Mental health: Asking the right questions...

Written by: Dr Pooky Knightsmith | Published:
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Tackling mental health problems does not have to mean expensive new products or interventions. Perhaps we just need to ask more questions, says Dr Pooky Knightsmith

Mental health and emotional wellbeing have come to dominate headlines in the past couple of years – a fact that has not escaped the business-minded among our communities who have looked to develop interventions that will “solve the problem” for us.

It is easy to be lured by the shiny things – the big promises and slick styling making it hard to say no.

But we should. Or we should at least say only a tentative “maybe”.

When we buy into products that are not evidence-informed we are, at best, potentially wasting money, and, at worst, putting our pupils at risk of harm. Easy for me to say with my research PhD, but how are you, a hard-working teacher who is already expected to be a font of academic knowledge, a pseudo-parent and therapist, supposed to take on the role of scientist too?

Well to be honest, it is not quite as hard as it seems. We just need to ask a few more questions. We need to channel our inner three-year-old and repeatedly ask the question “why”?

When we are told we will replace detention with meditation, we should ask “why?”. When we are told we will have a puppy room available to pupils before exams, we should ask “why?”. When we are told all of our pupils are going to do a healthy coping skills workshop we should ask “why?”.

Sometimes, we’ll get an acceptable answer, one that shows that this is not just a random intervention but one that has been thought-through and is being carefully implemented and measured. Sometimes we will find that we need to do a little more exploration.

Don’t get me wrong, I’m not against trying new things – I’m all for it, but I think that we should always have clear reasons for trying something, clear outcomes we are aiming for, and clear ways of knowing whether or not we have achieved our aim. But how?

Finding new things that might work

On the whole, the shiny things that come through your door in the form of a salesman, a glossy leaflet or a compelling email are likely not the best things you could be trying.

This will not always hold true and it’s great if they get you wondering about what you might try next to improve your pupils’ wellbeing – but before you pick up and run with the shiny thing, ask these questions:

  • Can you put me in touch with a colleague who’s had success with this in another school like mine?
  • Please can you explain the evidence that underpins the approach?
  • What are the costs – short-term and long-term? (There are often hidden costs for things like user licences, maintenance, or individual access to or analysis of questionnaires.)
  • What do young people say about the intervention?
  • How will I know if it’s working?
  • Can you reassure me this will not do harm?

You need to be a critical consumer in just the way you teach your pupils to be – who created this product and what’s in it for them? Are they likely to be a reliable resource (universities, healthcare providers and charities might fall into this bracket) or are they simply looking to turn a profit?

Keep in touch with local universities who might have new resources and research programmes for which they are looking for participants, and be prepared to scrutinise whether participating in these kinds of trials will be of benefit to your school – sometimes even if participation is free, the commitments in terms of time or staff are costly.

York’s Institute for Effective Education is a great place to check out what’s up and coming in evidence-based education interventions (and not just mental health ones).

Have clear objectives and measure impact

The best pathway for intervention adoption is when you have recognised a need as part of your whole-school planning and gone looking for something that suits your needs. Ask colleagues in other schools, ask CAMHS, ask colleagues in public health or online, ask your local university. Ask ask ask.

More likely than not, someone will have a suggestion for you. And once you find the intervention that feels like a good fit, be clear in what you hope it will achieve. Perhaps you expect to see a change in behaviour – more help-seeking, less pupils absent with anxiety, lower reported stress in the run up to exams, a reduction in absenteeism...

Your targets need to be SMART, otherwise it will be impossible to determine whether or not your intervention was effective.

That said, you also need to talk to people – did pupils like the intervention, did they feel it had an impact, would they recommend it to peers, did teachers like delivering it, did they feel it was a good use of time, was the training sufficient? And so on. We ask these questions to enable us to get best value for our precious commodities of time and money.

There are very few interventions out there that meet the gold standard of RCTs (that’s a randomised controlled trial in case you were wondering, basically a group of people get to try the shiny new thing, another group of people don’t, all other variables are controlled for and you see if there is a difference between the two). These are very hard to deliver in a school environment and are costly both in terms of time and money so we need to learn to live with a more realistic standard on the whole.

So not everything you ever use with our pupils will have been triple tested in a lab-like environment, but if each of us takes an active role as a critical consumer and in sharing what works, between us we can help to move the field forwards in a way that best meets the needs of the children we work with.

  • Dr Pooky Knightsmith directs the children, young people and schools programme at the Charlie Waller Memorial Trust, a charity that provides fully-funded mental health training to schools. Visit www.inourhands.com/cwmt/ and email training@cwmt.org or call 01635 869754 to make an enquiry. For more information on the charity itself, visit www.cwmt.org.uk

Mental Health Advice

Dr Pooky Knightsmith provides regular support and advice in SecEd. Her next article is due to appear on March 16. To read the previous articles in this series, go to http://bit.ly/2daU4zs. If there are specific issues you would like to see addressed, email pooky@cwmt.org or tweet @PookyH


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