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Supporting Children with Medical
and Mental Health Needs at School

 

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WHAT RESEARCH TELLS US

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Mental health awareness is growing in prominence both nationally and internationally.

The Mental Health Foundation Define Mental Health as:

"We all have mental health, just as we all have physical health. Being mentally healthy means that we feel good about ourselves, make and keep positive relationships with others and can feel and manage the full range of emotions. These can range from happiness, excitement and curiosity through to less comfortable feelings such as anger, fear and sadness. Good mental health allows us to cope with life’s ups and downs, to feel in control of our lives and to ask for help from others when we need support."  

The Challenge Facing Schools

 

In the most recent comprehensive survey of child and adolescent mental health in England today (1) 48.5% of children with a mental health disorder named a teacher as a source of professional support.

The challenge facing schools is knowing what to do to address the issues affecting the pupils they serve, in a way that is informed, evidence based and both practically and financially viable.

Current Research

 

One place to start is with what current research is telling us.

There is a considerable amount of research evidence available focusing on child and adolescent mental health in England and across the world. The research questions and methodologies are varied resulting in a wide range of findings and recommendations. The findings and recommendations presented here are from studies carried out in the UK or the USA.

The most recent survey of child and adolescent mental health in England was funded by the Department of Health. The Survey of the Mental Health of Children and Young People 2017 (MHCYP) (1) aims to improve understanding of the state of young people’s mental health and wellbeing. It covers children and young people between the ages of 2 to 19. The comprehensive report provides a variety of data including an analysis of trends, prevalence of types of disorders and the nature of support currently available. There have been follow up surveys in 2020 (wave 1), 2021(wave 2), 2022 (wave 3) and most recently in 2023 (wave 4). The key facts from the 2023 survey can be found below. 

A Snapshot of the Mental Health Needs of Children and Young People Today

 

  • In 2023, about 1 in 5 children and young people aged 8 to 25 years had a probable mental disorder.(7)
  • This was 20.3% of 8 to 16 year olds, 23.3% of 17 to 19 year olds and 21.7% of 20 to 25 year olds. (7)
  • After a rise in prevalence between 2017 and 2020, rates of probable mental disorder remained stable in all age groups between 2022 and 2023.(7)
  • Among 8 to 16 year olds, rates of probable mental disorder were similar for boys and girls, while for 17 to 25 year olds, rates were twice as high for young women than young men.(7)
  • Children aged 11 to 16 years with a probable mental disorder were 5 times more likely than those unlikely to have a mental disorder to have been bullied in person (36.9% compared with 7.6%).(7)
  • They were also more likely to have been bullied online (10.8% compared with 2.6%).(7)
  • In 2023, eating disorders were identified in 12.5% of 17 to 19 year olds, with rates 4 times higher in young women (20.8%) than young men (5.1%).(7)
  • 2.6% of 11 to 16 year olds were identified with eating disorders, with rates 4 times higher in girls (4.3%) than boys (1.0%).(7)
  • 5.9% of 20 to 25 year olds, were identified with eating disorders with no difference in rates evident between women and men.(7)
  • 20% of adolescents may experience a mental health problem in a given year (2)
  • 50% of mental health problems are established by age 14 years (3)
  • 75% of mental health problems are established by 24 years (3)
  • 30% of people living with a chronic physical health condition will also experience mental health difficulties. (4)
  • 46% of school children have experienced bullying. The experience of bullying can lead to serious mental ill health in adulthood including depression, anxiety self-harm and attempted suicide. (5)
  •  81% of young people say they would like school to teach them more about how to look after their mental health (6)
  • 82% of teachers said that the focus on exams is disproportionate to the overall wellbeing of their pupils (6)

What works in the School Setting?

 

Developing school systems and policies that tackle bullying and promote good mental health and wellbeing will benefit everyone.

Involve Everyone

  • A whole school focus on positive mental health.
  • Make sure your Anti Bullying Policy is fully understood and strictly enforced by all school staff.
  • Training for all staff in how to recognise and support positive mental health works best.
  • Start early with the youngest children particularly in areas that develop generic social and emotional skills.
  • Work with parents to share information and explain what the school is doing to support mental health and wellbeing.

Committed Leadership

  • Commitment to promoting good mental health by the school leadership is important.
  • Outcome are likely to be successful when strategies are completely and accurately implemented.

