November 17, 2023
DETAILED GUIDE for ScHools and Colleges
Mental health problems in children and young people are increasing at a rapid rate. Research tells us that around 1 in 6 to 1 in 4 children and young people are struggling with mental health problems. At the same time, 50% of adult mental health problems start during adolescence. The impact of poor mental health in childhood impacts on learning, life outcomes and physical health. This has resulted in schools and settings that work with children and young people being encouraged and supported to increase their capacity to prevent mental health problems from developing in the first place.
‘ early intervention means identifying and providing effective early support to children and young people who are at risk of poor outcomes. Effective early intervention works to prevent problems occurring, or to tackle them head-on when they do, before problems get worse’
Early Intervention Foundation
Our whole school approach to positive mental health and wellbeing, combines positive and organisational psychology theory with mental health in schools guidelines and recommendations. Our system model represents the dynamic way mental health and wellbeing is developed in schools and colleges. We use it to provide a framework for planning, developing and embedding school wellbeing.
Early intervention is a school-based mental health promotion and support programme. It aims to detect and respond early to students experiencing difficulties so that they can remain engaged in school. Early intervention services are usually provided by a team of teachers and practitioners who work together to support students. The team provides a range of services including individual targeted support, group work, parent support groups and whole-class teaching in strategies for wellbeing.
Early intervention programmes are based on the premise that it is better to prevent problems from occurring in the first place than to try to fix them after they have developed. This is because early intervention can reduce the impact of problems on students’ learning, development and wellbeing. Early intervention programmes also have a positive effect on school culture by promoting a supportive and positive environment.
Mental health issues for children and young people are increasing, this has been exacerbated by the covid pandemic. It is expected that 1.5 million young people will need mental health support in the next 3-5 years. Increasing capacity to provide early prevention is essential for schools and colleges to tackle this growing need and reduce mental health problems that not only impact on learning outcomes but also cause health inequalities that last a lifetime.
Suicide is the largest single cause of death in young people between the ages of 5 and 19, and 1 in 6 young people – approximately 4 children in every classroom – have a diagnosable mental health disorder. In the UK, we are lucky to have access to an excellent health service, but this health service is under immense pressure and children can wait weeks just for an initial mental health assessment. As young people wait to receive support, their risk of developing mental health problems increases.
Schools are an ideal setting to provide early intervention and prevention through increasing the capacity to promote wellbeing and protect mental health. Schools are now being encouraged to appoint a Senior Mental Health Lead to increase the capacity to provide more early prevention and prevent the onset of more enduring mental-ill health.
One of the priority roles of a school Senior Mental Health Lead (SMHL) is to ensure children and young people can get timely and appropriate support for their mental health and wellbeing. Part of this remit is to build effective working relationships with partner agencies and local mental health services.
The other and we would suggest most important, is to increase the opportunity for pupils and students to access support for mental health problems sooner before the mental health problems escalate and become harder to address. In many schools, this means they have to develop and provide their own targeted early prevention provision.
The introduction of the SMHL in many schools and colleges has built much greater awareness for the need to identify and provide more early support to prevent the onset of mental health problems. However, the supply does not meet the increasing demand, leaving schools and colleges to develop their own early intervention and prevention offerings for pupils and students.
If you're a new in post School Mental Health Lead, there are several duties you will have including providing prevention, early support, identification, and access to specialist support for mental health problems. What type of intervention and prevention and where it fits on the spectrum of mental health.
There are two different approaches to supporting children or young people's mental health. Firstly, and probably the most prevalent being the development of programmes that assist with the removal or reduction of issues or problems. For example by reducing depression, reducing anxiety, removing negative factors that cause mental health problems, such as anti-bullying strategies and stress reduction.
This can also include mental health problem awareness raising such as mental health first aid and anti-stigma work. Essentially taking the problem ‘away’.
However, research from the field of positive psychology tells us that taking away or reducing the problem, does not increase health and wellbeing. Improving positive mental health requires a different set of tools and strategies to those that reduce the risk factors.
The second approach and our focus here at Worth-it is the development and promotion of embedded and sustainable capacities for wellbeing. A focus on wellbeing and a move towards flourishing protects mental health and prevents the onset of mental health problems.
Strategies include supporting children and young people to cultivate positive feelings, develop positive behaviours for learning, and build positive ways of thinking, understanding and express emotions, recognising strengths and learning ways to be resilient and cope with challenges. This is known as Positive Education, applying the wellbeing science of positive psychology in school or educational settings.
Within a population, there is a certain percentage of people with a mental disorder or a mental health problem that is diagnosable. A group of people that are languishing, which means that you don't have mental health problems, but you have no strategies for mental health either.
The next cohort is children and young people with moderate mental health, which is most people. And then we have a small percentage, around 18%, that are flourishing.
World expert in positive psychology Professor Corey Keyes has identified through research that any child or young person that isn't flourishing, is at risk of developing mental health problems. Therefore targeted interventions for mental health can fit at any stage along this spectrum.
