mental health and wellbeing in schools

Question 1

mental health defined

Answer 1

• continuum: human emotional experience - extreme psychological distress & mental ill-health
• precise threshold for mental ill-health not clearly defined
• normal is dependent on context & culture
• Dogra et al. (2002)

Question 2

well-being defined

Answer 2

• quality of ppl’s lives
• dynamic state enhanced when ppl can fulfil personal & social goals
• objective measures: household income, access to educational resources, & health status
• subjective indicators: happiness, perceptions of quality life, & life satisfaction
• childhood wellbeing is multi-dimensional (physical, emotional & social wellbeing)
• focus on immediate lives but also future lives e.g. aspirations
• incorporates subjective & objective measures
• Statham & Chase (2010)

Question 3

is mental health a SEN?

Answer 3

• social, emotional & mental health difficulties
• 6.32 CYP may experience a wide range of social & emotional difficulties manifesting in diff ways
• include: becoming withdrawn or isolated; displaying challenging, disruptive or disturbing beh
• may reflect underlying mental health difficulties
• other CYP may have disorders such as ADD, ADHD or attachment disorder
• schools and colleges should have clear processes to support CYP, including how they will manage the effect of any disruptive beh so it doesn’t adversely affect other pupils (DfE, SEND code of practice, 2015

Question 4

when is mental health a problem?

Answer 4

• look at severity, complexity, persistence (impact on dev, learning & life)
• consider: risk factors, protective factors, societal & cultural values & influences
• handbook on CAMHS (department of health, 1995)

Question 5

framework of risk & resilience

daniels et al. (1999)

Answer 5

• experiential dimension (life events): adversity to protective
• personal dimension (personal traits): resilience to vulnerability

Question 6

well-being

Answer 6

• most CYP in UK found to be +ve about their lives
• UK 2013-14: ~8/10 young ppl (16-24yos) reported high or very high life satisfaction
• UK 2011-12: ~1/5 young ppl (16-24yos) reported some symptoms of anxiety or depression
• Tellus4 survey (2009) of 250,000 children in 3,699 schools: clear decline in measures of emotional health & wellbeing, largely due to fall in num of children who felt they could talk to an adult other than a parent if they were worried about something
• also slight drop in measure for participation in +ve activities (DCSF, 2010)
• index of Child Wellbeing in Europe: UK as 21st/28 countries for subjective wellbeing (Bradshaw & Richardson, 2009)

Question 7

ONS/NHS digital (2018)

Answer 7

• there has been a slight increase in overall rates of mental disorder
• emotional disorder rates increased, while other disorder types were stable
• rates of mental disordeer were higher in older age groups
• recognition of SEN

Question 8

slight increase in overall rates of mental disorder

ONS/NHS digital (2018)

Answer 8

• slight increase over time in prevalence of mental disorder in 5-15yos
• 9.7% in 1999, 10.1% in 2004, 11.2% in 2017
• 8.1% of children 5-10yos

Question 9

emotional disorder rates increased, while other disorder types were stable

ONS/NHS digital (2018)

Answer 9

• 4.3% in 1999, 3.9% in 2004, 5.8% in 2017
• increase evident in both boys & girls
• other types of disorder (behavioural, hyperactivity & other) remained broadly stable in prevalence

Question 10

rates of mental disorder were higher in older age groups

Answer 10

• 17-19yos 3x more likely to have a disorder than 2-4yos (16.9% vs 5.5%)
• diff disorders prominent at diff stages of childhood
• rates of emotional disorder highest 1-19yos
• behavioural & hyperactivity highest 5-16yos
• caution needed due to diffs in data collection

Question 11

recognition of SEN

ONS/NHS digital (2018)

Answer 11

• over 1/3 of 5-19yos with a disorder (35.6%) were recognised as having SEN
• 1/4 children with an emotional disorder
• ~2/3 children with a hyperactivity disorder
• 2/3 children with other less common disorder e.g. autism
• 49.6% with recognised SEN had an EHCP in place
• contact with professional services & informal support was more likely where parents & young ppl recognised there were severe & definite difficulties with emotions, conc, beh, or getting on with others

Question 12

areas of concern

Answer 12

• 50% of mental illnesses begin before age 14 (Kim-Cohen et al., 2003)
• 10-20% of adolescents may experience a mental health problem in any given year (Green et al., 2005)
• increasing emotional problems in girls but plateau for beh difficulties (Fink et al., 2015; Patalay et al., 2017)

Question 13

school influences

Answer 13

• what is known about the factors that contribute to CYP’s mental health & well-being in schools?
• how are these determined, assessed & supported

Question 14

learning linked to children’s wellbeing

Answer 14

• school env plays important in children’s social, emotional & behavioural wellbeing
• learning & enjoyment in primary school found to predict later wellbeing in secondary
• boys: learning in primary school strongest influence on behavioural aspects of later wellbeing
• girls: more predictive of social wellbeing (Gutman & Feinstein, 2008; Gutman et al., 2010)

Question 15

a good childhood?

