As anyone working in education will be aware, there has been an increase in the number of young people struggling with their mental health, however services to support them are often unavailable (Frith 2017; Essau 2005). As a result, schools are increasingly being seen as the ideal place where such support could be provided (Frith 2017; Department of Health 2015) especially as education in social and emotional wellbeing (SEW) is regarded with increasing importance (Hoagwood et al, 2007; Stormont et al, 2009) and will become part of the compulsory curriculum from 2020 (gov.uk, 2019).

Teachers are often the first point of contact for young people and parents who are worried about poor mental health (Ford et al, 2008; Sax et al, 2003). This can feel daunting for staff who probably haven’t had any specific training in mental health, especially when resources are limited and waiting lists long; it also diverts attention away from the academic curriculum which adds to the pressure felt, in a world ruled by attainment targets, league tables and performance management. However, studies have shown that poor mental health impacts negatively on attainment (Rodwellet al, 2018; Sellers et al, 2019), and increased support and psycho-education is associated with reduced behaviour problems and depressive symptoms (Lucier-Greer et al., 2014; Rodwell et al., 2018; Sellers et al., 2019) resulting in higher academic achievement.

In 2017, with the publication of ‘Transforming Children and Young People’s Mental Health Provision: a Green Paper’, the government outlined its intention to focus on social and emotional welfare. Schools are in an ideal position to deliver universal mental health education with a survey of teachers revealing the majority of teachers believe that mental health should be addressed in schools (Reinke et al. 2011). Despite this recognition, there is little focus on mental health training for teachers and it is still not part of initial teacher training (Shepherd et al, 2013). In addition, the current limited amount of collaboration between teachers and mental health professionals (Sharpe et al, 2016) means teachers feel they lack the confidence and support to address what they acknowledge to be an important issue (Moor et al, 2007; Roeser et al, 1997; Cohall et al, 2007).

Previous research has highlighted the call from teachers for specialised mental health training (Graham et al, 2011; Moon et al, 2017; Rothì et al, 2008; Walter et al, 2006) however when looking at the practicalities such as the pressures of timetabling, academic targets and funding, the difficulties of transferring mental health training into the classroom become evident (Rothì et al, 2008).

From a mental health services perspective, there are potential difficulties as programmes used previously have failed due to their inflexibility as teachers adapted them to meet the needs of the class (Taylor et al, 2014). As a teacher, it is second nature to adapt style and content to best fit the class sat in front of you as it’s not only a crucial part of classroom management, but also an Ofsted expectation (Ofsted, 2017; Symons, 2018). Any intervention must therefore be endorsed by the teachers who are going to deliver it (Hans et al, 2005). This demonstrates the need for research to identify ways that mental health training can be utilised effectively in the classroom.

The following study used focus groups of current teachers to allow the authors to better understand teachers’ wants, needs and opinions regarding mental health in schools (Shelemy et al, 2019).

The research aims of the study were to

• better understand what teachers would like from mental health training and resources
• explore their opinions on different ways of delivering interventions
• identify the factors that both help and obstruct teachers in providing good support to students

Methods

Participants

• Had to be practicing secondary school teachers in the UK
• Nine focus groups were formed with four to eight participants in each
• Forty-nine teachers, with differing amounts of prior mental health training, took part in the study
• Schools selected for the study were located in five different countries, across three regions of the UK
• Pastoral leads helped organise and recruit teachers within their school
• Focus groups were conducted until no new ideas were emerging.

Procedure

Initial interviews took place where teachers were told the aims of the research were to establish what schools wanted and needed in terms of mental health interventions and that all data would be anonymised.

Within the focus groups a semi-structured guide (based on previous research) was used to direct the discussion (Kidger et al, 2009; Shelemy et al, forthcoming).

Each focus group discussion addressed three aims:

1. Teachers’ needs and opinions regarding mental health provision within school
2. Teachers’ views on three independent mental health online resources delivered in different formats:
   • MindEd (2018), a free text based online resource
   • FutureLearn (2018), a mixed media Cognitive-Behavioural Therapy (CBT) online course
   • Kognito (2018), an animated interactive program that aims to train teachers on how to support and have a conversation about mental health
3. The format (text, video, interactive etc) of mental health training, and a review of the online resources.

