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Implementing mental health
promotion in schools in the UK
and learning from Dataprev in
Europe
Professor Katherine Weare
Professor Melanie Nind
University of Southampton
Skw @soton.ac.uk
Intecamhs meeting
Washington
November 2010
Aims
To give an overview of what
is happening with the
promotion of mental health
in schools in the UK
To communicate the key
findings of the Dataprev
project
My role
 Background in Health Promoting
Schools: Mental Health
 Wrote key document for UK Govt on
‘what works’ in promoting emotional
health and wellbeing.
 Helped create and monitor primary
and secondary “SEAL” programmes
 On working party for English
“Targeted Mental Health” programme
 Part of current “Early Intervention
“reviews and policy
 Reviewing evidence base for mental
health in schools and uncovering
programmes for EU: “DataPrev”.
Why schools in Europe are interested in
mental health
 Focus on positive mental health, wellbeing,
prevention, early intervention, social and
emotional learning, healthy schools
 Long term concerns to reduce problems e.g. stress,
anxiety, depression, bad behaviour, violence,
disaffection
 Changing focus of learning on skills rather than
just content: preparing students for lifelong
challenges
 Improved evidence: knowledge of effective
programmes and approaches
Current terminologies, paradigms,
discourses
Paradigm shift in understanding of the role of
mental health and wellbeing in schools in Europe
 Traditional view
 For young children
 Responsibility of the
home/ mental health
services
 For special needs/ those
with problems
 Trouble shooting/
prevention
 Bolt on extra/low status
activity
 An art not a science
New view
 Everyone including adults
 Everywhere e.g.
secondary schools,
workplaces
 All of us, including
‘without problems’(?)
 Positives e.g. growth,
strengths, capacities
 Central to educational
goals – learning and
behaviour
 Evidence based
Government interventions e.g.
Every child matters framework: wellbeingMental health for
4 reviews by National Institute for Clinical young people
Excellence on wellbeing in schools – new in the UK
one on early years underway
Early years review (ongoing with new govt)
Healthy schools framework – emotional
wellbeing
Plus
Work in voluntary sector e.g. Place2Be,
Pyramid Trust, Antidote,
Some imported programmes e.g. Paths, Second
Step, EL in Middle Schools, Friends
England: previous govt programmes e.g.
 Strong work on Personal, Social and
Health Education/ Enrichment/ Healthy
schools
 SEAL: 2/3 of primary, 10% secondary and
growing
 Targeted approaches, some through
SEAL, recent DCSF £60m
Scotland: use frameworks and localised
approaches e.g.
 Overall “Curriculum for Excellence”
 Restorative practices, Being Cool in
School, Creating Confident Kids
Wales
 Local work on emotional Literacy and
SEAL
Northern Ireland
 Mainly through PSHE
 Evidence based
 Emphasis on range of benefits
including links with learning
 Tailored to local needs
 Whole school approach
 Supportive and balanced ethos
and environment
 Balance universal, targeted,
indicated
 Explicit skill development:
integrated into teaching and
learning and curriculum
 Monitoring and evaluation
 Staff development
Principles behind
recent UK
approaches to
mental health in schools
Strong influence of international evidence that
well designed programmes improve
 Mental health problems anxiety, depression, stress
 Behaviour
 Attendance
 Exclusion – social and
educational
 Cultural and racial
understanding
 Teacher retention,
performance and morale
 Learning
Summary of results of 207 SEL programmes in
US:
 11% improvement in achievement tests
 25% improvement in social and emotional skills
 10% decrease in classroom misbehaviour, anxiety
and depression (10% in each)
Social and emotional learning (SEL) and
student benefits
www.casel.org/downloads/EDC_CASELSELResearc
hBrief.pdf
Primary SEAL
 Curriculum materials
 7 themes, 5 levels
 Guidance, overview, curriculum
ideas, assembly, whole school
opportunities
 Evaluation by IoE of pilot very