Positive Relationships

  • Build positive relationships. More than anything else, the findings suggest that positive relationships across the school are crucial to supporting good mental health.
  • School ethos influences how staff and student feel about themselves and others. A positive environment that values all members of the school community is better for everyone’s mental health.
  • Talking about mental health is good. Give children and young people the language to talk about how they are feeling.

Education and Health Working Together

  • Integrating health and education can help reach a wider audience for prevention and early intervention.
  • A balance of universal and targeted interventions works best.
  • Co-ordinated services with outside agencies including CAMHS.
  • Greater and longer- term impact of interventions is likely when mental health issues are integrated into the general classroom curriculum.

Resources

wellbeing break

Headstart Programme Evaluation (May 2023)
Evidence Based Practice Unit researchers have published the final evaluation of HeadStart, a huge programme delivered across six local authorities in England to explore and test new ways to improve the mental health and wellbeing of young people and prevent serious mental health issues from developing.
 https://www.annafreud.org/insights/news/2023/05/headstart-evaluation-shows-rich-learning-from-huge-mental-health-and-wellbeing-programme/

Transforming Children and Young People's Mental Health Transformation Programme (May 2023 Data release).
 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1156762/Transforming_CYPMH_implementation_programme__data_release_May_2023.pdf 

Educational attainment trajectories among children and adolescents with depression, and the role of sociodemographic characteristics: Longitudinal data-linkage study.
Wickersham, A.Dickson, H.Jones, R.Pritchard, M.Stewart, R.Ford, T., & Downs, J. (2021).
The British Journal of Psychiatry218(3), 151157.
 
A summary of key findings from the research team at University College London's Evidence Based Practice Unit. 

The effects of social deprivation on adolescent development and mental health.
Amy Orben, University of Cambridge Livia Tomova, Massachusetts Institute of Technology & Sarah Jayne Blakemore University of Cambridge & UCL
Recent research findings relevant to the experiences of young people during the period of Covid-19 lockdown.
https://psyarxiv.com/7afmd

The Education Endowment Foundation has put together a range of resources based on evidence that can help schools and families during the Covid 19 pandemic. Resources include giving advice about setting up a routine. It also emphasises the need to take care of physical and mental health and to set time and space for regular school work including quiet reading and some form of exercise. 
https://educationendowmentfoundation.org.uk/

Measuring mental health and wellbeing in schools
Professor Miranda Wolpert, Director of the Evidence based practice unit at UCL talks about the difference between wellbeing and mental health, the challenges of measuring outcomes and the importance of teachers in mental health support for young people.
www.youtube.com/watch?v=45xWOD8sYaA

Whole school approaches to mental health promotion: what does the evidence say?
Summary slideshow of current research evidence.
www.annafreud.org/media/5657/sim-slides-nh.pdf

Social and Emotional Learning Skills for Life and Work
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/411489/Overview_of_research_findings.pdf

Young Minds Wise UP
Prioritising wellbeing in schools.
youngminds.org.uk/media/1428/wise-up-prioritising-wellbeing-in-schools.pdf

Is teachers' mental health and wellbeing associated with students' mental health and wellbeing?
Teacher wellbeing and its impact on student’s wellbeing.
research-information.bris.ac.uk/explore/en/publications/is-teachers-mental-health-and-wellbeing-associated-with-students-mental-health-and-wellbeing(8abb4ef6-4c26-418c-ab56-b30dfed3b3e5).html

Further Reading 

References
1. Mental Health of Children and Young People in England, 2017 (NHS Digital)
2. Kessler RC, Berglund P, Demier O, Jin R, Merikangas KR, Walters EE, (2005) Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey
Replication. Archives of General Psychiatry.
3. Green H, Mcginnity A, Meltzer H, Ford T, Goodman R, 2005 Mental Health of Children and Young People in Great Britain: 2004. Office of National Statistics.
4. DCSF Department for Children, Schools, and Families . Working together to safeguard children: a guide to inter-agency working to safeguard and promote the welfare of children. Department for Children, Schools, and Families, HM Government; Nottingham, UK: 2010.
5. Meltzer H, Vostanis P, Ford T, Bebbington P, Dennis MS. Victims of bullying in childhood and suicide attempts in adulthood. Eur Psychiatry. 2011;26:498–503. [PubMed]
6. Wise up: Prioritising wellbeing in schools. Young Minds 2018
7.Mental Health of Children and Young People in England, 2023, wave 4 follow up to the 2017 survey, Newlove-Delgado T, Marcheselli F, Williams T, Mandalia D, Dennes M, McManus S, Savic M, Treloar W, Croft K, Ford T. (2023) NHS England, Leeds.
 

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