Results

The focus groups examined 2 main themes:

1. What should be done to improve teacher training?
2. External changes that were needed to help teachers cope with student mental health difficulties.

Improving teacher training

1. Content of training: identifying and supporting rather than solving

Focus groups expressed concern that they would be expected to take on the role of therapists, emphasising that their priority must remain educational. However, there was a desire to be able to identify subtle signs that students were struggling with their mental health so that they could respond in a way that would not exacerbate difficulties. Many teachers felt unsure as to what they should or shouldn’t say and wanted guidance on appropriate things to say and do to prevent student mental health from worsening.

2. Style of training: the need for training that has a real-world application

Focus groups felt it important that any training was related to classroom and educational scenarios, with examples and case studies related to their day to day role of teaching. Teachers expressed a need for clear practical classroom strategies that they could employ as needed, rather than a ‘wishy-washy’ overview of mental health.

3. Accessibility of training: the need for training to be engaging and active

It was agreed that any training should employ a mixture of teaching styles, should be interactive, promote discussion, and incorporate feedback and opinions from teachers. There was mixed feedback about online resources but there was an agreement that it needed to be straight forward and to the point due to time constraints, summary questions that assessed understanding were also found to be useful. In addition, the group felt that mental health training should also be more highly valued, with it being evidence-based, delivered by an expert, and that it should form part of continuing professional development.

External changes

Focus groups emphasised that any intervention must be wider than simply what they did within the classroom, highlighting the need for procedures and policies within the school. Improved communication with CAMHS was also considered vital, both in terms of offering advice, and in clear referral routes for identified young people. Teachers also emphasised the importance of supporting parents and wanted advice relating to this.

Conclusions

Mental health training for teachers must be practical, simple and interactive.

The focus groups agreed a ‘checklist’ showing that they wanted to provide teachers with the knowledge and understanding of the symptoms of mental health, so that they could respond appropriately. They also identified that any response needed to be wider than simply training teachers to respond in the classroom.

Strengths and limitations

• Only schools rated by Ofsted as ‘Good’ or ‘Outstanding’ took part. The mental health wants and needs of schools with lower Ofsted ratings may differ.
• Participants were selected by the pastoral leads within each school meaning there could be possible bias, potentially influencing the discussions in the focus groups.
• The experiences and views of the authors around the importance of supporting young people in schools will inevitably shape the research study design and data analysis.
• Notes from the study indicate that teachers from schools with funding for a dedicated counselling support service were not as passionate about receiving training, possibly because they already have resources and staff to support young people.

Implications for practice

Future studies should investigate similarities and differences between different school types, areas, academic outcomes and socio-economic status to identify additional needs faced by schools regarding more specific vulnerabilities.

Conflicts of interest

None reported.

Links

Primary paper

Lucas Shelemy, Kate Harvey & Polly Waite (2019) Supporting students’ mental health in schools: what do teachers want and need? Emotional and Behavioural difficulties, 24:1, 100-116, DOI: 10.1080/13632752.2019.1582742

Other references

Cohall, A. T., R. Cohall, B. Dye, S. Dini, R. D. Vaughan, and S. Coots. 2007. “Overheard in the Halls: What Adolescents are Saying, and What Teachers are Hearing, about Health Issues.” The Journal of School Health 77 (7): 344–350. doi:10.1111/j.1746-1561.2007.00218.x.

Department of Health. 2015. “Future in Mind – Promoting, Protecting and Improving Our Children and Young People’s Mental Health and Wellbeing.” (PDF)

Department of Health and Department of Education. 2017. “Transforming Children’s and Young People’s Mental Health Provision: A Green Paper.”  (PDF)

Essau, C. A. 2005. “Frequency and Patterns of Mental Health Services Utilization among Adolescents with Anxiety and Depressive Disorders.” Depression and Anxiety 22 (3): 130–137. doi:10.1002/da.20115.

