Analyzing Mental Health Nursing Needs of School Going Teenagers

This systematic literature review aims at understanding the areas where mental health nurses are to intervene immediately for addressing the concern of rising incidence of depression among school going youth in London. The paper highlights the implications for practice in this regard.

Running head: MENTAL HEALTH NURSING
Mental Health Nursing
Name of student:
Name of university:
Author note:

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Abstract
The rising incidence of depression among school going youth in London has drawn noteworthy
attention in the recent past. The mental health nursing needs of school going teenagers has been
the topic of research for the present systematic literature review. The paper aims at
understanding the areas where mental health nurses are to intervene immediately for addressing
the concern. The review clearly explains the rationale behind such a systematic review in context
of mental health nursing domain. The findings of the papers have been critically analyzed before
the main findings are presented. The discussion section highlights the implications for practice in
this regard.

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Table of Contents
Introduction......................................................................................................................................3
Methodology and Methods..............................................................................................................6
Findings.........................................................................................................................................10
Discussion......................................................................................................................................17
References......................................................................................................................................21

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Topic: The depressed youth of England: Analyzing mental health nursing needs of school going
teenagers
Introduction
Mental health disorder is a great burden for young people and early adolescence is the
period when mental health issues emerge. Teenagers are prone to adapt unhealthy behaviors like
smoking, drinking and illicit drug use during adolescence and these factors has an impact not
only on their health at that time but also in later life. Recent evident suggest that onset of 50% of
mental disorders is observed in people below the age of 18 years (Das et al. 2016). Among
mental health disorders, major depressive disorder is considered to be one of the leading causes
of disability, morbidity and risk of suicide and the prevalence of the condition in teenagers is
particularly increasing (Roberts 2014). Currently, the prevalence of mental health disorder in
England is also an area of attention for research because recent statistics has showed that mental
illnesses are the leading cause of health related disabilities in children and young people in
England. Children and youth in England are more likely to be engaged in smoking, drug abuse
and alcohol misuse than engaging in educational attainment and employment (Public Health
England 2016). Hence, analyzing the factors predisposing school going teenagers to mental
health risk is important to address the mental health needs of the group.
Review of studies done on risk factors associated with mental illness in adolescent has
given many insights about the possible reason behind rise in mental health disorders in youth.
Different categories of risk factor behind mental health issues in adolescent includes individual
factors, family factors, school factors, drug related factors and social factors. Individual risk in
children includes feelings of low self-esteem, anxiety, loneliness and feelings of worthlessness in

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teenagers (Pinto et al. 2014). In addition, school related factors include experience of bullying,
discrimination and low school performance. Bullying is a serious issue for school-age children
and adolescents as experiences of bullying renders both short term and long-term impact on
mental health of children (McDougall and Vaillancourt 2015). A study investigating about the
outcome of mental health in adolescents with bullying experience has revealed that bullied
school students had higher risk of depression and anxiety during their school years. Bullied
children were also found to have higher chances of psychosocial problems compared to children
who are not bullied. Impact of educational attainment of children due to bullying experience was
also found (Rothon et al. 2011). However, the lack of sensitivity analysis of data affected the
validity of the evidence. Hence, analyzing the role of this factor is essential to determine to
which extent mental health programs for school going adolescent in England can developed.
The above mentioned risk factors all pave the way for social isolation and consequently
development of mental health issues in adolescents. Bullying is just an example of school related
risk factors for mental problems in school going teenagers. Rothon et al. (2011) gave idea of the
impact of bullying on current health outcome and educational attainment in children, however it
underestimated the long term impact of such experience. Sigurdson et al. (2015) suggested that
victims of bullying have internalizing symptoms like that of depression, anxiety and fear or
externalizing symptoms such as tendency to show anger and aggression. This kind of behavior in
the long term compels children to engage in risky and impulsive behavior such as engaging in
criminal activities or engaging in drug abuse. It predispose them to high risk of psychiatric
hospitalization too. However, there might be other causes of depression and anxiety in school
going teenagers too. There is a need to understand the multiple factors involved in risk of mental

