Director of Public Health Annual Report 2023: Mental health matters

Good mental health starts before you are born and is shaped by experiences in the first years of life. A child’s emotional development is affected by the mental health of mothers during their pregnancy and the mental health of both parents after birth.

As children grow and develop other factors become important. This includes the support they receive from friends and from their school. Physical activity, contact with nature, and involvement with arts and music have also been shown to promote good mental health in children and young people.

The mental health of women during and immediately after their pregnancy has been shown to have a lasting impact on a child’s social, emotional and cognitive development.

Good mental health care during this period has been linked to fewer early births, lower infant deaths, better school attainment and reduced depression and anxiety in children.

Conversely, poorer mental health can have a long term negative impact on women, their partners and their children. Indeed, studies have linked stress of mothers during pregnancy to poorer mental health of their child in adulthood.

As many as 1 in 5 women experience mental health problems when they are pregnant or in the first year after they have had their baby. For some these problems are new while for others they represent a continuation or worsening of existing mental health issues. Depression and anxiety are most common but women can be affected by the full range of mental health conditions.

Both international evidence and UK surveys indicate that the Covid-19 pandemic increased the risk of mental health problems for pregnant women, with factors such as reduced support and worries about money increasing the risk of anxiety and depression.

It is important that mental health issues in pregnancy are recognised and treated. This may require action to overcome barriers to accessing support. This includes poor awareness amongst women and health care professionals and an unwillingness to talk openly about mental ill health.

The mental health of fathers is also important, especially as around 1 in 10 fathers experience perinatal depression.

The mental health of a father influences a child’s emotional development and fathers can have an important role in shaping a child’s family environment and providing a secure emotional bond.

A secure emotional bond with at least one caregiver is linked to longer term emotional health and evidence suggests a good bond between the baby and mother or father can have immediate and long-term consequences for positive mental wellbeing.

A secure emotional bond is built on the reliability and warmth of the parent or caregiver. For example, a parent who plays with, talks to, and cuddles their baby.

A parent or caregiver regularly reading to a child has been linked to improved social and emotional outcomes for both children and their parents, with the impact increasing the more often they read.

Becoming a parent can be a big change and some families benefit from extra support. Parenting programmes have been found to improve behaviour in children, reduce mental disorders, and positively impact on the mental health of parents.

As well as a supportive family, having friends is important to the mental health of children and young people, particularly during the teenage years.

There is good evidence linking loneliness to poorer mental health in adults and some research to suggest that this is also the case for children and young people.

In a national survey in 2016-17, 11.3% of British children (aged 10 to 15 years) and 9.8% of young people (aged 16 to 24 years) said they were often lonely. Loneliness was much higher in children in receipt of free school meals with more than a quarter (27.5%) saying they often felt lonely.

There is some evidence that loneliness amongst children and young people significantly increased in response to the Covid-19 pandemic.

The 2021 OxWell survey of just over 3,000 children and young people in Buckinghamshire found that 8.3 % of primary school age children often felt lonely with this figure increasing to 19% of secondary school age children, and 24.2% of young people in sixth form. A health and wellbeing survey will be conducted in 2023 and will help identify whether this has changed.

Moving beyond family and friends, schools can play an important role in promoting and protecting the mental health of children and young people. NICE guidance recommends that schools take a “whole school approach” to mental health, adopting a culture and ethos that supports the mental health of both children and staff.

A positive school environment can help children and young people develop skills in social, emotional and mental wellbeing both through the curriculum and through activities outside the classroom, including through play.

Schools are also uniquely placed to identify and provide targeted support for children at risk of worse social, emotional and mental health as well as support during life changes that have the potential to impact on mental health.

Physical activity is linked to many factors that promote better mental health, including improved sleep, higher self-esteem and self-confidence, reduced anxiety and lower depression.

For example, one English study found that just one hour of light physical activity each day resulted in a lower depression score (by between 8-11%) for children and young people aged 12-16 years.

Children and young people should aim for about one hour of moderate or vigorous physical activity every day.

Being around nature has been linked to both increased levels of physical activity and mental health benefits.

The strongest benefits occur where children have access to green space where they live or where they go to school. Forest school activities have been linked to improved physical skills (motor skills and physical stamina) and increased self-confidence. A 2020 survey of English children aged 8 to 15 found that 85% agreed that being in nature made them “very happy”.

There is promising evidence that involvement with arts, dance and music can improve the mental health of children and young people. There is also growing research into the use of arts and music in the treatment of mental health conditions.

Art therapy uses visual arts such as drawing, painting and sculpture to help or prevent emotional difficulties in children and young people. This can be easily used in schools and evidence suggests it can be effective at reducing anxiety, improving emotional and behavioural difficulties and promoting positive mental, social and emotional development.

Dance with groups or peers has been linked to improved wellbeing in young people aged 15-24 years.

Studies also indicate that dance psychotherapy may improve perceptions around body image in young men and women aged 17.

Music therapy involves combining musical experiences with therapy sessions. This has been shown to improve self-confidence and self-esteem in children and young people with mental health problems and to improve self-esteem in young people with behavioural and emotional problems.

Going to University, like all big changes in life, can have a negative impact and cause stress and anxiety, usually only for a short time. The loss of social support moving away from friends and family can also have a negative effect.

The experience of going to university and college was very different during the covid-19 pandemic and this had a negative impact for many students. Factors that are linked to increased wellbeing and lower mental health problems for older students are similar to other age groups – such as building supportive social networks and engaging in hobbies and exercise. It is also important that Universities and Colleges can facilitate support for students that need additional help with their mental health through links to services.