By Dusana Dorjee
Schools are often where children’s and adolescents’ mental health problems are identified. While there is ever growing demand for mental health support for pupils, such as in-school counselling and mentoring, the focus now – just like for any health problem – should be more on prevention than intervention.
Prevention makes sense financially, given that specialist mental health services for children and adolescents are currently overloaded, with long waiting lists. More importantly, helping young people develop traits, skills and strategies to protect their mental health can have a lifelong positive impact. And if mental health skills are broadly taught in schools and applied by pupils in a supportive learning context (and where possible also involve family, and are put into practice outside school) the health improvements could, in time, benefit the whole population.
In short, mental health prevention in schools makes a lot of sense. But according to a recent report, it is largely insufficient in UK schools. This is despite well-being being high on education policy agendas.
There seems to be an imbalance between learning about physical health and mental well-being. Most children are taught about the importance of things like exercise, a healthy diet and the risks of smoking in school. But they rarely learn about the impact of stress on their body, symptoms of anxiety and depression, or healthy mental habits. They are not taught how to prevent anxiety and excessive negative stress, or how to work with these experiences if they arise.
So how could schools effectively contribute to mental health prevention? To answer this question, we first need to be clear on what mental health prevention should focus on. In recent years, “resilience” has been frequently emphasised as central to mental health. But there are disagreements about what resilience means and how to measure it.
Definitions often place resilience in terms of positive responses to adversity. However, both resilience and well-being are strongly impacted by two core determinants of mental health – determinants of mental health which schools should be focusing on first for problem prevention.
The first determinant, “metacognitive self-regulation”, is linked to reflective self-control – the ability to notice what is happening in our mind and body, and effectively manage our attention and emotions. This means, for example, that a pupil might notice they have repeated anxious thoughts about an upcoming exam. Or that they often get a tummy ache when they have to speak in front of the class. Noticing these initial signs can prompt the pupil to apply some strategies to reduce the anxious thoughts or stress. They may disengage their attention from repetitive thoughts, or apply techniques that help them feel less anxious. In this way, the pupil can prevent the early signs of mental health difficulties that they are experiencing from escalating into overwhelming clinical health problems.
The second determinant of mental health is a sense of meaning and purpose in life. Research shows that adolescents who have a better sense of meaning and purpose are less likely to suffer from depression.
The sense of purpose arises in various forms. It could be a career one is working towards or a motivation to be really good at something, for instance. But when it goes beyond mere self focus, this sense can have particularly protective effects on mental health. Instead of solely focusing on “my achievements” or “my career”, one can find deeper meaning and purpose in connecting with something bigger. This can be a connection with nature, religion, spiritual self-exploration or a contribution towards a larger positive cause.
Importantly, strengthening metacognitive self-regulation and having a positive sense of meaning/purpose in life is not only central to well-being but can also enhance academic performance. For example, chronically increased levels of stress associated with unhealthy sleep patterns and excessive anxiety can interfere with learning and negatively impact on exam performance. So self-regulating effectively will have a ripple effect on academic achievement. Similarly, having a clear purpose, such as wanting to make a positive difference or compassionately care for others, can strongly motivate a pupil’s learning.
For children to develop their own metacognitive self-regulation and a sense of purpose and meaning, schools need to teach the relevant skills from early years until pupils finish education. Brief programmes in which children learn a few strategies are unlikely to have longer-term impact. A variety of approaches should be integrated into this, too, including attention training, mindfulness, and stress education. As well as basic cognitive-behavioural therapy strategies and relaxation techniques, there should be development of healthy qualities of mind such as compassion and gratitude, and reflective exploration of purpose and meaning of life including its spiritual dimensions.
Teaching such a curriculum will require somewhat radical changes to teacher education, however. It will also mean greater emphasis on teacher well-being – chronically stressed teachers who are unwell themselves are unlikely to be able to effectively deliver such lessons. Policy guidelines and school curricula will need changing, too.
It may seem like a lot to ask from an education system which is greatly stretched as is, but it might be the best investment we can make as a society.