNOWLEDGEMENTS

INTRODUCTION

Chapter 1: SETTING THE SCENE

1.1 Introduction

1.2 Social context

1.3 Children and young people’s mental health

1.4 ‘Every Child Matters’: What can we do to help?

1.5 Conclusion

Recommended reading

Chapter 2: THE FAMILY

2.1 Introduction

2.2 What is ‘normal’ family functioning?

2.3 The family life cycle

2.4 Family structure

2.5 Recent developments: narrative approaches to family therapy

2.6 Attachment and family therapy

2.7 Parenting support and education

2.8 Conclusion

Recommended reading

Chapter 3: PSYCHOSOCIAL DEVELOPMENT

3.1 Introduction

3.2 Theories of development

3.3 Infant attachment

3.4 Adolescent identity formation

3.5 Adolescent self-esteem

3.6 Adolescent reasoning ability

3.7 Adolescent egocentrism

3.8 The psychological impact of puberty

3.9 Adolescent brain development

3.10 The value of contextual theories in explaining development of children and adolescents

3.11 The PVEST model

3.12 Conclusion

Recommended reading

Chapter 4: SELF-HARM

4.1 Introduction

4.2 What is self-harm?

4.3 How common is self-harm?

4.4 Vulnerability and resilience

4.5 Promoting resilience

4.6 Models of self-harm

4.7 Assessment

4.8 Intervention

4.9 Informal support

4.10 Promoting positive behaviour

4.11 Self-help

4.12 Making access easier

4.13 Talking therapies

4.14 The personal impact of working alongside children and young people who self-harm

4.15 Conclusion

Recommended reading

Resources

Chapter 5: DEPRESSION

5.1 Introduction

5.2 Defining depression

5.3 Prevalence

5.4 Vulnerability

5.5 Assessment

5.6 Symptoms of depression in children and young people

5.7 Protective factors and promoting resilience

5.8 Interventions

5.9 Cognitive–behaviour therapy

5.10 Interpersonal psychotherapy for depressed adolescents

5.11 Medication

5.12 Psychodynamics

5.13 What else helps?

5.14 The family

5.15 Conclusion

Recommended reading

Websites

Chapter 6: SUICIDE

6.1 Introduction

6.2 What is suicide?

6.3 How common is suicide?

6.4 Vulnerability

6.5 Resilience

6.6 Risk assessment

6.7 Models of assessment and intervention

6.8 Applied suicide and intervention skills training

6.9 Skills-based training on risk management

6.10 Intervention

6.11 Prevention

6.12 Postvention

6.13 Conclusion

Recommended reading

Websites

Chapter 7: CHILD ABUSE AND CHILD PROTECTION

7.1 Introduction

7.2 Definitions of child abuse

7.3 Incidence and prevalence

7.4 Risk factors

7.5 Policy

7.6 Assessment

7.7 Prevention

7.8 Interventions

7.9 Conclusion

Recommended reading

Web resources

Chapter 8: EATING DISORDERS

8.1 Introduction

8.2 What are eating disorders?

8.3 How common are eating disorders?

8.4 What causes eating disorders?

8.5 Resilience factors

8.6 Assessment

8.7 Interventions

8.8 Psychological support

8.9 Conclusion

Resources

Books

Chapter 9: EARLY ONSET PSYCHOSIS

9.1 Introduction

9.2 Time to change?

9.3 Prevalence

9.4 Vulnerability to psychosis

9.5 Early and very early onset psychosis

9.6 Phases of psychosis

9.7 Prevention and early intervention

9.8 Assessment

9.9 Interventions

9.10 Drug treatment

9.11 Effectiveness of medication

9.12 Side effects

9.13 Talking therapies

9.14 Promoting resilience, staying well and recovery

9.15 Involving the family

9.16 Conclusion

Recommended reading

Websites

Chapter 10: ADHD

10.1 Introduction

10.2 What is ADHD?

10.3 The experience of ADHD

10.4 ADHD as a diagnostic category

10.5 Prevalence

10.6 Risk factors

10.7 Resilience: factors affecting outcome

10.8 Assessment

10.9 Interventions

10.10 Conclusion

Recommended reading

Chapter 11: AUTISTIC SPECTRUM DISORDERS

