What do we know about promoting mental health through schools
TL;DR: The most effective programmes in schools which address mental health have the following characteristics: • They provide a backdrop of universal provision to promote the mental health of all and then target those with special needs effectively, and are multi-dimensional and coherent.
Abstract: There is a growing evidence base on what schools need to do to promote mental health effectively. There is strong evidence that they need first and foremost to use a whole school approach. This shapes the social contexts which promote mental health and which provide a backdrop of measures to prevent mental health disorders. In this context the targeting of those with particular needs and the work of the specialist services can be much more effective. Schools need to use positive models of mental health, which emphasise well being and competence not just illness--this will help overcome problems of stigma and denial and promote the idea of mental health as 'everyone's business'. The most effective programmes in schools which address mental health have the following characteristics: They provide a backdrop of universal provision to promote the mental health of all and then target those with special needs effectively. They are multi-dimensional and coherent. They create supportive climates that promote warmth, empathy, positive expectations and clear boundaries. They tackle mental health problems early when they first manifest themselves and then take a long term, developmental approach which does not expect immediate answers. They identify and target vulnerable and at risk groups and help people to acquire the skills and competences that underlie mental health. They involve end users and their families in ways that encourage a feeling of ownership and participation, and provide effective training for those who run the programmes, including helping them to promote their own mental health. Using these starting points, we need to develop a rigorous evidence-based approach on this issue. We also require the facilitation of the dissemination of such research findings while encouraging new and innovative approaches.
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TL;DR: A framework is developed to demonstrate the contribution of whole school approaches embodied by the health‐promoting school approach to the promotion of school connectedness, defined as the cohesiveness between diverse groups in the school community.
Abstract: Purpose – The purpose of this paper is to develop a framework to demonstrate the contribution of whole school approaches embodied by the health‐promoting school approach, to the promotion of school connectedness, defined as the cohesiveness between diverse groups in the school community, including students, families, school staff and the wider community.Design/methodology/approach – A cross‐disciplinary review of literature was conducted to identify strategies consistent with the health‐promoting school approach and the values and principles that promote school connectedness. The review included peer‐reviewed articles and published books and reports identified from the databases spanning the education, health, social science and science disciplines and used search terms encompassing health and mental health promotion, schools, social connectedness, belonging and attachment. The paper is also a framework of the contribution of the health‐promoting school approach to promoting school connectedness and was d...
135 citations
TL;DR: This article develops an argument about why schools should be undertaking health related initiatives and highlights major findings from the literature about what is possible to achieve in school health and the circumstances under which the gains will occur.
Abstract: Schools across the world have been involved in health promotion and health education for nearly a century. Do school based initiatives make any difference to the education and health outcomes of young people? This article describes the process in developing the document Promoting health in schools: from evidence to action. The document was produced primarily for the Education sector. It develops an argument about why schools should be undertaking health related initiatives. It also highlights major findings from the literature about what is possible to achieve in school health and the circumstances under which the gains will occur. Attention is focused both on the evidence from the education sector, e.g. effective schools, learning and teaching approaches, and from the health sector, e.g. a whole of school or Health Promoting School (HPS) approach, as well as identifying outcomes from topic areas such as mental and emotional health, healthy eating and nutrition, physical activity, hygiene, sexual health and relationships, substance use and misuse.
113 citations
TL;DR: In this paper, a feasibility trial evaluated a mindfulness-based program customised for teachers and found that participants in the intervention condition reported significant reductions in stress, and significant increases in well-being post-intervention in comparison to their counterparts in the comparison group.