positive – measurable changes in
behaviour, attendance, learning,
test scores in numeracy and
literacy
 In 2/3 primary schools
Secondary SEAL
 Built on learning from SEAL
and others
 In 1/3 secondary schools
 Web based
 Strong whole school approach
 Guidance on evidence,
implementation, ethos, policy,
leadership, links with parents
and community, special needs
 Learning materials for years 7 Positive evaluations of pilot and
by Ofsted (inspectors)
 Mixed results of RCT
 Positive results from schools
which followed guidance
National Institute for Clinical
Exellence reviews concluded that
universal base is vital
 Less stigmatising
 Problems are widespread,
on a continuum, connected
 Same processes which
help everyone help those
with problems – ‘more’
not ‘different’
 Provides educated ‘critical
mass’ of people to help
those with problems
 But also need targeted
and early interventions
Targeting - start early and keep going
 Some brief interventions
work with mild problems
but most effective
programmes take time
 Involve parents
 Target the youngest
 Address problems early
 Spiral approach
 Revisit learning
 Integrate with rest of
school
Some demonstrably effective
approaches
 Long term programmes on
social and emotional skills –
reinforced in all interactions
with children
 Conflict resolution programmes
 Play based approaches
 Nurture groups
 Parenting skills
 Social skills and cognitive
behaviour therapy type mix
Targeted mental health in schools
 National programme:
£60 million
 ‘Pathfinders’
 Joined up working
 Must link with SEAL
 Evidence based approach
 Not yet evaluated
Key challenge – motivating staff
 What has this got to do with education?
 Overload“Too many initiatives”
 Cannot see the point (“our results are
good- why do we need it?)
 “Job of parents- not us”
 Too stressed
 Threatened, lack of skills, time, guilt
 Clarifying roles and expertise
 Need to involve all the SMT
 Lack of input into initial teacher
education
Barriers to developing mental health
in schools in the UK
 Academic critics- ‘therapeutic
education’ seen as harmful,
creating dependency, threatening
 Media scorn: silly, ‘nanny state’
 Target led nature of education,
especially secondary
 New government: focus on
subjects, back to basics,
‘peripheral issues’ will not be
subject to inspection
 Negative results of RCTs
Where next for the UK?
Use different language e.g.
‘resilience’ and ‘grit’ not
emotional literacy
Emphasise links with
learning
Involve private enterprise
e.g. in early intervention
New areas e.g. mindfulness
Dataprev: mental health
promotion in Europe
Role of the EU
 EU - strong role in public health.
 Mental health key areas for action, and
children and youth are one of the five
priority areas
 Sequence of meetings, conferences,
research projects, documents to guide
practice and policy
Evidence in Europe
 No strong tradition of evaluation- unlike US
 Reviews have found that projects not
robustly designed or evaluated – mostly
process evaluation, before and after, or case
study
 No networks to pull it together unlike
CASEL and SAMSHA in the US
 Some databases established but not
systematic, or not in English (e.g. Dutch)
The Dataprev project
 Reviewing evidence base systematically in
4 key areas: parenting, schools, workplace,
the elderly
 Identifying good practice: database of
effective approaches
 Aim: assist policy-makers with guidance
and training on transferability of specific
approaches and programmes to different
countries and cultures
 Improving lines of communication between
researchers and policy-makers.
Schools workpackage: identifying
and obtaining reviews
 Systematic search of wide
range of databases,
websites
 Direct contacts with
known experts
 Reference list from known
reviews
Found
 Assessing for quality 49 systematic reviews
10 evidence informed
 Post 1990
Outcomes – 80+ terms under
Some key sources of evidence
 US – widespread broad frameworks e.g.
‘character’, ‘social and emotional
learning’, ‘mental health’. 20 positively
evaluated programmes- some heavily
promoted in the UK
 Australia – widespread frameworks e.g.
