Building a sustainable approach to mental health work in schools

Sustainability is a major challenge to mental health work in schools, and many initiatives started by well-meaning individuals and agencies fade quickly. This paper outlines some key actions that can be taken to ensure that mental health work is sustained, as well as introduced, in schools. These actions include demonstrating that mental health work meets educational goals such as learning and the management of behaviour, using a positive model of mental well-being to which it is easy for those who work in schools to relate, using mentalhealth experts as part of a team, forging alliances with other agencies and working with a whole-school approach. Such approaches are more likely to meet the needs of people with more severe mental problems and provide a more stable platform for specialist interventions than targeted programmes. The paper goes on to suggest some practical steps to sustain work at the school level. These steps include assessing the current position, developing the vision, identifying the gaps, determining readiness and assessing the scene for change, securing consensus, planning the change, establishing criteria, and managing, evaluating and maintaining the change

"The daily grunt": middle class bias and vested interests in the 'Getting in Early' and 'Why Can't They Read?' reports.

It is a long-standing and commonly held belief in the UK and elsewhere that the use of elite forms of language reflects superior intellect and education. Expert opinion from sociolinguistics, however, contends that such a view is the result of middle-class bias and cannot be scientifically justified. In the 1960s and 1970s,such luminaries as Labov (1969) and Trudgill (1975) were at pains to point out to educationalists, with some success, that this 'deficit 'view of working-class children's communicative competence is not a helpful one. However, a close reading of recent think-tank reports and policy papers on language and literacy teaching in schools reveals that the linguistic deficit hypothesis has resurfaced and is likely to influence present-day educational policy and practice. In this paper I examine in detail the findings, claims and recommendations of the reports and I argue that they are biased, poorly researched and reflect the vested interests of certain specialist groups, such as speech and language therapists and companies who sell literacy materials to schools. I further argue that we need to, once again, inject the debate with the social dimensions of educational failure, and we need to move away from the pathologisation of working-class children's language patterns

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Taking a positive, holistic approach to the mental and emotional health and well-being of children and young people

Traditionally the focus of mental health work with children and young people, including those seen as having behaviour problems and Attention Deficit Hyperactivity Disorder (ADHD), has been on the individual child or young person, and specifically on the identification, referral and treatment of their problem. This is now changing, and child mental health work is starting to take a more holistic and preventive approach. There is fortunately a great deal of support for those who want to make this shift coming from many quarters. In this short chapter I have only the space to outline the nature of that shift and recommend that mental health work makes this shift with as much speed as possible, working closely with some new developments in research and practice to do so. The research evidence to support the assertions of this chapter can be found in some recent publications,1 2 3 which include case studies of five Local Education Authorities in England who are working with more holistic approaches in their work with children and young people, including work on child and adolescent mental health

Commentary: Work with young people is leading the way in the new paradigm for mental health

This paper is part of a special edition on mental health in schools, to which the major international theorists and practitioners, from Europe, the US and Australia, contributed. This paper was an invited commentary on the rest of the papers in the edition. Its basic thesis is that most work that goes under the banner of so-called ‘mental health’ tends to remain stuck in a medicalised, illness-focused, individualistic paradigm. This paper outlines the beginnings that can be discerned of a wider, holistic and positive approach to mental health promotion with young people and examines various aspects of the new paradigm in mental health, such as its focus on holistic, joined up approaches, empowerment and person centredness. It explores ways in which mental health promotion for young people is making serious progress to implement the new paradigm in practice, such as linking with work in education on such issues as emotional literacy and positive behaviour management, and that other sectors such as education might be informed by this example. <br/

What do we know about promoting mental health through schools?

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 articular 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 to facilitate the dissemination of such research findings while encouraging new and innovative approaches

Developing the emotionally literate school

Emotional literacy is the ability to understand and use information about our own and others emotional states with skill and competences, and make positive relationships with others. This book demonstrates how central this concept is to mainstream education. It defines the key terms used in the field, exploring the idea of emotional literacy and linking it to closely related concepts such as wellbeing, health, learning and intelligence. It outlines the scientific evidence behind the work in this area, explores ways in which schools can become more emotionally literate, and demonstrates the educational benefits of taking a whole school approach to emotional literacy. It gives a practical and up-to-date account of how schools can use emotional literacy to realise their goals of school improvement and effectiveness, increased learning, more effective teaching and learning, greater teacher satisfaction, and improved relationships between students, teachers, parents and the wider community. It explores new findings on ways in which emotional literacy relates to effective learning and whole brain thinking. It also examines how emotional literacy can be profiled, assessed and evaluated and the issues that surround this controversial area. It looks too at wider supports for the emotionally literate school, for example in LEAs and in Healthy School programmes. Chapters include: 1) What is emotional literacy and why is it important to schools? 2) What are we aiming at- what competences are we trying to develop and in what key ways can schools develop them? 3) Some key principles – a whole school approach, targeting, emotionally literate responses to behaviour. 4) Emotional literacy and learning – programmes, the curriculum, the process of learning, learning styles, accelerated learning. 5) What kinds of schools promote emotional literacy? – relationships, communciation, parents, teachers’ own emotional literacy. 6) Profiling, assessing and evaluating emotional literacy. 7) Wider supports for emotional literacy from Local Education Authorities and from Healthy School Approaches