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ill for teenagers and analyze the interaction between those factors to understand mental health
needs of adolescents.
Just like teenage pregnancy, prevalence of depression in school going teenagers has also
become great public health issue for England. To facilitate development of effective health
promotion program for children before they develop mental illness, there is a need to effectively
identify and interpret association between different risk factors and it role in long term risk of
mental health problem in adolescents (Swartz, Hariri and Williamson 2017). Previous research
has covered about risk factors separately, however the association between family and social
factor or other factor has not been covered. Hence, the main is to explore the factors behind high
number of depressed youth in England and find out factors present in their life that predispose
them to risk of developing mental health issues. By conducting systematic search on depressed
school going school going teenagers, the associated between different risk factors can be
effectively analyzed. This in turn will help to identify and analyze mental health nursing needs
for the population group too.
The main research question for the task is ‘What are the mental health nursing needs for
depressed youth of England. By means of systematic review of relevant research articles,
relevant research article related to the study objective will be selected. The evaluation of the each
paper in terms of research question and critical framework, useful information can be obtained
regarding ways to improve mental health of teenagers in England. Research in this area is also
significant because data obtained from the research will help to target not only just school
children, but also other social support groups that are a necessary part of their life. This will
facilitate the delivery of holistic care and realization of a healthy and productive youth
population in England.

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Methodology and Methods
Literature review strategy:
To retrieve relevant research articles specific to the research question, the strategy is to
analyze research articles published between the years 2010 to 2018. This has been done to ensure
that updated information is retrieved regarding performance and preparedness of the health care
system of England to tackle the issue. Research articles were mainly retrieved from databases
like CINAHL, MEDLNE, PubMed and PsychINFO. The rational for selecting these databases is
that all of them are renowned databases that published research articles in the area of health
science. For instance, PubMed published wide range of biomedical literature and all of them are
peer-reviewed articles thus promoting the trustworthiness and credibility of research evidence
(Ncbi.nlm.nih.gov 2018). Secondly, PsychINFO is also a relevant database for this systematic
review as it is the most trust library for literature in behavioral and social science. As depression
is an area that affects behavioral as well as social outcome for children, searching research article
from this database can yield useful result. Ensuring the credibility of research evidence is a
necessary criteria in research to save time and promote effective analysis of research data. This is
also important because outcome of this research would pave for evidence based health care in
England and integration of the information in health care practice (Gopalakrishnan and
Ganeshkumar 2013).
Apart from focus on selection of research from specific data bases and limiting the search
to certain date range, another important search strategy for the selection of articles for this
systematic review was the use of relevant search terms. The key search term for this systematic
review included ‘depression in teenagers of UK’, ‘depression in school going teenagers in UK’
and ‘mental health problem in school going teenagers of UK’. These were the primary research

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terms used in MEDLINE, CINAHL and PsychINFO. Use of Boolean operators like ‘AND’ and
‘OR’ futher refind the search process. Combination of keywords related to research question and
Boolean operators helped to get specific research article.
Types of evidence to be considered
As the main is to get answers related to mental health issues in youth of England and
identify mental health needs of the population, the search strategy is to include both qualitative
and quantitative research studies. Qualitative research studies can give descriptive information
related to mental health needs of youth in England, whereas quantitative research studies can
give idea about trends and extent to which certain risk factors increase risk of depression and
demand of mental health for school going teenagers. Based on this criteria, studies using cross-
sectional research design, randomized controlled trial, systematic review and mixed methods
study were analyzed. The preference has been given to primary research articles first and
secondary research articles were selected if it gave comprehensive data related to research
question.
Inclusion/exclusion criteria
The following were the inclusion criteria to identify relevant articles related to the
research question:
 The search was designed to obtain descriptive and statistical data on the problem of
depression in adolescent children of England. Hence, both quantitative and qualitative
research articles were taken for systematic review
 All research articles conducting research in clinical, community or school setting of UK
was considered for the research