Ford, T., H. Hamilton, H. Meltzer, and R. Goodman. 2008. “Predictors of Service Use for Mental Health Problems among British Schoolchildren.” Child and Adolescent Mental Health 13 (1): 32–40. doi:10.1111/j.1475-3588.2007.00449.x.

Frith, E. 2017. “Access and Waiting Times in Children and Young People’s Mental Health Services – the Education Policy Institute.” Education Policy Institute.

FutureLearn. 2018. “Understanding Depression and Low Mood in Young People.”

Gov.uk. 2019. “Press Release: All pupils will be taught about mental and physical wellbeing.”

Graczyk, P. A., C. E. Domitrovich, M. Small, and J. E. Zins. 2006. “Serving All Children: An Implementation Model Framework.” School Psychology Review 35 (2): 266–274.

Graham, A., R. Phelps, C. Maddison, and R. Fitzgerald. 2011. “Supporting Children’s Mental Health in Schools: Teacher Views.” Teachers and Teaching 17 (4): 479–496. doi:10.1080/13540602.2011.580525.

Han, S. S., and B. Weiss. 2005. “Sustainability of Teacher Implementation of School-Based Mental Health Programs.” Journal of Abnormal Child Psychology 33 (6): 665–679. doi:10.1007/s10802-005-7646-2.

Hoagwood, K. E., S. Serene Olin, B. D. Kerker, T. R. Kratochwill, M. Crowe, and N. Saka. 2007. “Empirically Based School Interventions Targeted at Academic and Mental Health Functioning.” Journal of Emotional and Behavioral Disorders 15 (2): 66–92. doi:10.1177/10634266070150020301.

Joyce, H. D., and T. J. Early. 2014. “The Impact of School Connectedness and Teacher Support on Depressive Symptoms in Adolescents: A Multilevel Analysis.” Children and Youth Services Review 39 (April): 101–107. doi:10.1016/j.childyouth.2014.02.005.

Kidger, J., D. Gunnell, L. Biddle, R. Campbell, and J. Donovan. 2009. “Part and Parcel of Teaching? Secondary School Staff’s Views on Supporting Student Emotional Health and Well-Being.” British Educational Research Journal 36 (6): 919–935. doi:10.1080/01411920903249308.

Kognito. 2018 “At Risk for PK-12 Educators.”

Lynn, C. J., M. M. McKay, and M. S. Atkins. 2003. “School Social Work: Meeting the Mental Health Needs of Students through Collaboration with Teachers.” Children & Schools 25 (4): 197–209. doi:10.1093/cs/25.4.197.

Lucier-Greer, M., O’Neal, C. W., Arnold, A. L., Mancini, J. A., & Wickrama, K. K. A. S. (2014). Adolescent mental health and academic functioning: empirical support for contrasting models of risk and vulnerability. Military Medicine, 179(11), 1279–1287.

MindEd. 2018 “Mental Health and Wellbeing.”

Moon, J., A. Williford, and A. Mendenhall. 2017. “Educators’ Perceptions of Youth Mental Health: Implications for Training and the Promotion of Mental Health Services in Schools.” Children and Youth Services Review 73(February): 384–391. doi:10.1016/J.CHILDYOUTH.2017.01.006.

Moor, S., M. Ann, M. Hester, W. J. Elisabeth, E. Robert, W. Robert, B. Caroline, et al. 2007. “Improving the Recognition of Depression in Adolescence: Can We Teach the Teachers?” Journal of Adolescence 30 (1): 81–95. doi:10.1016/j.adolescence.2005.12.001.

Ofsted. 2017. School inspection handbook.

Reinke, W. M., K. C. Melissa Stormont, R. P. Herman, and N. Goel. 2011. “Supporting Children’s Mental Health in Schools: Teacher Perceptions of Needs, Roles, and Barriers.” School Psychology Quarterly 26 (1): 1–13. doi:10.1037/a0022714.

