Well-Being: promoting mental health in schools

Well-Being: promoting mental health in schoolsNo. 2, 2012ContentsExecutive summary 2What is mental health/well-being? 3Costs associated with poor mental health 3Protecting well-being in children 5School-based mental health promotion 6Scientific evaluation of programmes 8Promotion of well-being in schools internationally 9Mental health among young people in Ireland 12Examples of promotion in Irish schools 14Challenges to implementation 15Conclusion 16No liability is accepted to any person arising out of anyreliance on the contents of this paper. Nothing hereinconstitutes professional advice of any kind. Thisdocument contains a general summary of developmentsand is not complete or definitive. It has been preparedfor distribution to Members to aid them in theirParliamentary duties. Authors are available to discussthe contents of these papers with Members and theirstaff but not with members of the general public.EditorialPublic discourse often presents mental health in awholly negative light, focusing on mental health„problems‟, rather than the concept of promotingmental well-being. Such thinking assumes thatmental health promotion is only relevant for aminority of people. In reality people have differentlevels of resilience to common problems in life, suchas stress and bereavement. People also employdifferent coping mechanisms. It is more accurate tothink of mental health, as something whichfluctuates throughout a person‟s lifetime. ThisSpotlight suggests that mental health should betreated like physical health; something to bemaintained and protected.Research indicates that resilience is best developedin the early years of a person‟s life. Skills childrendevelop at a young age will help them cope betteras adults. As such, many commentators advocatethat mental health promotion programmes shouldtake place in schools.This Spotlight is intended to give Members anoverview of approaches and examples of earlyinterventions both here and internationally andoutline what is considered best practice in thedesign of youth mental health programmes. It alsoexamines the returns for the individual and society.Committees TeamFebruary 2012Library & Research ServiceCentral Enquiry Desk: 618 4701 / 47021

Executive summaryGovernments around the world are nowrecognising the importance of mental well-beingto society. While measures of GDP provide apicture of the economic health of a nation,measures of well-being provide an indication ofhow life in a country is experienced.The costs of poor mental health in Ireland wereestimated to be €3BN in 2006. Although thecosts associated with poor mental health arelarge, in most countries expenditure on mentalhealth comprises a relatively small percentageof the overall health budget. In high incomecountries this proportion is, on average, around5%. In Ireland, 5.2% of the overall healthbudget goes towards mental health despite arecommendation in A Vision for Change that8.2% of the health budget be spent on mentalhealth.There is still a stigma attached to mental illness.In Ireland, it is estimated that 44% of peoplehave had a direct experience of mental healthproblems, yet most would not disclose a mentalillness. Studies indicate that most young peoplein Ireland have positive mental health but someschool students and young people have difficultycoping with stress in their lives.Mental health promotion involves buildingpeople‟s resilience against various stresses intheir lives and is referred to in several Irishpolicy documents including The National HealthPromotion Strategy (2000-2005), Reach Out(2005) and A Vision for Change (2006).Research shows mental health promotion ismost effective when it takes place early in aperson‟s life, therefore school may be afavourable location for such programmes to takeplace.but there are a number of school-based factorswhich can be further divided into protective andrisk factors. Mental health programmes attemptto maximise protective factors, while minimisingrisk factors.Several countries around the world have schoolbasedmental health promotion programmes.Some of these are implemented by State bodieswhile others are carried out by Non-Governmental Organisations (NGOs). Australia,for example, has several programmes. InIreland, programmes such as Zippy‟s Friends,Mind Out and the Jigsaw Meath Project arebeing implemented in schools with positiveoutcomes being reported.Research shows that mental health promotionprogrammes can be effective in equippingpeople with the skills necessary to avoid or dealwith mental distress. Studies indicate that thewhole-school approach is the most effectiveapproach to mental health promotion. Thisinvolves students, school staff, parents as wellas key community groups.School-based programmes can have positiveeffects for students in terms of:• behaviour and self-control;• social and emotional skills;• ability to learn and achieve academically;• problem-solving in social settings.The biggest challenges to implementing mentalhealth promotion programmes in schools are:funding, timetabling, programme fidelity andachieving full participation from all stakeholders.While researchers argue that mental healthprogrammes are most effective between theages of 2-7, many of the programmes availablearound the world target children older than this.Children‟s well-being is affected by factors intheir community, home, peers, and wider society2