Answer 15

• children society (2015) surveyed happiness in 10-12yos in 15 diverse countries
• england found to be more unhappy with their school experience than children in 11 other countries but not germany, south korea & estonia
• 38% of 10 & 12 yos in england reported they had been physically bullied in last month & 50% had felt excluded
• 2 children in every classroom were said to be dissatisfied with aspects of their school life
• main concerns: relationship with their teachers, things they learn, & other children

Question 16

factors that contribute to mental health

Answer 16

• psychological
• biological
• social
• societal, cultural, environmental, educational

Question 17

accessing support

meltzer et al. (2000)

Answer 17

• study of 10,438 children 5-15, 46% who had a mental health problem hadnt accessed a service 20m later
• of those that did: teachers most commonly consulted (43.6%), CAMHS workers (22.1%), social services (11.6%)

Question 18

tiers for child and adolescent mental health

Answer 18

1. frontline staff
2. network of professionals
3. specialist outpatient CAMH team
4. inpatient CAMH provision

Question 19

EP contribution to supporting mental health

Answer 19

• work to promote positive mental health, prevent and provide for short term mental health needs alongside other professionals
• supporting frontline professionals (teachers, GPs, social workers, health visitors etc.) to meet the mental health needs of children and young people
• to consult, involve & seek supervision from specialist CAMHS as, and when, appropriate and needed.

Question 20

mental health and EP: how accessed?

Answer 20

• specialising in the mental health of young people, a child psychologist may provide help and support to those experiencing difficulties
• a CAMHS team will include a child psychologist, but it may also be possible for schools to use the services of an LA educational psychologist or to commission one directly themselves, depending on local arrangements (DfE, 2015)

Question 21

mental health and wellbeing taskforce

DOH (2014)

Answer 21

• promoting resilience, prevention and early intervention.
• improving access to effective support – a system without tiers.
• care for the most vulnerable.
• accountability and transparency
• developing the workforce

Question 22

UK gov’s 3 pillars: mental health provision for CYP

Answer 22

1. to incentivise & support all schools & colleges to identify & train a designated senior lead for mental health
2. to fund new MHSTs, which will be supervised by NHS CYP’s mental health staff
3. to pilot a 4-week waiting time for access to specialist NHS CYP’s mental health services

Question 23

response to gov’s proposal on MHST

DfE (2017)

Answer 23

there was a strong message from respondents that the [mental health support] teams should work with a wide range of professionals and services. The top link chosen was to educational psychologists (19% of respondents), school based counsellors (18%) and local authority services (17%)

Question 24

MHST: what role for an EP?

Answer 24

• can be a valuable additional resource in and of itself, but can be even stronger when working closely with a range of other services.
• these other services include professionals who work closely with schools and colleges, such as educational psychologists, school nurses and counsellors, local authority troubled families teams, social services, peer networks, service user forums, and voluntary and community sector organisations.
• all of these roles play a crucial part in supporting young people with mental health problems and so we will test a range of models for putting the new teams at the heart of collaborative approaches with these professionals

Question 25

paradigms in understanding mental health

Answer 25

• medical-diagnostic model
• social model
• educational model
• psychological model

Question 26

medical model of mental health

Answer 26

• a useful way of understanding the complexity of the human condition and to develop treatments suited to particular conditions. (Scott, 2003)
• ‘Systematic proliferation of disease names created independently of their anatomical, biochemical, microbiological or physiological correlates.’ (Szas, 1979)

Question 27

critique of medical model

Answer 27

‘Biomedical perspectives remain dominant – and a concern with the overall complexity of a situation can become lost in an over-emphasis on diagnosing and treating individual ‘pathology.’ (Tew, 2005 p.216)

Question 28

what about the influence of circumstance?

Murphy & Fonagy (2012)

Answer 28

we have no way of relating the outcomes of health service interventions to educational or often even social service interventions, yet where children present with mental health problems it is more likely to be the consequence of circumstance rather than the characteristics of their presenting problem

Question 29

issues of context and implementation

Murphy & Fonagy (2012)

Answer 29

we need to understand more about alternative settings in which treatments [interventions and support] may be implemented, especially for those children and young people who are not currently reached by existing services. This should include not just physical locations such as schools and community centres, but also social contexts, for example involving community leaders, peers and near-peers

Question 30

EPs work with others and contribute to

Answer 30

• diagnostic processes ( e.g. ADHD, ASC pathways).
• supporting others to understand diagnostic processes and the impact of labelling
• support the implementation of evidence-base treatments or interventions for particular conditions (e.g. Behavioural for ADHD).
• attempting to bridge the gap in understanding between health, social care and educational settings.
• evaluating impact and implementation of evidence based/informed interventions in educational settings

Question 31

social model of mental health - some considerations

Answer 31

• studies of attitudes to mental health reveal that younger people have very negative views and use pejorative terms in their everyday language (Chandra et al, 2007).
• young people with mental health problems are more likely to experience higher levels of stigma than adults.
• stigma causes people to be secretive about their problems, and discourages them from seeking appropriate help. (Rose et al, 2007)

Question 32

tackling stigma

Answer 32

• providing: young people with info about mental health issues has been shown to improve attitudes to mental health & help seeking beh
• training: teachers in mental health issues has also been shown to improve understanding of mental health (Gale, 2010)

Question 33

young people’s voice

tew (2005)

Answer 33

• within many conventional medical, psychological and social approaches, there has been a tendency to impose frameworks upon people in ways that deny their own knowledge and expertise
• a holistic approach which helps to make links between what may seem bewildering thoughts, feelings and behaviours, and the realities of people’s social and personal experience may be more helpful

Question 34

what can schools do?