Abstract: Teacher stress is a serious and endemic concern. Mindfulness-based interventions show promise in reducing stress and increasing well-being by cultivating mindfulness and self-compassion. This feasibility trial evaluated a mindfulness-based programme customised for teachers. A sample of 89 secondary school teachers and staff were recruited and self-selected into the intervention (n = 49) or comparison (n = 40) conditions. Participants were asked to complete self-reports which measured stress (PSS), well-being (WEMWBS), mindfulness (FFMQ), and self-compassion (SCS; Kindness and Self-Judgement) at baseline and after the completion of the intervention. Results revealed that individuals in the intervention condition reported significant reductions in stress, and significant increases in well-being post-intervention in comparison to their counterparts in the comparison group. There was an observed large effect (η
p
2 > .14) for the intervention on all outcome measures, an effect that was maintained when controlling for baseline differences between the intervention and comparison groups. Furthermore, the majority (95 %) of teachers who attended the course found it to be acceptable. These results indicate that a customised mindfulness-based programme for teachers is a promising approach to reducing stress and increasing well-being, mindfulness, and self-compassion among secondary school teachers. However, the results of the current study are preliminary and the next phase of work will involve extending to a larger scale randomised controlled trial.
107 citations
Cites background from "What do we know about promoting men..."
...Schools play a vital role in shaping childhood and adolescent development and have great potential to promote health, including mental health (Eccles et al. 1993; Weare 2000; Weare and Markham 2005)....
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TL;DR: The findings have implications on the use of preventive versus reactive approaches, staff training and consultation, use of evidence-based practice in schools and joint care pathways.
Abstract: Background
Schools play an important role in promoting child mental health, but little is known about the approaches they undertake.
Methods
A scoping survey in England, involving 599 primary and 137 secondary schools.
Results
Although two thirds of school approaches focused on all pupils, these were predominantly reactive, rather than preventive interventions. They were also largely not evidence-based, were instead based on a plan while open to adaptation. Gaps were identified in teacher training and support.
Conclusions
The findings have implications on the use of preventive versus reactive approaches, staff training and consultation, use of evidence-based practice in schools and joint care pathways.
101 citations
TL;DR: The education intervention appeared to be successful in reducing stigma, promoting mental health knowledge, and increasing mental health literacy, as well as improving emotional well-being and resilience, although caution is advised before employing intergroup contact with younger student age groups.
Abstract: Objectives To investigate whether intergroup contact in addition to education is more effective than education alone in reducing stigma of mental illness in adolescents. Design A pragmatic cluster randomised controlled trial compared education alone with education plus contact. Blocking was used to randomly stratify classes within schools to condition. Random allocation was concealed, generated by a computer algorithm, and undertaken after pretest. Data was collected at pretest and 2-week follow-up. Analyses use an intention-to-treat basis. Setting Secondary schools in Birmingham, UK. Participants The parents and guardians of all students in year 8 (age 12–13 years) were approached to take part. Interventions A 1-day educational programme in each school led by mental health professional staff. Students in the ‘contact’ condition received an interactive session with a young person with lived experience of mental illness. Outcomes The primary outcome was students’ attitudinal stigma of mental illness. Secondary outcomes included knowledge-based stigma, mental health literacy, emotional well-being and resilience, and help-seeking attitudes. Results Participants were recruited between 1 May 2011 and 30 April 2012. 769 participants completed the pretest and were randomised to condition. 657 (85%) provided follow-up data. At 2-week follow-up, attitudinal stigma improved in both conditions with no significant effect of condition (95% CI −0.40 to 0.22, p=0.5, d=0.01). Significant improvements were found in the education-alone condition compared with the contact and education condition for the secondary outcomes of knowledge-based stigma, mental health literacy, emotional well-being and resilience, and help-seeking attitudes. Conclusions Contact was found to reduce the impact of the intervention for a number of outcomes. Caution is advised before employing intergroup contact with younger student age groups. The education intervention appeared to be successful in reducing stigma, promoting mental health knowledge, and increasing mental health literacy, as well as improving emotional well-being and resilience. A larger trial is needed to confirm these results. Trial registration number ISRCTN07406026; Results.
86 citations
References
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TL;DR: The various literatures on the adjustment of children of depressed parents, difficulties in parenting and parent-child interaction in these families, and contextual factors that may play a role in child adjustment and parent depression are reviewed.
