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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