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6 What do young people think about health issues?
Evidence suggests that children generally view health as primarily to do with diet, exercise and dental hygiene (Hill and Tisdall 1997; Armstrong, Hill and Secker 2000; Ridley and McCluskey 2003). Judgements of whether a young person is healthy are usually based on appearance (slim or fat), eating habits and athletic ability. The relationship between health and appearance is particularly evident in adolescence and impacts on eating patterns. Adolescent females tend to perceive slimness as a 'good thing', a social asset or being fit (Brannen et al. cited in Hill and Tisdall 1997; Armstrong, Hill and Secker 2000).
Younger children often describe ill health in terms of behaviour such as wanting to lie down, although they often explain illness in terms of contagion. Older children have more understanding of symptoms and a greater awareness of the social context (Hill and Tisdall 1997).
Many young people have a different view of the meaning of the terms 'mental health' and 'mental illness' compared to health professionals. Accessing services can be seen as stigmatising. One study (Secker, Armstrong and Hill 1999) interviewed 120 young people from a variety of social and minority ethnic backgrounds, who attended mainstream schools in rural, suburban and inner city areas in Scotland, about their views of mental health. The focus of the study was on the young people's perceptions of mental health. They identified four key features which contributed to, or promoted good mental health: family and friends, having people to talk to, personal achievements and feeling good about yourself. These are features not always present in the lives of looked after and accommodated children and young people.
A major theme to emerge from the interviews was the need for adults to make young people feel safe and cared for both physically and emotionally in terms of promoting good mental health. Professionals did not feature significantly as a group of adults the young people would turn to or trust, but they often had access to wider family networks (Armstrong, Hill and Secker 2000). It has been suggested that many looked after children do not have access to a number of trusted adults to whom they can turn for advice or support, in stark contrast to the majority of children in the community (Mather, Humphrey and Robson 1997), though usually, but not invariably, there is at least one person who is seen as a source of support (Hill 1999).
A survey of looked after and accommodated young people in Glasgow (Scottish Health Feedback 2003) showed that they identified exactly the same factors contributing to good health as the general youth population: physical fitness, healthy eating and physical attractiveness. Praise and encouragement were thought to promote health or make you healthy; providing a link between how you feel, your level of self esteem and how you are able to function in life. Those young people also asked for more information or advice on a range of health topics including sexual health, mental health, drug and alcohol problems as well as physical health. Young people saw living in residential care as a barrier to a healthy lifestyle, for example through not having the opportunity or enough money to meet the cost of some sports or exercise activities (Ridley and McCluskey 2003).
Young people also wished to be listened to during consultations, whether it was a routine health check or more specialist intervention. Young people often reported that they did not feel listened to (Bundle 2002; van Benium, Martin and Bonnett, in Scott and Ward (2005) and that professionals and health organisations were difficult to approach (Buston 2002).
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