From the onset of the pandemic and its associated restrictions, educators and others were quick to voice their concerns about the detrimental impact on the mental wellbeing of children and young people.
Unsurprisingly, a “substantial” increase in demand for pastoral and mental wellbeing support has been reported (EBPU, 2022). According to school leaders, already-vulnerable pupils, such as those with SEND, were most affected, while other pupils have experienced low wellbeing and mental distress for the first time.
We must remember that children and young people’s mental wellbeing was a major public health concern before Covid-19 struck, with the prevalence of emotional difficulties such as anxiety and depression having been on the rise for some time (Sadler et al, 2018).
But for many children and young people, traditional support structures crumbled during lockdown, including the physical haven of school.
With the return to classroom learning came the opportunity for schools to prioritise mental health and allow pupils to catch-up socially and emotionally. However, the focus quickly centred on academic gaps despite the fact that wellbeing problems are significant. In July 2021, one in six children aged five to 16 were identified as having a probable mental health problem according to NHS data – five in every classroom (NHS, 2021; SecEd, 2021a).
While it is broadly recognised that learning environments should be at the heart of emotional wellbeing and early intervention, it remains a significant challenge for schools to fulfil their potential for nurturing pupil wellbeing and supporting their mental health needs, and the debate continues as to the role, responsibilities and boundaries schools should adopt.
Barriers and facilitators
Schools can make a difference to the mental wellbeing of their pupils and there is a wealth of research evidence on school-based interventions spanning recent decades (e.g. Durlak et al, 2011; Franklin et al, 2017).
Mental health promotion in educational settings has become a central focus for government policy. The mental health Green Paper (DoH & DfE, 2017) put schools firmly in the spotlight for service provision, while the new relationships, sex, and health education curriculum (DfE, 2019) places statutory responsibility on state-funded schools to promote mental wellbeing and provide appropriate support for pupils experiencing difficulties.
Although we are some way behind other high-income countries such as the United States and Australia in embedding school-based mental wellbeing services, evidence from the Children’s Society (2019) shows that 56% of children in England are willing to seek wellbeing support within the school environment. So what does effective mental wellbeing provision in schools look like in practice?
A whole-school approach
A whole-school approach recognises the importance of working collaboratively with all members of the school community and therefore permeates behaviour policy, curriculum design, the support of pupils and staff, and parental engagement (O’Reilly et al, 2018).
Despite having huge potential, embedding a whole-school approach to mental wellbeing is complex – school environments are diverse and dynamic and there is huge disparity among schools in terms of ability and resources to implement such universal support.
The main barriers include a lack of adequate funding and staff buy-in, insufficiently trained staff, and not engaging your pupils in the development of interventions (O’Reilly et al, 2018).
The key role of pupil voice
Pupils have traditionally been seen as passive recipients of services targeted at them. A review of the literature on the wellbeing of children and young people with mental health needs showed that studies often relied on the testimony of adult informants (e.g. parents/carers and service providers), yet children and young people were keen to participate in decisions about interventions and services aimed at them. One young person pointed out: “Don’t do this as a tokenistic gesture. Listen to us because we are the ones who really know what it’s like. Make sure we are at the heart of planning, commissioning, and evaluating.” (Children’s Commissioner, 2017).
Mental health interventions
Clearly, there is no one-size-fits-all solution and mental health provision in schools requires a continuum of intervention programmes which are sensitive to the developmental needs and diversity of pupils.
Government guidelines (DfE, 2019) recommend commissioning expert services and encourage schools to build relationships with external agencies to help fulfil their statutory requirements: “Working with external organisations can enhance delivery… bringing in specialist knowledge and different ways of engaging.”
However, despite the strong impetus for collaborations with external partners, Vostanis et al (2013) urged a cautious approach, claiming that much work in this area was not sufficiently evidence-based.
As Weist and Murray (2008) insist, intervention quality is crucial and implementation decision-making should be based on robust evidence of programme effectiveness.
But how do schools know which interventions to choose? There is growing recognition (Brown, 2018) that school leaders need support to ensure that the most effective and appropriate interventions are implemented.
Case studies of good practice
Greater responsibility on schools for pupil wellbeing and health education has led to calls for “real-world” evaluations of specific programmes (Brown, 2018) to demonstrate the benefits for recipients and help identify the “essential ingredients” of effective interventions, thus generating ecologically valid evidence of good practice for schools to share.
