Cognitive behavioural therapy-based support in schools could help alleviate the looming mental health crisis
A new report highlights what works and for whom to support young people's mental health within schools.
A new study, out today (21/07/2021), has found that for teenagers at risk of developing mental health problems, cognitive behavioural therapy-based interventions (CBT) show promising evidence of impact, particularly for addressing depression symptoms. For those already displaying signs of depression, the evidence shows that targeted interventions need to be delivered by a non-teaching professional, such as a psychologist.
The evidence review, by the children’s charity the Early Intervention Foundation, found that teachers and schools have a significant role to play in enhancing young people’s mental health and wellbeing.
The review found that universal teacher-delivered interventions (support delivered to all pupils) which focus on developing social and emotional skills, are effective in enhancing young people’s mental health and wellbeing and in reducing symptoms of depression and anxiety in the short-term. This means that providing these interventions in secondary schools can improve young people’s mental health.
What’s less effective?
In contrast to these findings, the effectiveness of mindfulness-based interventions, which are gaining popularity in schools and wider society, is quite mixed in terms of its impact on mental health. The review also highlights weak findings on the effectiveness of ‘positive youth development’ interventions, which cover an array of approaches, including engaging youth leadership programmes, personal mentoring, and engaging youths in sports and recreation activities.
Dr Jo Casebourne, chief executive, Early Intervention Foundation said: “The results from this review provide good evidence that enhancing skills such as emotional regulation, communication skills, conflict resolution skills and empathy, is a crucial part of young people’s overall development and their ability to achieve in school, work, and life.
“We need to invest in approaches that have been shown to work. It is clear from this comprehensive review that social and emotional learning interventions would be more beneficial than other approaches, such as mindfulness or positive youth development interventions. We really must avoid investing heavily in approaches that are shown not to work.
“For some young people, additional support is necessary. Our review found that externally delivered cognitive behavioural therapy-based interventions can have a significant impact on young people’s mental health, in particular on symptoms of depression. These findings are promising and highlight the important role that school-based early intervention can play in meeting young people’s mental health needs.
“The review also shows that quality of implementation matters. When programmes are implemented with poor quality, they are unlikely to have an impact. This is why teacher training is so important. We need to invest in teacher training that equips teachers with the knowledge and skills to implement programmes with high quality. We’d like to see Gavin Williamson really focus on this as part of the Covid recovery”.
Other key findings
Bullying prevention interventions are effective in reducing bullying victimisation and perpetration
However, the review also found few interventions designed to address conduct problems and cyberbullying
There is limited evidence on the effectiveness of school-based interventions designed to prevent suicide and self-harm
Violence prevention interventions have been shown to have a small but positive effect on aggressive behaviour in the short-term. There is evidence that some of these interventions can also have an impact on other behavioural outcomes including bullying victimisation and pupil wellbeing.
1) Schools need to be supported in giving equal priority to mental health and academic achievement
The current system weighs heavily on the side of academic performance, which makes it difficult for schools to find the time to meet the mental health and behavioural needs of pupils.
2) Substantial investment in high quality teacher training and support is needed
Accomplishing effective implementation of mental health and behavioural interventions in real world practice requires high-quality teacher training and support. There is a need for whole-school teacher training to enable all school staff to understand and model these skills and behaviours through their everyday interaction with young people.
3) Schools need to be supported in the identification of vulnerable pupils at risk of developing mental health and behavioural problems
All students can benefit from universal social and emotional skills-based interventions, but it is important that young people at risk of developing serious mental health and behavioural disorders are identified before problems become engrained, and that they then receive targeted support, such as CBT-based early interventions.
4) Provide external mental health expertise to schools to support the most vulnerable
Professionally delivered targeted interventions are needed to better support the most vulnerable pupils who are most at risk of developing mental health and behavioural problems. Schools need to be able to hire mental health professionals who are qualified to deliver targeted support effectively.
5) Focus on high-quality implementation of interventions
National policy-making must focus on high-quality implementation and providing schools with implementation support, for example, in building readiness and commitment for change among all school staff, understanding the needs of the pupil population, developing an action plan, addressing barriers to implementation and embedding these practices within schools.
Dr Casebourne commented: “The decline in young people’s mental health is well documented. We hope this study – the biggest of its kind in at least a decade – will inform the next steps towards providing the most appropriate mental health support within schools. The evidence review shows that when delivered to a high standard, school-based mental health and behavioural interventions can help address some of the biggest challenges young people, families, schools and society as a whole are currently facing.”
Emma Thomas, Chief Executive of YoungMinds said: “This important report demonstrates the crucial role that schools can play in supporting children’s mental health. The pandemic has put extraordinary pressures on young people, and the Government must do all it can to ensure that all schools are equipped to provide evidence-based interventions and to make mental health a priority in everything they do.
“This means making mental health a bigger part of Initial Teacher Training and continuous professional development. It means ensuring accountability systems recognise the importance of wellbeing as much as they do academic performance. And it means guaranteed funding for the full roll-out of Mental Health Support Teams as well as for early intervention services outside schools – including through early support hubs in local communities.”
Prevalence of mental health problems:
More than one in seven young people (15.3%) aged 11–19 in England had at least one mental disorder in 2017, according to the Mental Health of Children and Young People (MHCYP) survey.
A follow-up survey carried out during the Covid-19 lockdown (July 2020) indicates that one in six young people (17.6%) aged 11–16 years were identified as having a probable mental disorder. This figure increases to one in five (20.0%) among young adults aged 17–22.
This evidence review consists of:
A systematic review of meta-analyses and narrative reviews published between 2010 and August 2020
A systematic review of primary studies published between 2017 and August 2020.
The evidence review synthesises the results from 34 systematic reviews and 97 primary studies that evaluated the effects of school based interventions on young people’s (age 12-18 years) wellbeing, mental health and behaviour.
The Early Intervention Foundation (EIF) is an independent charity that champions and supports the use of effective early intervention to improve the lives of children and young people at risk of experiencing negative outcomes. For more information, see: www.eif.org.uk