11.1 Introduction

11.2 Definition and classification

11.3 Prevalence

11.4 Risk factors/causation theories

11.5 Associated problems

11.6 Development

11.7 Assessment and diagnosis

11.8 Management of care

11.9 Conclusion

Recommended reading

Useful websites

Chapter 12: MISUSE OF SUBSTANCES

12.1 Introduction

12.2 Substance use and substance misuse

12.3 Prevalence

12.4 Patterns of use and misuse in children and young people

12.5 Vulnerability and resilience

12.6 Environmental and family factors

12.7 Early intervention and recognition

12.8 Assessment

12.9 Intervention

12.10 Conclusion

Recommended reading

REFERENCES

INDEX

This edition first published 2011

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Library of Congress Cataloging-in-Publication Data

Understanding children and young people’s mental health / edited by Anne Claveirole, Martin Gaughan.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-72345-6 (pbk. : alk. paper) 1. Child psychiatry. 2. Child psychopathology. 3. Adolescent psychiatry.

4. Adolescent psychopathology. I. Claveirole, Anne. II. Gaughan, Martin.

[DNLM: 1. Mental Disorders. 2. Adolescent Psychology. 3. Child Psychology. WS 350 U548 2011]

RJ499.U477 2011

618.92′89—dc22

2010013939

A catalogue record for this book is available from the British Library.

Dedication

I would like to dedicate our book to my mother and father — Anne

To Babs, for being so kind and supportive, and Kirsty for being everything a father could wish for — Martin

NOTES ON CONTRIBUTORS

Liz Brodie

RMN, MA (Hons), PGDip Drug and Alcohol Studies, PG Cert (TLHE)

Lecturer in Mental Health

School of Nursing, Midwifery and Social Care

Edinburgh Napier University

Edinburgh

Scotland

Anne Claveirole

RGN, RMN, RNT, L es L., MSc, Cert Ed, PhD

Lecturer and Researcher in Children and Young People’s Mental Health

School of Nursing, Midwifery and Social Care

Edinburgh Napier University

Edinburgh

Scotland

Gavin Cullen

RMN, BSc in Mental Health Practice, PG Certificate in CBT

Senior Charge Nurse

NHS Lothian Child and Adolescent Mental Health Services

Royal Edinburgh Hospital

Edinburgh

Scotland

Martin Gaughan

RMN, RNLD, MPhil, PG Cert (TLHE), Bsc (Hons)

Lecturer in Children and Young People’s Mental Health

School of Nursing, Midwifery and Social Care

Edinburgh Napier University

Edinburgh

Scotland

Julie Hendry

RMN, PGDip Child Care and Child Protection

Mental Health Practitioner

Co-ordinator in Child Sexual Abuse Team

NHS Lothian Child and Adolescent Mental Health Services, Edinburgh

Scotland

Geraldine Jones

BA (Hons), BSc (Hons), MSc Occupational Psychology, DEd Pscyh

Member of the British Psychological Society

Lecturer in Developmental Psychology School of Life, Sport and Social Sciences

Edinburgh Napier University

Edinburgh

Scotland

Lorna Jones

RN (Mental Health), BSc (Hons) Neuroscience, BSc Mental Health Nursing, NMC Registered Specialist Practitioner (Mental Health)

Independent and Supplementary Nurse Prescriber

Team Leader/Community Nurse Specialist in ADHD Team

NHS Lothian Child and Adolescent Mental Health Services

Edinburgh

Scotland

Marlene Macinnes

MA (Hons), BSc (Hons), MSW, Dip SW, Certificate in Child Protection Studies

Social Worker, NHS Lothian Child and Adolescent Mental Health Services

Edinburgh

Scotland

Gillian Marshall-McConnell

MA Professional Development – Disability Studies, PGCE Special Needs

Independent Consultant Related Qualifications and Assistant

Director for the Scottish Society for Autism

Glasgow

Scotland

Jayne Reed

RN (Mental Health), BSc Nursing with Health Studies, MSc Adolescent Addiction Studies