Rodwell, L., Romaniuk, H., Nilsen, W., Carlin, J. B., Lee, K. J., and G. C. Patton. 2018. Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training. Psychological Medicine, 48(5), 861–871. https://doi.org/10.1017/S0033291717002434

Roeser, R. W., and C. Midgley. 1997. “Teachers’ Views of Issues Involving Students’ Mental Health.” The Elementary School Journal 98 (2): 115–133. doi:10.1086/461887.

Rothì, D. M., G. Leavey, and R. Best. 2008. “On the Front-Line: Teachers as Active Observers of Pupils’ Mental Health.” Teaching and Teacher Education 24 (5): 1217–1231. doi:10.1016/J.TATE.2007.09.011.

Sax, L., and K. J. Kautz. 2003. “Who First Suggests the Diagnosis of Attention-Deficit/Hyperactivity Disorder?” Annals of Family Medicine 1 (3): 171–174. doi:10.1370/AFM.3.

Sellers, R., Warne, N., Pickles, A., Maughan, B., Thapar, A., & Collishaw, S. (2019). Cross‐cohort change in adolescent outcomes for children with mental health problems. Journal of Child Psychology & Psychiatry,60(7), 813–821. https://doi.org/10.1111/jcpp.13029

Sharpe, H., T. Ford, S. T. Lereya, C. Owen, R. M. Viner, and M. Wolpert. 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. doi:10.1111/camh.12166.

Shelemy, L., K. Harvey, and P. Waite. forthcoming. “Secondary School Teachers’ Experiences of Supporting Mental Health.”

Shepherd, J., S. Dewhirst, K. Pickett, J. Byrne, V. Speller, M. Grace, P. Almond, D. Hartwell, and P. Roderick. 2013. “Factors Facilitating and Constraining the Delivery of Effective Teacher Training to Promote Health and Well-Being in Schools: A Survey of Current Practice and Systematic Review. Factors Facilitating and Constraining the Delivery of Effective Training to Promote Health and Well-Being in Schools: A Survey Of current Practice and Systematic Review.” NIHR Journals Library. doi:10.3310/PHR01020.

Stormont, M., W. M. Reinke, and K. C. Herman. 2009. “Introduction to the Special Issue: Using Prevention Science to Address Mental Health Issues in Schools.” Psychology in the Schools 47 (1): n/a-n/a. doi:10.1002/pits.20447.

Symons, R. 2018. “Thriving Futures, a whole school curriculum response to addressing the social and emotional welfare needs of secondary school pupils.” Education and Health 36 (4): 99-106.

Taylor, J. A., R. Phillips, E. Cook, L. Georgiou, P. Stallard, and K. Sayal. 2014. “A Qualitative Process Evaluation of Classroom-Based Cognitive Behaviour Therapy to Reduce Adolescent Depression.” International Journal of Environmental Research and Public Health 11 (6): 5951–5969. doi:10.3390/ijerph110605951.

Undheim, A. M., and A. M. Sund. 2005. “School Factors and the Emergence of Depressive Symptoms among Young Norwegian Adolescents.” European Child & Adolescent Psychiatry 14 (8): 446–453. doi:10.1007/s00787-005-0496-1.

Underhill, C., and M. G. Olmsted. 2003. “An Experimental Comparison of Computer-Mediated and Face-to-Face Focus Groups.” Social Science Computer Review 21 (4): 506–512. doi:10.1177/0894439303256541.

Walter, H. J., K. Gouze, and K. G. Lim. 2006. “Teachers’ Beliefs about Mental Health Needs in Inner City Elementary Schools.” Journal of the American Academy of Child & Adolescent Psychiatry 45 (1): 61–68. doi:10.1097/01.chi.0000187243.17824.6c.

Way, N., R. Reddy, and J. Rhodes. 2007. “Students’ Perceptions of School Climate during the Middle School Years: Associations with Trajectories of Psychological and Behavioral Adjustment.” American Journal of Community Psychology 40 (3–4): 194–213. doi:10.1007/s10464-007-9143-y.

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