Summary

Public health approaches for identifying and responding to mental health difficulties amongst children and adolescents

Emma Soneson

Mental health difficulties amongst children and adolescents are a significant societal concern requiring urgent attention and action, and public health approaches may be useful in reducing their incidence, prevalence, and impact. Schools are increasingly featured within UK policy as a key setting for addressing mental health difficulties, yet school staff often do not feel adequately prepared for this role. In this dissertation, I aimed to explore what role schools can play within the public health approach to child and adolescent mental health difficulties; determine whether schools can improve the identification of and response to mental health difficulties; and identify the ‘key ingredients’ of an effective, feasible, and acceptable school-based approach to student mental health.

The introductory chapter provides an overview of the scope, aetiology, and impact of mental health difficulties amongst children and adolescents; describes the public health framework that supports the research in this dissertation; and highlights the role of schools within the public health approach to child and adolescent mental health difficulties. The first two empirical chapters present two studies that examined self-report data from the OxWell Student Survey to better understand English school students’ access to and perceptions of school-based and other mental health support. The first of these studies determined whether experience of adversity is related to access to and perceived need for mental health support amongst secondary school students. The second study explored whether various aspects of students’ school experience and their impressions of their wider school culture influence their perceptions of school-based mental health support. The next two chapters describe two studies aimed at improving UK primary schools’ response to pupil mental health difficulties. The first of these chapters describes a consensus study that contributed to the development of a new school-based identification programme. The second presents a feasibility study of an existing low-intensity teacher training programme that aimed to improve identification of and response to pupil mental health difficulties.

In the first empirical chapter, I demonstrated that experience of adversity is significantly associated with both prior access to and perceived need for mental health support. This chapter illustrated how many children and adolescents who may benefit from mental health support, and particularly those with experience of adversity, are not accessing it. In the next chapter, I showed how schools may be able to address this care gap through school-based mental health provision, but that students’ perceptions of such support vary according to their school experience and impressions of their wider school culture. This suggested that the provision of mental health support is only one aspect of a broader school-based approach to mental health. In the next chapter, I described the development of the new identification programme guided by stakeholder consensus. The prototype programme features a ‘combined’ approach of staff training, mental health education for pupils, and (potentially) universal screening, and merits further development and evaluation. In the final empirical chapter, I demonstrated how an existing teacher training programme may be a potentially effective, feasible, and acceptable intervention for promoting more accurate identification and facilitating access to support for pupils with mental health difficulties.

Taken together and as discussed in my final chapter, these findings provide valuable insight into the role of schools within the public health approach to child and adolescent mental health difficulties. First, the included studies illustrated several ways that schools can be involved in prevention and early intervention. Second, the studies demonstrated that schools do have significant potential to improve both identification of and response to mental health difficulties. Finally, the findings of this dissertation suggested five ‘key ingredients’ for school-based approaches to mental health, including (1) contextualisation of all mental health interventions within a wider school culture that values mental health; (2) identification and management of barriers to intervention implementation and sustainability; (3) support from wider systems; (4) attention to the needs of vulnerable children and adolescents; and (5) partnership working with key stakeholders. It is paramount that schools are supported and empowered to take an increased role in child and adolescent mental health.