Senior Community Mental Health Nurse (Young People and Substance Use)

NHS Lothian Community Drug Problem Service

Edinburgh

Scotland

Duncan Tennant

RMN, RGN, MSc, UKCP Registered Family Therapist

Senior Specialist in Systemic Psychotherapy at the Department of Psychiatry at St John’s Hospital, NHS Lothian

Livingston, West Lothian

Scotland

FOREWORD TO UNDERSTANDING CHILDREN AND YOUNG PEOPLE’S MENTAL HEALTH

During the last 20 years or so, spurred in many ways by Rutter’s epidemiological study in the mid-1970s, the whole subject of children’s mental health has risen quite extraordinarily on the political agenda. Before then, the emphasis of concern amongst those working closely with children largely rested upon children’s social and economic welfare, their education and protection. The idea of ‘children’s mental health’ sat uncomfortably in people’s minds – the word ‘mental’ being so firmly associated with illness that to put it alongside that of ‘children’ was tantamount almost to stigmatising them all. Gradually, however, there has occurred a significant shift in thinking in social policy. The mental health of children is now seen as of crucial importance, and the promotion of children’s mental health at large is now viewed as necessary as the prevention and treatment of specific mental health problems.

Two reasons for this stand out. The first has to do with a growing realisation that so many of the social ills that worry us all – criminality, violence, drug and alcohol misuse, dysfunctional families, child abuse – have much to do with the mental health of those involved. The knowledge that we have gained, during the course of the twentieth century and more recently, of child development and family functioning has brought home to us the fact that we can so readily make sense of many of these problems and indeed anticipate them. The other has to do with a growing recognition that some of the pressures of our contemporary society are bearing heavily on the minds of our children, so much so that their mental health is in jeopardy. The inexorable pace of technological and cultural change in our times in an ever widening global context is making the task of growing up increasingly difficult. It is also making the art of parenting all the more challenging. Most of the evidence that we now have testifies to the fact that we have a mounting child mental health problem on our hands.

It is in the midst of this frankly alarming context that we welcome the arrival of this book. It sets out to help us understand what is going on in the minds of children and young people today and in their parents and carers. It lays out the social, cultural and family predicaments in which children are living and then takes us through some of the different kinds of muddle and trouble and anxiety and terror that different kinds of children suffer at different times of their lives. Throughout, it holds in mind the sheer complexity of children’s mental health problems, the sheer interdependence of so many factors that influence the course of their development. Children struggle through life with different endowments, different experiences of attachment to their parents, different shapes and sizes of families. Children from different ethnic backgrounds have to make their way against particular resistances and obstacles in our society. And boys and girls go through different mental experiences as they deal with their different bodies and the expectations placed upon them by other children and adults.

It is indeed a confounding world of difference, something that clearly defies clean categorisation or certain diagnosis and treatment. In relation to most of the mental health problems and disorders, there is an almost insurmountable difficulty in arriving at a consensus about definition. And because of this, prevalence rates of child mental disorders vary widely.

However, despite such complexity, all is not lost – for in the face of it, therapeutic endeavours of all kinds abound. It is an endearing characteristic of most therapists and carers that, in the face of adversity and often long odds, they carry an abiding hope that they can make things better for the children and their families who come their way. However damaged or thwarted children may be, therapists and carers work to help them to become ‘what they are capable of becoming’ and to be as flexible and as resourceful as they can be under the circumstances in which they live. It may be that they do not fully succeed, that minimising harm may be as much as can realistically be achieved in some cases, but at least they try to bring about positive change.

How they go about doing this is a story in itself. The ways of therapy are diverse and in many ways baffling. Whatever may be asserted by some therapists, the fact is that little is known for sure from research about which therapeutic techniques work best with which kind of children from which kind of environment at which point in time. However, what can be said with some conviction is that no therapy can work without nurturing a consistent and reliable therapeutic relationship in which the child can feel safe enough to communicate his or her difficulties. There is much to be said too for those therapies that excite a curiosity in children to explore their selves and behaviour, as well as those that can bear the paradoxical and complicated nature of so many mental health problems in children and families. For example, what tolerance do therapists have in making sense of the young teenager who damages her body ‘in an attempt to preserve the integrity of the mind’ (p. 112)? And how far can they give due consideration to those who have the everyday responsibility of caring and parenting and teaching children in difficulty with themselves and others?