Promoting mental, emotional and social health: a whole school approach

Based on a careful review of the international evidence, this book aims to provide a clear and practical overview of ways in which mainstream schools can promote the mental, emotional and social health of all those who work and learn there. It outlines the competences that constitute emotional and social health and wellbeing, and examines the evidence that social and emotional learning and academic achievement can go hand in hand, and that the same key factors underlie both emotionally healthy and effective schools. It explores the areas of school life that are key to promoting social and emotional health, including the curriculum, teaching and learning, relationships with families and the community, and school management

Building bridges : the relationship of medical education to health promotion

This research interviewed, and examined curriculum documentation produced by, all those who coordinated the courses and attachments that make up the undergraduate medical curriculum at the University of Southampton, and interviewed some other key individuals, to examine where the goals, content and processes of medical education overlap with those of health promotion, and where they diverge.The main areas of overlap were the interest shown by most of the specialities in: patient centredness, especially communication skills, which were essentially self empowerment; holism which looked at the patient in their social and pyschological entirety; and prevention, including the giving of lifestyle advice. Some specialities were also interested in: 'relative health', i.e. helping patients to feel as 'well' as possible; behaviour change and psychological approaches; epidemiology and risk; and critical appraisal and evidence base. There was some recognition of the importance of teaching students about their own health, and particularly some concern and teaching about student stress.The main divergencies were a lack of interest in positive health; a strong tendency to identify health promotion simply with prevention; the marginalisation a psycho-social perspective, and in particular a lack of interest in broader social perspectives; and a dismissal of the reflective and interpretive epistemologies of the psycho-social sciences as commonsense. The parts of the curriculum that were most likely to support the concepts and principles of health promotion tended to be seen as of lower status than those that concentrated on 'high tech', interventionist medicine.This research suggests that those who would develop health promotion in medical education should build positive links with the areas of overlap rather than starting from a negative and confrontational perspective, and use language and concepts familiar to medicine, while emphasising the relevance of their discipline to medical contexts. They should attempt to integrate health promotion across the curriculum, especially in the clinical specialities, and concentrate particularly on developing health promotion in the parts of the curriculum likely to provide a supportive environment for it.</p

What can we Learn for the Future Development of the Health Promoting School Idea from the Experience of a Project in two Regions in Russia?

The European Network of Health Promoting Schools (ENHPS) has now spread across 38 European countries, and includes over 500 schools with 400,000 students. Russia has officially been part of this network from the outset, but the idea has never taken off in Russia as readily it has in other parts of Europe, and, partly due to the sheer size of the country, it has not in practice had a great deal of impact. In 1999 David Rivett, from the World Health Organisation European Office Copenhagen, whose particular responsibility it was to facilitate the development of the Health Promoting School (HPS) in Eastern and Central Europe, saw an opportunity to develop the HPS in two Oblasts (regions) in Russia offered by a new World Bank funded project. This project provided support to help schools in Rostov (in the South, near the Caspian sea) and in Novosibirsk (in Siberia) develop more modern approaches to education. Another Oblast, Tver, in the centre of Russia, was also part of the project, but funded separately. David Rivett approached the Health Education Unit at the University of Southampton, where staff had experience of developing the HPS in Central and Eastern Europe to organise a development project over three years. The aim of this project was to introduce a HPS approach into the three Oblasts, and to discover how some basic concepts and ideas found within HPS networks in other parts of Europe could best be developed there, using the key principle that the HPS is a process not a preset outcome (Jensen and Simovska, 2002:2) and has to be developed in each context in a way that is appropriate, and which builds on the needs, perceptions and understandings of participants. This chapter explores what can be learned from the experience of these two Oblasts for the development of the HPS approach. It is based on evidence from Rostov and Novosibirsk Oblasts (Tver is not included as it was not part of the World Bank funded project and not evaluated in the same ways)