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 behaviour). 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. www.youthspace.me 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 www.youthspace.me 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. www.youthspace.me Why schools are vital to improving emotional health and wellbeing of young people 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. www.youthspace.me www.youthspace.me