This was the impetus behind the collection of case studies (Jayman et al, 2021) which contributes to a burgeoning resource bank for schools. Among the range of interventions showcased is the after-school Pyramid Club programme and Book of Beasties, a mental wellness card game.
The LifeMosaic project (Jayman & Potopov, 2022), meanwhile, demonstrates the transformative potential of a pupil-teacher collaboration which led to the design and development of a mental wellbeing app, now integrated within the case study school’s pastoral support system.
In a similar vein, during lockdown some existing face-to-face support services in schools were adapted to online provision. A review of 50 studies from nine countries (James, 2020) found several benefits associated with remote delivery. These included increased flexibility, reduced waiting time and not having to rely on parents/carers for transportation; moreover, many disadvantaged and traditionally marginalised groups (such as the LGBT+ community) found digital services more accessible.
Post-lockdown, hybrid services have evolved offering new ways of support and, importantly, greater choice for children and young people. In some schools, Covid-driven changes have resulted in the implementation of a more comprehensive whole-school approach, accelerating change and bringing greater attention on mental health and wellbeing issues (EBPU, 2022).
Sustaining effective mental health provision in schools
There is clearly some excellent practice already embedded in schools. However, this does not negate the scale of the challenge educators face. The Children’s Commissioner for England (2022) has fervently advocated the importance of preventative action and early intervention to avoid more serious difficulties emerging and poorer outcomes later on.
This approach aligns with the current focus on schools and their pivotal role in delivering mental wellbeing education (DfE, 2019) as well as providing mental health support.
Furthermore, while evidence-informed decision-making around mental health interventions is a necessary first step, achieving intervention sustainability must be the long-term goal. Common factors found to promote sustainability comprise both school-level and external factors (Moore et al, 2022).
The influence of senior leadership on developing a mentally healthy school culture was seen as paramount, creating a cascade effect on resource allocation and staff engagement. In addition, intervention characteristics (e.g. quality of resources, perceived benefits for recipients and adequate training) were key factors affecting staff buy-in. Conversely, staff capacity, workload and competing priorities were identified as major internal barriers to sustainability; while lack of funding was a perennial, externally imposed constraint.
As we look forward, the government has promised 400 mental health support teams by 2023 to work with schools, the aim being to give children and young people and parents/carers timely access to advice from a health professional. The teams will also help staff within schools through training sessions for parents and workshops for teachers.
Worryingly, however, this provision will still only benefit around a third of England's pupils (SecEd, 2021b). Meeting escalating demand and providing immediate and appropriate mental wellbeing support for children and young people will continue to be a monumental challenge for many educators.
Takeaway tips for effective whole-school mental health provision
- Senior leadership should be the driving force behind co-ordinated action, starting with an audit of where you are now. Does your school have a practical framework in place to support mental health and wellbeing for students and staff? Existing policies which reference mental health can be the basis for developing a clear and accessible “living” document which should be regularly reviewed.
- Elect a senior mental health lead to facilitate joined up provision with mental health and specialist service providers. This is a pivotal role, and the incumbent requires appropriate training, supervision, and on-going support. DfE-funded training places are available (DfE, 2022).
- Rally the entire school community: Collaboration and commitment from pupils, staff, parents/carers, and governors are the bedrock of a whole-school approach. Form a mental health and wellbeing action group comprising representatives from all key stakeholders including a member of the senior management team.
- Embed informed intervention decision-making, based on the strength of the evidence, to help ensure interventions are effective and appropriate. For example, the Early Intervention Foundation (EIF) guidebook provides information about early intervention programmes that have been rigorously evaluated and shown to improve outcomes for children and young people as well as relative costs.
- Needs analysis using well-validated measurements will help identify the mental health support required for your specific learning community. Guidance on a range of validated tools available to help measure and monitor students’ mental wellbeing is available from Public Health England (PHE, 2022).
- Engender a positive wellbeing culture to champion and keep a spotlight on mental health, for example, by celebrating initiatives such as national children’s mental health week and creating your own calendar of wellbeing promotion events, while ensuring mental health remains a standing item on regular stakeholder meetings.
Conclusions
In a climate of unprecedented need and limited access to resources, now more than ever, smart strategies must be embedded across schools. Building back better mental wellbeing support involves genuinely listening to our pupils and offering varied and tailored provision underpinned by a robust evidence-base.