The authors of this book need to be congratulated on tackling the many various issues and problems that any study of child mental health involves. Their writing is direct and straightforward, they provide us with useful facts and they give us a measured and unbiased analysis of the variety of views and perspectives that abound in this field. Their chapters, moreover, are organised in such a way that they leave us with little doubt where we are going and what we are supposed to do. They set us activities which we are expected to carry out and introduce us to the relevant literature and resources.

All in all, the book generates a sense of critical enquiry within us and reminds us that the promotion and treatment of children’s mental health is everybody’s business. In this day and age (to pick up the first few words of the Introduction to this book), children’s mental health is now truly seen as a major public health issue. The Scottish Executive’s title for its report on child abuse (2002a) captures the gist of it all: It’s Everyone’s Job to Make Sure I’m Alright. And it can be said that it is the job of this book to go some way in making sure that this happens.

Peter Wilson

Psychotherapist and former Director of YoungMinds

ACKNOWLEDGEMENTS

We would like to thank the library staff at Comely Bank Campus who under the excellent leadership of Sheena Moffat have been so helpful and supportive over the years: Margarete Case, Cathy Coventry, Margaret Green, Julie McGregor, Agnes Miller, Cluny Nixon, Brenda Prior, Val Robertson, Simon Ward and of course Sheena Moffat herself.

We would also like to thank the young people with whom we have worked over the years: you have been an inspiration to us. Finally thanks to all our colleagues in the mental health team at Edinburgh Napier University and in the NHS Child and Adolescent Mental Health Services: most of our ideas have come to maturity through discussions with you.

INTRODUCTION

In this day and age, children and young people face challenges unknown to those of previous generations. They have to perform educationally, socially and interpersonally. They are expected to look good and called upon to make consumer choices. They negotiate relationships using methods and media unheard of 20 years ago, from text messaging to online networking. Their behaviour is recorded, examined and made public through ‘YouTube’ and ‘Bebo’. They are available 24 hours a day via mobile phones and the Internet. As technology develops, they will have to accommodate further changes. For some young people, the hurdles are made greater by adversity, whether poverty, physical, learning or developmental disability, trauma, immigration, asylum seeking or refugee status. Children and young people face these unprecedented challenges under the scrutiny of the public and the critical eye of the media.

As society changes, family life is exposed to turmoil. Many children and young people have to make sense of and adapt to the changes imposed by separation, loss, divorce and the reconstitution of families. Those looked after by local authorities have to adopt new rules and negotiate different ways of being, with new adults in their lives, sometimes in institutional settings. In refugee and asylum seeking families, they have to adapt to a new culture, in unfamiliar surroundings, often in poverty. This book is about the mental health challenges children and young people face and how we, adults, can work alongside them to help them face and overcome such challenges.

What is remarkable is that most children and young people are able to cross the choppy waters and emerge into adulthood relatively unscathed. However, there is also growing concern about changing trends in their mental health, with new risk factors for all, and particular ones for some, of developing problems. The mental health of children and young people receives increasing attention. More than ever before, their emotional and psychological well-being has become the subject of research, with a new focus on the early years.

In this book we have brought together practitioners and academics who are specialists in the theory and practice of children and young people’s development and mental health to write about particular areas of interest and expertise. Our aim is to inform and challenge the reader with its content, and to encourage further exploration of the subject. We hope that, while it starts from a UK perspective, this text will be of interest to people working in other English-speaking countries.