As a SMHL you may be thinking the most important area to focus on is supporting children with a mental illness or mental health problems, are those to support with your pathway to specialist provision. Which is a key priority in your role to increase access to specialist mental health provision through building referral pathways. However, the offering for early intervention and prevention work really needs to focus on preventing children from moving towards languishing and increasing capacities for mental health and wellbeing for those children who have moderate mental health, ultimately moving all people up the spectrum towards flourishing.
The approach to working with SMHL’s in our DfE assured Wellbeing Club trains and supports them in how to develop and provide school-based intervention and early prevention to help those children and young people that are languishing or have moderate mental health to increase strategies for positive mental health and wellbeing.
As a Senior Mental Health Lead, you'll be coordinating a range of targeted prevention. These will be for children and young people who are classified as more at risk or vulnerable. The categories of risk factors will differ from school to school. What makes a child or young person more at risk or vulnerable to developing mental health problems? Examples include refugee children or asylum seekers.
Other at-risk cohorts include young carers, those that are cared for, those that experienced bullying, those with special educational needs and disabilities, those with parents with a mental health problem or mental illness, LGBTQ+, those that have experienced adverse childhood experiences (ACEs), which include living in a household with domestic violence, drugs and alcohol, bereavement, quite a lot of traumatic events in childhood that can lead to being more at risk.
Other children that require targeted prevention include those with early signs of common mental health problems, that can be as many as one in four children in your class might be struggling with poor mental health, and early signs of anxiety or low mood and depression.
Lastly and an often overlooked cohort are those languishing children and young people. Those that don't have a mental health problem, but don't have any strategies or capacities for personal mental health and wellbeing either. Children that are languishing are at risk of developing mental health problems.
Increasing your capacity as a school to provide more targeted intervention programmes not only improves mental health for at-risk cohorts, they also develop essential components of resilience and wellbeing, including students’ emotional literacy, communication skills, relationships, and thinking skills. This is increasingly important in preparing for transitions, exams and making important decisions. Other positive results include improved behaviour and conduct.
The wider impact of increasing wellbeing and mental health support can benefit the whole school community. Schools that provide a range of targeted mental health provision see multiple benefits. These include improvement in children and young people's levels of wellbeing is associated with increased engagement in learning, positive behaviours for learning and attainment, and as young people become more resilient and self-reliant become less dependent on school support, freeing up staff capacity and reducing staff stress.
You may not be sure what type of intervention to coordinate and develop in your SMHL role. The first job is to identify what type of intervention you already have in place through provision mapping, which means listing out and making a map of the support for mental health available in your school or college. When doing this exercise it can provide an opportunity to review those and monitor the provision in place to see if they are fit for purpose and effective, or do you want to change any of them.
Some examples of mental health provision include small group programmes around developing confidence or reducing anxiety, or helping deal with challenging situations. Even homework, revision groups, or peer support groups can provide a type of early intervention by increasing positive relationships and positive behaviours for learning. We also have in primary schools, nurture groups, and circle time, golden time, achievement assemblies, and regular rituals and routines in school provide a valuable opportunity to develop wellbeing and promote mental health.
It may seem like an attractive idea or a good solution to put on a workshop day for pupils to promote wellbeing and resilience. However one-off lessons, workshops or presentations provide little lasting impact in the prevention of mental health problems for children and young people. Workshops can be useful to gain a buzz around wellbeing for pupils, students or staff, they can be a good way to launch or celebrate any wider wellbeing initiatives and ongoing work in your school such as children's mental health week.
Wellbeing workshops can be great to give wellbeing some kudos by having an external organisation come in and deliver workshops to pupils. Indeed this is something we have done for years, with 1000's of children and young people and national schools and settings. Externally provided workshops can also take a bit of work off your plate in developing part of your wellbeing curriculum.
However, we advise using workshops with caution they can be expensive and not produce the outcomes you are hoping for. Most other subjects are not taught as a one-off 45 minute event once in the whole time a pupil is at school, why should wellbeing be?
It is important to be realistic about what the purpose of having a wellbeing workshop is for. If it is to prevent mental health problems with vulnerable it is probably not a robust enough intervention to choose. The minimum we would suggest is a programme of workshops supported by a wider whole school work around developing mental health and wellbeing. There are other much more impactful targeted early intervention options listed below.
An important and effective specialist targeted intervention to consider is providing students with coaching sessions to help develop resilience. You may not have considered coaching as an intervention for young people especially to help with mental health and wellbeing.
Like counselling, coaching is a 1-2-1 targeted intervention programme that supports young people to build awareness through talking to a trained supportive adult. There are some key differences between counselling and coaching.
In our experience, we have found that the easiest way to choose between Counselling and Coaching as an approach to support young people is to focus on the starting point of the young person and what it is they are looking for. Do the young people have a level of moderate mental health, but aren't diagnosed as being mentally ill? Or are they languishing (low mental health without elevated levels of mental illness?
