Missing link – promoting mental wellbeing in primary schools

Mental health services are playing catch up with provision for physical health across every part of the public sphere.

In significant part this is a problem of timing. Our understanding of mental wellbeing for a long time lagged far behind our knowledge of physiology and physical health.

And, while the third sector has numerous hard-working organisations focused on this area, the realities of funding – stemming from both a strained public purse and also that historical lack of knowledge – mean voluntary groups still have more good ideas than they can roll out.

One area with perhaps a greater deficit than any other aspect of mental health provision is amongst primary school children. For a lot of people, the need for such wellbeing support might not be immediately apparent, but numerous studies have revealed a different picture.

These problems were previously identified in the Bamford report, published nearly ten years ago:

• 10% of children aged 5 to 15 experience a clinically defined mental health problem and the prevalence of problems has been increasing over the past 50 years. These include anxiety disorders (4%), conduct disorders (5%) and hyperactivity (1%)
• There is now a growing body of evidence that positive mental health cannot be gained by treating mental disorders alone… providing the most effective evidence based treatment for one half of all people with depression would only reduce thecurrent burden of depression by less than one quarter… evidence demonstrates that mental health promotion and prevention can lead to health, social and economic gain, increases in social inclusion and economic productivity, reductions in the risks for mental and behavioural disorders and decreased social welfare and health costs
• A number of studies are beginning to calculate the economic cost of failing to address early signs of emotional problems in childhood. [Research has] found that the cumulative costs of public services used through to adulthood by individuals with ‘troubled behaviour’ were 10 times higher than for those with no problems. Conduct disorder was the most significant predictor, with greatest costs incurred for crime, followed by extra educational provision, foster and residential care, and state benefits

Gaps

Bamford made a number of recommendations for the direction of NI mental health services and many of these have still not been implemented, despite this review still being hailed as the future for local provision.

When all this is taken into account, together with the general benefits that stem from early intervention, it makes a compelling case for much more mental health provision in primary schools.

Caroline McCoubrey, from Action Mental Health, says there is a gap in provision for children of this age, and that better services could reap huge rewards.

In response to this, the charity has put together Healthy Me, an in-school workshop programme currently catering for P6 and P7 classes, but which can cater for children aged from seven to 11.

“When it comes to secondary-school level a lot of organisations provide a range of services, and there is lots of good work being done on support settings for really young children, aged 0-3, such as Sure Start – but then very little in primary school years.

“There is a real need to start talking about mental health earlier. When children get past 13 or 14 they are more careful about what they say but at primary-school level they are less inhibited by their peers and talk more freely. If you can get them talking about mental health they don’t carry stigma with the issue as much later on. They still have peer influence but don’t have as many barriers to talking about things.”

Both CAMHS (Child and Adult Mental Health Services) and the Royal College of Psychiatrists (RCP) have been hugely supportive of the charity’s move to increase work in primary schools – with the RCP in particular “always pushing earlier interventions”, and with published papers recommending “universal interventions, applied to the entire population.”

It is hoped such measures can have a three-fold positive effect on mental health: help individual children at that time, better equip all children for good mental health throughout their lives, and also to reduce stigma in the short and long terms.

Healthy Me

AMH ran a pilot programme four years ago which, for budgetary reasons, they were not able to roll out – until now.

Healthy Me is aimed at children aged between seven and 11 but currently focuses on the final two years of primary school. It is a half-day workshop designed to get kids talking about mental health, to both improve mental wellbeing amongst this age group and also raise awareness of the idea of mental wellbeing itself.

The charity has secured the resources to offer the course and several primary schools have taken up the offer and will receive a visit from support officers in the coming months.

An initial meeting helps prepare teachers for the course and provide them will some information on children’s mental health, while there is also a supplementary aspect whereby they do a follow up session with parents. AMH has found that some parents can be defensive when the issue of mental health in young children is raised but has tailored its work with this in mind.

Children take part in an interactive, three-hour session that is designed to open and fun, and then also take part in follow-up work with their teachers, using tools provided by AMH, in order to reinforce the messages of the scheme.

Lessons

The charity’s own appraisals of the scheme have been positive – and found that children who had taken part in the course were able to discuss it in significant detail, months later including a summer holiday period, which shows how much they took in at the time.

It also helped some of the key aims of the programme, which is to promote: awareness of emotional well-being and positive mental health; the parity of mental health with physical health; and help-seeking behaviour.

AMH was pleased with the pilot, which was delivered to 267 P6 and P7 pupils from five primary schools in the then Southern Education and Library Board area with a mix of Catholic and Protestant ethos, with one school also having a large population of black and minority ethnic pupils with many non-English speakers. The cohort also included children with learning difficulties, some requiring classroom assistant support.

The pilot led to a significant rise in recognition of mental health as a part of health (44.9% prior to session, 68.8% post session), reflecting an increased understanding of parity between mental and physical well-being.

Ms McCoubrey said: “We found that a lot of the children already had a good understanding of the importance of physical health and also how best to achieve that – the importance of a good diet and exercise, the dangers of smoking, and so on. But there was much less awareness of mental wellbeing.

“However a healthy mind and a healthy body reinforce one another and, after taking part in the course, there was a greater understanding of this.

“Healthy Me is only one scheme. We are pleased with the results so far and also pleased to have found the resources to offer it to schools, but ultimately we think these sorts of lessons should be part of the curriculum, particularly under PDMU (Personal Development and Mutual Understanding).”

As well as offering a new service to primary schools across Northern Ireland, AMH’s work so far provides plenty worth thinking about for education officials across Northern Ireland – as well as those whose briefs cover health, communities, or other relevant settings, as we work towards a more joined-up and coherent set of policies and provision in Northern Ireland.