What is mental health/ well-beingand why should we measure it?Mental health is defined as a state of well-beingin which every individual realizes his or her ownpotential, can cope with the normal stresses oflife, can work productively and fruitfully, and isable to make a contribution to her or hiscommunity. 1The World Health Organization Mental HealthDeclaration (2005) claims that the social andeconomic prosperity of Europe will depend onimproving mental health and well-being. Theywrite: 2 “Mental health and well-being arefundamental to quality of life, enablingpeople to experience life as meaningfuland to be creative and active citizens.Mental health is an essential component ofsocial cohesion, productivity, and peaceand stability in the living environment,contributing to social capital and economicdevelopment in societies (WHO, 2005).”Several international organisations measurewell-being through social reporting, including theUnited Nations, the Organisation for EconomicCo-operation and Development (OECD), andthe European Commission. Within the EuropeanUnion (EU) there is a strong emphasis onidentifying the determinants of mental wellbeing,which is seen as an investment in the future. 3At national level, countries such as NewZealand, Germany, the Netherlands, Australia,and Canada have been producing social reportsfor a number of years. Canada has recentlydeveloped the Canadian Index of Well-Being. 4The first Canadian report using this indexhighlighted the discrepancy between GDP and1 http://www.who.int/features/factfiles/mental_health/en/index.html2 http://www.euro.who.int/__data/assets/pdf_file/0008/8853 www.nice.org.uk/nicemedia/pdf/PH012Guidance.pdfSimilar4 http://ciw.ca/en/well-being when it showed that from 1994 to2008, Canada‟s GDP grew by 31% but quality oflife grew by just 11%. As rationale for creation ofthe index, the authors of the report claim:“GDP makes no distinction betweeneconomic activities that are good for ourwellbeing and those that are harmful.Spending on tobacco, natural and humanmadedisasters, crime and accidents, allmake GDP go up.”The National Economic and Social Council(NESC) Well-Being Matters: A Social Report forIreland was published in October 2009. Uponpublication Dr. Rory O‟Donnell said:“GDP can measure economic output butdoes not take adequate account of the valueof education, our health, or the naturalenvironment. Our social progress is linked tothe capabilities of our people and that iswhere well-being matters.”Researchers conducting The Gallup World Pollsurveyed thousands of respondents in 155countries between 2005-2009. 5 Respondentswere asked to rank their daily experiences ofhappiness on a life evaluation score from 1-10.Subjects that reported high scores wereconsidered "thriving." The results, which werepublished in 2010, found that Denmark was thehappiest country, followed by Finland, Norwayand Sweden.Costs associated withpoor mental healthThe WHO estimates that up to 20% of childrenand adolescents worldwide experience adisabling mental health problem. 6 The costs ofmental ill health are considerable, the OECD(2008) report 7 that 21 million people in 28European countries (4.5% of the totalpopulation) have depression, with an associatedcost of more than € 118 billion (1% of the5 http://www.forbes.com/2010/07/14/world-happiestcountries-lifestyle-realestate-gallup-table.html6 Amnesty International and Children‟s RightsAlliance (2011). Children‟s Mental Health CoalitionBackground Paper.7 OECD.(2008).Mental Health in OECD Countries.www.oecd.org/dataoecd/6/48/41686440.pdf3

egion‟s GDP). Direct costs were €42 billion,comprised of outpatient care (€ 22 BN),pharmaceuticals (€ 9 BN) and hospitalisation (€10 BN), but indirect costs due to workabsenteeism and premature mortality accountedfor two-thirds of the total (€76 BN).The Mood Disorders Society of Canada (2009)report that costs for disability due to depressionare the fastest growing disability costs forCanadian employers. 8world median for high income countries 11 but islower than set out in A Vision for Change, whichrecommends that 8.2 per cent of the overallhealth budget be allocated to mental health. 12The European Commission (2006) reportidentified a divide between the apparentimportance of mental health promotion indocuments and speeches, across countries, andtranslating these words into reality.In Ireland the costs of poor mental health wasestimated to be 2% of GNP (€3BN) in 2006.Figure 1: Mental Helath Expenditure in theEEAExpenditure on mental healthSome governments (Austria, Australia,Germany, Hungary and Switzerland, forexample) have established health promotionfoundations, which are statutory bodies withlong-term and recurrent public resources. 9In a survey by the European Commission(2006) 10 a lack of funding was cited as the mainobstacle to mental health promotion. Thisbroadly reflects a lack of funding towards mentalhealth more generally. In many countries,spending on mental health represents a verysmall proportion of the overall health budget.Figure 1 compares countries‟ expenditure onmental health as a percentage of their overallhealth budget. The chart shows thatLuxembourg spends the largest proportion oftheir health budget on mental health, followed bythe UK, Sweden and Germany.In 2010, Ireland spent 5.2% of its overall healthbudget on mental health. This is in line with the8 http://secure.cihi.ca/cihiweb/products/roi_mental_health_report_en.pdf9 http://heapro.oxfordjournals.org/content/early/2011/04/04/heapro.dar023.abstract10European Commission. (2006). Mental HealthPromotion and Mental Disorder Prevention acrossEuropean Member States: a collection of countrystories. Accessed on 7th February 2012 athttp://ec.europa.eu/health/archive/ph_projects/2004/action1/docs/action1_2004_a02_30_en.pdfProfessor James Heckman is the Henry SchultzDistinguished Service Professor of Economicsat the University of Chicago and Nobel Laureate(2000). 13 His research shows that earlychildhood education has a positive effect on thehealth and well-being of children and society.Heckman is particularly interested in childrenthat come from disadvantaged backgrounds andargues that early education can offset some ofthe effects a disadvantaged background can11 WHO. (2011). Mental Health Atlas 2011.http://whqlibdoc.who.int/publications/2011/9799241564359_eng.pdf12 http://www.irishpsychiatry.ie/Libraries/External_Affairs/CPsychI_Pre-Budget_Submission_2011.sflb.ashx13 http://heckman.uchicago.edu/4

