Key issues in promoting mental health The Design for Living partnership

Understanding concepts for working with children and young people Simon Ward

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Key issues Mental health promotion .......................................................................................................2

The Design for Living partnership, which comprises Action Mental Health, The Youth Council for Northern Ireland and the Health Promotion Agency, for Northern Ireland has facilitated a series of seminars concerning young people for a number of years. The seminars aim to build capacity among practitioners from many disciplines who work with young people in Northern Ireland. This paper has been commissioned by the partnership to highlight key issues in mental health concepts. It will help practitioners frame their work in promoting and supporting the mental health of children and young people. The paper is written by Simon Ward, who is a Senior Educational Psychologist with Children, Schools and Families Service in Sefton, England.

Resilience ...................................................................................................................................2 Mood management .................................................................................................................3 Emotional intelligence............................................................................................................3 Emotional needs ......................................................................................................................3 Physical needs ..........................................................................................................................4 Optimism and hope ................................................................................................................4 Disputation .................................................................................................................................5 Mastery action ...........................................................................................................................6 Positive psychology ................................................................................................................6 Positive emotions ....................................................................................................................6 Summary ................................................................................................................................. 10 References .............................................................................................................................. 11 Useful websites ..................................................................................................................... 12 Other Design for Living key issue papers .................................................................... 12

Introduction Children and young people are more likely to flourish if they experience pleasure, engagement and meaning in their lives. Inculcating certain attitudes, skills and experiences will increase the likelihood of young lives working out well. This paper therefore focuses

on some of the key concepts, models and research themes that form the latest theoretical frameworks in the field of positive mental health. It is suggested that these concepts are vital to understanding children’s and young people’s mental health, and essential for positively developing it.

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

Mental health promotion Mental health promotion is an umbrella term that covers a variety of strategies, all aimed at having a positive impact on mental health. Dr Nick Baylis, a lecturer in positive psychology at Cambridge University, suggests two key skills are necessary for positive mental health.1 • To learn not only to cope but also to prosper in the face of adversity (without this skill, the pain of loss and rejection, setback and adversity will sour one’s relationship with life). • The ability to create feelings of profound pleasure and happiness through healthy positive means.

Resilience Children and young people vary widely in the way that they respond to a set of circumstances. Some may do well, even in the most adverse circumstances, whilst others appear to have little capacity to cope with lesser difficulties. Forty to fifty years ago, psychologists studying children growing up in high-risk environments realised that a proportion of the youngsters developed well despite the adversity they faced in life. This capacity was termed ‘resilience’ and researchers began to investigate the factors and processes that seemed to be involved in its development. Viewed in terms of their strengths rather than their weaknesses, struggling children were found to develop great inner resources that helped them to learn to adjust and adapt to the changed circumstances of their life. When surrounded by the right supports (protective factors), they could not only survive descending odds, but go on to have productive lives, often made more meaningful by their struggle.

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Resilience is not a trait that people either have or do not have, it involves behaviours, thoughts and actions that can be learned and developed by anyone. It can be defined as: ”The human capacity to face, overcome and ultimately be strengthened and even transformed by life’s adversities and challenges …a complex relationship of psychological inner strengths and environmental social supports throughout a person’s life”.2 Early research focused on children deemed to be living in high-risk environments, but recent studies have indicated that growing up in the modern world puts psychological demands on children, who are increasingly facing stress and pressure. Resilience theory has moved on to encompass all children, rather than just those ‘at risk.’ A number of models have been developed identifying the key factors and processes that seem to be important in the development of resilience. 1. Internal factors • Social competence (including empathy and impulse) • Problem solving skills (including self-efficacy and optimism) • Autonomy (a sense of mastery, a belief that one’s own efforts can make a difference) • A sense of purpose and future (ambitions, goals, optimism and hope) • An awareness of strengths and talents • A sense of humour. 2. External factors • Strong social support networks • The presence of at least one unconditionally supportive parent or parent substitute • A committed mentor or other person from outside the family • Clear and consistent boundaries • The setting and communication of high expectations

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

• The provision of opportunities for meaningful participation and the ability to make a difference • The explicit teaching of life skills (such as communication, conflict management, assertiveness, stress management) • A positive school experience • Opportunities for participation in a range of activities that highlight strengths and interests • Exposure to challenging situations that provide opportunities to develop both problem solving and emotional coping skills.

