In this section I introduce common terms including mental health, mental wellbeing and mental disorder. I look at how common youth mental disorders are and explain how we assess them. Finally, I consider how to support children and young people with mental disorders.

What Is Mental Health? What about Mental Wellbeing, Mental Fitness and Mental Flourishing?

• ➢ Mental wellbeing, also often known as mental fitness, describes your mental state, i.e., how you are feeling and how well you can cope with day-to-day life, which can change quickly. Mental and physical fitness are of equal importance.

• ➢ Mental flourishing is the state of experiencing positive emotions, psychological and social functioning, most of the time, and enables you to engage with a meaningful life (1). Its opposite state is languishing, where people may describe their lives as ‘hollow’ or ‘empty’.

• ➢ Mental health, according to the World Health Organization (WHO), is ‘a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’ (2). Mental health is a longer-term state than mental wellbeing or fitness and tends to change more gradually.

How Are Mental Health and Wellbeing Linked?

Mental health and wellbeing are linked and are overlapping concepts, but they are not the same.

• ➢ If you experience difficulties with mental wellbeing for some time, you are more likely to develop mental health problems. For example, children who live in very deprived communities with little support are much more vulnerable to mental health problems than those from well-off communities and with good support from parents and caregivers.

• ➢ If you already have a mental health problem, like bipolar disorder, you are more likely to have periods of low mental wellbeing. However, it’s also worth noting that people with mental health problems can also have times when they experience positive wellbeing. In our example, the person with bipolar disorder can have periods when their wellbeing is very good, for example in between episodes of illness. That’s why aiming to improve mental wellbeing is important whatever your mental health status.

Which Factors Can Affect Mental Wellbeing and Mental Health?

Several factors can affect mental wellbeing and mental health:

• ➢ Positive mental wellbeing is influenced by lifestyle factors like sleep, diet and exercise, positive relationships as well as school and home experiences. Children who develop in lower-stress environments will generally be more able to experience positive mental wellbeing.

• ➢ A mixture of inherited and environmental factors can interact to cause mental health problems. For example, when a parent has alcohol problems, the child has an increased risk of mental health problems. However, the child’s risk of developing mental health problems is also influenced by other factors, such as their genetic makeup and their available support. This illustrates the complex interplay of both genes and environment which make up an individual’s risk of mental health difficulties.

• ➢ Many factors are common to both mental wellbeing and mental health. For example, severe early attachment difficulties, stress and trauma, and poverty and inherited factors can affect both mental health and mental wellbeing. A 2016 UK study by Patalay and Fitzsimons looked at predictors of mental illness and wellbeing in 11-year-olds (Reference Patalay and Fitzsimons3). It showed that mental wellbeing was predicted by aspects of a child’s social life and relationships, such as bullying, and perception of feeling connected to others at school. On the other hand, other factors such as underlying health problems are more likely to predispose to mental health disorders. Mental health disorders are also strongly affected by other important factors, such as inheritance.

What Is a Mental Health Disorder? What about a Mental Condition?

There is often confusion around whether to use the term ‘mental disorder’ or ‘condition’. A good rule of thumb is as follows:

• ➢ A mental health disorder is a behavioural or mental pattern of symptoms that causes significant change which can impair functioning. There is a noticeable step change in functioning from a period of being well to being mentally ill. For example, you can have an episode of depression where you become unwell and struggle to function, after which you recover.

• ➢ A mental health condition is a term used for in-born difficulties such as autism and ADHD where the brain is wired up differently. There isn’t a significant step change in functioning from being well to being unwell. Instead, the brain is on a different developmental pathway to what is typical, and a condition will evolve over time. There isn’t a specific cure for mental conditions such as autism.

What Proportion of Young People Have a Mental Health Disorder?

• ➢ 1 in 6 children and young people (aged 5–19 years) in the UK in 2021 had at least one mental health disorder (4).

• ➢ 50% of mental disorders develop by age 14. This shows why investing in young people’s mental health is so important and has long-term implications.

How Do Mental Health Professionals Assess Someone’s Mental Health?

• ➢ Mental health professionals are trained to assess a person’s mental state. This includes assessing how someone looks, speaks, understands and behaves. We ask questions about mood, thoughts and the person’s ability to understand experiences.

• ➢ Observation of play and behaviour is often more helpful in younger children than asking direct questions.

• ➢ Taking a history of a child’s or young person’s difficulties is a core part of a mental health assessment. There is a systematic format for the process of gathering information which involves getting key information from the young person or child themselves, if possible.

• ➢ Gathering information from significant adults around the child is a crucial part of the assessment.

• ➢ We also look at a child’s or young person’s ability to function or do the activities needed to manage at school, family life or friendships.

How Can You Best Support Children’s Mental Wellbeing?

• ➢ You can help children and young people develop positive mental wellbeing and learn coping skills for managing stress.

• ➢ Firstly, ensure children’s basic needs are met, including offering supportive care and providing them with enough food, shelter, rest, security and warmth. Maslow, a psychologist writing in 1943, famously set out a pyramid of basic needs. Food, water, rest, warmth and safety are at the bottom of the pyramid and being able to think creatively is at the top (Reference Maslow5).

• ➢ Attend to the child’s inner psychological needs. What makes each child tick? Understanding this is an evolving process and the best approach is to listen to the child and try to make sense of their thinking.

• ➢ Read and understand helpful materials. By reading this book you are one step ahead. You can also consult useful online resources, for example the Royal College of Psychiatrists’ website www.rcpsych.ac.uk to support positive mental health and wellbeing.