have on a child‟s future. 14 Figure 2 is based onU.S. data and indicates that money spent onchildren during the pre-school years providesthe best return to investment. Returns graduallydecrease as a person reaches school age andare significantly less when a person finishesschool. Heckman (2008) argues that investmentin pre-school offers a better financial return tothe State and society than investment in publicjob training. This is because „skill begets skill‟,i.e. a good early foundation makes later skillacquisition easier. 15Figure 2: Rate of return to investment inchildren and young people 16Protecting well-being in childrenThere have been a number of indicators createdby researchers in the field of child Well-Being,as outlined in Gordon et al.‟s (2010) report ofindicators The well-being of children and youth -a stocktaking report on data sets and indicators,Work-in-Progress Report 2010. 18 In the contextof promoting child mental health, it is useful tooutline the various spheres in which childrenexist and how these impact on well-being.Figure 3 shows how children‟s rights and wellbeingcan be promoted. 19 Research indicatesthat stronger links between each system ofcircles (shown below) leads to greater resilienceand healthier individual outcomes. In otherwords, the more involved a child is with theirpeers, family, community etc., the greater theirwell-being will be.Figure 3: The Child’s Rights Ecology ModelEsping-Anderson (2008) writes that investmentin children has: 17„„…over the past half century, been almostexclusively directed at formal education. It isonly quite recently that we have come to realisethat the foundations of learning – as well as thechief mainsprings of inequalities – lie buried inthe pre-school phase of childhood and thatschools are generally ill-equipped to remedy abad start.‟‟14 Heckman, J. and Masterov, D.V.(2007). Theproductivity argument for investing in young children.National Bureau of Economic Research.15 http://www.childandfamilypolicy.duke.edu/pdfs/10yranniversary_Heckmanhandout.pdf16 http://literacyencyclopedia.ca/index.php?fa=items.show&topicId=30017 http://www.fahcsia.gov.au/sa/families/pubs/scoping_study/Pages/chapter_two.aspxMorrison and Kirby (2010) write that it is not justthe absence of risks and problems that influencechildren‟s psychological well-being but also thepresence of positive factors in their lives topromote positive development. 20 While many18 http://www.eiesp.org/hosting/a/admin/files/Indicators_Stocktaking_Report_2010%5B1%5D.pdf19 http://labspace.open.ac.uk/mod/oucontent/view.php?id=425702&printable=120 Joint Consortium for School Health (2010).5

factors which influence a child‟s well-being takeplace in the home, or broader society, there arefactors which can be developed in schools.Within the school system, programmes tend todeal with the following risk and protectivefactors: 21Box 1: Child well-being –protective and riskfactorsProtective factors• positive relationshipswith peers and teachers• feelings of positiveregard• participation in schooland communityactivities• opportunities and skillsfor achievement• opportunities and skillsfor communication• recognition ofcontribution andachievements• sense of securityRisk factors• absenteeism• alienation• bullying• disengagement• isolation• low academicachievement• violenceResearch shows that some of the most commonproblems which challenge students‟ well-beingare family dysfunction or other family problems,impulse control, other behavioural problems,22 23bullying, and stress/anxiety/depression.Schools as a setting for promoting positive mentalhealth: better practices and perspectives.21 http://www.rch.org.au/emplibrary/gatehouseproject/Gatehouse_Team_Guidelines.pdf22 http://www.intercamhs.org/files/Principals%20Survey%20-%20Germany%20(09-28-10).pdf23 Ainley, J., Withers, G., Underwood, C., Frigo, T.(2006). National Survey of Health and Well-BeingPromotion Policies and Practices in SecondarySchools: Report to the Australian Principals‟Associations Professional Development Council.School-based mental healthpromotionClarke and Barry (2010) 24 show that positivemental health promotion is best done in theearly years of a child‟s life, particularly from theages of 2-7 years. The WHO‟s Ottawa Charter(1986) refers to the importance of the school asa setting for mental health promotion. It has alsobeen found that there is a strong relationshipbetween health, classroom performance,participation and student attitudes. 25Health promotion is about realising people‟spotential to make them more resilient andinvolves building strengths, competencies andresources. This section will look at how mentalhealth promotion can be implemented withinschools.Best practice in school-based healthpromotionCharacteristics of successful mental healthpromotion programmes are: 26• good theoretical and research base;• clarifying key goals and objectives;• evaluation and high quality researchmethods;• infrastructural support from management;• programme fidelity, not re-invention; and• transferability between countries andcultures.Clarke and Barry (2010) show that programmeswhich adopt a whole-school approach areparticularly likely to lead to positive mentalhealth, social and educational outcomes. Ascited by the Joint Consortium for SchoolHealth 27 a systematic review carried out by24 Clarke, A.M. and Barry, M. (2010). An evaluation ofthe Zippy‟s Friends emotional wellbeing programmefor primary schools in Ireland25 http://www.healthpromotion.cywhs.sa.gov.au/Content.aspx?p=15426 Barry, M. (2007). Generic Principles of EffectiveMental Health Promotion. International Journal ofMental Health Promotion.27 JCSH. (2010).Schools as a setting for promoting6