Mood management Studies in the USA, Europe, Australia and Asia indicate that children today experience more anxiety and depression than they did in previous generations. This trend extends across ethnic and socioeconomic lines.3 Dr Jean Twenge in her book Generation Me (2006) cites research stating that the average college student in the 90s was more anxious than 85% of students in the 50s.4 The change was so large that ‘normal’ schoolchildren in the 1980s reported higher levels of anxiety than child psychiatric patients in the 1950s. The arguments and evidence about the rise in depression and anxiety do not appear to be about definitions, nor are they the result of any biological changes. Many researchers believe the rise has to do with societal change during the twentieth century. In this context, interest in mood management has flourished and in particular there is interest in the steps needed to deal with negative emotion.

Emotional intelligence This is the term popularised by Daniel Goleman in his book of the same name, but first used by psychologists Salovey and Mayer (1990).5, 6

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Emotional intelligence is described as ‘the ability to recognise, handle and appropriately express one’s emotions.’ It is characterised by five key skills. • Self-awareness: knowing one’s emotions, recognising a feeling as it happens. • Managing one’s emotions: handling feelings in an appropriate way. • Motivating oneself: marshalling emotions in the service of a goal, emotional self-control, delaying gratification. • Empathy: recognising emotions in others. • Handling relationships: managing emotions in others. Rather than try to focus on individual difficulties, programmes that have been developed within this framework have emphasised the need to focus on the development of generic social and emotional skills such as: self-calming, meditation, anxiety and anger management, communication skills, impulse control, goal setting, persistence, assertiveness, empathy and conflict management. They have also highlighted the need to focus on both the ‘taught and caught’ principle, ie a need to explicitly teach skills while at the same time provide environments in which these skills are modelled, valued and encouraged.

Emotional needs A range of psychologists and other researchers has long looked at the question: what are the basic human needs which if unmet lead to negative emotional consequences? Self-determination theory (SDT) developed by Ryan and Deci postulates the existence of three inherent, fundamental needs, which are universal (found throughout different cultures and times).7 These basic psychological needs are: • autonomy – the need to choose what one is doing, being an agent of one’s own life;

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

• competence – the need to feel confident in doing what one is doing; • relatedness – the need to have human connections that are close and secure, whilst still respecting autonomy and facilitating competence. SDT theory asserts that when these needs are satisfied, motivation and wellbeing are enhanced. Joe Griffin and Ivan Tyrrell have postulated a list of emotional needs which they term ‘the human givens’: • • • • • • • • •

the need for security in a safe territory; the need for attention (to give and receive it); the need to be emotionally connected to other people; the need to be part of a wider community (we are social creatures); the need for friendship, fun, love, physical intimacy; the need to have a sense of status within social groupings; the need to achieve and feel competent; the need for privacy to rest, reflect and consolidate learning; the need to be stretched – from which comes our sense of ‘meaning’.

Working from this framework can help to ensure that people get their emotional needs met in a balanced and socially appropriate way.8

Physical needs Our emotions are connected to our thoughts, behaviours and our physiology. It is no surprise that a large amount of research links good diet, sleep and exercise to wellbeing. In his review of research between mood and physical exercise, the late Oxford University psychologist Michael Argyle, found the benefits of regular exercise were many: lower stress, less tension, less tiredness,

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lower feelings of anger and depression, increased vigour, higher self-esteem, more positive body image and increased reports of positive moods.9 This is one of many studies, and the data is so strong in the case of the link between exercise and physical and emotional wellbeing that the conclusion is unavoidable. Consideration also needs to be given to ensuring adequate sleep and a balanced diet.

Optimism and hope Chris Peterson, a leading psychologist, likens optimism to Velcro in that it is attached to all the ingredients, which promote wellbeing.10 More than 20 years of solid scientific research has found many advantages of adopting an optimistic viewpoint. • Optimists adapt better to negative events. • Optimism is conducive to problem-focussed coping, humour, making plans, positive reframing, (putting the situation in the best possible light) and, when the situation is uncontrollable, accepting the situation’s reality. • Optimists exert more continuous effort and tend not to give up. • Optimists report more heath-promoting behaviour (eg healthy diet, regular medical check-ups) and enjoy better physical health than pessimists. • Optimists seem to be more productive. • Optimists are more popular than pessimists, with stronger social ties. Professor Martin Seligman, author of Learned Optimism and The Optimistic Child, argues that each of us has our own ‘explanatory style,’ a way of thinking about causes of things that happen in our lives.11 He suggests that there are three main dimensions that we use to interpret events and these are ‘permanence’, ‘pervasiveness’ and ‘personalisation’.