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 The criteria for selection of articles was that it must be published between 2010 to 2018
 The most specific criteria was selecting articles that targeted school going adolescent
population for research.
 Another relevant criterion was the discussion only on depression or mental health issues
in youth and no other physical illness in adolescents.
The exclusion criteria for the systematic review included the following:
 Research articles published before 2010 were excluded.
 Research articles done with adults or those aged above 18 years were excluded
 Research articles done in other country apart from UK was excluded
Critical framework to be used:
The quality of the final selected articles has been evaluated by the use GRADE (Grading
of Recommendations, Assessment, Development and Evaluation) rating system framework for
this review. This framework analyzes research article on basis of parameters such as study
limitations, consistency, directness, precision, publication bias and quality (Balshem et al. 2011).
Data extraction:
The strategy for analysis and extraction of research data included two step processes. The
first process was to use screen articles by the review of title and abstract. Based on this strategy,
a total of 30 articles were found to be relevant to the research questions. The full text review of
these articles was done in the next phase. The eligibility criteria for inclusion of the study were
that it should match all the inclusion criteria mentioned above. At this stage, type of study
design, results of the study and outcome measures were analyzed. Hence, a total of 45 articles

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were found relevant as per the research question and topic of the systematic review. After review
of abstract, a total of 30 articles were found eligible for the review. Finally, based on full test
review of articles, a total of 10 articles were critically analyzed for this systematic review. The
following is the flow diagram for searching the articles.
No. of articles identified through data base
search (n=45)
No. of articles found after removal of
duplicates and irrelevant articles (n=30)
No. of records screened by reviewing abstract
(n=30)
Articles excluded
(n=15)
Full text articles assessed for eligibility
(n=20)
Studies included for systematic review (n=10)

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Findings
The present section of the paper summarizes the findings of the research papers included
in the study. Each study has been assessed critically, and the key points of the papers have been
presented. The papers throw light on the research question to address it adequately.
Pitchforth et al. (2017) studied mental health and well-being trends among young people
and children in the UK. As per the researchers, there is a growing concern about the wellbeing
and mental health of young people and children in the UK. This has led to increased demands for
referrals to mental health services, counselling services and admissions for self-harm. The
researchers carried out an investigation of the trends in mental and physical health outcomes
through a national health study. Data were collected from 34 surveys carried out in England,
Wales and Scotland. Seven outcome indicators were under scrutiny. The study indicated that the
prevalence of self-reported mental health condition increased considerably, almost six fold, over
the last two decades. The findings reinforce the urgent need of considering the factors that lead
to poor mental health status among children in the UK.
Kidger et al. (2014) studied self-reported school experience of children in South West
England in relation to predictors of self-harm and mental health. The researchers had opined that
different aspects of school life among adolescents are associated with poor mental health status
and a higher risk of self-harm. However, existing literature did not consider prospective studies.
To bridge the gap in the literature, members of the Avon Longitudinal Study of Parents and
Children (ALSPAC) birth cohort were required to complete postal surveys of school experiences
aged 14, and self-harm behaviour aged 16. Examination was done to understand the relationship
between school experiences and related self-harm with the help of multivariable logistic
regression models. The school experiences studied were feeling connected to the school,

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enjoyment of school and perception of teachers as fair. The study indicated that self harm in
children aged 16 years had a clear association with earlier perceptions of school which mainly
encompassed strangled relationship with others and poor acceptance by others
(OR=2.43[1.76,3.35] and OR=2.69[2.16,3.35]. The study concluded that when students feel
unconnected with the environment in school or were unhappy due to unfair treatment of teachers,
chances of self-harm were more. Assessment of the perceptions of the school would act as a tool
for understanding preventable interventions for self-harm. The study had a limitation that the
outcome and exposure measures were self-reported.
Bullying and mental health problems in school going children have been well
documented in the literature. Rothon et al. (2011) carried out a prospective study to the extent to
which bullying can have an impact on mental health status of school going children, and the
usefulness of social support to buffer the negative effect on children. The researchers considered
as a representative multiethnic sample of adolescents who attended East London secondary
schools covering three different boroughs. The study indicated that adolescents who are bullied
have fewer chances of achieving academic success as compared to those who are not bullied.
These children also had the tendency to suffer from depressive symptoms. Social support when
given to this population had been effective in the promotion of good mental health. The finding
that drew considerable attention is that support from family and peers were not sufficient in
protecting adolescents from mental health challenges, indicating the need of support from
nursing professionals. The study had a key limitation that the key measures of the study were
self-reported.
Stewart-Brown et al. (2011) pointed out that the last two decades had marked an
augmented interest in the arena of mental health issues of children. The researchers from the UK

