In the coming weeks, the House of Commons Education and Health Select Committees will be hearing oral evidence on their inquiry into children and young people’s mental health and the role of education. Members of the Manchester Institute of Education have written three blogs expanding on some of the key issues in their submission and drawing on their research into education and mental health. Here, as the first in the series, Dr Cathy Atkinson looks at the different approaches to mental health intervention in schools and how policy in this area should be developed.

• There are high societal and economic costs of mental health difficulties in limiting access to paid employment, independent living and community inclusion
• The ways in which schools might help support young people’s metal health falls into three categories: universal, targeted and intensive
• Schools need to have policies and best practice on all three levels in order for intervention to be most effective
• Educational psychologists working in schools play an important role in identifying levers for change within a system to move towards stability and recovery
• Policy makers must prioritise understanding young people’s perspectives and consult with them in order to implement the most effective school-based mental health support

Figures suggest that 20% of adolescents will experience a mental health problem at any given time, while 10% of children aged 5-16 have a mental health need which could be clinically diagnosed.  While front line services supporting child and adolescent mental health are significantly over-stretched, the societal and economic costs of mental health difficulties in limiting access to paid employment, independent living and community inclusion remain enormous.

Three levels of interventions in schools

Over the past few years, there has been a focus on how schools might help support the mental health of young people. Essentially, this has centred on support across three levels: universal, targeted and intensive. Universal interventions promote an understanding of wellbeing amongst all students; for example, by helping them to understand their own thoughts and feelings, the transient nature of emotions; and by giving them strategies to cope with difficult times.  Targeted support might be given in-school to students that are at risk and intensive support would be accessed by the most vulnerable students and would typically involve other agencies, such as child and adolescent mental health or counselling services.

Teachers and other school-based staff can help across all three levels. Positive teacher-student relationships are essential in offering daily support for students to manage their emotions and talk through issues which arise over the course of the school day.  At the targeted level, staff are often vigilant for changes in behaviour which might indicate that the young person is experiencing emotional stress and can signpost or access support in-school.  In terms of intensive approaches, a key member of staff might work alongside another professional, such as a counsellor or a psychologist, to implement strategies that may help support a vulnerable young person.

For these interventions to be most effective, schools need to ensure they have policies and resources, and follow best practice on all three levels. This could minimise the likelihood of children’s mental health needs getting to the point where intensive interventions are needed; potential issues can be recognised early and addressed or even prevented at the universal and targeted levels, before they escalate to the points at which involvement from specialist agencies are needed.

The benefits of having educational psychologists in schools

Educational psychologists (EPs) that work in schools are well-positioned to support students and staff working with them across all three levels of intervention. Generally, EPs work across a number of schools and are able to work with young people within the school context.  Research suggests that this can be beneficial to students who perhaps wish to talk openly, but feel wary of doing so with someone they see every day in school.  Seeing someone who is perceived as more ‘neutral’ to the school situation, might help them to talk more honestly about the difficulties they are experiencing.

EPs usually work with students in schools, which may be appealing to a young person who does not want the ‘stigma’ of going to a hospital or counselling setting for help.  There may also be the potential, in consultation with the young person, for the EP to influence things within school to reduce the emotional stress they are experiencing. For example, difficulties may relate to an unaddressed learning need (e.g. dyslexia), problems in a relationship with another student or member or staff, or difficulties finding a safe space at the time of an emotional ‘crisis’.  It is important to look for levers for change within a system which may provide the first small steps towards stability and recovery.

Mental health as a continuum

It is important that young people with mental health needs are not seen as a separate or distinct group.  There is a continuum of mental health, from positive to problematic; from emotional wellbeing to distress.  Each and every one of us is vulnerable to mental health problems if placed under enough emotional stress which is exactly the same for young people. The United Nations Convention on Children’s Rights observes that there is worldwide pressure on educational achievement, with increased focus on academic targets, at the expense of leisure and play opportunities which is bound to have an effect on most children’s mental health and wellbeing.

Peer support

The exponential rise in the popularity of the Internet and social media means that young people today are the pioneers of an online society which the adult generation has not experienced as adolescents, thus lacking an understanding of many of the issues it presents. Therefore, young people often have the best awareness of exactly how to help other young people in need and what the facilitators and barriers to them accessing the support might be.

In my role as an educational psychologist, I have recently been speaking to young people in schools about how we might best support student mental health amongst the whole student population.  The responses they have given have been illuminating; they’ve identified flash points within the school year which might prove problematic, understood why young people might have difficulty talking to members of staff they see on a daily basis and could suggest solutions. They also know which sort of publicity would be appealing to young people seeking support and the preferred way they might have of asking for help.

Young people themselves are an enormous resource in identifying, planning and delivering mental health support for students in schools.  Policy makers should consider taking a co-production approach to developing strategies to address children and young people’s mental health; understanding young people’s perspectives and consulting with them may well be fundamental to implementing the most effective school-based support.