Stewart-Brown (2006) on behalf of the WHO,revealed that school-based programmes areparticularly effective if implemented usingapproaches common to the WHO‟s HealthPromoting Schools approach. Box 2 providesmore detail on this approach.Box 2: WHO’s Health Promoting Schools 28Health promoting schoolsA Health Promoting School (HPS) is based onthe WHO Ottawa Charter. There are sixcomponents to this:Healthy school policiesPolicies which promote health and wellbeinge.g. healthy food practices; discourage bullying.The school’s physical environmentThe physical environment refers to buildingdesign, location, amenities; natural light; spacefor physical activity, facilities for learning,healthy eating.The school’s social environmentRelationships between staff and students,parents and the wider community.Individual health skills and action competencies.Skills and experiences enabling competencieswhich improve the health and well-being ofthemselves and others in their community.Community linksConnections between the school, students,families and key local groups and individuals.Health servicesLocal school-based or school-linked healthservices such as mental health services topromote students‟ social and emotionaldevelopment; to reduce barriers to intellectualdevelopment and learning and to improve socialinteractions for all students.positive mental health: better practices andperspectives.28 IUHPE (2009). Achieving Health PromotingSchools: Guidelines for Promoting Health in Schools.Accessed on 10 th February 2012 athttp://www.iuhpe.org/uploaded/Publications/Books_Reports/HPS_GuidelinesII_2009_English.pdfSpecific approaches to school-basedmental health programmesThere are three approaches to school-basedmental health programmes: 291. Universal Programmes - aim to improvethe mental health of the whole populationof children2. Targeted Programmes - aim to improvethe mental health of children atincreased risk of mental health problems3. Indicated Programmes - aimed atchildren who are already manifestingsigns of mental health problemsThis Spotlight will concentrate on UniversalProgrammes, in keeping with the view thatpromoting mental health is something whichrelates to everyone.Universal programmes include classbased/curriculum based skills (such as SocialPhysical and Health Education (SPHE) as wellas a whole–school approach. As the wholeschoolapproach is found to be more effective(more on effectiveness later) we look at this inmore detail.Whole-School ApproachThe whole-school approach is favoured by manyexperts in the field of mental health promotionas it involves students, staff, parents and issustained over time; factors which tend to makeintervention more successful. 30According to the International Union for HealthPromotion and Education (IUHPE) (2005) thewhole-school approach is sometimes referred toas „healthy school‟, „health promoting school‟,„universal‟, and „multi-systemic‟ but there is alack of agreement about what it means inpractice. 31The WHO (2000) has a four level whole-school29 Clarke, A.M. and Barry, M. (2010). An evaluation ofthe Zippy‟s Friends emotional wellbeing programmefor primary schools in Ireland30 Ibid.31 http://www.iuhpe.org/upload/File/PE_SH_05.pdf7

approach to mental health promotion, as shownin figure 4. The base of the diagram representsthe environment of the school itself and includeseveryone belonging and associated with theinstitution. The next tier represents mentalhealth education and is targeted at students andteachers. The third tier will only involve studentswith mental health needs and involvesinterventions such as counselling, angermanagement, peer mediation etc. The fourth tierinvolves a very small percentage of studentswho require professional treatment.Figure 4: The World Health organisation’sfour-level , whole-school approach to schoolchangeScientific evaluation ofprogrammesThere have been several scientific reviews ofprograms which target school-going children‟ssocial, emotional, behavioural and cognitiveskills. These are summarized by Clarke andBarry (2010) 33 who find that mental healthpromotion in schools has the following benefits:• Improvements in behavior and self-control;• Improved social and emotional skills;• Increased ability to learn and achieveacademically; and• Improved problem-solving in social settings.The European Union Dataprev project reviewedschool-based mental health programmes andincluded reviews of 52 interventions. 34 Theseinterventions were found to have beneficialeffects on children, families and communities, aswell as on mental health, social, emotional andeducational outcomes. Weare and Nind (2011)write that these effects are statistically small butlarge in terms of real-world impacts. Most ofthese reviews (46 of 52) were of universalprogrammes. 35In terms of specific groups, one study found thatsome school-based programmes for children ofdivorced parents resulted in improved copingskills, reduced depressive symptoms and fewerbehaviour problems at one-year follow-up. 36For a larger version of the above diagramplease click here.The first step in implementing the whole-schoolapproach is to form a core group of committedschool staff. When this is done, programmeorganisers contact community and familypartners. 3232 Education Development Center. (2011). Realizingthe promise of the whole-school approach tochildren‟s mental health: a practical guide forschools.Clarke and Barry (2010) write that withoutintervention, emotional and behaviouralproblems in young people may be lessamenable to intervention after eight years ofage, resulting in an escalation of academic33 Clarke, A.M. and Barry, M. (2010). An evaluation ofthe Zippy‟s Friends emotional wellbeing programmefor primary schools in Ireland.34 Weare, K. and Nind, M. (2011). Mental healthpromotion and problem prevention in schools: whatdoes the evidence say? Health PromotionInternational, Vol. 26.35 Ibid.36 Shekhar, S., Jané-Llopis, E., Hosman, C. (2006).Prevention of mental and behavioural disorders:implications for policy and practice. World Psychiatry5:1, February 20068

