Schools have an important role to play in supporting students’ mental health. School-based mental health services and interventions improve access to care by reaching a higher number of children and young people (Anderson et al., 2017). In fact, recent national survey data shows that many children and young people access mental health and well-being support within their schools (Newlove-Delgado et al., 2022).

Both external (e.g., CAMHS – children and adolescent mental health services) and internal (e.g., school counsellors, teachers) professionals contribute to providing mental health support to students within schools (Marshall et al., 2017; Sharpe et al., 2016). While many teachers acknowledge they play a role in supporting children’s mental health, many feel unprepared and report a need for additional training and support to effectively respond to their students’ needs (Maclean & Law, 2022; Shelemy et al., 2019), and of course some teachers simply feel that they have enough to do already and mental health support should not be part of their role. A key question in this discussion, given all of the competing demands, is how to best equip school staff to address and support their students’ mental health.

Effective partnerships between school staff and mental health services have the potential to improve students’ mental health support. The present study by Fazel and colleagues (2023) reports on two pilot projects exploring the implementation of two partnership initiatives in the United Kingdom:

1. The first project investigated the utilisation and possible impact of a mental health service liaison to school staff (the InReach programme)
2. The second project examined the utilisation and acceptability of a mental health skills training programme for school staff (the School Mental Health Toolbox).

Methods

The InReach programme

The authors reported on the first 3 years of the InReach programme, a liaison service where 15 mental health specialists (InReach workers) from CAMHS, partnered with secondary schools to provide mental health support. InReach workers visited schools each week and met members of staff or students to discuss students’ individual or systemic mental health concerns. Whenever they interacted with a school, InReach workers were asked to provide logs reporting on:

• The kind of advice and support provided;
• The areas of need they were asked to address;
• The potential impact of their activities.

The School Mental Health Toolbox (SMHT)

233 members of staff from secondary schools attended the SMHT training. The training drew from existing cognitive behavioural therapy (CBT) and other evidence-based psychotherapeutic techniques with the aim of helping school staff to support students’ mental health, focusing on ‘tools’ such as:

• Sleep hygiene;
• Behavioural change for mood and/or anxiety difficulties;
• Relaxation techniques;
• Mapping social networks to address social isolation;
• A ‘treasure box’ preparing students for difficult situations;
• Approaching students who have experienced trauma;
• Problem-solving.

Three months after the training, 105 participants completed a follow-up questionnaire, asking them to indicate which tools they had used, with how many students, how helpful they had found the training, and the likelihood that they would recommend the SMHT to others.

Results

The InReach programme

InReach workers reported a total of 1,233 visits to schools and 1,653 different activities. The InReach service was most commonly used to provide consultation and advice to one or multiple school staff members, and meeting with students both individually and in groups. During these visits, emotional difficulties in students, particularly anxiety, were the most common area of need discussed, present in 59% of logs. Behavioural problems, such as aggressive behaviour and bullying, were the second most discussed need, present in 25% of logs. The potential benefits of the InReach service included:

• Providing advice and support to school staff in the form of strategies to help manage the students;
• Improved communication with CAMHS;
• Assisting with safeguarding issues;
• Liaison with other services;
• Signposting to other services.

The School Mental Health Toolbox (SMHT)

• Three months after the training, 85% of responding school staff had used skills learned during the SMHT training with a student;
• Nearly half of respondents (48%) had used the tools with students with behavioural and emotional difficulties, and some (23%) school staff members also reported using the tools for their own mental health and wellbeing;
• The most commonly used tools were relaxation techniques (42%) and sleep hygiene advice (42%);
• Most respondents found the training helpful (M = 4.2, SD = 0.9 on a 1-5 Likert scale with 5 as ‘very helpful’) and would recommend it to a colleague (M = 7.7, SD = 2.0 on a 0-10 Likert scale with 10 as ‘very likely’).

Conclusions

This study found that partnerships between educational and mental health professionals show the potential to improve student mental health support within schools.

The InReach service demonstrated the important role that CAMHS professionals can play in supporting school staff and students, with several potential benefits that highlight the need to continue building partnerships between these services. In addition, most school staff who attended the SMHT training and responded at 3 months follow-up, reported using the tools provided and would recommend the training to colleagues.

Overall, the results of this descriptive article are promising. Considering the current deterioration of mental health in children and young people, and the logistical and accessibility benefits of school-based mental health services, a better understanding of these types of partnerships should be a priority for research and policy.