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highlighted that social and economic wellbeing of children and adolescents is important for
addressing challenges faced in societies. The parent-child relationship has been denoted to be a
crucial factor for understanding the mental health outcomes of the children. Interventional
support is required to support parents in enabling a good mental health status of children. The
researchers carried out a systematic review encompassing systematic reviews as part of
Workpackage 2 of the DataPrev project. The aim of the project is to maintain a dataset for
evidence-based programs promoting mental health in Europe. The research indicated that
children who come from families where parenting style is weak are at most risk of suffering
mental health issues. Neglect and serious abuse have also been the contributory factors for the
poor mental health status of adolescents. Alcohol and substance abuse have been the noteworthy
forms of abuse linked to mental health challenges. Promising programs are needed that focus on
antenatal education for families so that parents can support children in their difficult times.
Mental health professionals are to consider parent-child psychotherapy that includes
multicomponent, multisystemic, intensive family support approaches.
Dogra et al. (2012) in their paper discussed the mental health issues of children and
young people in the UK who come from minority ethnic groups. Present research that discusses
the mental health concerns of children among ethnic minorities indicates that the UK is severely
struggling with the issue. The mental health concerns mainly emerge from discrimination and
lack of access to adequate care services. Social and cultural factors such as socioeconomic
disadvantage and social class influence the extent to which individuals from the ethnic groups
suffer poor mental health. The common ethnic groups are Black Caribbean, Black, and South
Asian that contribute to diversity in family and demographic characteristics. Adolescents
commonly suffer from anxiety, depression and heightened psychological stress that has a

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negative impact on their later life course. Racial discrimination is mostly associated with mood
disorders and depressive conditions. Higher levels of mental distress create an unfavourable
environment that has been proved advantageous to coping methods that are unhealthy. Such
conditions, coupled with limited access to high quality medical care and substance abuse, are
known to lead to stress.
Mental health services provided to students are failing to meet the rising demands, as
noted by Dubicka and Bullock (2017). Mental health of children has been receiving less
importance in the UK though the burden is increasing with each passing year. The paper reflects
on the prevalent crisis in evidence that discuses systematic discrimination against children who
subsequently suffer mental health issues. Inspections carried out in Wales and England indicates
that children who live in isolation from families and friends are more likely to suffer from
depression and anxiety. The paper had been remarkable in discussing the areas of faults in
present mental health services. There is a lack of updated data, which focus on mental health
conditions prevalent among children in the UK. Further, there is also a need of consistent
investment across adolescent and child mental health services. Though the government has been
expanding existing workforce on mental health, delivery of services is highly challenging.
Arseneault, Bowes and Shakoor (2010) highlighted that bullying is a prime cause of
depression suffered by adolescents in the UK. Bullying victimization is a concern for parents,
youth, schools and mental health care providers across the country. Children suffering from
bullying show predominant signs of adjustment problems and distress. Bullying is an unpleasant
yet commonly encountered experience among adolescents when they enroll in a school system
that is supposed to provide formal education. Consequently, studies have not given required
attention to understand the stressful events in individual’s lives that are linked with mental health

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problems. Cross-sectional studies have identified that children who suffer bullying have more
inclination towards exhibiting signs of anxiety and depression. Bullying had been previously
considered as normal phenomena on interaction among adolescents. Present research challenges
the mentioned viewpoint. Longitudinal studies highlight that children undergoing bullying in
school are prone to suffer from anxiety, depression, withdrawal symptoms and other
internalizing problems. Reduced assertiveness and poor self-regard have also been proved the
impact of bullying in school. Children who are depressed and anxious often send signals that
they are leading an unpleasant life. Children become aggressive and at times attract hostility
from peers. Apart from depression and anxiety, social isolation is also a notable factor for mental
health status of children. Suicidal ideations and self-harm behaviors have been noticed among
children who are depressed due to social environment. Suicidal ideations, as exhibited by victims
of bullying, are exacerbated by deep feelings of rejection by parents who fail to provide healthy
social environment. Social exclusion has been linked with poor communication with individuals
in the society who could otherwise build up a strong support system. Lastly, poor self-esteem is
also a concern for youths in the country. Children suffering violence and negligence at home are
more vulnerable to suffer issues such as depression. All of the above mental health problems are
further triggered by abusive situations in the school.
Ttofi (2015) researched on the association between adolescent bullying and depression.
The researcher acknowledged that children throughout school years are in the constant need of
peer support. Peer group participation has been linked repeatedly with the mental health status of
adolescents. When an individual does not fit in a peer group, issues arise. Young people are the
target of racism, homophobia and other forms of bullying and disturbances. The psychosocial