The initial chapters focus on the context of children and young people’s lives: twenty-first century society (Chapter 1) and the family (Chapter 2); Chapter 3 examines individual psychosocial development at two crucial moments of a child’s life, infancy and adolescence. In Chapters 4–12, we have chosen to present particular mental health difficulties which children and young people may have to face; not every category of problem is there, nor do we believe that children and young people’s problems can be neatly packaged. We recognise that there is a need to focus on those children and young people who have complex needs and do not fit easily into diagnostic categories. Children and young people with learning disabilities, those looked after and accommodated, refugees and asylum seekers, ethnic minorities and those young people whose developing sexuality takes them beyond expected social norms are neglected groups whose mental health issues can be overlooked. Standard interventions are not suitable for everyone and may need to be adapted to engage and support children, young people and families who differ from the mainstream, live on the margin of society or are viewed as ‘different’. The chapters on mental health challenges highlight some of the complex problems children and young people face and we intend them to be read as information resources, to encourage reflection and an examination of values, attitudes and thoughts.

Much of the writing in this book is about relationships. The relationships children and young people have in the home are the bedrock of mental health, from the earliest bond between mother and child to the growing bonds between all family members – which must lead us to pause and reflect on the needs of those who do not have families, or those who live in chaotic families, and consider the different and sometimes challenging environments in which children and young people develop. The relationships young people have at school and with significant adults in their local environments are also crucial. Thinking about how we, as health and social care staff, engage young people, and their families/carers is central to working alongside children and young people.

At the time of writing, a number of key strategies which embrace newer ways of constructing mental health are being proposed in England and Scotland. In England, the Department of Health (2009) is consulting on ‘New Horizons’ – a mental health strategy with a whole population approach which lays the foundation for community ownership of mental health issues. For more than a decade, the Scottish government has been at the forefront of development in proposing that mental health be mainstreamed and that everyone take responsibility for ensuring that children reach their full potential. It is encapsulated in Towards a Mentally Flourishing Scotland (Scottish Government, 2009). We hope Understanding Children and Young People’s Mental Health will contribute to increasing awareness of children and young people and that it will promote reflection on the mental health issues that affect them.

Chapter 1

SETTING THE SCENE

Anne Claveirole

School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, Scotland

1.1 Introduction

In this chapter, we will examine the context in which the mental health problems of children and young people emerge: our western society and its recent developments; the globalisation process and its impact on our culture; what children and young people’s mental health is, what endangers it, what protects it and how we can promote it; what mental health problems are, how we might prevent their occurrence as well as intervene to resolve, or at least improve, them. We take a child to be under 18 years of age.

Learning outcomes

After studying this chapter, you should be able to:

1. Reflect on the present social conditions of industrialised countries, such as the one you live in, with regard to community, individualism, trust and well-being.

2. Appreciate the impact of social conditions in industrialised countries on some indicators of children and young people’s well-being.

3. Define mental health in younger people and discuss the difference between mental health problems and mental disorders.

4. Be aware of current trends in children and young people’s mental health difficulties and have some understanding of their evolution.

5. Recognise the difference between risk, protective, precipitating and maintaining factors in the lives of children or young people who have mental health problems or mental disorders.

6. Understand and critique current national mental health-promoting strategies aimed at influencing the mental health of children, young people and families.

7. Critically examine your service’s own assessment procedures and reflect on its treatment practices regarding the therapeutic relationship with and participation of children, young people and their parents.

1.2 Social context

Global context

Globalisation is a recent word which refers to the growing interdependence of individuals and nations. Cultural, economic and political changes in one corner of the globe affect everyone’s environment, economy and politics: we are increasingly aware of living in one world, linked by active networks of information and communication.

Throughout this world, societies have changed more rapidly in the last hundred years than at any time in history. Pre-modern societies (hunting–gathering, pastoral or agrarian) have been disappearing, leaving just a few in remote areas of the earth, undermined by modernisation. Previously traditional countries like India and China are becoming industrialised and their populations urbanised. In the nations of Europe and North America, the rate of technological development has led to radical changes in social structures and lifestyles. These changes have taken place over an extremely short time:

The Englishman of 1750 was closer in material things to Caesar’s legionnaires than to his own great-grandchildren (Landes 1969 in Fulcher and Scott 2007).

The way nations weather such changes has an impact on national communities and individuals: the families, children and young people who are the focus of this book. When, in 1989, the United Nations issued the Convention on the Rights of the Child (United Nations 1989), their intention was to lay down international norms of well-being for all children regarding their entitlements to protection, education and, in proportion to their growing maturity, self-determination. Most states of the world signed this convention because they recognised that children’s successful growth and development is the key to a society’s well-being and its future, and that it cannot be left to chance.

