Blog
Doing more of what works: new evidence provides insight and opportunities for change in how schools support good mental health
EIF associate and author Jean Gross CBE highlights some of the key findings in our new, major report on adolescent mental health, from the perspective of schools looking for the most effective approaches to tackling issues from stigma and reticence to seek help, to depression, anxiety and self-harm, to behavioural issues such as bullying.
There has never been a moment when schools have been more interested in pupils’ mental health and wellbeing than now, given not only the widely reported increase in mental health problems linked to COVID-19, but also the equally well-documented rise that pre-dated the pandemic.
In England, the government has committed to funding training for a senior mental lead in every state school by 2025, to enable them to implement a whole-school approach to mental health and wellbeing. In Wales, there is currently a consultation on statutory guidance on similar lines. Both nations have provided extra funding to help schools support pupils directly affected by the pandemic: in England, for training and resources, and in Wales for an increase in local authority funding for the school-based counselling services which all local authorities must provide.
This activity means it is timely to take a close look at the evidence on what mental health and wellbeing strategies are most likely to work, for whom, and in what circumstances. EIF’s new systematic review does just that, examining the latest research on the effectiveness of universal and targeted interventions with young people in secondary schools – interventions aimed at enhancing their mental health and wellbeing, preventing or reducing mental health difficulties, and preventing behavioural difficulties and bullying.
What’s typically happening in secondary schools?
Robust survey data on current approaches in secondary schools is lacking, but my conversations with schools and the stories they tell in social and print media suggest that they fall into four broad groups:
- awareness-raising activities (such as assemblies, lessons or digital resources) to increase knowledge about mental health and increase help-seeking
- personal, social and health education (PSHE) lessons, which include teaching pupils how to respond to stress and negative emotions, and sometimes include mindfulness activities
- a whole-school focus on resilience and character-building, which runs across all subject areas, usually includes work on growth mindset, and often includes out-of-class opportunities for students to make a difference to their school or community
- targeted support for individuals, including school-based counselling or sessions delivered by non-teaching staff, such as mentors.
Tapton School in Sheffield provides an example of one now fairly widespread approach. The school, which took part in a Department for Education pilot of collaborative working between schools and Child and Adolescent Mental Health Services (CAMHS), uses assemblies to tackle the stigma around mental health and increase students’ knowledge of signs and symptoms. There is comprehensive advice on wellbeing on the school website, with pages for students, parents and staff. The PSHE curriculum was reviewed to thread mental health into every unit of work. Year 7 transition sessions, for example, start with discussion about mental health and wellbeing as pupils settle in. Students across age groups were surveyed to find out what they found stressful during the school year, at different times, and have learned strategies to prepare for approaching pressure points. Staff have had training from mental health specialists and some have volunteered to act as mental health and wellbeing champions, to whom students can turn when they need a listening ear.
How do current approaches stand up to scrutiny?
In the chart below I have compared the main approaches used by schools with the strength of evidence of their impact, according to the conclusions of the EIF review.
|
Type of approach |
EIF systematic review findings |
|
Awareness-raising activities to increase knowledge about mental health and increase help-seeking |
The review finds good evidence that such approaches (‘mental health literacy interventions’) can have a positive impact on young people’s mental health knowledge, but limited evidence that they impact on stigma, attitudes towards mental health, and help-seeking behaviour. |
|
The taught PSHE curriculum |
The research reviewed examines prescribed programmes, rather than school-developed curricula. It suggests, however, that there is good evidence for social and emotional learning (SEL) programmes, that explicitly teach emotional knowledge and expression, emotional regulation, communication skills, relationship skills, conflict-resolution skills and responsible decision-making. Universal prevention approaches which include elements of cognitive behaviour therapy (reframing how we think about emotions and situations) also come out strongly in the research. The review finds emerging but less strong evidence for positive psychology classroom interventions (sometimes called ‘happiness lessons’), which focus on strengthening young people’s positive emotions, relationships and character strengths. |
|
Mindfulness |
While meditation and mindfulness-based interventions have grown in popularity over the last few years, evidence of effectiveness in improving mental health and wellbeing outcomes is limited or inconclusive. One leading mindfulness intervention, .b (dot-b), has demonstrated impact on selected outcomes across some rigorous trials, while other studies found no significant intervention effects. |
|
Resilience and character development |
These approaches are usually multifaceted, including taught sessions that embrace elements of SEL and positive psychology. Other key elements relate to what the review’s authors have termed ‘positive youth development’: youth-led projects to develop students’ self-esteem, sense of purpose, decision-making, leadership skills and positive interactions with others. Here, the review concludes that there is very limited evidence of impact on mental health and wellbeing. |
|
Targeted support for individuals, such as school-based counselling or sessions delivered by non-teaching staff such as mentors |
The evidence for interventions adopting approaches other than cognitive behavioural therapy (CBT) to address mental health symptoms, including psychotherapy and counselling, is mixed. CBT approaches emerge strongly as effective, when delivered by external professionals, and with some encouraging findings for digital programmes. |
What does this mean for schools?