problems, antisocial behaviour and eventualschool drop-out in later years.Promotion of well-being in schoolsinternationallyThis section will give details and examples ofthe number of countries that implement schoolbasedmental health programmes.Countries with programmes in placeTable 1 shows the results of a WHO (2008) 39survey and details the percentage of countriesthat implement programmes and/or activities inschools to promote the mental health of childrenand adolescents. In over 40% of the countriessurveyed, programmes were available in themajority of schools.The activities includeworkshops on conflict resolution, social andemotional learning, and overarchingprogrammes that address several topics specificto target groups.Table 1: Implementation of programmes inschools EU, Israel, Norway, Switzerland.A recent review of U.S. school practices foundthat 59% of schools have programmes, toaddress children‟s social and emotionalcompetencies, in place. 37 Also in the U.S., TheAcademic, Social, and Emotional Learning Act(2011) will provide for the training of teachersand principals to meet the social and emotionalneeds of their students. It will also provide for anexpansion of the availability of programs thatteach students skills such as: problem‐solving,conflict resolution, responsible decision-making,and relationship building. 38Programmes/activityinschoolsYESAll ormost37 Durlak, J.A., Weissberg, R.P., Dymnicki, A.B.,Taylor, R.D., Schellinger, K.B. (2011). The Impact ofEnhancing Students‟ Social and Emotional Learning:A Meta-Analysis of School-Based UniversalInterventions. Child Development, Vol 82(1), Pgs.405-432.38 http://casel.org/publications/academic-social-andemotional-learning-act-of-2011-summary/(81-100%)MajorityEU EU15 Israel,NorwayandSwitzerlandTotal7% 0% 67% 10%30% 33% 33 31%The European Commission‟s (2006) reportstates that over half of the countries surveyedhad national educational programmes. Thesame report draws attention to Austria wherethe Austrian Network of Health PromotingSchools, “aims at promoting the somato-psychosocialhealth of students, teachers and parents,consists of 120 schools and is supported by aknowledge centre on school-based healthpromotion, which provides numerous factsheets, guidelines and programme descriptionson many topics including mental health issues”.(51-80%)Some(21-50%)A few(1-20%)7% 7% 0 12%41% 40% 0 31%NO 11% 13% 0 14%No infoavailable4% 7% 0 2%39 WHO. (2008). Policies and practices for mentalhealth in Europe – meeting the challenges.www.euro.who.int/document/e91732.pdf9

Specific programmes and what they involveA selection of other notable mental healthpromotion programmes are as follows:MindMatters – Australia (all years)MindMatters is funded by the AustralianGovernment and takes a whole-school approachto mental health and well-being, which focuseson the entire school community as well as theschool environment. The approach is influencedby the WHO model for school mental healthpromotion. A survey of Australian schoolsshowed that MindMatters was used in some wayby over two-thirds of schools surveyed and wasa key resource in 18% of schools. 40MindMatters helps schools and theircommunities to:create a positive climate of mental healthand wellbeing;be pro-active in the promotion of mentalhealth and wellbeing for all students; andsupport prevention and early interventioninitiatives for young people with mentalhealth and wellbeing challenges.The programme is facilitated by a CD-ROM andbooklet, first published in 2000. The threedimensions of the MindMatters approach are:school ethos and environment;curriculum: teaching and learning; andinternal and external partnerships andservices.Gatehouse Project – Australia (all years)The European Network of Health PromotionSchools produced a booklet called Models ofhealth promoting schools in Europe. 41 Thebooklet contains information and learninggathered over ten years. The GatehouseProject 42 is a whole-school approach which has40 Ibid.41 http://www.schoolsforhealth.eu/upload/ModelsofhealthpromotingschoolsinEurope.pdf42 http://www.rch.org.au/gatehouseproject/about/indexadapted the models of this document andincluded them in their strategy. The GatehouseProject operates at the following levels:classroom (teaching and learningenvironment and relationships) – feelingof connectedness;whole school (policies, programs,practices of the school) – ethos of theschool; andlinks with the community (school, home,community organizations) – how schoolmight strengthen links with thecommunity to increase sense ofconnectedness.FRIENDS for life – various countries (7-16years)FRIENDS for Life is a childhood anxietyprevention programme acknowledged by theWHO. The programme is currently used inschools and clinics in Australia, New Zealand,Canada, the United Kingdom, Ireland, Germany,Finland, the Netherlands, the United States,Mexico, Norway, and Portugal. 43The programme aims to build resilience inyoung people and help them cope with andmanage anxiety. The programme is aimed atchildren aged 7-11 years and youth aged 12-16years.The effectiveness of FRIENDS has beenshown in several Australian studies as well as inthe United States, United Kingdom andCanada. 44FRIENDS is a universal programme whichconsists of ten sessions and two boostersessions. The programme takes place in classtime, avoids labelling children and is found to beas effective when run by teachers as.cfm?doc_id=17643 http://www.friendsinfo.net/44 http://www.friendsinfo.net/downloads/FRIENDSAbstractsBooklet.pdf10

