Bright Futures, a three-year programme of work commissioned by the Mental Health Foundation has published its report, The Big Picture. It constitutes the most comprehensive inquiry into the mental health and emotional development of children and young people in Britain this century. The programme has taken over 1,000 pieces of written evidence from relevant professionals and the oral testimony of health and education professionals, service providers, academics, parents and children.

It does not make for pleasant reading. Of the 15 million children and young people under 20, mental ill-health affects 20 percent at any one time. The particular disorders vary according to age and gender. Overall figures from epidemiological studies of children and adolescents spanning the years 4-20 suggest that diagnosable anxiety disorders affect around 12 percent, disruptive disorders around 10 percent, attention deficit disorder an estimated 5 percent, specific developmental disorders such as bed-wetting and substance abuse up to 6 percent, depending on age group.

The report attributes the emotional well being of children and young people to the health of society itself. At one time, such a statement would have been unremarkable, but it is a departure from the recent past. Former Conservative Prime Minister Thatcher notoriously declared that, "There is no such thing as society", inaugurating a period in which social policy was refashioned in the most backward manner. Increasingly, social and psychological problems affecting children have been variously ascribed to individual causes based on "genetic disposition" or, more grotesquely, to some "innate evil", as in the furore surrounding the killing of the toddler Jamie Bulger by two 10 year old boys.

Those involved in the survey express a clear consensus that there has been "substantial increases in psychosocial disorders affecting youth since the Second World War in nearly all developed countries." One of the points stressed in the introduction, is that the report is not just about improving services and care for these children, but seeks to examine the social changes and pressures that have led to this increase in mental health problems. The authors note that life has become much more competitive for children, and this is given little recognition. In addition, "we are less tolerant of those--including children--who are different, who do not conform, or who seem to present a threat to the safety, comfort or well-being of others."

The report refutes the oft-cited claim that Britain is a child-centred society. It shows that children are defined almost exclusively in terms of their impact upon adults' lives and by governments in terms of their economic potential. The authors cite the increasing tendency to portray children as either angels or devils. They say that, in spite of the wealth of literature on this subject over the past period, a troubled child is less understood than its Victorian counterpart was.

Attention is drawn to a "fragmentation of extended family networks (although somewhat exaggerated) reducing contact with other adults." The report adds that, "concerns about safety and risk of abuse or violence (again exaggerated)have limited the amount of time children play outside unsupervised, travel alone or are allowed to attend clubs etc." As a result, there are growing numbers of children who may have no more than two or three significant adults in their lives and whose physical territory is limited to home and school. This serves to increase the risk of mental ill health among children.

In dealing with the factors affecting the mental health of children and young people, the report lists "risk" and "resilience" factors. The "risk" factors are those that increase the probability of mental ill health, which may be within the child themselves, the family or the broader environment.

There is a complex interplay between the range of risk factors in a child's life and more positive protective factors such as good communication skills, the support of at least one parent and a wider supportive network. The risk factors are cumulative, so that the greater the number and more severe the risks, the greater the likelihood of a child developing a mental health problem. The likelihood is greatly increased when adverse external circumstances, adverse family relationships and the particular child's own characteristics reinforce each other. The report weighs heavily on these external factors such as unemployment, divorce, parenthood and stressful life events.

The authors readily acknowledges that it is not easy to demonstrate causal links between trends in society and their impact on children and young people. But the point is made that, "It is striking that the rise in psycho-social disorders over the last 50 years applies particularly to adolescents and young adults." This is underscored by the fact that there is evidence of a significant change in the traditional "rites of passage", particularly for young men, and especially regarding employment. The report notes, "the change in the labour market over the past decades now marginalises young people who previously would have gained employment without difficulty. The loss of unskilled and semi-skilled work places a higher premium on standards of literacy and numeracy not required by previous generations of young people. This necessitates a major shift for children to be able to achieve educational standards not previously demanded."

The Big Picture brings out the contradiction in government policy. Whilst there is a broad consensus that providing support to families is the best way to raise children, this is "ever more difficult as the role of the state in supporting families has in recent years been reduced." It points to the marginalisation of children through increased school exclusions and the emphasis on "league tables" for examination results. In particular, the report cites the pressure on single mothers to go to work. It shows that despite the emphasis on equipping children with skills, this does not include emotional ones.

Specialist mental health services for children and adolescents are currently under-funded and short of resources. Yet the inquiry received a considerable amount of evidence to show that early intervention was effective in combating mental health problems, including help aimed at families and in the school setting.