The EIF review is based on a substantial body of evidence – 34 systematic reviews published since 2010 and 97 one-off intervention studies published in last three years. It can be trusted, and it has yielded a number of challenges for our current practice.
First, it would appear that raising students’ awareness of mental health symptoms and reducing stigma may not of itself be effective. The mental health literacy interventions reviewed consistently improved students’ awareness and knowledge of mental health, their comfort in talking about it and their self-reported ability to recognise signs of mental health difficulties.
But knowledge does not necessarily change behaviour. Only three of the 11 reviewed studies reported any impact on help-seeking intentions. I am reminded here of a recent finding from a survey of over 3,000 secondary students, in which almost half of pupils said they wouldn’t speak to anyone in school if they were worried about their own mental health or that of another pupil.
Second, the review highlights the power of universal, systematic SEL approaches for promoting wellbeing and reducing depression and anxiety. These approaches need not consume large amounts of curriculum time: those reviewed generally consisted of between 10 and 21 lessons delivered over a school year, with lessons tending to last between 45 and 90 minutes. A number of well-evidenced SEL programmes available in this country are listed in the EIF Guidebook. SEL programmes worked, according to the review, when they followed the SAFE principles described in EIF and the Education Endowment Foundation’s SEL guidance for primary schools: (Sequenced set activities which develop skills chronologically, Active forms of learning, Focused time to develop skills, and Explicit targeting of a core set of skills).
The review also suggests that we cannot rely on simply providing opportunities to develop character and build resilience through positive youth action: explicit curriculum attention to skills development also seems to be needed.
Third, threaded through the EIF report is an emphasis on whole-school approaches, where what is learned in classrooms is backed up by a supportive school environment. There is, research suggests, no point in importing standalone programmes, however well-evidenced, into a school where adults do not practise what they preach. This is brought forcefully home in a recent report finding that almost half of pupils surveyed have been disciplined by their schools for behaviour linked to mental health problems.
Fourth and finally, these findings emphasise the power of ‘universal’ programmes. These have an impact on everyone who participates, but their greatest effect was on pupils most at risk of poorer mental health outcomes. This does not mean that we can dispense with additional targeted help where students develop clinical symptoms, but it does suggest that the number needing such help might be reduced through class-based promotion and prevention activities.
What should be asked of school staff?
At a time when more and more seems to be asked of schools, the review invites us to reflect on what can be asked of teachers and other school staff, and what should be the province of others. The evidence is clear: universal interventions to promote mental health and wellbeing can be effectively delivered by teachers, but there is no evidence that interventions delivered by school staff are effective in addressing the needs of students with symptoms of depression and/or anxiety. The review finds that for this group of young people, CBT interventions delivered by external professionals, such as psychologists, provide the only convincing evidence in terms of improving mental health outcomes.
What else?
There is much more of interest to schools in EIF’s report, not least the promising evidence it sets out on the effectiveness of interventions designed to reduce sexual violence and harassment, which is timely and likely to be influential. I expect that the review will have a wide readership.
What will be interesting is the response it generates. The findings suggest that not all we are currently doing to support mental health in our secondary pupils is going to work, and that it could be time for something of a rethink. But as we have seen with the interventions themselves, knowledge and awareness does not necessarily lead to behavioural change and different decisions being made. Let’s hope in this case that it does, and that the challenges this new evidence presents are taken on by government, schools and the organisations that support them.