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development of children is hampered because of this. The researchers established a clear link
between bullying victimization and non-reporting to family members and teachers.
Ochard et al. (2017) put forward a valuable paper on clinical characteristics of adolescent
receiving treatment for depressive disorders. The study was based on the evidence that
adolescence is the stage of life where one is at higher risk of suffering from depression. The
paper aimed at studying referrals for depression to a UK routine public healthcare service in
England. 100 adolescents and their caregivers were requested to engage in structured diagnostic
interview through which anxiety and depression were measured. The results indicated that
almost half of the adolescents being referred to the service met diagnostic criteria for a
depressive disorder. Cognitive disturbances, low mood or irritability, sleep disturbances and
negative self-perceptions were the symptoms of depression. Further suicidal ideation was
common. The study had a limitation of participant recruitment as all referrals could not be
included in the study.
Fink et al. (2015) considered carrying out a comparison of two cross-sectional studies
focusing on mental health difficulties in early adolescents in England from 2009 to 2014. An
analysis was carried out with data collected from two cross-sectional samples of adolescents
aged 11- 13 years. The total pooled sample was of 3366 adolescents. Mental health difficulties
were assessed through a questionnaire. The results concluded that mental health problems were
multidimensional, mainly encompassing conduct problems, emotional problems, peer problems,
hyperactivity, and pro-social behaviour. One significant finding was that girls suffered more
mental health problems as compared to boys. Societal level influences were notable in inflicting
mental health problems. A major limitation of the study was that the samples were not randomly
allocated.

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York and Jones (2017) in their research paper mentioned that in the UK and across the
globe, the number of foster children is on the rise in the recent years. As per the researchers,
mental health problems among looked after children is on the higher side as compared to
children in the general population. It is to be noted that mental health services for these children
are not adequate. Research indicates that exists a poor prognosis for children who are suffering
from mental health issues, and the contributing factor is incapability of the mental health-nursing
workforce. The researchers aimed at understanding the mental health difficulties of children and
young people and their experiences of accessing relevant services. They carried out a qualitative
study with grounded theory approach with the help of semi-structured interview conducted with
the foster care providers. The study highlighted that children and adolescents do not receive
sufficient support to cope up with their mental health needs, and are at higher risk of suffering
from a mental disorder as compared to other children. As per the research, children living in
foster care suffer mental health issues such as depressive symptoms, anxiety, and general health
difficulties. Due to the higher prevalence of mental disorders, there is a need of children welfare
agencies with competent nursing professionals. The study had some limitations such as small
sample size and data confined to one geographic area. The study would therefore not be
generalized though the relevancy of the study is high.
The above summarization of the research papers gives valuable information that is
helpful in addressing the research question. At this juncture, it would be pivotal to discuss the
implications for mental health nursing practice based on the study findings. The next section of
the paper would address this arena in details.

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Discussion
The present literature review has been noteworthy in highlighting the mental health
nursing needs for school going youths who suffer from depression. To the best of knowledge, the
research papers considered for the study have highlighted the distinct risk factors for youth to
suffer from depression. The social and school environments have been found to be contributing
to the rising incidence of depression among this section of the population in the country. From
this research, it seems apparent that there is a need of good access to mental health nursing care
services in the first place if real barriers in the elimination of depressed condition among youths
are to be achieved.
Pitchforth et al. (2017) discussed the high prevalence of depression among school goers
and the risk factors for the same. Kidger et al. (2014) had drawn in the relation of depression
among school-going youth with the school environment. Unfair school treatment received from
teachers has been noted to be a significant factor for depression among the youth. Bullying in
school has been indicated to be another noteworthy factor for depression among youths as
explained by a number of studies. Rothon et al. (2011) had researched on this issue, the findings
of which have been supported by Arseneault, Bowes and Shakoor (2010). Ttfoi (2015) also
brought into limelight the issue of bullying among school goers. The social factors that
contribute to depression among youths have been understood from the other studies. While
Stewart-Brown et al. (2011) analysed neglect and abuse at home, as the risk factors for
depression, Dogra et al. (2012) pointed out social class influence and poor socioeconomic
condition to have a link with depression. Dubicka and Bullock (2017) stated that isolation from
families is also a chief aspect of depression among school-going youth. Arseneault, Bowes and
Shakoor (2010), and Ochard et al. (2017) have discussed suicidal tendencies among depressed

