Shakespeare’s “All the world’s a stage” speech in As You Like It, defines the many parts we play in our journey through life, from mewling and puking infant to second childishness and finally to mere oblivion. What is not expressed is that the manner in which we move from one stage to the next will have profound effects on our wellbeing for the rest of our life. Success in early transitions from perinatal life to childhood and on to early adulthood, are of particular importance, both to individuals and to society.
In the early years we depend on both family and state. Failure to complete this stage successfully is largely attributed to environmental and societal factors whose mitigation rightly attracts considerable attention and resources.
However, in the next transition, from childhood to early adulthood, the individual is passing through puberty, with its own complexities, possibly moving on from full-time education, and is thus becoming less dependent on family and state support and more reliant on their own capabilities. Their transition to adulthood will be determined by an interplay between personal characteristics, such as behavioural and educational attributes, and the influence of their family, society and physical environment.
Understanding the role of these factors in this transition and how they may be modified to favour success and reduce the likelihood of a negative impact on mental and physical health and wellbeing is of particular relevance to young people, communities and institutions today.
These considerations prompted the RSE Scotland Foundation, a charitable body connected to the Royal Society of Edinburgh (RSE), to award grants to fund two interdisciplinary research projects within the area of Health, Happiness and Wellbeing. Focus was provided by consulting specialists in health, social sciences, economics, arts and government, with further definition coming from an expert advisory group formed of RSE fellows. This group recommended a tightly delineated, three-stage study of factors affecting the transition from youth to successful adulthood in Scotland. The ultimate goal would be to devise and conduct novel interventions during the transition to adulthood that would improve wellbeing during and beyond this period into independent living.
The first stage of the study will review interventions tried in other times and places, which have or have not been beneficial, and what lessons these hold for the future. The RSE Scotland Foundation invited applications for grants to produce two systematic evaluations of work in this field: one review to cover interventions in the target population as a whole, the other to evaluate interventions aimed at individuals deemed to be at risk of adverse outcomes during the transition.
The successful applicant to produce the review of population interventions is a consortium from four Scottish universities, led by Dr Joanne McLean of the Mental Health Foundation, which intends to work with a panel of adolescents to ensure that they “take account of outcomes that indicate successful transition from the perspectives of young people in Scotland today”.
Another team, led by Dr Kathryn Skivington of the Social and Public Health Services Unit, University of Glasgow, is tasked with the review on individual interventions and hopes “to identify evidence on what works in improving the mental health and wellbeing of adolescents who face the biggest challenges in their transition to adulthood”.
These reviews will be assessed in mid-2016 by the expert advisory group in the hope that their findings, in addition to their intrinsic value, will trigger a second stage in the initiative. This, too, is intended to be awarded competitively, and may involve community as well as academic participation.
To quote Professor Marie Johnston, one of the expert advisers, “This exciting new programme tackles a question of importance to individuals and society; are there interventions that can enable young people to become happier, healthier adults?
The phase 1 grants will find and then integrate available but scattered evidence. Later phases will build on this to develop and evaluate interventions that might be effective in improving the future lives of young people in Scotland”.
We began with Shakespeare, let’s finish with Burns and his “Epistle to a young friend” where he talks about living a full and independent life.
“To catch Dame Fortune’s golden smile, assiduous wait upon her, and gather gear by ev’ry wile, what’s justified by honour: Not for to hide it in a hedge, nor for a train attendant; But for the glorious privilege of being independent.”
• Sir Kenneth Calman is a Fellow of the Royal Society of Edinburgh and former Chief Medical Officer of Scotland. He is a member of the Health, Happiness and Wellbeing expert advisory group.