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

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Permanent vs. temporary (always vs. not always) A person with a pessimistic explanatory style will assure that when something goes wrong, it will always go wrong. Those with an optimistic style will assure that this will be better next time. This is temporary, eg I am stupid vs I didn’t revise.

Personal vs. external (me vs. not me) When things go wrong, pessimists will often blame themselves, internalising the cause. Optimists on the other hand, consider a greater number of factors, including external events, other’s actions etc that may have contributed.

Pervasive vs. specific (everything vs. not everything) An optimist would see failure as a specific setback rather than all pervasive. Pessimists on the other hand may ‘catastrophise’ and see their failures as global, eg I’m rubbish at sport vs I didn’t play well at the start of the second half.

Can optimism be learned? The answer quite simply is, yes. Although there may well be a genetically inherited component to optimism and early childhood experiences certainly shape an optimistic or pessimistic viewpoint, we can use several strategies to counter pessimism.

This can be summarised as follows: Explanatory style: when bad things happen Optimistic

Pessimistic

External “I didn’t have much to do with it.”

Personal “It’s my fault/I make bad things happen.”

Temporary “It was a blip”

Permanent “Things will always be awful/I will never succeed.”

Specific “It won’t change anything else. It’s unusual for this to happen to me.”

Pervasive “My whole life will be spoilt. It always happens to me.”

As Dr Reivich, co-author of The Resilience Factor and The Optimistic Child suggested in 2006: ”I want to stress that these are thinking styles, these are not personality traits and because they are thinking styles, they are changeable”.12

Disputation If someone else falsely accuses us of something, we can usually manage to dispute this. When, however, we falsely accuse ourselves of something (‘I’m rubbish,

I’ll never be any good etc’) we don’t tend to dispute it. The key to success is careful monitoring of, recognising and disputing our negative thoughts. When disputing pessimistic explanations, we need to ask what evidence we have for our beliefs. We should see if we can find an alternative explanation for failure. Even if an optimistic explanation is not applicable, what are the implications of this adversity? Is it really that catastrophic or can we put it into perspective or reframe it?

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We can also challenge other people’s pessimistic explanations in feedback to them, ie if someone is using ‘me’, ‘always’, ‘everything’ explanations for failure, (‘I always get everything wrong’, ‘I’m stupid,’ etc), we may respond with a more optimistic outlook that focuses on specific, non-pervasive causes (‘Sometimes maths can be difficult, which bit can’t you do yet?’)

“Psychology is not just the study of weakness and damage; it is also the study of strength and virtue. Treatment is not just fixing what is broken, it is nurturing what is best within ourselves”.14

We can also make sure that our feedback highlights effort (which is changeable) rather than ability (which appears fixed). In this way, people can take failure, negative feedback and mistakes as learning opportunities, as opposed to a reflection of their ability.

• the study of subjective wellbeing (positive emotions and mood); • the study of positive individual traits (strengths and virtues); • the study of positive institutions (family, schools, democracy etc).

Mastery action Mastery action leads to mastery thinking, ie succeeding at something, overcoming an obstacle or achieving a goal can all lead to a change in belief about oneself. Pessimistic thinking can often lead to a lack of effort, risk taking or engagement in challenges. As Martin Seligman suggests: “In order for your child to experience mastery, it is necessary for him to fail, to feel bad and to try again repeatedly until success occurs. None of these steps can be circumvented. Failure and feeling bad are necessary building blocks for ultimate success and feeling good.”13 We can place too much emphasis on avoiding negative emotion, which is there for a reason: to inform us that something in our world needs changing and to galvanise us into action.

Positive psychology In 1998, the new president of the American Psychological Association, Dr Martin Seligman, having taken stock of the field of psychology, declared in his inaugural presidential address that:

The new field was labelled ‘positive psychology’ and has three pillars or central concerns:

The field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within them and to enhance the experiences of love, work and play. Happiness and wellbeing are the desired outcomes of positive psychology. While the word ‘happiness’ can seem off-putting to some people, the scientific findings from positive psychology are greatly reassuring. Research and treatment in the realm of mental health has had a focus on ‘what is wrong with people?’ Positive psychology asks ‘what is going right with people?’