Yet, as we take stock, global development does not appear fully to support the goals of the convention. Disparity of wealth throughout the world has increased: over 21% of the world’s population still lives on less than a dollar a day (Bellamy 2005), and more than 80% live in countries where income differentials are widening (United Nations 2007). Although many poor countries signed the convention, their struggle to invest in health, education and social welfare remains acute and often fails. In wealthy ones, there is growing awareness that childhood is being shaped by forces which are often at odds with the best interests of children (UNICEF 2007).

This English-language text will focus on children and young people’s mental health in English-speaking industrialised countries, taking the UK where it is published, as its starting point. However, immigration brings into these countries the influence of many other cultures on child development, child care and family life, and this must be taken into account.

Rich industrialised countries

In the UK, the Centre for Economic Performance (CEP) at the London School of Economics reviews evidence from the social sciences, particularly psychology and economics, to make policy recommendations to the government (http://cep.lse.ac.uk/_new/about/default.asp). As part of its programme of research, the CEP has investigated mounting evidence that well-being has been static since the Second World War in spite of unprecedented economic growth (Layard 2005). Whereas people are richer, work less, have longer holidays, travel more, live longer and are healthier, they are not happier, and the correlation between income and well-being stops at a certain average gross domestic product (GDP); evidence of this exists for industrialised countries like Japan, North America and those of the European Union (Layard 2005). Moreover, levels of clinical depression, alcoholism and crime, which show a considerable increase in the same period in the same countries (Rutter and Smith 1995), confirm that wealth does not mean happiness. Layard (2003) defines happiness as ‘feeling good’ and ‘enjoying life’ and unhappiness as ‘feeling bad and wishing things were different’. Another indicator of this surprising state of affairs is a recorded increase in mental health problems across all age groups but particularly among young people (West and Sweeting 2003, Collishaw et al. 2004).

In the same vein, recent findings from an extensive public consultation regarding society today, conducted in the UK by the Joseph Rowntree Foundation (JRF), show a strong consensus of views among respondents that shared values have declined, communities break up, individualism is high and poverty is corrosive in our otherwise affluent society (JRF 2008). Layard’s research (2005) found something similar: in 1999 less people thought others could be trusted (29%) than in 1990 (44%) or in 1959 (56%). Autonomy, self-determination and individual freedom are currently held as core social values; however, when individuals come to think that making the most of their own life is their primary duty, ahead of community concerns and looking after each other, a balance is lost and individualism sets in (Layard 2005), which is the opposite of trust and mutuality. Yet trust plays an important part in social well-being. In an analysis of the findings of the annual life satisfaction survey Gallup World Poll taken in 130 countries (Gallup Organisation 2007), the economist John Helliwell (2003) draws attention to the fact that trust is closely linked to life satisfaction. Trust in neighbours, the police, colleagues and employers is rated as highly valued so that the way people relate to each other and the extent to which they engage in helping others correlate strongly with their satisfaction with life. Helliwell (2008) suggests that this should be more regularly monitored in global and national surveys and used for planning in organisations, businesses and communities.

Activity

Look up Helliwell in this chapter’s Recommended Reading section and go to the recommended website.

Read one of Helliwell’s papers, make notes of the main messages and take time to reflect on the issues.

Children and young people face pressures which are not dissimilar to those of adults: growing economic inequality, pressure to consume, family break-up, competition with peers and focus on achievement; new technologies and media which expose them to new activities and pleasures but also to dangers and difficult choices (Layard and Dunn 2009). If they do not do well, their future may be compromised. A successful adult life in the complex economies of industrialised countries requires a high level of education and skills, yet many young people do not complete their secondary school education and do not have the qualifications that will enable them to access employment (European Commission 2008). UNICEF (2007: 39) raises concerns about ‘the changing ecology of childhood’ in rich countries because the social context there, marked by economic instability, individual priorities and rumbling discontent, does not prioritise the nurturing of children and young people.