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youths. Fink et al. (2015) added that conduct problems, emotional problems, peer problems,
hyperactivity, and pro-social behaviour are all related to depression.
The findings of all the studies add credence to the significance of involvement of nurses
in addressing mental health issues among school going youths. The studies report that social,
family and interpersonal problems are the most common driving factors for depression among
the youth. The studies indicated that early detection and appropriate interventions as delivered by
mental health nurses are best health promotion activities, which hold prime importance for
addressing depression among youths. Nurses are required to be mindful of those at high risk of
depression. Nurses are placed in a vital role to screen for depression and promote better mental
health. In the research of Coyne et al. (2015), it has been brought into focus that depression
among youths who are school goers is to be perceived as a major crisis. Increased awareness and
mental health programs can reach out to those in need of help. School going youths need the
attention to instil a feeling of being valued and accepted when they suffer from depression.
The role of mental health nurses in supporting and caring for school going children and
adolescents in England is of prime importance. The key findings of the present research indicate
that mental health nurses are to provide high quality care to the vulnerable population if the
rising incidence of depression among school going children and adolescents are to be curbed.
Mental health nurses have a pivotal role in creating a healthy environment for depressed youths
so that they can have a better quality life (Bohnenkamp et al. 2015). As the country’s most
important health care providers, nurses are known to be in the unique position to have a
noteworthy influence on youth depression and related concerns. Nurses have the training to carry
out accurate assessment and to provide education and support to youth, parents, schools and the
public for promotion of effective protective measures for depression (Halter 2017). Mental

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health nurses are provided with the opportunity to advocate for, and make sure that strict policies
for addressing depression confer with care providers. Mental health nurses working in the
community settings have the power to influence community settings while working in
collaboration with the community health nurses (Kelly 2018).
The role of mental health nurses as a buffer to stress has to be discussed in here. The need
of social support for enabling coping strategies for youth suffering from depression is primitive.
Social support can manifest community social capital and act as the instrumental provisions for
enabling intimate relationships among the youth and families (Rueger et al. 2016). Following the
discussion of Camara, Bacigalupe and Padilla (2017) it can be noted that informative support,
material support and social company would be the strategies through which nurses can intervene.
This form of support has been effective for depressive youths who need a driving force for
reinforcement of self-esteem. In school-going youth, such form of support from mental health
nurses has been revealed to be superior that any other forms of support.
To address the unique needs of the youth, families and school workers, and to deliver
interventions in a timely manner, the right professional with the necessary skills are to be
included in the settings. As opined by Cheng et al. (2014) adolescents might be embarrassed and
reluctant to discuss the issues they are facing and might not open up to the nurses. In such a case
nurses are to educate the youth that mental disorders such as depression is a serious concern,
which is driven by physiologic imbalances. There is, therefore, a need for specific treatment for
reducing the impact of the condition on daily life. Nurses can, therefore, encourage youths by
mentioning that depression is not a reflection of a character flaw. Educating the youth that the
path to recovering from depression is steady and praiseworthy would help them eliminate all
feelings of hopelessness. This approach has also been proven effective in improving adherence to

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treatment regime. Townsend and Morgan (2017) in this regard mentioned that Specialist nurses
could provide different interventions such as dialectical therapy, behavioural therapy and family
therapy as per the needs of the youth.
Across the UK, including London, initiatives have been taken up to ensure that young
people get access to the appropriate mental health services within the required period. This
encompasses the inclusion of mental health nurses in school health workforce (Archer 2015). In
order to be completely effective in the mentioned objective, barriers that prevent care delivery
are to be overcome. Such barriers include lack of resources, time constraints and lack of
specialist training and education. Such factors lead to lack of readiness to care for depressed
youth and poor level of confidence to intervene optimally. In the UK there is a professional
guideline for mental health nursing that entails nurses to provide competent and effective care
while updating skills and knowledge base. Adequate training provided to mental health nurses
would facilitate effective referral processes and support adequate resource utilization.

