School Mental Health Promotion

Schools contribute strongly to risk and resilience factors for mental health, and programmes to promote mental health are among the most effective of school health promotion programmes. (1) A large evidence base has been developed stretching back over many years (2).

These programmes can mitigate some of the effects of suboptimal parenting. They also support other school health programmes like those aiming to reduce alcohol and drug misuse, which alone can be relatively ineffective. (1) These programmes may also offer parenting support. Universal approaches are important to underpin targeted approaches and are effective in their own right. The optimum approach is to offer both. (3) (4)

There is pervasive evidence linking academic achievement to mental health and wellbeing, and this can be used as a powerful argument to promote uptake in a service which may not have health as a priority.

Evidence based programmes range in type from:

Universal

Based solely in the classroom and aim to improve children's skills in, for example, emotional literacy, conflict resolution and relationship building using manualised approaches. The most effective use interaction games and simulations, whole-class and small group work. They focus on the positive. An example of this sort of approach is the PATHs programme.

Bullying prevention programmes which aim to change the ethos of the school and develop zero tolerance policies. An example of this is the Olweus Anti-Bullying programme.

Behaviour management programmes in which teachers are trained in behaviour management approaches and offer rewards for good behaviour. An example of this is The Good Behaviour Game.

Whole-school approaches which aim to change the ethos of the school as well as providing classroom teaching. They may involve peers, for example, as mediators in conflict. They usually involve parents and may provide parenting support. Staff development is key with a view to improving staff wellbeing as well as to offering rigorous programmes. These programmes take a long-term view; they need to start early and continue for a long time.

An example is the Seattle Social Development Programme implemented in England as Communities that Care. The Family Links Nurturing Programme is a UK developed programme which takes a whole school approach. SEAL (the English Social and Emotional Learning programme which was implemented to some extent in all schools) took a whole-school approach, but not all schools implemented all aspects and provision was very variable.

These programmes can be challenging to provide. School engagement is essential to sustainability and thus programmes usually work better if offered by teachers than by outsiders. Support from the headteacher is necessary for long-term success and significant change to the school ethos. School engagement is enhanced if programmes can be modified for each school, but a balance needs to be struck between encouraging autonomy and implementing core components which are essential to success in the way they have been painstakingly researched and developed. Even well evidence based programmes like PATHs may fail to show long-term gains when implemented in some settings (5).

The latest outcome evaluation of the Social and Emotional Learning (SEAL) Programme which was introduced to some degree into most schools in England, has shown that schools which implemented the programme on a whole-school, universal basis had an influence on school ethos, student experience, persistent absence and school attainment (6). As with parenting programmes, attention to detail in implementation and training and development of all school staff is important.

Targeted

Provision of Cognitive Behavioural Therapy (CBT) and social skills training to individual children identified as experiencing difficulty; targeted programmes which are offered to children in groups can increase bullying. The UK Targeted Mental Health in Schools Programme (TAMHS) adopted this approach. These approaches are often provided by practitioners, psychologists who are not employed in the school.

Provision of a staffed facility in which children with problems can take themselves when they start feeling overwhelmed or causing problems eg. A Place2B.

References

1) Stewart-Brown. What is the evidence on school health promotion in improving health or preventing disease and, specifically what is the effectiveness of the health promoting schools approach. Editors: WHO Regional Office for Europe, Health Evidence Network, Health Evidence Network report. Copenhagen, 2006

2) Weare K, Nind M. Promoting mental health of children and adolescents through schools and school based interventions: evidence outcomes report of the work package Three of the Davaprev Project 2011

3) Weare K, Wolfgang M: What do we know about promoting mental health through schools? Global Health Promotion. September 2005 vol. 12 no. 3-4 118-122

4) Weare K. Mental Health and Social and Emotional Learning: Evidence, Principles, Tensions, Balances Advances in School Mental Health Promotion 2010;3: 5-17 Special Issue: Perspectives from the United Kingdom

5) Gingrich, Robert D ; Hudson, James R. Child Abuse in a Small City: Social Psychological and Ecological Correlates; J. Soc. & Soc. Welfare 376 (1981)

6) Bannerjee R, Weare K, Farr W, Working with 'Social and Emotional Aspects of Learning' (SEAL) Associations with school ethos public social experiences attendance and attainment. British Educational Research Journal 2013 (in press)