The mental health dividend

2 May 2018

Stephanie Waddell is the lead for vulnerable children and young people at the Early Intervention Foundation

This article was originally published in the April issue (£) of Community Practitioner, the journal of Unite/Community Practitioners and Health Visitors Association

The government’s Transforming Children and Young People’s Mental Health Provision green paper, published in December, puts the spotlight on the role of schools. Schools will be incentivised to identify designated senior leads for mental health who can oversee the whole school approach to promoting good mental health. They will be supported by new mental health support teams which will provide new capacity for intervention for children with mild to moderate needs. The teams will be supervised by NHS staff, but schools will jointly manage their work. This is logical. In a world in which demand for specialist mental health support is far outstripping NHS capacity, schools must be enabled to provide greater support at the sub-clinical level for children with emerging signs of mental health problems.

This new infrastructure is to be welcomed, but, as the government recognises, it needs to add value by complementing rather than replacing work within the current system. Designated senior leads need to be people with real authority and influence within the school, rather than simply the person who deals with mental health. Mental health support teams need to work closely with school nurses and other school staff. They need to increase the capacity for joint problem solving involving schools and child and adolescent mental health services (CAMHS), rather than simply delivering a set of interventions or referring to CAMHS.

Our view is that all this needs to be underpinned by the firm foundation offered by Social and Emotional Learning – by schools which prioritise children’s social and emotional development alongside their academic attainment. Our research at the Early Intervention Foundation (EIF) has shown that social and emotional skills, including self-awareness, self-management, social awareness, relationship skills and responsible decision-making are fundamental to children’s health and wellbeing.

Why social and emotional skills are critical

Skills like self-awareness, self-regulation, relationship skills, and self-efficacy are important for children’s future success and wellbeing. Emotional wellbeing and self-esteem in childhood are strongly associated with good mental health in adulthood. Similarly, social skills, self-control, self-regulation and self-efficacy also appear to be important to later mental health and wellbeing.

Research also indicates that some social and emotional skills lay the foundation for later skill development. Skills learned in primary school act as building blocks for more complex skills learned throughout secondary school (Jones, S.M., & Bouffard, S.M., 2012).

Children from disadvantaged backgrounds tend to have lower levels of self-control and emotional health than other children and this inequality gap can be seen in children as young as three. This socioeconomic gap in social and emotional skills in the early years risks embedding a mental health gap as children get older.

What helps children to develop skills

These skills can be taught and developed throughout childhood, adolescence, and beyond. Promoting social and emotional development involves teaching and modelling social and emotional skills, providing opportunities for children to practice these skills and giving them the opportunity to apply these skills in various situations. Schools play a central role.

There is strong evidence for the impact of high-quality school-based social and emotional learning programmes on the development of these essential life skills. Many of these are on the EIF Guidebook, which provides information about programmes that have been evaluated and shown to improve outcomes for children and young people. Some of these programmes have been shown to reduce the risk of negative mental health outcomes, including anxiety and depression. These programmes fall into three main groups: 1) universal classroom-based interventions which teach a range of skills through a developmentally appropriate curriculum; 2) whole-school interventions which operate at different levels and involve coordinated action involving the curriculum, the school ethos and environment and family and community partnerships; and 3) targeted interventions, which are designed for children at increased risk of development mental health problems and are often delivered through small-group work. These programmes reinforce and supplement sessions with the whole class.

Research suggests that social and emotional learning programmes need to be integrated within a whole-school approach that also includes more targeted support for children with emerging mental health needs.

The value of universal social and emotional learning programmes in combination with targeted interventions should not be underestimated. Universal support can provide a backdrop of provision, potentially reducing demand for targeted work through CAMHS, and creating a supportive environment that can sustain improvements for children who have needed additional help.

How to support schools

We know anecdotally that social and emotional learning in schools is patchy. Schools are under pressure to focus on academic attainment and are not incentivised to prioritise the teaching of social and emotional skills. Indeed, those head teachers who do prioritise social and emotional learning are often described as ‘brave’ or ‘courageous’. Pragmatic is closer. These heads are often working in deprived areas and they have recognised that without supporting their children to develop the ability to understand and manage their emotions and behaviour, build healthy coping strategies, develop self-esteem and build positive relationships, they will not see the academic results that they aspire to.

We will continue to make the case to government that social and emotional learning should be given greater prominence within schools and that high-quality, evidence-based provision should be scaled up. Social and emotional learning should of course be a core part of relationships and sex education and any personal, social, health and economic (PSHE) curriculum, but it should also be embedded within everyday teaching and learning. This is not just about PSHE. Crucially, we want the new Ofsted common inspection framework to include specific consideration of how effectively schools are supporting the development of social and emotional skills within their day-to-day practice.

We need to support heads, teachers, and other school staff, notably school nurses, SENCOs (Special Educational Needs Co-ordinators) and educational psychologists, to create caring, safe and nurturing school environments and to teach children the skills they need to be happy, healthy and successful in their lives. These are the kinds of environments that promote emotional wellbeing and mental health and support children who may already show the signs of mental health problems. They are the bedrock of the system changes proposed by government in the children’s mental health green paper. To overlook this and consign the conversation about social and emotional learning to the PSHE debate risks severely limiting the impact of the new investment in sub-clinical mental health provision in schools.