Emotions and Mental Health

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Young people with chronic health conditions, such as juvenile arthritis, can be more likely to have mental health struggles like low mood or worry. 

While young people manage their condition, changes in symptoms or medical treatment, how other people act with them, and how they see themselves might make these struggles show up.

The following information is general guidance on mental health in young people.

For expert support and advice, please talk to a professional specialising in mental health. There are useful website links at the end of this webpage.

Worry

Worry can show up because of school-work problems or exam pressure, friendship/family difficulties or bullying, and changes in the health condition or its management. 

Worry can feel different for different people, but some people talk about:

• Butterflies 
• Tingles
• Fast heartbeat
• Quick shallow breathing
• Dry mouth
• Feeling sick
• Needing to use the bathroom
• Getting warmer and sweaty
• Feeling tense and stiff
• Headaches
• Not being able to concentrate on the here and now
• Trouble sleeping

We all worry a certain amount, anxiety and stress in some situations is necessary. For example, we wouldn’t cross a road safely if we weren’t slightly anxious about the traffic. But when the worry feels too much, goes on for too long, or gets in the way of life, it can be helpful to try different ways of responding to it.

Relaxation Techniques

• When the situation causing worry is out of your control, it can be helpful to use self-help relaxation techniques. 
• They work by calming the nervous system, helping take you out of “fight or flight” mode, which is what makes you feel the way you do when worry shows up. They are a skill and take time to practice, but the more you do them, the better they will be at managing anxious symptoms, letting you choose to get on with the life you want.
• One evidence-based method is “progressive muscular relaxation”. This involves tensing and relaxing the muscles throughout the body. Working from the feet towards the head, the muscle tensing is held for about 5 seconds, and then allowed to immediately relax. As you work through the muscles in the body, tensing and relaxing eventually this creates a feeling of warm heaviness spreading throughout the whole body.
• Another proven technique that you can do anywhere is “diaphragmatic breathing”. There are many different patterns of breathing talked about these days, but to help best with worry, there are two golden rules: 
  • 1 – breathe from your belly, not your chest. Place a hand on your tummy and think about gently pushing it out as you breathe in, your hand and belly should then fall back towards you as you breathe out. 
  • 2 – breathe out for longer than you breathe in. It doesn’t matter if you count, or how many seconds you use if you do count, nor whether you pause in between inhales and exhales. But spending more time doing a long slow controlled outbreath helps the nervous system drop the fight or flight response.
• Here is a video that can help: Box Breathing Exercises

Low Mood

We all feel sad from time to time, especially when something from our lives has been lost. But when we don’t feel like we’re bouncing back, there can be some signs to look out for, which might mean some help is needed.

When someone becomes depressed and feels low, their level of activity reduces and patterns of thinking change. They can include:

• Feel hopeless
• Lose interest in what they normally do
• Stop doing as much
• Sleep more or less
• Eat more or less
• Feel more tired, grumpy, or sad
• Stop talking to people as much
• Think they are worthless and lose sight of who they are or want to be

Getting Going Again

We can see that low mood can make us withdraw from engaging in life. To help it is important to schedule pleasurable activities into our day. These activities should be things that you value, or that used to bring you joy. It can be anything from seeing friends, painting, playing a sport, learning a new recipe, playing games with the family, looking after animals, to writing a story or song. If your body isn’t currently able to do exactly what you liked before, think why you liked it, and find other activities that might share those values. Don’t worry if you don’t feel like doing them, or they don’t lift your mood at first. Stick with them, the doing comes first, the motivation comes second. 

Keep a diary of your activities in a day, and rate your mood at the end of each day. This can help show you which sort of activities have a better chance of lifting your mood. Then make more time for these. It can be hard to stick to your scheduled activities, especially at the start. Have a think about who can help you with this, and ask them to remind you about or join you in the activities. The more people you let know you’re trying to do this, the more likely you’ll get going again faster. People are usually more than happy to help. People like to be of use to each other and doing these things with other people can give you a chance to talk through what’s going on, and help you not feel so alone. 

If tricky thoughts show up, they can make it harder to stick with plans. Just notice these thoughts. Remind yourself that they are thoughts not facts, and that you can still choose to do whatever you want, no matter how you might be feeling. Continuing to make choices that bring you closer to what you care about and the person you want to be will help those sort of thoughts show up less. And when different more positive thoughts start showing up, write these down in a notebook or on your phone, to help your outlook change even faster.

Self Harm

It’s a behaviour, not an illness, it’s not attention-seeking and is often a secretive and private act.

Self harm can be used to:

• Communicate feeling of distress
• Give relief from emotional pain and tension
• Regain feelings of control
• Self punish for feelings of guilt or shame

Self harm can range from minor injury to dangerous and life-threatening behaviour. Young people self harm for many reasons, including bullying and poor body image. Possible warning signs that a young person is self harming are:

• Unexplained accidents or injuries include cuts, bruises or cigarette burns to sometimes easily hidden areas of the body
• Not feeling good about themselves
• Having more time alone
• Having bigger changes in mood more often
• Not getting on as well with school-work
• Loss of interest in favourite hobbies or sports
• Keeping fully covered, even in warm weather. Also avoiding situations where revealing clothing is expected (for example PE at school)

Self-harm is most often used as a coping mechanism when the young person hasn’t found a safer way to manage their struggles.

• Inviting them to talk about it is the first step. If they are happy to share the situation and thoughts and feelings that leads to the self-harm, you may be able to work together to think about what changes could be made.
• Working together to try and find a different coping technique to replace the behaviour is the next step. Some suggestions can be found here.
• If the young person is experiencing high levels of worry, or low mood, or anger, provide information regarding effective help and treatments. There are website links below.
• Professionals who can help include the school nurse, psychiatrists, Child and Adolescent Mental Health Service (CAMHS), clinical psychologists, counsellors, drug and alcohol treatment services and other mental health services.

Useful apps: Headspace, Calm, Calmharm, Sleepio, moodgym, Moodkit, sam (self-help anxiety).

Updated: 31/01/2023

Next review: 31/01/2024