Authentic collaborations among pupils, parents/carers, educators, health professionals, and researchers are needed to ensure that mental wellbeing interventions are relevant, meaningful and effective.
- Dr Michelle Jayman is a developmental psychologist with a background in education and extensive experience in schools. She is a founder member and convenor of the BERA mental health, wellbeing and education special interest group and a champion for the BPS education section. Her main research interests include children’s and young people’s mental health and wellbeing, and programmes and interventions to support and improve learner outcomes.
Supporting new digital natives
Dr Jayman is co-author of the book Supporting new digital natives: Children’s mental health and wellbeing in a hi-tech age (Policy Press, October 2021). Visit https://bit.ly/3pHOls4
Further information & resources
- Book of Beasties: www.bookofbeasties.com
- Brown: Mental health and wellbeing provision in schools: Review of published policies and information, Department for Education, October 2018: https://bit.ly/3HaE67q
- Children’s Commissioner: Children’s voices: A review of evidence on the subjective wellbeing of children with mental health needs in England, October 2017: https://bit.ly/3dPstbp
- Children’s Commissioner: A Head Start: Early support for children’s mental health, July 2022: https://bit.ly/3PLENH3
- Children’s Society: The good childhood report: Youth summary, 2019.
- DfE: Relationships education, relationships and sex education (RSE) and health education, 2019: https://bit.ly/3dR32WW
- DfE: Guidance: Senior mental health lead training, last updated August 2022: www.gov.uk/guidance/senior-mental-health-lead-training
- DoH & DfE: Transforming children and young people’s mental health provision: A Green Paper, December 2017: https://bit.ly/3KgBFBH
- Durlak et al: The impact of enhancing students’ social and emotional learning: A meta‐analysis of school‐based universal interventions, Child Development (82,1), 2011.
- EIF: The EIF Guidebook: https://guidebook.eif.org.uk/
- Evidence Based Practice Unit (EBPU): Unprecedented challenges and innovative responses: Schools’ and colleges’ experiences of supporting mental health and wellbeing during the coronavirus pandemic, UCL & Anna Freud Centre, accessed August 2022: https://bit.ly/3wqOIee
- Franklin et al: The effectiveness of psychosocial interventions delivered by teachers in schools: A systematic review and meta-analysis, Clinical Child and Family Psychology Review (20,3), 2017: https://doi.org/10.1007/s10567-017-0235-4
- James: Remote mental health interventions for young people A rapid review of the evidence, Youth Access, 2020: https://bit.ly/3PLEiNb
- Jayman, Ohl, & Jewett: Supporting new digital natives: Children’s mental health and wellbeing in a hi-tech age, Policy Press, October 2021: https://bit.ly/3pHOls4
- Jayman & Potopov: Re-imagining mental wellbeing strategies in schools. In Wellbeing and Schooling: Cross cultural and cross disciplinary perspectives, McLellan, Faucher, & Simovska (eds), Springer, 2022.
- Moore et al: Barriers and facilitators to sustaining school-based mental health and wellbeing interventions: A systematic review, International Journal of Environmental Research and Public Health (19), 2022: https://bit.ly/3dT4vMw
- NHS: Mental Health of Children and Young People in England 2021: Wave 2 follow up to the 2017 survey, September 2021: https://bit.ly/3owAmpA
- O’Reilly et al: Review of mental health promotion interventions in schools, Social Psychiatry and Psychiatric Epidemiology (53), 2018: https://doi.org/10.1007/s00127-018-1530-1
- PHE: Measuring and monitoring children and young people’s mental wellbeing: A toolkit for schools and colleges, accessed August 2022: https://bit.ly/3QUeqzR
- Pyramid Club: www.uwl.ac.uk/business/pyramid-clubs-schools
- Sadler et al: Mental health of children and young people in England 2017, NHS, 2018: https://dera.ioe.ac.uk/32622/
- SecEd: Mental Health Support Teams: Expansion welcomed but will it be too little, too late? March 2021b: https://bit.ly/3t7e2SA
- SecEd: Loneliness, sleeping problems and eating disorders drive mental health crisis, October 2021a: https://bit.ly/3qGn35n
- Vostanis et al: How do schools promote emotional well-being among their pupils? Findings from a national scoping survey of mental health provision in English schools, Child and Adolescent Mental Health (18), 2013: https://bit.ly/3QKKqq5
- Weist & Murray: Advancing school mental health promotion globally, Advances in School Mental Health Promotion (1,1), 2008.