Health Promoting Schools, ‘Resilience’ –
‘Kidsmatter’ and some positively
evaluated programmes e.g. ‘Friends’
 Europe – Health Promoting Schools –
other key initiatives not so important e.g.
EU, anti-bullying in Scandanavia
Programmes found in Europe 15 Large named US programmes that
pass systematic review
 7 smaller European programmes
 3 European programmes that not yet in
systematic review but which would be
eligible
 2 larger national programmes that
currently being evaluated
Quality of the evidence
 Strong group of programmes/ approaches
 Clear impact on anxiety, stress,
 Some impact on depression, behaviour,
crime
 Some impact on +ve mental health and
academic learning
 Few adverse effects
 Effects cannot be relied on even in country
of origin
 Most that are robustly evaluated originate in
the US – few trials in Europe
 A few programmes that are European in
origin
Quality of the evidence: problems
 Heterogeneity – comparison difficult
 Not many programmes have long
term evaluation
 “Poor” design – e.g. randomisation
and blinding almost impossible
 Systematic review methods not well
suited to multi-modal long term
school interventions- may be
missing some features
 But on the whole the results of the
reviews support the qualitative work
What appears to make implementation
more effective
 Consistent implementation
 Whole school - multiple modalities,
positive school ethos, integration
 Skills development – CBT/ social
skills, developmentally appropriate,
integrated with general curriculum
 Inclusion of parents, teachers, and
peers – supported by training
 Longer time frame
Tailoring balance
 UK and Europe generally
suspicious of scripted
programmes.
 Too much prescription – lack of
ownership, engagement,
depowerment.
 Too much tailoring – dilution,
confusion, hard to evaluate
Age, stage, length
 Early interventions seem more
effective
 Booster sessions useful
 One offs never found to work
 Short term can help with conduct
disorders and anxiety
 Conduct disorders seem to need
longer interventions
 Few programmes for 11+ age.
Mostly conduct disorder. Evidence
base weak. No clarity about length
of intervention.
Targeting
Balance/ mutual support:
 Universal
 Targeted
 Indicated
 More impact on boys
that girls
 More impact on high
risk than low (ceiling
effect?)
Whole school approach: using
Skill development
Curriculum and
Methods
Pupil support
Pupil involvement
Management
Leadership
Policies
Staff
School climate and
ethos
Community
Parents
Outside agencies
Physical environment
Who should deliver?
 Hard to be definitive as few
direct comparisons,
 Psychologists effective,
especially for short term and
complex interventions
 Teachers often used, long term
input, sustainable, integrated.
Need training, can be effective,
although unreliable judges of
students
 Essential to involve parents as
Best when agencies part of the team – parenting
education effective
work together
 Peer learning/ mediation
effective
Whole school approach- features that seem influential
Staff development
Parents
Peers
Involved and
trained
Curriculum and
Methods- CBT
and social skillsintegrated
Climate,
ethos, values,
attitudes
Appropriate
targeting
Curriculum
 Usually a key part of
effective interventions
 Whatever the issue, CBT/
social skills mix seems to
help
 For long term impact,
needs integrating with
wider curriculum and
processes
Specific mental health issues
 Self esteem and depression harder
to influence than anxiety and
conduct disorder
 Conduct disorder – reasonably
good evidence, long term
approach needed, training
teachers to be less negative and
work with parents more
effectively helps
 Bullying/ conflict resolution –
peer training essential
 Universal suicide prevention
unwise
Specific mental health issues
 Self esteem – tough to influence.
Best if focused on
 Depression – also tough.
Associated problems make it
complicated. Long term,
CBT/Social Skills indicated.
 Anxiety, stress, coping – easier to
influence with medium term
interventions using mixed
methods e.g. relaxation, CBT,
meditation, body work
 ADHD – no effective
interventions found so far
Next steps for Dataprev
 Finish final report (!)
 Database of effective
“approaches”
 Conference in the
Hague in February to
share findings with
policy makers