Why are Schools so Important to Children’s Mental Health?

Why are Schools so Important to Children’s Mental Health?
‘The importance of investing in the early years is key to preventing
ill health later in life, as is investing in healthy schools’
The accumulation of experiences a child receives shapes the
outcomes and choices they will make when they become adults.’
Marmot Review 2010 – Fair Society Healthy Lives p.33
How common are mental health problems in the school years?
The majority of mental health problems emerge during adolescence and early
adulthood with over half appearing before the age of 16. At any one time 10-20% of
young people of school age will have a mental health problem yet most are not
identified or appropriately supported at the time.
The Impact on Educational Performance
Poor mental health is associated with low educational performance and
absenteeism; additionally, conduct and hyperkinetic disorders disrupt the educational
environment for other children. Many other problems such as teenage pregnancy,
substance use and bullying are associated with mental health issues.
How can Schools make a difference?
Research strongly supports the positive impact of adopting a whole school approach
to improving wellbeing and emotional resilience. There are many ways to introduce
positive mental health into the school environment.
Why should we be concerned?
The UK comes bottom of the rank for children’s well-being in a UNICEF study
in comparison with North America & 18 European Countries (UNICEF 2007).
It’s a common problem: At any one time - one in ten children and young
people have a diagnosable mental health problem, the majority of which are
either emotional disorders (depression or anxiety) or conduct disorders.
Poor mental health is often the underlying factor behind risk behaviours
(including substance abuse, risky sexual activity) and health outcomes,
(including teenage pregnancy, eating disorders, injuries, bullying and violent
Poor mental health can be a symptom of a child at risk: children and young
people frequently express their emotional distress in the form of mental
disorders and behaviours such as self-harm.
Not addressing poor mental health in childhood results in ongoing problems
including self-harm and increased suicide; low educational and employment
achievement; increased violent and offending behaviour.
Research suggests that around 46% of failure to complete secondary school
can be attributed to psychiatric disorders.
Some are more affected than others
Looked after children (those in care or receiving accommodation from a local
authority) have rates of mental disorder between four and five times higher than for
young people in the general population.
Young people from Black and Minority Ethnic (BME) groups who are contact with the
youth justice system have a higher proportion of post-traumatic stress disorder
compared with others. Lesbian, Gay, Bisexual and Transgendered (LGBT) young
people are at increased risk for mental health problems, particularly depression:
overall, young LGBT people are four times more likely to suffer major depression
and three times more likely to have a generalised anxiety disorder.
Discussing mental health can be difficult
Young people describe how stigma can make it difficult to talk about mental health –
particularly outside of their close family and peer groups. Adolescence involves a
great many developmental changes with issues of identity, relationships, physical
changes, transitions to schools, colleges and work. It can be difficult to ‘spot’ mental
health difficulties as so much change is already going on, but if young people are in
distress then listening to their worries is often the first step to addressing issues. It is
important that teachers have the understanding and confidence to discuss emotional
wellbeing and mental health in the school environment.
What does Policy say we should be doing?
‘Mental health promotion in schools is at the forefront of UK mental health policy
(DH, 2011)
‘Mental health was the highest priority as young people considered this to be key for
good health in all other areas. Two issues that were consistently highlighted during
the youth participation exercises were the lack of information and education on
health and the environment, and the barriers caused by current attitudes/peer
pressure…” Children’s Environment and Health Strategy for the United Kingdom:
HPA 2009
‘Schools play a vital role in promoting physical and mental health, and emotional
wellbeing, underpinned now by a duty to promote the wellbeing of pupils in the
Education and Inspections Act 2006…better techniques for early identification and
assessment of additional need, and more effective joined-up working to support swift
and easy referral to specialist services…’ The Childrens Plan DCSF 2007
An Ofsted report from 2005 (Healthy minds promoting emotional health and wellbeing in schools) concluded that schools should make the promotion of pupils’
emotional health and well-being a priority. Some of their findings included:
The best schools promoted good emotional health and well-being by valuing
and respecting every individual.
Very good whole-school systems to eradicate bullying reduced the risks of
pupils developing mental health difficulties.
Few schools used national guidance to plan and provide support for pupils’
emotional well-being.
Partnerships with external agencies were unsatisfactory in nearly a quarter of
the schools visited. Primary and special schools were more successful than
secondary schools in tackling emotional health and well-being through wholeschool initiatives.
Particularly good arrangements for working with parents included initiatives
such as parenting classes and home visits, where parents could talk openly
about their concerns and their children’s behaviour.
Other effective provision involved pupils’ self-referral, peer support and flexible
approaches by schools to modifying the curriculum and timetables.
Even where services were available, schools, parents and pupils were not
always aware of how they could be accessed.
Local and national voluntary organisations played an important role in working
with schools and local authorities to provide services. They were often better at
monitoring and evaluating the impact of their work, since they depended on
such evidence to attract further funding.
Whole-school approaches to promoting good mental health
‘The best schools promoted good emotional health and well-being by valuing and
respecting every individual. In the schools visited, those which embodied a value
system that embraced all children identified fewer children with mental health
problems. These schools promoted many and varied opportunities for pupils to share
their thoughts and feelings. They used the curriculum to develop pupils’ listening
skills and an understanding of other people’s points of view: this culture permeated
school life.’
Young people with mental health problems are often unlikely to seek help
Young people have lower levels of emotional health ‘literacy’ and knowledge demonstrating poor help- seeking behaviour in relation to their mental health –
particularly from professional sources of help (this is particularly the case for boys
and young men.) Poor mental health literacy (Jorm et al 2006) reduces the likelihood
of identifying symptoms of disorder, stigma (Barnley at al; 2006; Jorm et al; 2007) is
still highly relevant to young people’s lives; reliance on peer groups and family
members – who themselves may have poor mental health literacy and reliance on
self all play a part in increasing delay in appropriate help-seeking and intervention.
Why schools are vital to improving emotional health and wellbeing of young
Schools have a key role to play in the implementation of emotional wellbeing and
mental health knowledge in young people. They have unparalleled access to young
people, including those from ethnic minority groups, and those with less obvious
mental health problems such as depression or anxiety, who may otherwise be
missed by psychiatric services. They also have the ability to address interrelated
academic, emotional, behavioural, and developmental needs.
However, there are often little resources, including time and money to develop
programmes into increasing mental wellbeing. Schools are under resourced and
therefore cannot always address these non-academic barriers to learning as
thoroughly as they would like to – yet investing in providing emotional resilience in
students and staff can benefit the school in many positive ways in addition to
improving mental health. The Royal College of Psychiatry have stated: ‘‘Promoting
mental health can save money in the short and long term. Evidence shows the costeffectiveness of investing in mental health promotion, mental illness prevention and
early intervention strategies’
Schoolspace – our Schools research programme in Birmingham
We have set up an on-going programme of research in Birmingham and have so far
completed a randomised controlled trial in 6 schools, numerous surveys and focus
groups with students and teachers and most recently are working on developing an
intervention for Eating disorders (See SchoolSpace Study for more information) with
staff from the University of Birmingham, Warwick University and a number of
Birmingham schools.