Strengths and limitations

This study explored the implementation of two partnership initiatives between educational and mental health professionals in supporting schools to address the mental health needs of their students. Whilst the findings of these pilot studies are promising, the results were descriptive. As indicated by the authors, it is necessary to explore the effectiveness of these services on students’ mental health by conducting robust, adequately powered studies focused on student outcomes, and to also explore students’ experiences of these partnership initiatives using interviews. Without this, it is hard to determine the actual impact of the programme. In addition, initial programme outcomes may not necessarily be maintained (Moore et al., 2017), making it necessary to also investigate whether any gains are sustained over the long-term.

In this study, the utilisation of both initiatives was explored, and the authors admit the barriers and facilitators for the implementation of these services should be investigated to inform programme developers and refine these partnership initiatives. However, initial intervention implementation efforts may not be maintained in the longer term and previous studies suggest low levels of sustainability for evidence-based interventions in schools (Herlitz et al., 2020). As schools are dynamic ever-changing organisations, it is necessary to explore whether potential changes in the school context hinder or facilitate the long-term delivery and use of the programme. Overall, further cohort and qualitative studies investigating the effectiveness, implementation and sustainability of these services are needed.

Implications for practice

The current article reports on two pilot studies, meaning the conclusions that can be drawn are currently limited. However, there are still clear implications for research and practice.

• Some teachers acknowledge the need for further training to support their students’ mental health, particularly considering the deterioration of mental health in children and young people in recent years. Further training should be provided to teachers in this domain, and the results of this study have the potential to inform the design and delivery of this type of training. For instance, relaxation techniques and sleep hygiene advice were the most used training tools used by school staff, which suggest these should be components to be kept in teacher training. However, further qualitative research is still necessary to understand why certain strategies were more used than others.
• Support and training for dealing with behavioural and emotional difficulties were particularly relevant, suggesting that teacher training programmes need to include modules that provide incoming teachers with the strategies and tools needed to support students with these issues. This extends to the training of other educational professionals internal to a school, such as staff providing pastoral care.
• On the other hand, schools seemed to benefit from having regular support from external mental health professionals through the InReach programme, so this partnership should not be dismissed. InReach workers provided advice and guidance to school staff but also worked directly with students. Complex or more severe mental health issues need to be managed by mental health specialists and although teachers recognise the role they play in supporting in students’ mental health, they also acknowledge that they should not take on the role of a therapist (Shelemy et al., 2019).

Taken together, it seems that a combination of mental health training for school staff and direct support from mental health professionals external to schools might optimise the mental health support provided to students. Overall, partnerships between educational and mental health services should be promoted and further studied.

Statement of interests

The author declares no conflicts of interest.

Links

Primary paper

Fazel, M., Soneson, E., Sellars, E., Butler, G., & Stein, A. (2023). Partnerships at the Interface of Education and Mental Health Services: The Utilisation and Acceptability of the Provision of Specialist Liaison and Teacher Skills Training. International Journal of Environmental Research and Public Health, 20(5), 4066.

Other references

Anderson, J. K., Howarth, E., Vainre, M., Jones, P. B., & Humphrey, A. (2017). A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people. Children and Youth Services Review, 77, 164–176.

Herlitz, L., MacIntyre, H., Osborn, T., & Bonell, C. (2020). The sustainability of public health interventions in schools: a systematic review. Implementation Science, 15(1), 1-28.

Maclean, L., & Law, J. M. (2022). Supporting primary school students’ mental health needs: Teachers’ perceptions of roles, barriers, and abilities. Psychology in the Schools, 59(11), 2359-2377.

Marshall, L., Wishart, R., Dunatchik, A., & Smith, N. (2017). Supporting Mental Health in Schools and Colleges- Quantitative Survey. NatCen Social Research.

Moore, J. E., Mascarenhas, A., Bain, J., & Straus, S. E. (2017). Developing a comprehensive definition of sustainability. Implementation Science, 12(1), 1-8.

Newlove-Delgado, T. M., F., Williams, T., Mandalia, D., Davis, J., McManus, S., Savic, M., Treloar, W., & T., F. (2022). Mental Health of Children and Young People in England, 2022. NHS Digital.

Sharpe, H., Ford, T., Tanya Lereya, S., Owen, C., Viner, R. M., & Wolpert, M. (2016). Survey of schools’ work with child and adolescent mental health across England: a system in need of support. Child and Adolescent Mental Health, 21(3), 148–153.

Shelemy, L., Harvey, K., & Waite, P. (2019). Supporting students’ mental health in schools: what do teachers want and need? Emotional and Behavioural Difficulties, 24(1), 100-116.

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