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References
Archer, J., 2015. Collaborative care improves clinical outcomes for adolescents with depression
treated in primary care. BMJ evidence-based medicine, 20(1), pp.20-20.
Arseneault, L., Bowes, L. and Shakoor, S., 2010. Bullying victimization in youths and mental
health problems:‘Much ado about nothing’?. Psychological medicine, 40(5), pp.717-729.
Balshem, H., Helfand, M., Schünemann, H.J., Oxman, A.D., Kunz, R., Brozek, J., Vist, G.E.,
Falck-Ytter, Y., Meerpohl, J., Norris, S. and Guyatt, G.H., 2011. GRADE guidelines: 3. Rating
the quality of evidence. Journal of clinical epidemiology, 64(4), pp.401-406.
Bohnenkamp, J.H., Stephan, S.H. and Bobo, N., 2015. Supporting student mental health: The
role of the school nurse in coordinated school mental health care. Psychology in the
Schools, 52(7), pp.714-727.
Camara, M., Bacigalupe, G. and Padilla, P., 2017. The role of social support in adolescents: are
you helping me or stressing me out?. International Journal of Adolescence and Youth, 22(2),
pp.123-136.
Cheng, Y., Li, X., Lou, C., Sonenstein, F.L., Kalamar, A., Jejeebhoy, S., Delany-Moretlwe, S.,
Brahmbhatt, H., Olumide, A.O. and Ojengbede, O., 2014. The association between social
support and mental health among vulnerable adolescents in five cities: findings from the study of
the well-being of adolescents in vulnerable environments. Journal of Adolescent Health, 55(6),
pp.S31-S38.

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Coyne, I., McNamara, N., Healy, M., Gower, C., Sarkar, M. and McNicholas, F., 2015.
Adolescents' and parents' views of child and adolescent mental health services (CAMHS) in
Ireland. Journal of psychiatric and mental health nursing, 22(8), pp.561-569.
Das, J.K., Salam, R.A., Lassi, Z.S., Khan, M.N., Mahmood, W., Patel, V. and Bhutta, Z.A.,
2016. Interventions for adolescent mental health: an overview of systematic reviews. Journal of
Adolescent Health, 59(4), pp.S49-S60.
Dogra, N., Singh, S.P., Svirydzenka, N. and Vostanis, P., 2012. Mental health problems in
children and young people from minority ethnic groups: the need for targeted research. The
British Journal of Psychiatry, 200, 265–267.
Dubicka, B. and Bullock, T., 2017. Mental health services for children fail to meet soaring
demand. BMJ, 358, j4254.
Fink, E., Patalay, P., Sharpe, H., Holley, S., Deighton, J. and Wolpert, M., 2015. Mental health
difficulties in early adolescence: a comparison of two cross-sectional studies in England from
2009 to 2014. Journal of Adolescent Health, 56(5), pp.502-507.
Gopalakrishnan, S. and Ganeshkumar, P., 2013. Systematic reviews and meta-analysis:
understanding the best evidence in primary healthcare. Journal of family medicine and primary
care, 2(1), p.9.
Halter, M.J., 2017. Varcarolis' Foundations of Psychiatric-Mental Health Nursing-E-Book: A
Clinical Approach. Elsevier Health Sciences.
Kelly, N., 2018. Mental health nurse non-medical prescribing: Current practice, future
possibilities. Nurse Prescribing, 16(2), pp.90-94.

