Mental Health and Wellbeing through Schools

The Way Forward

Rosalyn H. Shute, Phillip T. Slee, Rosalyn H. Shute, Phillip T. Slee

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780415745277
• eBook ISBN: 9781317655053
• Topic: Education
• Subtopic: Education Counseling

Mental Health and Wellbeing through Schools brings together international experts from various disciplines to identify and address a range of current challenges in this rapidly-developing field of endeavour.

The opening chapter details lessons learned from research and practice, outlining some emerging challenges for the effective implementation of mental health initiatives in schools. Subsequent chapters take up the various issues, exploring problems and proposing solutions. Topics fall within four broad areas:

Organisational and leadership issues such as dealing with 'wicked' or 'hard-to-tame' (complex and resistant) problems and taking a broad public health approach;

Teacher-related issues, such as how to integrate programs successfully into schools, and teacher skills and professional learning;

The challenges and opportunities of new technologies, including cyberbullying and the use of online, multimedia and mobile resources for both student and teacher learning and support;

The need for a greater focus on targeted interventions for at-risk students, such as those with disabilities; also addressing 'hard-to-tame' problems such as bullying, youth suicide and depression.

Mental Health and Wellbeing through Schools will be of interest to those involved in researching, developing, evaluating and implementing mental health initiatives in schools, including academics, practitioners, educators and educational and Mental Health policy makers. It will also be of use to professionals, such as nurses and social workers, concerned with the wellbeing of children and adolescents. The book will have international appeal, with contributors from around the world, experienced in a range of contexts.

Rosalyn H. Shute is Adjunct Professor of Psychology at both Flinders and Federation Universities (Australia). Her research expertise lies broadly in clinical child psychology and paediatric psychology/child health and wellbeing. She is an experienced teacher of Developmental Psychology, educational and clinical child/paediatric psychology.

Phillip T. Slee is a Professor in Human Development in the School of Education at Flinders University, Adelaide, Australia. He is a trained teacher and registered psychologist. His main areas of interest include childhood bullying/aggression, mental health and wellbeing, stress and teacher education. He has a particular interest in the practical and policy implications of his research. He and Shute recently co-authored Child Development: Theories and Critical Perspectives.

SECTION 1

Overview of challenges

1

STUDENT MENTAL HEALTH PROGRAMS

Current challenges and future opportunities

Brian Graetz

This introductory chapter draws upon the research literature and experience in developing, implementing and evaluating Australia’s national government-funded secondary and primary school mental health initiatives. It raises various challenges in four areas: for leaders and organisations; for teachers; new technologies; and the need for targeted interventions. It therefore acts as a springboard for the chapters that follow, which take up aspects of these various themes.

Schools have long been viewed as a natural setting in which to deliver student mental health initiatives and programs (Ross, 1980). This view has largely been born from the twin observations that youth mental health represents a major public health issue and that schools provide the optimal ready-made vehicle for reaching large numbers of young people (as well as the key adults critical to their development). Advocacy for student mental health programs in schools is routinely observed in research, policy and mainstream news. For example, epidemiological studies typically find youth mental health difficulties to be relatively common (the figure of around one in five young people being often identified), and they invariably conclude with a recommendation for the broad scale roll-out of school-based programs – particularly those that can prevent mental health difficulties so as to reduce the impact on individuals and demand on limited services. Stories about mental health or social issues affecting youth (such as suicide, self-harm, and drug and alcohol misuse) are commonly reported in the media, with accompanying commentary regarding the need for schools to run programs that ‘teach’ students how to manage various challenges such as bullying, stress, anxiety and depression.

Over the past 30 years there have been numerous youth mental health and wellbeing programs developed for delivery in primary and secondary schools (Catalano, Bergland, Ryan, Lonczak, & Hawkins, 2002; Greenberg, Domitrovich, & Bumbarger 2001; Weare & Nind, 2011). Programs have varied enormously in their goals, theoretical underpinnings, intervention targets and delivery models – reflecting the diversity of funding sources and academic disciplines involved. While not always readily classifiable, some of the common ‘program’ types include: social and emotional learning programs; problem prevention or early intervention programs for specific mental health difficulties; resilience programs; mental health education (‘literacy’) programs; and programs focused on strengthening connections to the ‘school community’. Individual programs may or may not be delivered as part of a whole school approach or broader framework seeking to generate collective action and encompassing multiple elements and targets (e.g., the Health Promoting Schools Framework, World Health Organization, 2000).

Today, there is a relatively large number of evidence-based student mental health and wellbeing programs available for schools. The Collaborative for Academic, Social and Emotional Learning (CASEL) in the United States identifies around 20 evidence-based social and emotional learning programs for primary schools. In Australia, KidsMatter – the national primary schools mental health initiative – identifies nearly 100 programs spanning the mental health promotion through to early intervention spectrum (Graetz et al., 2008). There is also now a compelling body of research showing that student mental health and wellbeing have a significant impact on the core business of schools. Numerous studies have shown student mental health difficulties to be strongly associated with poorer classroom behaviour, academic performance, school attendance and retention (Masten et al., 2005; Mihalas, Morse, Allsopp, & McHatton, 2009). Conversely, developmental science has shown that cognitive development goes hand in hand with social and emotional development and that enhancing children’s social and emotional competencies has significant academic payoffs (Dix, Slee, Lawson, & Keeves, 2011; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Heckman, 2008).