Answer 34

• teaching about good mental health & emotional resilience
• whole school approach which build understanding about mental health, tackle stigma & develop emotional resilience
• successful ev-based models that increase access to mental health support & services e.g. TAMHS (Targeted Mental Health in schools, 2009)

Question 35

role for schools

murphy & fonagy (2012)

Answer 35

in relation to CYP’s health in terms of both potential of schools to foster the dev of resilience & providing opportunities for the delivery of interventions aimed at improving mental health

Question 36

EP role within the social model

Answer 36

• draw att to the fact that CYP’s school experiences can impact their mental health, distress & wellbeing
• promote systemic responses to mental health, distress & wellbeing
• help address issues of stigma & inclusion
• help young ppl to understand & cope with their experiences of mental disress

Question 37

educational model

Answer 37

• concerned with the dev of social & emotional competence
• places emphasis on teaching & learning of emotional awareness & social skills
• draws on concepts such as emotional literacy & social & emotional aspects of learning

Question 38

five key social and emotional skills

DfES (2007)

Answer 38

1. self-awareness
2. self-regulation
3. motivation
4. empathy
5. social skills

Question 39

work within the educational model

Answer 39

• national healthy school initiatives (DfES/DoH, 1999)
• social & emotional aspects of learning (SEAL) initiatives
• work on developing emotional literacy in schools (Weare, 2005)
• supporting emotional literacy (Burton, 2008) via support assistants (ELSA) (Burton et al., 2010)
• use of peer mentoring (national mentoring network and DfES (2004)
• developmental group work - circle time (Mosley, 1993: 1998) and R-time (Sampson, 2004)

Question 40

EP work within the educational model

Answer 40

• training on the SEAL
• offer supports to help the theory underpinning the approaches e.g. concepts of emotional intelligence (Goleman) & emotional literacy (Gardiner)
• work with schools to develop whole school approaches
• offer training key staff in the knowledge and skills around how to support emotional literacy, peer mentoring & use of cooperative group work
• provide training on strengths based approaches such as solution focused & oriental practice (deShazer, 1990; O’Hanlon, 2000) & +ve psych (Seligman et al., 2009)
• working with schools to provide targeted group work to those children identified as at risk of social emotional & behavioural problems (Squires, 2002)
• working with schools to support the identification, assessment & provision of support of social, emotional & behavioural needs (DfE, 2015)

Question 41

psychological model

Answer 41

• recognises: the importance of the interaction between the person & environment & vice versa
• considers: the impact of the ind on the system, & system on the ind, the impact of beh, cog, emotion & interpersonal interactions
• typically adopts: an eco-systemic approach & “research-practitioner” mindset using a case formulation, hypothesis testing & problem solving, diff forms of consultation, assessment, evaluated intervention & systems work

Question 42

individualist approach

Answer 42

• pipe-end
• pathogenic
• mandatory
• dependency
• inequitable
• additive
• maintains status quo (Harrison & MacDonald, 1997)

Question 43

whole system approach

Answer 43

• systemic
• salutogenic
• particpatory
• sustainable
• equitable
• integrative
• population health gain builds social systems

Question 44

limitations of treatment/therapy

murphy & fonagy (2012)

Answer 44

• many CYP don’t respond adequately to best-evidence treatments: need to find out more about sub-groups who don’t respond to treatment, explore whether better results could be achieved by alternative means
• possibility of adverse outcomes from psych therapies needs to be investigated & reported with same diligence (as pharmacological treatments)

Question 45

interactive factors framework

monsen & frederickson (2008)

Answer 45

• biological
• cognitive
• behavioural
• all linked to environment

Question 46

mental health: the ecosystem

Answer 46

• teacher, child & task
• class & peer group, culture & environment
• school culture, curriculum & beh policy
• national & local policy & initiatives promoting mental health in schools

Question 47

EP use of eco-systemic theory

Answer 47

• draws on principles of ecology & systems theory
• attempt to understand the interactions within & between
• microsystem: exo-system, macro-system, meso-system
• promote change using consultation

Question 48

evidence-based practice

Answer 48

• EPs role on appropriate support & interventions
• considerations: case, evidence, context
• range of meta-analytic studies & systematic reviews of interventions: choosing what is best for you
• NICE guidelines for health & care professionals: EPs are a statutorily regulated profession

Question 49

future possibilities

Answer 49

• as unmet need is so high, we need to develop innovative methods of service delivery (e.g. the internet, the media [& social media] & improving mental health literacy in the wider community) in the contexts of prevention & intervention (Murphy & Fonagy, 2012)
• EP work in support of ELSAs (Burton, 2002)
• EP work developing relational approaches in schools