clinicians. 45 The following steps describe howthe initiative works: 46Step 1 The school selects which yearlevel they want FRIENDS to beintroduced (e.g. ages 10–12 or 15–16)and adds the program to its yearcurriculum.Step 2 The school purchases programmanuals for the teachers responsible forthe year level selected.Step 3 These teachers are given asimple 1 day group-training sessionprovided by a Pathways Health andResearch Centre accredited FRIENDStrainer.Step 4 The school then orders thenumber of workbooks required (one foreach child) and collects the money fromthe parents, or arranges for parents tobuy the books from the school‟s usualtextbook supplierStep 5 The school encourages parentsto become involved with the program byattending optional parent sessions whichcan be run by a teacher using theprogram manual.Social and emotional aspects of learning(SEAL) – England (all years)SEAL is “a comprehensive, whole-schoolapproach to promoting the social and emotionalskills that underpin effective learning, positivebehaviour, regular attendance, staffeffectiveness and the emotional health and wellbeingof all who learn and work in schools.” 47National Strategies report that it is currentlybeing implemented in around 90% of primaryschools and 70% of secondary schools inEngland. 4845 http://www.friendsinfo.net/downloads/FRIENDSintrobooklet.pdf46 Ibid.47 https://www.education.gov.uk/publications/eOrderingDownload/DFE-RR049.pdf48 Ibid.SEAL is designed to promote thedevelopment and application to learning ofsocial and emotional skills that have beenclassified under the five domains proposed inGoleman‟s (1995) model of emotionalintelligence. These are: 49Self-awareness;Self-regulation (managing feelings);Motivation;Empathy; andSocial skills.At the school level, SEAL is characterised bythe following principles: 50Clear planning focused on improvingstandards, behaviour and attendance;Building a school ethos that provides aclimate and conditions to promotesocial and emotional skills;All children are provided with plannedopportunities to develop and enhancesocial and emotional skills;Adults are provided with opportunitiesto enhance their own social andemotional skills;Staff recognise the significance ofsocial and emotional skills to effectivelearning and to the well-being of pupils;Pupils who would benefit fromadditional support have access to smallgroup work;There is a strong commitment toinvolving pupils in all aspects of schoollife;There is a strong commitment toworking positively with parents andcarers; andThe school engages well with otherschools, the local community, widerservices and local agencies (NationalStrategies SEAL Priorities, 2009-2011).49 Ibid.50 https://www.education.gov.uk/publications/eOrderingDownload/DFE-RR049.pdf11

Caring school community – USA (5-11 years)The Caring School Community (CSC) is amodified version of what was formerly knownas the Child Development Project. Its statedobjectives are to “promote core values, prosocialbehaviour, and a school-wide feeling ofcommunity.” There are four elements to theprogramme: 51Class meeting lessons – teachers andstudents discuss issues and identifyand solve problems collaboratively; Cross-age “buddies” programmes –pairing older and younger studentstogether for learning and recreation;Homeside activities – conversationalactivities to do with theirparents/guardian; andSchoolwide community – bringstudents, parents, and school stafftogether to create new school traditions.The programme which targets K-6 students (age5-11) is designed to be implemented over oneyear. Since it began in 2004 the programme hasbeen implemented in 2,756 classrooms. Studieson the effectiveness of the Child DevelopmentProject (there has been no study of the CSC)show positive effects for behaviour but nodiscernible effects in the knowledge, attitudes,and values and the academic achievementdomains. 52Mentally Healthy Schools – New ZealandThe Mentally Healthy Schools (MHS) initiativewas developed by the Mental Health Foundationin 1997 and again takes a whole-schoolapproach to mental health promotion. Earlychallenges centred around de-stigmatising theterm „mental health‟. As part of this staff andstudents had a conversation around whatmental health meant to them and the kind ofassociations they had with it. After six years ofworking with schools, the Mental HealthFoundation of New Zealand put a set of51 http://ies.ed.gov/ncee/wwc/pdf/intervention_reports/WWC_Caring_School_042307.pdf52 http://ies.ed.gov/ncee/wwc/pdf/intervention_reports/WWC_Caring_School_042307.pdfguidelines together. 53 These guidelines includeactivities within the school and in the widercommunity to promote and support the mentalhealth status of all those associated with theschool. Such activities include, among others:meetings with cultural groups in the community,anti-bullying initiatives, parent support groups inthe community, open days, and publication of aschool magazine.Further information on what is taking placeinternationally can be found on the InternationalAlliance for Child and Adolescent Mental Healthand Schools (Intercamhs) website. 54 Intercamhsis an international alliance which aims topromote the mental health and well-being ofchildren and young people.Also, SHE Network is a network of NationalCoordinators from 43 countries in the EuropeanRegion, which focuses on school healthpromotion and is supported in its work by theWHO Regional Office for Europe, EuropeanCommission and the Council of Europe. 55Mental health among youngpeople in IrelandIn Ireland, it is estimated that 44% of peoplehave had a direct experience of mental healthproblems, 56 either personally or through familyand friends. Yet a report by the Health ServiceExecutive (HSE, 2007) shows that 60% ofpeople would not want their personal experienceof a mental health problem to be disclosed. 57Surveys of young people‟s well-being show thatmost young people experience positive mentalhealth. The Health Behaviour in School-agedChildren (HBSC) is a cross-national researchstudy conducted in collaboration with the WHORegional Office for Europe. One item on thesurvey asks students to rate how happy they are53 www.mentalhealth.org.nz/file/downloads/pdf/file_250.pdf54 http://www.intercamhs.org/html/resources.htm55 http://www.schoolsforhealth.eu/index.cfm?act=tekst.tonen&tid=656 http://www.mentalhealthreform.ie/home/mentalhealth-in-ireland/57 http://www.healthpromotion.ie/hpfiles/docs/HSP00612.pdf12

