The UK has witnessed a steep rise in mental health difficulties among children and young people in recent years. The NHS reports that in 2022 18 per cent of children aged 7 to 16 had a probable mental health disorder, up from 12 per cent in 2017.
In response, the UK government has adopted new policies and increased funding for mental health in schools.
While schools may be well placed to promote children’s wellbeing and mental health, there is a high expectation for school staff to be actively involved in such support. This approach may pose problems, not only in terms of mental health expertise and clarity around roles and responsibilities but also in terms of the high demands and workloads already placed on those working in schools.
For these reasons, our small team of researchers from education, medical humanities and psychology at the universities of Exeter, Bath and Bristol have been asking three key questions:
- What impact is this new policy agenda and funding having on schools?
- Is it really fair to place the responsibility of children’s mental health on school staff?
- How can schools ensure that children and young people are best supported without further increasing teacher workloads?
From September 2022 to March 2023, we researched mental health in schools in the South West of England to generate new insights about the role of schools in supporting mental health over time and the current challenges schools face as they strive to meet government expectations for mental health provision.
So what did we find?
Mental health support in schools: where are we now?
Contrary to much of the 20th century - when schools were not seen to hold any official responsibility for supporting young people’s mental health - today’s school leaders recognise that schools may have a duty to protect children and young people’s wellbeing and to respond to mental health difficulties.
However, the way in which such duties are undertaken is closely related to school context.
School leaders expressed strong frustration at being the primary support available to children and young people experiencing complicated or serious mental health difficulties, in a context where the availability of child and adolescent mental health services (Camhs) is limited.
“We’ve got a lot more children now who are school refusers with anxiety, who have tried self-harming. The numbers are rising quite quickly,” said a mental health lead at a rural secondary school. “I have people coming to me to say, ‘This person is not feeling their best; this person’s struggling,’ and it’s quite overwhelming for me, because I’ve only just started the role [as mental health lead].”
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In England fewer than half of the 1.4 million children estimated to have a mental health disorder managed to access NHS mental health services during the 2021-22 financial year. Many of those who did access services had to wait a long time.
As one mental health lead and head of Year 10 at a large secondary school explained, in the current situation, “with healthcare being stretched and social care teams being stretched… a lot is being pushed on schools because we’re the ones who are here”.
School leaders who participated in our study also felt that school-based support could not necessarily address some of the wider causes of emerging mental health difficulties that extend beyond the school gates.
“[We’re] not recognising that actually this is a societal issue,” a member of the senior leadership team for a multi-academy trust said. “We need to go back to the drawing board and ask, ‘What are we causing that’s contributing to where we are?’”
We also found multiple contrasts between the mental health programmes being implemented in schools and the visions of “whole-school” approaches to mental health laid out in government policy documents between 2017 to 2021. While such approaches are considered to be the gold standard, there is still ambiguity about how schools should be implementing them or, indeed, how effective they are.
How can schools better support mental health?
Bringing the strands of our project together, our data suggests a notable shift towards recognising schools as being legitimate and well-placed spaces for both promoting children and young people’s wellbeing and identifying and responding to those experiencing mental health difficulties.
However, multiple frictions and gaps - in both policy and practice - raise important questions about the extent to which schools can, and should, be primary sources of mental health support for the next generation.
Importantly, our study signalled a significant gap in existing knowledge of how schools are implementing mental health interventions, and what impacts they are achieving. Therefore, we cannot say with confidence what schools should be doing to deliver the greatest outcomes, or to deliver interventions well.
However, our study did point to some areas where schools may need to focus more attention.
1. Look after staff wellbeing first
The emphasis for most schools appears to be pupil mental health and wellbeing. However, a school is, arguably, only as strong and healthy as its staff.
Schools should monitor the mental health and wellbeing of staff and put in place appropriate measures to promote staff wellbeing. This includes ensuring manageable workloads and being responsive to the additional emotional burdens staff may face in taking on greater responsibilities for pupils’ mental health.
2. Provide care-related training
Mental health workers are care workers, and although teaching does involve care and support, schools should not underestimate the distinctions between these professions.
Schools should ensure that staff involved in mental health work (including their managers) have a clear understanding of what they are expected to take on, and that they are provided with appropriate training, resources and supervision to fulfil their roles and uphold necessary boundaries.
Senior leadership teams could consider gathering regular feedback from mental health leads and other staff delivering mental health and wellbeing interventions to assess whether existing training and supervision are sufficient.
Leaders may also want to explore whether their school is eligible to access Department for Education funding for senior mental health lead training, as anecdotal evidence suggests that many eligible schools have not taken up this opportunity.
3. Have a clear approach to working with additional services
Schools should maintain and implement clear policies on when and how to refer pupils for support from additional services.
Leaders might also consider communicating to the government about the state of mental health in their school and what the need is for specialist care services beyond schools, including health and social care for pupils and their families. Anyone can do this by finding the contact details of their MP and writing to them.
Ultimately, while the government is likely to measure the success of its mental health policies and funding through its own channels, we highly recommend additional independent research to examine how schools are implementing mental health interventions and the impact of this work, and to identify good practices that can be shared widely.
Dr Katie Howard is lecturer in education and psychology at the University of Exeter, Dr Rachel Wilder is lecturer in education at the University of Bath and Dr Naomi Warne is Prudence Trust fellow at Bristol Medical School, University of Bristol
They explore their research further in their new podcast: The Mental Health in Schools Podcast