23
MENTAL HEALTH NURSING
Kidger, J., Heron, J., Leon, D.A., Tilling, K., Lewis, G. and Gunnell, D., 2015. Self-reported
school experience as a predictor of self-harm during adolescence: A prospective cohort study in
the South West of England (ALSPAC). Journal of affective disorders, 173, pp.163-169.
Mangle, L., Phillips, P., Pitts, M. and Laver-Bradbury, C., 2014. Implementation of independent
nurse prescribing in UK mental health settings: focus on attention-deficit/hyperactivity
disorder. ADHD Attention Deficit and Hyperactivity Disorders, 6(4), pp.269-279
McDougall, P. and Vaillancourt, T., 2015. Long-term adult outcomes of peer victimization in
childhood and adolescence: Pathways to adjustment and maladjustment. American
Psychologist, 70(4), p.300.
Ncbi.nlm.nih.gov. 2018. Home - PubMed - NCBI. Retrieved 18 March 2018, from
https://www.ncbi.nlm.nih.gov/pubmed/
Orchard, F., Pass, L., Marshall, T. and Reynolds, S., 2017. Clinical characteristics of adolescents
referred for treatment of depressive disorders. Child and Adolescent Mental Health, 22(2), pp.61-
68.
Pinto, A.C.S., Luna, I.T., Sivla, A.D.A., Pinheiro, P.N.D.C. and Braga, V.A.B., 2014. Risk
factors associated with mental health issues in adolescents: a integrative review. Revista da
Escola de Enfermagem da USP, 48(3), pp.555-564.
Pitchforth, J., Fahy, K., Ford, T., Wolpert, M., Viner, R.M. and Hargreaves, D.S., 2017. G118
Mental health and well-being trends among children and young people in the UK, 1995–2014;
analysis of repeated cross-sectional national health surveys. Arch Dis Child, 102(Suppl 1).

24
MENTAL HEALTH NURSING
Public Health England 2016. The mental health of children and young people in England.
Cumbria.gov.uk. Retrieved 18 March 2018, from
http://www.cumbria.gov.uk/eLibrary/Content/Internet/537/6381/4278314423.pdf
Roberts, C., 2014. Depression During Adolescence. Encyclopedia of Primary Prevention and
Health Promotion, pp.1066-1075.
Rothon, C., Head, J., Klineberg, E. and Stansfeld, S., 2011. Can social support protect bullied
adolescents from adverse outcomes? A prospective study on the effects of bullying on the
educational achievement and mental health of adolescents at secondary schools in East
London. Journal of adolescence, 34(3), pp.579-588.
Rothon, C., Head, J., Klineberg, E. and Stansfeld, S., 2011. Can social support protect bullied
adolescents from adverse outcomes? A prospective study on the effects of bullying on the
educational achievement and mental health of adolescents at secondary schools in East
London. Journal of adolescence, 34(3), pp.579-588.
Rueger, S.Y., Malecki, C.K., Pyun, Y., Aycock, C. and Coyle, S., 2016. A meta-analytic review
of the association between perceived social support and depression in childhood and
adolescence. Psychological Bulletin, 142(10), p.1017.
Sigurdson, J.F., Undheim, A.M., Wallander, J.L., Lydersen, S. and Sund, A.M., 2015. The long-
term effects of being bullied or a bully in adolescence on externalizing and internalizing mental
health problems in adulthood. Child and adolescent psychiatry and mental health, 9(1), p.42.

25
MENTAL HEALTH NURSING
Stewart-Brown, S.L. and Schrader-Mcmillan, A., 2011. Parenting for mental health: what does
the evidence say we need to do? Report of Workpackage 2 of the DataPrev project. Health
Promotion International, 26(suppl_1), pp.i10-i28.
Swartz, J.R., Hariri, A.R. and Williamson, D.E., 2017. An epigenetic mechanism links
socioeconomic status to changes in depression-related brain function in high-risk
adolescents. Molecular psychiatry, 22(2), p.209.
Townsend, M.C. and Morgan, K.I., 2017. Psychiatric mental health nursing: Concepts of care in
evidence-based practice. FA Davis.
Ttofi, M.M., 2015. Adolescent bullying linked to depression in early adulthood. BMJ. 350,
h2694.
York, W. and Jones, J., 2017. Addressing the mental health needs of looked after children in
foster care: the experiences of foster carers. Journal of psychiatric and mental health
nursing, 24(2-3), pp.143-153.