Impact on children and young people’s well-being

The Good Childhood Inquiry commissioned by the Children’s Society (Layard and Dunn 2009) suggests that children and young people experience childhood in a different way to previous generations. The report mentions some of the changes which have brought this about:

Information technology: children have access to previously unimaginable levels of information;

Demographics: children regularly interact with different cultures, languages, faiths and traditions (some schools service populations where up to forty languages are spoken);

Family break-ups and both parents working;

School examinations and pressure for good results;

Highest level of relative poverty for 50 years and an increased lack of social mobility.

Such concerns about children’s well-being are paradoxical because, like adults, children have better lives than ever before: better health, better education, better homes, more holidays away and more money and possessions, including access to technology for communication, music and entertainment.

How do children and young people fare in our English-speaking industrialised countries? In 2007 UNICEF, the United Nations’ arm concerned with children’s welfare, published an overview of children’s well-being in countries of the Organisation for Economic Cooperation and Development (OECD), using as much data as were available and comparable in each country. The OECD is a group of 30 industrialised nations founded in 1948 to develop economic and social policy. All its member states are based on representative democracy and have a free market economy; together they account for two-thirds of the world’s goods and services (UNICEF 2007). In the report, each country is scored on six dimensions of well-being broadly corresponding to sections of the United Nations Convention on the Rights of the Child (1989): material well-being, health and safety, education, family and peer relationships, behaviours and risks, and subjective well-being (see Table 1.1). By well-being UNICEF means the following:

When we attempt to measure children’s well-being what we really seek to know is whether children are adequately clothed and housed and fed and protected, whether their circumstances are such that they are likely to become all that they are capable of becoming.

Above all we seek to know whether children feel loved, cherished, special and supported within the family and community, and whether the family and community are being supported in this task by public policy and resources (UNICEF 2007).

The UNICEF report shows the UK and USA faring poorly on almost all measures of child well-being. The average score of these countries puts them at the bottom of a league of 21 rich nations for which enough comparable data were available. Ireland and Canada are in the middle third of the table; no suitable data were available for Australia or New Zealand (see Table 1.1). Findings from the UNICEF 2007 report are summarised here together with comments from a 2009 report on child well-being and poverty in Britain, which addresses similar issues (Child Poverty Action Group, CPAG, 2009).

Table 1.1 Summary of the Findings of a UNICEF (2007) Report Regarding Six Dimensions of Child Well-being in 21 Rich Countries

Source: Adapted from UNICEF (2007).

These 21 OECD countries had sufficient comparable data to be included in the table; nine others (Australia, Iceland, Japan, Luxemburg, Mexico, New Zealand, the Slovak Republic, South Korea and Turkey) did not.

*Each number denotes a dimension of well-being: 1: Material well-being; 2: Health and safety; 3: Educational well-being; 4: Family and peer relationships; 5: Behaviour and risks; 6: Subjective well-being.

**The overall ranking for the USA is determined by its average rank over five of the six indicators; insufficient data being available for the ‘Subjective well-being’ category (see report p. 26).

The effort to measure and monitor child well-being is recent. The available data still vary across countries. This UNICEF Report Card (2007) is more detailed and complete than previous ones but there are still gaps and inadequacies. One of these is the prevalence of data regarding mainstream children (those who live at home and go to a standard school) over data about vulnerable and excluded children: those with disabilities, those who do not go to school, those from ethnic minorities, refugees and children brought up in institutions. However, efforts are now being made to develop representative indicators of child well-being and to collect comparable data across the world.

Indicator 1: material well-being

Poverty was assessed by combining indicators of relative income poverty, unemployment and deprivation. It is well documented that poverty affects child well-being in multiple ways, particularly if it is prolonged (Bradshaw and Mayhew 2005). Children brought up in poverty are more vulnerable to poor health, learning and behavioural difficulties, underachievement, low aspirations, teenage pregnancy, low skill levels, low-paid jobs and unemployment. This does not mean that many children brought up in poverty as it is defined here will inevitably experience these negative outcomes but it does mean that poverty is a serious disadvantage.

In 4 of the 21 countries considered, less than 5% of children live in relative income poverty (a certain percentage below national