with their lives at present. The 2006 report foundthat 92% of boys and 89% of girls felt very orquite happy with their lives. 58 In contrast, almosttwo in three young people in Ireland are „unableto cope with the problems they face‟ accordingto a Headstrong report (2009). 59The report on the outcome of a consultation withteenagers on mental health, What helps andwhat Hurts, conducted by the Office of theMinister for Children and Youth Affairs (OMCYA)was published in June 2009. The study foundthat pressure to „look a certain way‟ and exampressures were two of the most important „hurt‟factors. Among „what helps‟ was having a „safespace‟ to spend time with friends and family andto develop a positive self-image.Irish policy towards mental health promotionArticle 24(2) of the UN Convention on the Rightsof the Child requires States to ensure that allquarters of society have access to educationabout „basic knowledge of child health.‟The importance of mental health promotion inboth children and adults is mentioned in severalIrish policy documents. The Report of theNational Task Force on Suicide (1998) identifiesthe need for programmes to increase theawareness of mental illness in Irish society. TheNational Health Promotion Strategy (2000-2005)includes, as a strategic aim, the promotion ofpositive mental health through identifyingmodels of best practice.In 2005 the Government published a nationalstrategy for action on suicide prevention, whichidentified strategies to deal with mental healthdifficulties among young people. The report wasentitled Reach Out and recommended thatschools be used to promote positive mentalhealth.58 http://www.nuigalway.ie/hbsc/documents/hbsc_2006_english_version.pdf59http://www.headstrong.ie/content/almost-two-threeyoung-people-ireland-%E2%80%9Cunable-copeproblems-they-face%E2%80%9D-surveyIn 2006 the UN Committee on the Rights of theChild concluded that Ireland‟s programmes andservices for child mental health were inadequateand pointed to the stigma surrounding mentalhealth problems in this country. The UNCommittee therefore recommended that theGovernment undertake awareness raisinginitiatives in order to de-stigmatise mentalillness. 60Recommendation 10.5 in A Vision for Changestates: 61“For those children in school settings it isrecommended that the SPHE be extended toinclude the senior cycle and that evidencebasedmental health promotion programmesbe implemented in primary and secondaryschools.”Since the publication of A Vision for ChangeSPHE does take place in the senior cycle.In 2010 the National Office for SuicidePrevention (NOSP) held a forum, the theme ofwhich was „Promoting Positive Mental Healthand Reducing Stigma‟. 62 Currently the NOSP isinvolved in an interdepartmental group(education, health, HSE) examining bestpractice in mental health promotion in schools.The NOSP coordinates the development of anddissemination of information resources throughwww.healthpromotion.ieThe Health Promotion Unit at the Department ofHealth & Children has provided funding forspecific research initiatives, led by the Centre forHealth Promotion Studies at the NationalUniversity of Ireland (NUI). Work at the unit hasincluded:• The development and implementation of theMind Out positive mental health promotionprogramme,60 Amnesty International Ireland.(2009).Children‟sMental Health Coalition Background Paper.Accessed at http://www.childrensmentalhealth.ie/wp-content/uploads/2011/02/CMHC-Briefing-Paper-Oct-2009.pdf61 http://www.dohc.ie/publications/vision_for_change.html62 http://www.nosp.ie/annual_report_2010.pdf13

