Second Edition Miranda Wolpert, Rita Harris, Sally Hodges, Peter Fuggle

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THRIVING

The grouping of “thriving” is often portrayed in the centre of the THRIVE model but could equally be portrayed 

as around the outside. It is perhaps worth nothing that this was how it was initially portrayed but then people 

complained the picture looked like a plughole - on such bases are pictorial representations of ideas moulded! 

Thriving is included as a concept to indicate the wider community needs of the population supported by 

prevention and promotion initiatives. In our publication in November 2014 we did not include a detailed 

discussion of the needs of this grouping so we have started with a discussion of this grouping in this version. 

Context: All those children, young people and families who do not currently need individualised mental health 

advice or help are considered to be thriving. This is based on the assumption that not everyone requires or 

would benefit from mental health interventions, and indeed offering specific mental health interventions which 

cut across individuals’ own strength and strategies may sometimes be iatrogenic. 

This does not mean that those thriving in the community will not benefit from more general interventions 

to support mental health and wellbeing. The THRIVE framework would suggest this group should receive 

community initiatives that support mental wellness, emotional wellbeing and resilience of the whole 

population. This is an area of mental health support that some consider has been neglected by mental health 

professionals and commissioners over the years, but one where the potential impact could be great – by 

understanding the factors likely to lead to psychological harm, services can apply strategies to tackle these 

causes and prevent harm to individual children. This requires rigorous understanding of the environmental 

causes of potential harm to children and young people’s psychological health, and the active application of 

strategies to try to reduce or remove these as far as possible before they affect a child’s emotional wellbeing: 

primary prevention.

There are many factors that are known to increase the likelihood of the development of mental health 

difficulties in children and young people (World Health Organisation, 2012). These include individual factors 

such as: learning disability, physical health problems and sexuality; social factors such as poverty, poor 

education, and abuse and neglect; and environmental factors including injustice, discrimination, social and 

gender inequalities, and exposure to war and natural disasters. 

The relationship between risk factors and mental health problems is complex, and the impact of exposure to 

the risk will vary from child to child – but all children exposed to potential causes of psychological harm will 

have an increased chance of developing mental health problems either in childhood or later in life. 

Data: It is anticipated that at any one time around 80-90% of the total population of children and young people 

will fall into the needs-based grouping of thriving (based on Green et al’s (2005) view that around 10-20% of 

children and young people have problems significant enough to warrant specialist help).

Resource: There is no hard-and-fast rule for how much resource should be allocated to this category and as yet 

no economic evaluations that can robustly guide policy in this regard. Reports from current practice suggest 

that in many areas around 10-15% of the budget in children and young people mental health services is 

allocated to support community resilience programmes; consultation with teachers, health visitors and others; 

and other forms of intervention to support widespread wellbeing and mental health. It is anticipated that in any 

case-mix-adjusted payment system it is likely this work would need to be top sliced to be able to continue.

Need: Before reaching adulthood, all children and young people will experience many episodes of 

psychological distress. The quantity and impact of these events will depend largely on the environment in 

which the child lives, and the quality of care they receive from the people around them. For most children 

the distress they encounter will be mild and relatively short lived, and they will continue to thrive. For some 

children the impact of events will be so great that they will need more professional care and treatment. Despite 

the distress that negative events can cause it would not be helpful to try and remove all the emotional upset 

from a person’s life – in fact we know that these experiences, if not overwhelming, can help a person become 

more resilient and help them learn to manage bigger upsets later in life. To give children the best start in life 

it is important that systems promote emotionally healthy environments, and make every effort to prevent 

psychological harm. Child maltreatment is now known to be one of the biggest risk factors for children and 

young people developing mental health difficulties. Maltreatment can take a number of different forms, and 

can lead to a number of different outcomes. Selective prevention strategies that work with vulnerable families 

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and provide community-based interventions to build parenting skills and social support (e.g. mellow parenting 

(Puckering et al., 1999), help to build healthy protective attachments – particularly in the early years. This should 

be alongside the strengthening of child protection services to safeguard children more effectively in order to 

prevent maltreatment and trauma. 

Provision: To promote thriving, the THRIVE framework expects that the system actively applies research 

evidence of the kind of interventions that are likely to reduce the risk of developing mental health difficulties 

and promote wellbeing and mental health. Opler et al (2010) define categories of prevention that might be 

seen to fit with the THRIVE framework of primary prevention: “1. Universal prevention: Targeting the general 

public or a population group that has not been identified on basis of individual risk. 2. Selective prevention: 

Targeting individuals or populations subgroups who have biologic, psychological, or social factors placing them at a 

higher than average risk for developing mental disorders.”

Services should also help increase awareness and promote psychological wellbeing and health at a whole 

community level – again through the application of evidence-based psychological approaches. There is much 

work to be done to expand the role of mental health professionals into this realm of mental health promotion 

(Knapp, McDaid, & Parsonage, 2011). This will involve awareness raising, consultation and training that is not 

necessarily focused on a particular child or family.

Examples of whole community approaches to promote psychological wellbeing include the ‘The Big Noise’, 

adapted from the ‘El Sistema’ movement (Tunstall, 2012). It encourages whole communities to become 

empowered and take an active role in their lives and community. The vehicle for this change is music, giving 

instruments to children and encouraging them to put on concerts, pulling together the community and 

fostering feelings of self-efficacy and wellbeing (Scottish Government Social Research, 2011). Whole school 

approaches include the Time 2 Talk project in Haringey, run by Nick Barnes and colleagues, which raises 

awareness about emotional wellbeing and mental health, and challenging mental health stigma.

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