Positive emotions Until recently, researchers had very little interest in positive emotion. In fact, attention was only paid to joy or happiness as an indicator that an individual wasn’t depressed. Groundbreaking work by Professor Barbara Fredrickson has now provided an explanation for the role of positive emotion.15 Her broaden-andbuild theory suggests that while negative emotions narrow people’s perspective and keep them focused on the specific problem or threat in hand, positive emotions broaden people’s likely thoughts and actions as well as their behaviours.

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

If we are feeling positive, we are more likely to be creative and to see more opportunities that are open to us, more likely to be open to relationships with others and more likely to have a wider array of cognitive and behavioural options within our repertoire. Research also shows that positive emotions undo negative emotions, fuel psychological resiliency and are good for our health. It is for these reasons that in order to promote wellbeing, we need to focus as much on facilitating ‘happiness’ as on fixing or dealing with difficulty. In his 2002 book Authentic Happiness Seligman identified three levels of happiness: • the pleasant life (pleasure and positive emotion); • the engaged life (participation in activities which are intrinsically interesting and rewarding for the individual and induce flow); • the meaningful life (serving a goal bigger than oneself, particularly using one’s own signature strengths).16 The pleasant life The first route to greater happiness is hedonic, increasing positive emotion. When people refer to being happy they are often referring to this route. Pleasure can come from a variety of sources (eg food, music, drink) and it is a quick but transient fix, so pleasurable experiences produce only a temporary lift. Much of what we are encouraged to desire in modern consumer society belongs to this type of happiness: money, big houses, cars, clothes, technology, entertainment, celebrity. As human beings, however, we rapidly and inevitably adapt to new circumstances and soon take them for granted. This has been labelled ‘the hedonic treadmill’ and as we, for instance, accumulate more material possessions and accomplishments, our expectations rise.

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Savouring and mindfulness Research suggests that we can obtain more pleasure from routine aspects of daily life by training ourselves to notice, reflect on and appreciate simple things. The sheer speed of modern life and our extreme focus on the future can easily impoverish our present. Almost all technological advances in recent years have been about doing more and doing it faster. This, coupled with the human brain’s tendency to focus on threat (the negativity bias) or negative aspects of a situation can lead to us failing to notice vast swathes of our lives which are positive. A simple task named ‘the three good things exercise’ by Martin Seligman demonstrates this point.17 He asked subjects to write down on a pad, at night, three good things that had happened that day, and for which they felt grateful or thankful. His research shows that, for many people, this simple exercise can increase happiness and even counteract mild to moderate depression. Essentially it works by re-focussing our attention to look for what is good in life. The engaged life The second route to happiness is not through pleasure and positive emotion but through engagement. Essentially this is the concept of flow. Flow This is a term coined by Mihaly Csikszentmihalyi who discovered that people of all cultures, ages and interests in life report their involvement in activities in a similar way.18 Flow happens when we become so engrossed in an activity that we lose ourselves. It can be induced in numerous and varied ways eg sport, art, challenging conversation. He suggested eight key conditions: • the task is challenging and requires skill • we concentrate fully on the activity • there are clear goals

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Key issues in promoting mental health • • • • •

Understanding concepts for working with children and young people Simon Ward

we get immediate feedback we have deep involvement there is a sense of control our sense of self vanishes we lose our normal sense of time.

As can be seen from this list, positive emotion can be absent throughout the process. It may even be that we experience discomfort, eg mountaineering, hard physical or mental exertion, writing reports. But afterwards, we have such a strong sense of gratification, that we see the activity as enjoyable and satisfying. Flow activities, therefore, contribute substantially to our feelings of happiness and wellbeing. We are so involved in an activity that the rest of the world seems to have disappeared, our mind isn’t wandering, we are totally focussed on the activity to the extent that we may not even be aware of ourselves. This is the opposite of the narrow, inward focus present in anxiety, anger and low mood and the rumination that accompanies it. Flow can only be experienced when we encounter challenges that test our skills, yet our capacities are such that it is just about possible for us to meet the challenge. Achieving this state, therefore, requires effort and a risk of failure. Much of modern society is about finding short-cuts to feeling good: TV, fast food, reality shows, drink, drugs. Indeed, many of the activities that we choose to pursue in our leisure time are passive (eg watching TV) and lead to an absence of flow.

