Salutogenesis, and factors that impact on mental and physical health for YCE.
Organisations such as the Carers UK have published many reports and research documents on the need for wider society to acknowledge the role of carers, and for government to find new ways to support carers to continue. From a range of studies, we understand that the work all carers do has a cost value of approximately 132 billion pounds per year. A young carer is deemed to be anyone under 18 and provides care for family, friends and or/neighbours. Young carers usually provide care for parents, although this extends to siblings and other family members such as grandparents. Young carers are supposed to be assessed by staff form their local authority/council to see what their needs might be in terms of support for school and respite from their caring role. There are an estimated 700,000 young carers in the UK, and of these we know 68% of young carers are bullied in schools. We know that on average 48 school days are missed because of caring responsibilities, and only half of young carers have someone in school who knows about their caring role and supports them.
What is salutogenesis?
Salutogenesis is the term coined by medical sociologist Arron Antonovsky. The word means ‘origins of health’. Antonovsky’s work initially involved discovering ways in which to cure disease from a public health perspective. The medical model he worked to was a ‘pathogenic’ one, which focuses on finding out what is wrong and fixing or curing. After some time he realised that this is not the whole picture of how we live well as humans, and he discovered that there is another way, a ‘salutogenic’ way of thinking and being in the world. This discovery led him to many more years of research, until he published two very important books, these are Health, stress and coping: New perspective on mental and physical well-being published in 1979, and Unravelling the mystery of health – How people manage stress and stay well published in 1987. These books and the many more research papers Antonvosky has published form the cornerstones of salutogenic thinking and practice.
To have a salutogenic mindset and to practice using Antonovsky’s salutogenic model means that you focus primarily on what is working well, and from there begin to develop a ‘sense of coherence’ (SoC) about your life and any situation you might find yourself in. Having a SoC is proven to increase wellbeing, resourcefulness and resilience, and those that possess it will fare better than their counterparts who do not.
There has been many successful applications of Antonovsky’s theories of wellbeing within a range of contexts, these include, educational, community, work, health, prison, and care home settings. Our work at grays, has led us to incorporate Antonvsky’s theories with others that support learning, and bringing about positive change. This means we have had successful application of salutogenesis within front-line public sector workplaces, community groups and settings, and with carers who we identify as the ‘third workforce’.
Salutogenesis and YCE
We are concerned in this programme about developing a SoC with Young Carers in Education (YCE), and in order to do so we are mindful of how early life experiences can contribute to or detract from mental, emotional and physical wellbeing. We know that time spent in school, and the relationship that develops with teachers are critical in shaping social, emotional, and cognitive development, and have the potential to positively impact YCE to overcome the adversities that may face them by having a caring role.
The emotional development of young children is correlated to the characteristics of the environments in which they live, including their families, school, and community (Reid, Patterson, & Snyder, 2002).
Research has shown that in preschool children, having a SoC was a protective factor for ‘high risk children’. This continues in successive school environments and is further strengthened by the perception of the teacher as someone who accepts them, and makes time for them. Furthermore, studies have shown that children with a low SoC exhibit disruptive behaviour, and, that this is linked to social difficulties within the school environment. Children who develop a SoC are more likely to have emotional self-regulation and be able to engage with and be accepted by their peers. This aligns with the findings our (grays) 2018 scoping exercise during which YCE spoke of feeling isolated, lonely, and misunderstood by both teachers and peers.
An additional factor to consider in relation to YCE relates to the home environment, and whether there is reciprocal support for the YCE. We know that some YCE may experience a loving and supportive environment at home, or, they may feel unacknowledged, un-rewarded and overworked. The former strengthens resilience and wellbeing, and the latter detracts from it. In addition where a YCE has a minor caring role because the ‘cared for’ receives most care from parents, it is worthy of note that the stress this causes parents (particularly mothers are affected) is likely to manifest in parental depression which has a knock on effect in terms of wellbeing for the whole family. This resonates with the 2018 (grays) survey in which YCE spoke of feeling neglected because their siblings were the priority at home.
In terms of a SoC contributing towards somatic health, studies have shown there is an association between a low familial SoC and the manifestation of diabetes and psychiatric problems. Two factors are likely to be in play here, one is related to the effects of stress on human health and the second is not having a mediating factor, such as a SoC, that has shown to help manage stressful experiences/environments.
Some YCE may have a finely developed SoC, and sufficient resilience to transform their experiences into those that are salutary which help them as their lives unfold. Others, who do not, would benefit from interventions that enable them to accrue coping strategies and a positive self-regard that will go some way to levelling the playing field in the immediate and long term.
Components of salutogenesis
Having a salutogenic mindset forms part of Antonovsky’s work, and this means that we view our lives as being on a continuum, where it is natural at some points to experience challenge, change, and even traumatic episodes. Some of these events will bring about an alteration in wellbeing, so the events themselves may prove to have a negative impact or if you have a SoC….to be salutary. As human beings we can be supported to discover ways in which we choose how we see these events and by doing so remain in control of our responses to them.
Having a SoC revolve around three components, put simply these are:
- Comprehension – engaging with this aspect of Antonovsky’s model requires you to take a step back and look at what is happening within a bigger picture.
- Management – requires you to examine what resources you are utilising to deal with events, and to consider new ways of doing things
- Meaning – involves you finding a positive reason as to why these are your experiences, and helps you to find purpose from the events that are unfolding
Generalised Resistance Resources (GRRs) are the final element of Antonovsky’s salutogenic model. GRRs are all of the internal and external assets that act as buffers to stress, and help us to manage and flourish within stressful environments. They can be anything from having someone you or a YCE can trust to talk with, a mentor, exercise, mediation, having some respite time from care work, having friends and/or peers with whom you can spend time with, and having ways in which you and YCE can proactively identify and deal with stress.
YCE have a potential to be overwhelmed by the duality of the roles they try to fulfil. Our scoping work with YCE has shown that in order to create an environment in which YCE can develop a SoC and flourish at school they need these critical things:
- friends to play with
- to feel, and are included
- to have a sense of belonging
- to be acknowledged and respected
Things that detract from this include:
- the burden of care work combined with school work
- fear of being shouted at for not completing homework
- not having anything ‘just for themselves’
- being bullied because they don’t fit in
If we think about today’s workplace, we know that it has the potential to be stressful. In terms of cost, work related stress caused 11.7 million lost working days in 2015/16, and the overall economic cost to the UK was estimated to be over £5 billion. Research undertaken by the HSE has shown that of all UK professional groups who work in stressful environments, teachers and nurses fared the worse. The potential for stress that teachers experience to impact on YCE is very real. The resources and social capital that shape the learning environment also create a bi-directional relationship between the teacher and the student in terms of wellbeing. So for example, if the teacher is stressed this is likely to impact upon the student, if the student manages to achieve set exam results this positively impacts upon the wellbeing of the teacher. Social capital determinants are the same for YCE and the teacher, both need to be valued, recognised, and rewarded. Without these fundamental features within the learning environment, teachers may become disengaged from work and leave the profession. When we are thinking about YCE and the importance of school as an ‘anchor’ for their developing resilience and wellbeing, we have to think about supporting teachers too. The value of psychological safety in the learning environment is of particular importance to vulnerable students; YCE need teachers to co-create a no bullying and respectful community, importantly as role models there also needs to be a positive, supportive working culture for teachers too.
From the work, we have undertaken with YCE so far, the GRRs identified included:
- teachers know and understand the role YCE have to play outside of school.
- being supported to become more determined so that YCE could try harder
- having stamina to keep trying
- having opportunities to show peer compassion and showing others ‘having a heart of gold’ YCE would eventually win through.