Best Practice

How to support students with milder mental health issues

Mental health Pupil wellbeing Vulnerable children
While 20% of young people are thought to have a ‘probable’ mental health issue, the majority would not meet the criteria for clinical diagnosis. So how can we support these children? Dr Stephanie Thornton advises
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The most recent survey for the NHS (Newlove-Delgado et al, 2023) reported that in the UK, just over 20% of children aged 8 to 16 and about 23% of 17 to 19-year-olds have a “probable mental disorder” (figures that rose between 2017 and 2021, covering the period of the pandemic, but neither rose nor fell between 2022 and 2023).

These figures are truly appalling. But they are also hard to evaluate. They are based on interpretations of self-report from children and teenagers, rather than on clinical assessment. No break-down of the nature or severity of these “probable mental disorders” is provided.

So what percentage of our youth have a mental disorder that meets the criteria for clinical diagnosis – as opposed to an issue that may be distressing, but is sub-clinical?

The question is important if we are to provide appropriate support as clinical and sub-clinical problems may benefit from very different interventions.

 

Current approaches are struggling

Schools are on the frontline when it comes to identifying need and finding support for children and teenagers with mental health issues. Schools cope valiantly. But this is a huge responsibility to put on staff who may have little training in this area.

The government commitment to put a mental health practitioner in every school sounds promising – and so far 16,700 schools have accessed the funded mental health lead training (DfE, 2024). But how much can a single practitioner be expected to achieve when more than 20% of the pupils in a school may have problems?

What triage, what support, what interventions, what referrals to CAMHS are these practitioners supposed to offer, across the broad spectrum of mental health issues? What qualifications or training will they have, and what oversight will there be to ensure quality control? Where are so many practitioners going to come from? And how will those practitioners themselves be supported – every responsible agency offers practitioners in mental health, whether professional or volunteer, a debriefing support: someone to share the stresses, someone to go to when in doubt.

We await the answers on all of this – certainly with a new government in place and getting to grips with the issues and deciding what to do with the previous government’s initiatives in this area.

As we all know, referral to CAMHS is an uncertain business. The fourth report of the Commission on Young Lives (Longfield, 2022) confirms that CAMHS is overwhelmed. There are too few resources to cover the scale of the problem.

Simply throwing money at this may not resolve that: the key resource CAMHS needs is trained staff, and training to the levels required takes time. It is very unclear where enough extra staff with the right qualifications could come from in any reasonable time-frame.

As it stands, and seems likely to remain for some time, waiting lists for CAMHS are long, sometimes many months or even years, even when there is serious concern such as suicide risk (Longfield, 2022). And time spent on those waiting lists can be damaging, exacerbating problems (YoungMinds, 2022).

 

Addressing the youth mental health crisis

What to do, in the face of our situation, where so many of our children and teenagers have mental health problems, professional resources are tight, and waiting lists are long? Experts offer a number of suggestions…

 

Digital apps

The National Institute for Health and Care Excellence endorses the use of certain digital apps to provide mental health support for those on waiting lists for CAMHS (NICE, 2023). This sounds like the obvious solution for our tech-obsessed youth – until you examine the detail (Thornton, 2023).

NICE itself is cautious, commenting that there is still little evidence that these apps offer effective interventions. A digital approach is obviously only appropriate for “neurotic” issues such as anxiety and depression, rather than psychotic issues such as schizophrenia or paranoia.

What research there is shows that even in anxiety and depression, apps benefit those with mild, sub-clinical issues but not the severely depressed or anxious (Firth et al, 2017).

Furthermore, these apps work best when used in conjunction with face-to-face support (Ly et al, 2015), which means that they will be a further pressure, rather than a relief on resources.

As NICE points out, such direct monitoring is essential, to prevent apps from doing harm. Like any other medical intervention (penicillin saves countless lives but kills allergic people every year; common therapeutic practices such as mindfulness can help some, but can damage others – Lustyk et al, 2009), digital apps can potentially do harm.