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an approach that is to try and identify and fix weaknesses and problems. More recently, research has shown that identifying and maximising the use of personal strengths, qualities and attributes can lead to higher levels of health, happiness and success.20 It appears that it is of greater benefit to accept our relative weaknesses, and concentrate our energy on developing and using our strengths. That is not to say that we shouldn’t try to improve our weaknesses, just that most of our energy should go into using and improving our strengths. Martin Seligman states: ”I do not believe that you should devote overly much effort to correcting your weaknesses. Rather I believe that the highest success in living and the deepest emotional satisfaction comes from building and using your signature strengths”.21 Chris Peterson and Martin Seligman worked with a team of colleagues to develop a classification of character strengths that exist in cultures all around the world. The process resulted in the identification of 24 character strengths which are organised into six ‘virtues’ and outlined by the ‘values in action’ classification (VIA)22:

One of the best ways of increasing flow in our lives is by identifying and using our signature strengths.

• Wisdom – cognitive strengths that entail the acquisition and use of knowledge; • Courage – emotional strengths that involve the exercise of will to accomplish goals in the face of opposition, external or internal; • Humanity – interpersonal strengths that involve taking care of others and building strong relationships; • Justice – civic strengths that underlie healthy community life; • Temperance – strengths that protect against excess; • Transcendence – strengths that forge connections to the larger universe and provide meaning.

Strengths Traditionally, work around mental health has taken

The VIA inventory of strengths is a self-report questionnaire of 240 items which can be completed

Csikszentmihalyi states: ”The cushioning of frustration, the premature alleviation of anxiety and learning to avoid the highest challenges all impede flow”.19

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Understanding concepts for working with children and young people Simon Ward

online for free at www.authentichappiness.com. Individuals receive immediate feedback on their top five strengths (a youth version is also available). The meaningful life The third route to happiness is ‘the meaningful life’ and according to Seligman this is: “using your signature strengths and virtues in the service of something much larger than you are”. 23 Meaning, by definition is seeing a goal bigger than oneself, eg having a clear mission and purpose in life, putting others’ needs before our own, volunteering etc. Results from research have consistently shown that personal strivings promote wellbeing by structuring people’s time, giving them a sense of meaning and purpose and supplying a useful target for measuring growth and progress. If, however, a person’s goals are just extrinsic, ie fame, power, feeling good, money etc this can be toxic for wellbeing. It is much better to have intrinsic goals, eg to develop better as a person, to contribute to the group/community/society etc. Oliver James states: ”The great majority of people in English speaking nations now define their lives through earnings, possessions, appearances and celebrity and those things are making them miserable because they impede the meeting of our fundamental needs.” 24 Seligman feels that a large factor in the increase of depression is the rise of ‘individualism’ in society, the ‘me’ culture.25 “If people are isolated from larger concerns, they will believe that all that matters in life is what happens to them. This means that set-backs, failures and

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problems, which are an inevitable part of life, can become overwhelming and so they feel unable to cope. When life is challenging or disappointing, young people cannot put it into perspective.” As previously stated, humans have a very basic need to belong to groups and to interact with others. Deiner conducted a study of the most and least happy people and discovered that the single unifying factor, the trait that the happy group had in common and on which they differed from the unhappy group, was the breadth and depth of close trusting relationships.26 It can be easy, however, to overlook the most rewarding relationship available to us – helping relationships. When people help, whether volunteering time, mentoring etc, this work frequently translates into large gains in wellbeing. Helping others makes us feel good and tends to promote our sense of worth and competence. In short, if people have pleasure, engagement and meaning in life, they are likely to experience happiness, life satisfaction and wellbeing and lead more flourishing lives. As Daniel Kahneman (2002 Nobel laureate) said: ”Happiness is a skill”. 27 This means that while there are no quick fixes, there are certain attitudes, skills and experiences which increase the likelihood of things working out well. As with any skill, through effort, we can learn it, practise it and improve it for ourselves and by helping young people to realise it for themselves.