However, despite the availability of programs and the strong evidence for their benefits to students and the broader school community, large-scale roll-out and the sustainment of programs in schools remain the exception rather than the norm. The more common picture observed over the years is one of student mental health and wellbeing programs being delivered in the ‘margins’ of school life, sustained by a few dedicated staff members with minimal – and often precarious – short-term funding (Adelman & Taylor, 2000).

Researchers examining why dissemination has been so challenging often bemoan the lack of resourcing and inadequate policy frameworks, particularly curriculum (Weist, 2004). The general view is that these have been at insufficient levels for schools to effectively plan, integrate and sustain student mental health and wellbeing programs into ‘normal’ school practices (Adelman & Taylor, 2000; Han & Weiss, 2005). Difficulty in securing ongoing funding has been a constant theme over the years and, while frustrating, reflects the ongoing reality of funders managing competing and evolving budget priorities. In particular, programs developed and initially funded by organisations external to education jurisdictions understandably struggle when they seek to obtain jurisdiction ‘buy-in’ in terms of funding or staffing resources to secure a program’s longer-term future.

A related issue, which probably receives less critical attention, is the quality of individual programs and the implementation demands they place on school communities (Han & Weiss, 2005). The extent to which individual programs understand the ‘real world’ needs and limitations of schools is a critical question. Programs developed and trialled under optimum conditions with significant funding and staffing resources often struggle when they are rolled out in the real world of reduced funding, tightly controlled curriculum, leadership turnover, and time-poor and stressed staff with limited opportunities for professional learning during school hours (Ringeisen, Henderson, & Hoagwood, 2003). There are also obvious tensions with respect to what is known about successful program implementation and school realities. As a general rule the more ambitious the program goals in terms of student mental health impacts, the greater the implementation and resourcing requirements. For example, evidence indicates that mental health problem prevention and social and emotional competency programs are effective when they are delivered over the longer term with sufficient intensity and a reasonable level of fidelity (National Research Council and Institute of Medicine, 2009; Nation et al., 2003; Weare & Nind, 2011). Many schools understandably struggle to meet such program demands even with reasonable resourcing.

Ultimately, the extent to which student mental health and wellbeing programs can be incorporated into mainstream school practice with appropriate funding and resourcing may well depend on whether greater clarity and agreement can be achieved at senior government levels (and the broader community) on the central questions of: ‘What is the appropriate role and function of schools with respect to student mental health and wellbeing?’ and ‘How does the role of schools relate to that of other sectors whose remit specifically covers youth and family mental health?’

Historically, schools have been provided with limited guidance on these crucial questions. While education policy frameworks identify student wellbeing as important, they tend to provide little detail beyond the need for schools to attend to students’ social and emotional development as well as their cognitive and academic development (although the recent inclusion of social and emotional competencies into the new national curriculum in Australia reflects a notable exception). In particular, there has been relatively little guidance given to schools as to how they should respond to those complex student mental health or social issues, such as suicide and self-harm, that negatively impact on individuals and the broader school community. Even amongst the experts there is ongoing debate about the types of program that would produce the greatest benefits: for example, whether schools should focus more on universal mental health promotion or problem prevention efforts or early intervention programs targeting students with elevated risk or exhibiting difficulties – as well as whether screening for risk or difficulties should occur (Craig, 2009; Spence & Shortt, 2007). These debates at times reflect the differing views (and occasional positioning) of the various experts involved and are often played out with program funders, policy makers and school leaders, resulting in even greater confusion. It is not surprising that schools report being unsure of their role and, as a consequence, tend to remain reactive in this space (Hopkins, 2014).

Disappointingly, there has been only limited research on the views of school leaders, staff, parents and students with respect to youth mental health programs being delivered in schools and the types of program preferred. Recent research in the United Kingdom and Australia with students and school staff indicates a high level of awareness of youth mental health issues and the need for practical education and ‘upskilling’ such as how to support a student who is distressed (Graham, Phelps, Maddison, & Fitzgerald, 2011; Kidger, Donovan, Biddle, Campbell, & Gunnell, 2009). Notably, staff identified a clear link between the mental health of students and their own mental wellbeing. The findings from the 2009 Intercamhs (International Alliance for Child and Adolescent Mental Health and Schools) survey of 1,200 principals across 27 countries indicates that school leaders appreciate the significance of student wellbeing with over 80 per cent identifying student emotional/mental health as being ‘very important’ for academic achievement. When asked to rank the main student mental health and wellbeing issues confronting schools, principals identified the following three in order of priority: (1) bullying and harassment; (2) impulse control; and (3) anger management. With respect to training, education materials and resourcing supports the following four were given highest priority: (1) student and family supports for those with serious problems; (2) programs/strategies to teach students social and emotional competencies; (3) knowledge of effective promotion/prevention strategies and implementation; and (4) how to identify mental health problems early.