 

Recasting the problem

There are some mental health problems that are obviously medical issues needing professional intervention. Clear examples are schizophrenia, OCD, PTSD, anorexia, major depression or anxiety disorders, bipolar disorder…

Individuals with such disorders should have priority from medical services and CAMHS.

But it is very far from clear what percentage of our young suffer from such disorders, as we don’t have good data. It is a good bet that much of the “probable mental disorder” reported by the NHS research (Newlove-Delgado et al, 2023) is anxiety and/or depression, and that the majority of those reporting symptoms in this area would not meet the criteria for clinical diagnosis if directly triaged by a professional.

Some experts suggest that medicalising these sub-clinical levels of dysphoria is counterproductive, and that such issues are better viewed as existential malaise, as “languishing” (as opposed to “flourishing” – Fielding, 2021).

Changing language in this way is not to belittle the suffering of a child or teenager who says they are anxious, afraid, sad, depressed, nor to deny them support. Rather, it is hoped that recasting sub-clinical mental health problems in this way will open new possibilities for recovery.

A medical diagnosis of dysphoria implies that medical intervention is necessary for a cure, and that assumption can induce a passive mindset, waiting for the “white knight” (doctor, nurse, psychologist) to effect a rescue/cure.

This is disempowering. Some experts suggest that changing the language of sub-clinical dysphoria to reduce medical emphasis could empower the young to take more pro-active approach to managing mental health (Keyes, 2024). Could this mitigate the damage of the waiting list?

 

Empowering resilience through emotional development

Individuals who are resilient in the face of the “the slings and arrows of outrageous fortune” have a more positive “can-do” mindset than the less resilient (Hauser et al, 2006).

View your lack of success on a task not as failure but as opportunity to learn, and the risk of depression and anxiety is reduced. Understand that “personality” is, more than most suppose, a function of how we choose to react, that personality can grow and change (Schleider & Weisz, 2017), that your emotions are not dictated by events but that you can be in charge and can decide how to react (Siemer et al, 2007), and your ability to regulate your emotions and reduce anxiety and depression will grow.

These positive attitudes can be taught. In fact, recent research has shown that even very young children can benefit from being taught to recognise, understand and regulate their emotions, training that provides them with strategies that reduce their vulnerability to anxiety and depression in a sustainable way (Luby et al, 2020). This training is cost effective: parents can deliver it after a short course of instruction.

 

Embracing the positive in life

The NHS research above comments that mental disorders are most common in the young who don’t engage in “out-of-school” activities. There is considerable research that shows that, while not a panacea, engaging in music, sport and art, in school or out, can deliver benefits for mental health in the young (see Thornton 2022a; 2022b; 2022c). Should we commit more resources to those activities?

There is also research that shows that a mindset of “living in gratitude”, noticing the good things in life despite problems, is a powerful tool protecting mental wellbeing (Emmons & McCullough, 2004).

This is not to advocate a Pollyanna approach (the tendency for people to remember pleasant items more accurately than unpleasant ones): we need to teach the young to face the difficult realities of our world in resilient ways. Rather, it is to say: a “doom-scrolling” approach to life, a negative attention bias toward fixating only on the bad, will bring you down.

There is also generally some good in life, despite the setbacks and stresses. There are simple interventions to foster a more positive attention bias – for example, list five small blessings today (that conversation with a friend, the lovely sandwich at lunch, etc).

The deeply depressed and anxious have a negative attention bias and so find this task almost impossible at first – but the effort to find five blessings each day gradually shifts attention bias to the positive, and relieves dysphoria.

  • Dr Stephanie Thornton is an author and lecturer in psychology and child development. She is the co-author of Understanding Developmental Psychology (Macmillan International/Red Globe, 2021). To read her previous articles for SecEd, visit www.sec-ed.co.uk/authors/dr-stephanie-thornton 

 

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