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

Summary • Two key skills are necessary for positive mental health – learning to cope and even prosper in the face of adversity, and the ability to create feelings of happiness through healthy positive means. • Resilience is not a trait that people either have or do not have, it involves behaviours, thoughts and actions that can be learned and developed by anyone. • Children today experience more anxiety and depression than they did in previous generations. • Emotional intelligence is the ability to recognise, handle and appropriately express one’s emotions.

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• Optimism can be learned, although there may well be a genetically inherited component to optimism and early childhood experiences certainly shape an optimistic or pessimistic viewpoint, we can use several strategies to counter pessimism. • Failure and feeling bad are necessary building blocks for ultimate success and feeling good. • Negative emotion is there for a reason: to inform us that something in our world needs changing and to galvanise us into action. • If children and young people have pleasure, engagement and meaning in life, they are likely to experience happiness, life satisfaction and wellbeing and lead more flourishing lives.

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

References 1. Baylis N. Learning from wonderful lives. Cambridge: Well-Being Books, 2005. 2. Masten AS. Ordinary magic: resilience processes in development. American Psychologist, 2001, 56; 227–238. 3. Layard R. Happiness: lessons from a new science. Penguin, 2006. 4. Twenge J. Generation me. New York: Free Press, 2006. 5. Goleman D. Emotional intelligence. London: Bloomsbury Publishing, 1996. 6. Salovey P, Caruso D, Mayer JD. In: Linley PD, Joseph S, editors. Positive psychology in practice. Hoboken, New Jersey: John Wiley and Sons, 2004. p. 447–463. 7. Ryan RM, Deci EL. Self determination theory and the facilitation of intrinsic motivation and wellbeing. American Psychologist 2000, 55; 68–78. 8. Griffin J, Tyrrell I. The human givens: a new approach to emotional health and clear thinking. HG Publishing, 2003. 9. Argyle M. The psychology of happiness. East Sussex: Routledge, 2001. 10. Peterson C. A primer in positive psychology. Oxford University Press, 2006. 11. Seligman MEP. Learned optimism, New York: Knopf, 1991. 12. Reivich K, Shatte A. The resilience factor. New York: Broadway Books, 2003. 13. Seligman MEP, Reivich K, Jaycox LH, Gillham J. The optimistic child. New York: Harper Perennial, 1995.

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15. Fredrickson BL. Positive emotions. In: Sayer CR, Lopez SJ, editors. Handbook of positive psychology. New York: Oxford University Press, 2002. p. 120–134. 16. Seligman MEP. Authentic happiness. New York: Free Press, 2002. 17. Seligman, MEP, Steen,TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. American Psychologist, 2005, 60; 410–421. 18. Csikszentmihalyi M. Flow: the psychology of happiness. London: Rider, 1997. 19. Csikszentmihalyi M. Flow: the psychology of happiness. London: Rider, 1997. 20. Buckingham M, Clifton D. Now discover your strengths. New York: Free Press, 2001. 21. Seligman MEP. Authentic happiness. New York: Free Press, 2002. 22. Peterson C, Seligman MEP. Character strengths and virtues: a handbook and classification. New York: Oxford University Press, 2004. 23. Seligman MEP. Authentic happiness. New York: Free Press, 2002. 24. James O. Affluenza. London: Arrow Books, 2007. 25. Seligman MEP, Csikszentmihalyi,M. Positive psychology: an introduction. American Psychologist, 2000: 55; 5–14. 26. Deiner E, Seligman MEP. Very happy people. Psychological Science, 2002: 13, 81–84. 27. Kahneman D, Diener EL, Schwartz N. Well-being: the foundations of hedonic psychology. New York: Russel Sage Foundation, 2003.

14. Seligman, MEP. The president’s address. American Psychologist, 1999, 54; 559–562.

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Key issues in promoting mental health

Understanding concepts for working with children and young people Simon Ward

Useful websites www.positivepsychology.org www.authentichappiness.org www.mindfields.com www.centreforconfidence.co.uk www.projectresilience.com www.6seconds.org www.strengthsinfocus.com

Other Design for Living key issue papers Masculinity and mental health, Dr Ken Harland The nature of self-esteem, Dr Tony Humphreys The key issue papers are available only as PDF files at the following sources: www.healthpromotionagency.org.uk www.mindingyourhead.info www.actionmentalhealth.org.uk www.ycni.org

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