A coach can help a young person move from languishing up the mental health spectrum toward moderate mental health. They then may want to help the young person go from having good levels of wellbeing toward flourishing (typically a Coach supports this process of change). Coaching tends to be a shorter focused intervention that increases personal resources for wellbeing and resilience
Alternatively, the young person may feel that they are in emotional distress and they that they are really struggling with something traumatic or psychologically distressing (typically a Counsellor or therapist will help with this depending on the level of distress). Counselling relationships can be long-term in nature.
Coaching is an effective evidence-based approach that improves levels of wellbeing, develops resilience and reduces mental health problems and increases academic success.
The coaching process helps young people to develop wellbeing and resilience through learning and practising skills and strategies with their coach during the coaching sessions.
It is also through experiencing a coaching relationship with a trusted adult who believes in them that can help encourage and motivate young people to apply wellbeing and resilience strategies that they can use to manage their emotions, cope with stress, overcome challenges and setbacks. Something we all agree most young people would benefit from.
Positive peer support and peer relationships are key ways to increase capacities for mental health and wellbeing amongst children and young people. Peer-to-peer interventions can work in cases when the child or the young person doesn't want to or won't engage in an intervention or support.
Supporting the young person vicariously through supporting their peer group around them can help the peers lead by example, for example teaching the peer group effective strategies for positive mental health and wellbeing will indirectly benefit the young person or child through increasing the quality of the interactions the peers have with the targeted young person.
Another strategy to increase engagement for targeted cohorts is to work with the young person and a friend that will help the other young person engage in the support that is available they both can benefit from the intervention but the friend can act as a role model and encourage the peer to access targeted support. Working with peer groups can be more of a long-term strategy but in some cases, the power of friendship and the power of positive peer groups can be an effective intervention.
With teachers and other school staff under so much pressure, it can be hard to implement the extra pastoral support or targeted mental health provision that young people require. One popular and evidence-based approach to supporting peer wellbeing is to train pupils to become mental health or wellbeing ambassadors. Ambassador programmes can increase the capacity to support many low level issues that impact on mental health and wellbeing as well as reduce mental health stigma, so pupils feel more able to ask for help and gain access to provision that prevents the onset of mental health problems.
We have designed our Wellbeing Ambassadors programme with this in mind, to train young people to support each other and recognise when they need to ask for more support, thus reducing the amount of time teachers spend dealing with low-level issues. The Wellbeing Ambassadors' training enables them to offer informal one to one peer support as well as set up drop-in sessions and run campaigns to open discussions around mental health and reduce any stigma surrounding mental health problems.
Working with parents can also be an effective targeted intervention especially when you can't directly work with the child or the young person because maybe it's not suitable or they won't engage. Working with and supporting parents can provide an indirect impact that can really help the wellbeing of the child or the young person.
We have also worked with schools who have developed many innovative approaches to early prevention, these include having wellbeing pets including cats and wellbeing dogs. Using outdoor learning to embed a wellbeing curriculum or integrating sport and exercises as a way of providing early prevention.
Another way to provide the right provision for the right pupils and students is to develop ways to identify needs earlier. There are three main ways to increase the identification of needs in children or young people who might be suffering or struggling with poor mental health. As a SMHL as part of your whole school approach you will be developing mechanisms to have all of these three ways working effectively together.
The first way is the identification of cohorts more at risk. So these are the types of cohorts that we covered earlier in this article, who might be more at risk due to circumstances or situations that they're in that have made them more at risk of developing a mental health problem. Using data readily available in the school can help with this process.
The second and possibly most important way to identify needs is by knowing your children and young people and spotting changes to mood or levels of wellbeing. Staff can identify changes to behaviour that are sudden or erratic, or different. This can then trigger signposting or referal onto the pathways that your school has in place.
Due to the nature of school environments, this may be easier in a primary setting, than it might be in a secondary or FE college setting. However, opportunities for staff to identify needs in students can include academic tutor programmes, learning mentors or tutor time. With some training, staff will be able to identify if they have any worries or concerns about young people's changes to mental health. This will work much in the way that we do with safeguarding in that knowing that something's not quite right, and that instinct to spot sudden changes to the wellbeing of students and make a referral.
Thirdly we can use monitoring and identification tools. Monitoring can be more effective if tools are used as part of the process for signposting or referral into your pathway for early prevention. Identification instruments can also be used as part of your specialist provision offer as a way to triage or screen for certain issues or struggles, which can enable a more appropriate intervention to be provided.
Using identification tools in this way can be more effective and appropriate than measuring everyone in the whole school or college, which can be unnecessary and time consuming, if other processes for identification of needs are working well.
Key to all mental health provisions and interventions being effective is the whole school approach to mental health which involves all staff developing a shared and understood approach to mental health. This is highly effective because all children and young people are learning wellbeing strategies through the promotion and protection of positive mental health and wellbeing. So that is an intervention in itself.
If you are looking for DfE assured training to increase your capacity to support the prevention of mental health problems in your school or setting the check out our Wellbeing Club for SMHLs.