• Funding of research for the development ofa regional evidence-based mental healthstrategy for the North West region; and• Grant aid for a global review of theeffectiveness of mental promotion by theInternational Union for Health Promotion andEducation (IUHPE).Examples of mental healthpromotion in Irish schoolsThis section looks at the existence of mentalhealth promotion programmes in Ireland, takingplace within the school system. It should benotes that the programmes in this section are inaddition to other supports which are common tomost schools, such as: guidance counsellors,SPHE, and the National EducationalPsychological Service (NEPS).Zippy‟s Friends is based around a set of sixillustrated stories about a group of children, theirfamilies, friends and an imaginary stick insectcalled Zippy. It usually runs for 24 weeks, withone 45-minute session each week.Theprogramme has been implemented in over 16countries. A recent evaluation by Clarke andBarry (2010) found that the programme wasadapted to Irish schools without any problemsand integrated well within the SPHE curriculum.In addition the programme had positive effectson children‟s emotional literacy, and improvedteachers‟ relationships with children. 64Teachers made a number of recommendationsas to how Zippy‟s Friends could be improved.The most common recommendation was that awhole-school approach should be taken.Teachers reported that the biggest difficulty theyencountered in implementing the programmewas finding the time to do it.Jigsaw Meath project (age 12-15 years)The Jigsaw Meath project is a whole-schoolapproach to mental health which is being pilotedin Navan: (Beaufort College in Navan, St.Oliver‟s Post Primary in Oldcastle, St Peter‟sCollege Donboyne and Athboy communityCollege) and one Youthreach centre in Laytown.The Jigsaw Meath project is part of a nationalnetwork of Jigsaw projects and is aimed atyoung people. The programme is an initiative ofthe non-profit group Headstrong and works inpartnership with communities. A maincomponent of the Jigsaw process is gettingyoung people involved in their communities. 63Zippy’s Friends (age 5-9 years)In 2007 a joint partnership was set up betweenthe HSE and the Department of Education andScience to implement Zippy‟s Friends. It wasplanned to pilot the programme as part of theSocial, Personal and Health Education (SPHE)curriculum with children in first class. The pilottook place in 30 designated disadvantaged(DEIS) schools in the west of Ireland. The 24week programme took place over two schoolyears.MindOutMindOut is a programme developed by HealthPromotion HSE West and NUI Galway whichtakes place in secondary schools.The programme was developed in consultationwith students, teachers, and health promotionpractitioners. MindOut is a twelve sessionmental health programme. The MindOut projectis aimed at 15 to 18 year olds in the Irish schoolsetting. The project includes schools from bothIreland and Northern Ireland.The aims of the programme materials that havebeen developed are to:• identify a range of coping strategiesavailable to young people in stressfulsituations;• identify rational thinking skills for use incontrolling negative emotions;• raise awareness of feelings and how to dealwith them positively;63 http://www.jigsaw.ie/page/promoting-mental-health64 Clarke, A.M. and Barry, M. (2010). An evaluation ofthe Zippy‟s Friends emotional wellbeing programmefor primary schools in Ireland.14

These echo challenges found in other studiessuch as: getting stakeholders involved,differences in school ethos, absenteeism withinthe programme, and creating partnerships withparents, community groups and healthagencies. To help create these partnershipssome schools have recruited a core team to actas the link with the wider community. 72 Anotheridentified problem is inconsistency in followingthe guidelines of each programme.ConclusionStudies show that mental health promotion ismost effective when it takes place early in aperson‟s life. The school setting may be a goodchoice for such programmes to take place, asthis is where young people spend much of theirtime. Research indicates that the whole-schoolapproach is the most effective way of targetingmental health promotion. This approach seeksto change the ethos of the school and to makemental health a priority in education. In order forthe whole-school approach to work, partnershipsmust to be formed between students, teachersand the wider community.Considering the current pressures on theeducation system and the pressure to achievegood academic results, implementing the wholeschoolapproach across schools in Ireland, andincreasing the level of mental health promotioncurrently on offer, would be challenging.Nevertheless, evidence would support the viewthat mental well-being is positively related tostudent performance, so there is a strongargument for putting it at the centre of the schoolethos.In addition to the school setting, there is arecognised need to protect and improve wellbeingacross all age groups in society. This hasbeen identified by the WHO, the OECD and theEuropean Commission among others. All ofthese organisations are currently involved inmeasuring well-being and mental health. Acrucial part of this is the development ofindicators, which is on-going. Such work issupported by evidence which suggests thatinvestment in positive mental health can result,not only in improved quality of life to theindividual, but in significant economic and socialreturns.The biggest challenges facing mental healthpromotion programmes are funding, timetablingand „buy-in‟ (the active participation ofstakeholders). Where the whole-schoolapproach is properly implemented, there isevidence to show that students benefit in arange of ways such as improved coping skills,behaviour and learning outcomes.While researchers argue that mental healthprogrammes are most effective in childrenbetween the age of 2-7, many of theprogrammes available around the worldapproach and target older children, often over11 years of age. In addition, while studiesindicate that the whole-school approach is themost effective means of delivering mental healthpromotions many of the programmes on offer inIreland and elsewhere are curriculum based,rather than whole-school.72 Power, M., Cleary, D., Fitzpatrick, C. (2008).Mental Health Promotion in Irish Schools: A SelectiveReview. Accessed on 24 th February 2012 athttp://www.schoolmentalhealth.co.uk/nasp/power.pdf16