Abstract: This article reviews the various literatures on the adjustment of children of depressed parents, difficulties in parenting and parent-child interaction in these families, and contextual factors that may play a role in child adjustment and parent depression. First, issues arising from the recurrent, episodic, heterogeneous nature of depression are discussed. Second, studies on the adjustment of children with a depressed parent are summarized. Early studies that used depressed parents as controls for schizophrenic parents found equivalent risk for child disturbance. Subsequent studies using better-defined samples of depressed parents found that these children were at risk for a full range of adjustment problems and at specific risk for clinical depression. Third, the parenting difficulties of depressed parents are described and explanatory models of child adjustment problems are outlined. Contextual factors, particularly marital distress, remain viable alternative explanations for both child and parenting problems. Fourth, important gaps in the literature are identified, and a consistent, if unintentional, "mother-bashing" quality in the existing literature is noted. Given the limitations in knowledge, large-scale, long-term, longitudinal studies would be premature at this time.
2,435 citations
TL;DR: Meta-analysis was used to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents and found most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies.
Abstract: Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.
983 citations
TL;DR: The Positive Youth Development Evaluation project as mentioned in this paper was initiated by the United States Office of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation to evaluate the effectiveness of youth development programs.
Abstract: This article summarizes a much lengthier one that appeared in Prevention and Treatment. The earlier article grew out of a project initiated by the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. The Positive Youth Development Evaluation project described why policy makers, practitioners, and prevention scientists advocated a shift in approach for how youth issues are addressed in this country. The Positive Youth Development Evaluation project sought to define how youth development programs have been defined in the literature and then to locate, through a structured search, strong evaluations of these programs and summarize the outcomes of these evaluations. In the current article, we explain why prevention has shifted from a single problem focus to a focus on factors that affect both positive and problem youth development, describe what is meant by positive youth development, and summarize what we know about the effectiveness of positive youth develop...
705 citations
TL;DR: To reduce the burden of depression, the author argues for a chronic disease management model and asks why more of those who relapsed did not return to us for treatment.
Abstract: In 1970 L G Kiloh and I finished recruiting patients for a prospective study of depression in admissions to a new general hospital psychiatric unit. When we published the 15 year follow up we discovered that our patients had not done at all well.1 Only a fifth recovered and remained continuously well, three fifths recovered but had further episodes, and a fifth either committed suicide or were always incapacitated. An English 15 year follow up study published at the same time showed identical results.2 The obvious conclusion was that people admitted to hospital in the 1970s with a depressive illness did not have a good prognosis. In retrospect, I ask why more of those who relapsed did not return to us for treatment. These results are not atypical. A detailed 12 year follow up in US specialist care showed that patients on average had symptoms in 59% of weeks and met full criteria for a depressive episode in 15% of weeks.3
Depression seems to be a chronic recurring disorder, seldom well managed if one simply waits for the patient to initiate further consultations.
#### Summary points
The burden of depression is not being reduced
The episodic nature of depression and the acute response to treatment means that episodes seem easy to treat
They can be if patients comply with drug and cognitive therapy regimens
The main problem is the next recurrence, if patients do not to come for treatment at all
To reduce the burden of depression, we argue for a chronic disease management model
We should manage depression proactively to ensure long term compliance with treatment
I identified references to remission and relapse of depression during the writing up of the Australian national mental health survey. References to long term prognosis came from my earlier work. A conference question, …
255 citations
TL;DR: In this article, a complex interactional model of classroom factors that contribute to the development of students' self-evaluations is presented, including task structure, grouping practices, feedback and evaluation procedures and information about ability, motivational strategies, locus of responsibility for learning, and the quality of teacher-student relationships.
Abstract: This paper presents a complex interactional model of classroom factors that contribute to the development of students’ self-evaluations. This model integrates previously investigated factors, suggests the operation of additional factors, and extends the notion of the operation of classroom factors to account for the possibility that certain factors may compensate for or negate the effect of otherwise crucial factors in influencing students’ interpretations of and reactions to classroom events. Described are (a) task structure, (b) grouping practices, (c) feedback and evaluation procedures and information about ability, (d) motivational strategies, (e) locus of responsibility for learning, and (f) the quality of teacher-student relationships. This notion of compensating and negating features within the classroom environment can be applied to understanding other student outcomes as they are influenced by teaching processes.
214 citations