Part 2: The role of schools in child and adolescent mental health.
This is part 2 of a summary of Are the kids alright? Examining the intersection between education and mental health. Part 1 and context can be found here.
The role of schools in contributing to the ‘crisis’
Humphrey asserts that the transformation of the education system in recent years has ‘contributed to this public health crisis.’ In doing so he references several other authors who have reached similar conclusions.
Hutchings (2015) states that ‘Increased accountability measures in schools have a clear and demonstrable negative impact on child and adolescent mental health’.
Sharp (2013) appears more cautious in suggesting that, ‘There are clear indications… that the pressure to perform in an increasingly micro-managed, accountable education system may [my emphasis] be playing a part in developing mental health problems and in suicidal behaviour’ (p.10).
Bonell et al., on the other hand, highlights the role of both accountability and the removal or erosion of interventions not directly related to the academic curriculum.
‘The push for accountability… alongside the erosion of more ‘whole child’ orientated provision (e.g. the removal of the funding for the National Healthy Schools Programme, the continued failure to make PSHE statutory), has created a ‘zero sum game’ approach to attainment and mental health/wellbeing, wherein a clear message is sent to schools that time spent on the latter is time lost on the former’ (Bonell et al. (2014).
These factors, according to Humphrey, have produced or amplified stressors that increase the ‘allostatic load’ on pupils in school. Those exposed to additional stressors are more likely to have their coping strategies overwhelmed, which can trigger the onset of mental health difficulties.
This last paragraph would certainly support what we already understand regarding the cumulative aspects of stress and other forms of mental ill-health, especially for those with lower stress thresholds.
In her commentary on Humphrey’s open dialogue paper, Poppy Nash (Psychology in Education Research Centre, University of York) highlights a number of additional factors. To paraphrase Nash, the increase in the performativity culture in schools and the changing nature of teaching (that existed even before the recent changes to the GCSE curriculum), has focused more on attainment and achievement, to the detriment of encouraging curiosity and exploration. The emphasis on extrinsic motivators rather than intrinsic ones (that are more closely associated with higher levels of subjective wellbeing) have encouraged a culture of target setting and striving rather than developing a love of learning.
Another potential issue, claims Nash, is the apparent reluctance of Oftsed to prioritise pupil mental health and wellbeing, an obstacle recognised in recent a House of Commons report (House of Commons Education and Committees of Session 2016-2017).
In addition, Nash highlights the drive by schools to get A-level students into a ‘good university’ rather than explore alternative options and career paths (e.g. apprenticeships).
Diahann Gallard (Liverpool John Moores University) adds in her response that teachers mental health and wellbeing in closely related to that of pupil mental health and wellbeing and that any intervention should involve whole school strategies. While Ford highlights other factors that lead to mental ill-health amongst children, specifically, bullying.
Why have schools become the focus in this area?
Paradoxically, schools are both held partially responsible for the increase in mental health problems and lauded as a major tool in its resolution.
Humphrey points out that schools have been given more responsibility in mental health through policy changes. Including:
- Revised code of practice for special needs and disabilities explicitly referencing mental health throughout (Department of Education, 2014).
- Guidance for mental health and behaviour in schools (Department of Education, 2016)
- Counselling in schools (Department of Education, 2016)
- Developing links between schools and CAMHS (Department of Health, 2015)
- Commitment to make Mental Health First Aid training available in every secondary school in England (2017)
- Two major DFE funded RCTs, one on school-based approaches to mental health literacy and one on school-based approaches to mental health promotion, including mindfulness.
Mental health provision in schools, although not new, has seen an unprecedented rise in activity over recent years.
Ford does point out, however, that policy is running ahead of evidence, citing the drive to offer Mental Health First Aid in schools while the only trial of Mental Health First Aid in schools is still collecting data, while an Australian study is still yet to report its findings.
The reasons Humphrey cites for a mental health focus in schools include:
- Their extremely broad reach
- Prolonged period of engagement with young people
- They form the central hub in many communities
- They are the primary developmental context after the family
- Half of all lifetime cases of mental ill-health have their first onset by age 14
- Parents are most likely to contact teachers for advice and support regarding mental ill-health
- Universal interventions (e.g. mental health literacy initiatives) can influence outcomes for children who would not otherwise access the support they need through the usual pathways
- Prevention work in schools might be seen as more inclusive and less stigmatising that specialist interventions
- Longitudinal development cascade research consistently highlights connections between children’s mental health and their academic attainment.
Humphrey makes a good case for school based interventions in mental health, but I think he does this without fully considering the impact this might have on teachers and other school staff. It’s not just teacher workload that concerns me (although this is a very important issue), but also the emotional toll of coming face to face with the problems of others. Many mental health professionals are encouraged (or are required) to undergo personal therapy and counselling due to the emotional aspect of their roles and, while a teacher will be less involved than say, a clinical psychologist, there is the potential that teachers will become overwhelmed by students own mental ill-health. Indeed, Ford does suggest that school-based interventions could produce more stigma, not less, as Humphrey implies.
A broad consensus
As far as a mental health crisis is concerned, there appeared to be a general consensus amongst the paper’s commentators (I have only included a very small selection here, due mainly to space and time constraints). The role played by schools, as both catalysts and possible saviours, also received favourable responses.
Finally, there was general agreement that the crisis was more than the latest child panic, primarily due to the weight of evidence. This is not to claim that the mass media are not in part to blame from exaggerating these claims (they most certainly are), but rather that evidence from multiple sources would suggest that something is not quite right, that young people shouldn’t feel as pressured as they do, that their subjective feelings of wellbeing shouldn’t be as low as they are.
On a personal note, as a father to a teenager about to sit GCSE’s, a teacher and a psychologist my main questions after looking at the evidence is are we doing enough and is what we are doing the best way forward?