Taken together, these findings indicate that school leadership, staff and students believe student mental health and wellbeing to be an important issue for school communities and, moreover, that they are seeking practical support to deal with a range of issues. Working to identify and address the needs of school communities may well provide the foundation for more effective advocacy with respect to funding and improve program uptake and sustainability. For example, if school staff view a clear link between student mental health and their own wellbeing, then greater buy-in for student programs may be achieved if they also encompass self-care strategies for staff (Graham, Phelps, Maddison, & Fitzgerald, 2011; Kidger et al., 2009).

A second – and perhaps more telling – point that can be drawn from the above research is that school leaders are seeking effective responses to ‘pointy end’ or complex issues which often cause the greatest distress and impact on students, staff and the broader school community. Today, schools are grappling with a host of challenging issues such as suicide, self-harm, drug use, depression, anxiety, bullying and school violence, which – on anecdotal evidence at least – are becoming more prominent (Eckersley, 2011). Although these problems are not new, they are not static either and their immediate drivers and manifestations (e.g., cyberbullying) are continually evolving, as are their likely ‘remedies’. Increasingly, many of the key youth mental health issues are being viewed as ‘wicked problems’ – not in the sense of being evil but because they are not readily solvable within any one sector of the community (Sanson, Havinghurst, & Zubrick, 2011) – see Chapter 2. Schools, with their need to focus on student learning and academic outcomes, under standably tend to look for ‘quick fixes’ that require minimal resourcing or the need for time-consuming community engagement and collaboration. Unfortunately, few ready-made solutions exist for many of the significant youth mental health issues, and schools will probably continue to struggle to identify effective responses until models are in place that can drive better coordination and integration between schooling, mental health, family and community services (Greenberg, 2004; Sanson et al., 2011). Not that this means schools have the luxury of opting out: being on the ‘front line’ means that schools and staff have little choice but to manage as best they can.

The above discussion is not to suggest that schools cannot have a significant impact on students’ mental health and wellbeing. It is, however, meant to highlight the need for school leadership to be well educated about programs and approaches that seek to impact across whole student groups or year levels, and to give careful consideration to their choices. This includes having a good appreciation of school community priorities and a realistic understanding of what can be achieved with the available resources, time and commitments, and knowing that a school can only do so much by itself and that support from the broader service (and parent) community is likely required to make any serious headway. Ideally, schools should be able to make conscious decisions regarding such things as the relative priority they give to universal mental health promotion or problem prevention efforts versus more-targeted strategies for those students at risk or already experiencing difficulties.

The need for schools (and jurisdictions) to become more discerning about their choices is becoming increasingly apparent as more student mental health programs or resources are becoming available. Advancements in web-based technologies are rapidly expanding the possibilities for schools in this space, not only in terms of student mental health programs and services, but also in areas such as staff professional learning and online tools for monitoring or evaluating the mental health and wellbeing of students and the broader school community.

Historically, student mental health programs have been predominantly delivered ‘face-to-face’ to students by either mental health professionals or school staff, often after completing some level of training. The level of funding required for face-to-face delivery has been one of the main limiting factors for broadscale program roll-out in schools as the costs quickly become prohibitive. Many youth mental health programs are now being developed or converted for online delivery, which enables program content to be directly delivered to students in a standardised manner (Christensen & Hickie, 2010). Online programs have been found to be particularly promising for problem prevention or for treatment programs for high-prevalence mental health disorders such as depression and anxiety, where studies have found similar mental health outcomes for online as for face-to-face delivery (Cuijpers, van Straten, Warmerdam, & Anderssan, 2008). Similarly, online technologies are expanding counselling or support options for youth (e.g., webchat) – an age group that has been traditionally poor at accessing help, often because of concerns over privacy (Gulliver, Griffiths, & Christensen, 2010). The introduction of smartphones has further expanded the frontiers with the explosion of mental health apps, ranging from the basic (e.g., apps that provide mental health information) to the sophisticated such as those which seek to monitor a young person’s mental health and provide a tailored response via the automatic collection of data on such things as physical activity, social media use, and even music preferences (Donker et al., 2013; Proudfoot, 2013).

Online mental health programs, apps and services are still in their infancy and the extent to which these will provide schools with effective vehicles to support student mental health and wellbeing is unknown. While they potentially provide options across the mental health promotion, prevention and early intervention spectrum, there remain some significant challenges. Many of the emerging programs have limited evaluations (evaluations for apps are virtually non-existent) and low completion rates for online programs are noted (Christensen, Reyno...

Table of contents

• Cover Page
• Half Title page
• Epigraph
• Title Page
• Copyright Page
• Contents
• Figures and Tables
• Contributors
• Foreword
• Preface
• Section 1 Overview of challenges
• Section 2 Challenges for organisations and leaders
• Section 3 Challenges for teachers
• Section 4 The challenges and opportunities of new technologies
• Section 5 Targeted interventions
• Section 6 Reflections
• Index