Defining mental health education
What do we mean by mental health education? At the moment, according to Ian MacDonald – a mental health trainer with the Charlie Waller Memorial Trust – there seems to be a general push that any sort of “awareness” or “education” will bring about improvements in mental health. This is a simplistic notion that does not explain what anyone hopes to achieve or, just as importantly, how.
He also points out the need to be circumspect in the face of easy media headlines about mental health “crises” in the young population. That is not to say that problems do not exist, but a more nuanced approach is needed.
Against this background, the government is making health education universal for pupils of all ages from September 2020 (DfE, 2019). Primary school children will learn that mental wellbeing is a normal part of daily life and why simple self-care – like getting enough sleep and staying active – is important.
The new secondary content will build on this, ensuring that pupils can spot the signs of common mental illnesses in themselves or others, and that they know how to discuss their emotions accurately and sensitively.
PSHE as a subject was considered by Ofsted in 2013 as “not yet good enough”. What we can learn from that? Ian continued: “It’s important to acknowledge that schools ‘don’t know what they don’t know’. Health education hasn’t been part of teacher training and there have been huge discrepancies around the quality of support and CPD offered to staff. Evidence-based CPD and access to up-to-date best practice is going to be really important.”
Ian believes that a lot of support can be gained from local mental health networks, such as the one set up by the London Borough of Bromley, which is pulling together local school mental health leads to identify best practice and disseminate information.
Evidence-based approaches
Ian believes that a lack of a coherent strategy around PSHE and health education has made it difficult to obtain a robust evidence-base on what produces the most effective outcomes in terms of delivery. The disparity in how schools have viewed and treated the subject has led to a postcode lottery around the quality of health education, too.
However, Ian said that there are correlations between schools with outstanding Ofsted judgements and outstanding models of health education delivery. We also know the contribution that good wellbeing makes to academic achievement for young people.
Historically, there have been three broad categories of delivery that schools have adopted:
- Delivery via off-curriculum days or “drop days”, where schools dedicate just one or two days to the topic, delivering through a carousel model with each class receiving one lesson on a range of topics during the course of the day. Ian told me this model is widely considered the least effective and made the analogy with PE teaching: “One or two sports days in isolation per year would not make a PE curriculum, so why should we use this model for PSHE?”
- Delivery through weekly tutor time, where pupils have contact with their nominated tutor. This is often seen as an easy way to slot the topic into a regular curriculum-style model, but the flip side is that other whole-school issues may take precedence. It also requires all tutors to be confident and competent in delivering the lesson content.
- Delivery via dedicated curriculum time using teams of specialist teachers. This is recognised as the most effective and desirable model of delivery. It makes planning easier and more collaborative, and results in improved satisfaction and outcomes for teachers and pupils alike.
At the moment, much of what is delivered is purely information, but the evidence points to the need to develop what Ian refers to as “life-skills”.
He said: “Rather than talking about what makes them anxious, young people should be learning healthy ways of coping, and planning and negotiation skills that they can use in everyday life.”
Delivery of mental health education
A particularly important point around delivery is the choice of imagery and language, as Ian explained: “We still see regular links being made between mental illness and serious crime; and regular use of the so-called ‘head-clutcher’ stock photo alongside mental health stories. These represent a very negative image of mental health issues rooted in despair, hopelessness, struggle and suffering.”
However, positive work is also being done to challenge stigma, for example through the Time to Change campaign.
In the same vein, we need to consider how we talk about conditions and emotions. Suggesting that someone is “suffering” from depression tends to pathologise what they are feeling and risks conditioning pupils into thinking that these things are to be avoided. Talking about “experiencing” feelings like anxiety makes it easier to explore what has caused those feelings. As Ian explained: “This simple shift in thinking can have an impact on whole school approaches to wellbeing. It helps us normalise rather than medicalise elements of everyday life.”
Fellow Charlie Waller Memorial Trust mental health trainer Dr Andrew Reeves made a useful comparison about how wellbeing can be overlooked in the discussion about mental health: “Mental health is typically framed in the negative. This can result in fewer opportunities for students, and staff, to contextualise it as something that is relevant for everyone in all situations. It is akin to a physical health education programme that only focusses on disease and diagnosis, and overlooks the importance of physical wellbeing.”
How we talk about mental health
Mike Armiger is an educator, advisor and coach in education and mental health who features in Ian’s recent book Teen Substance Use, Mental Health and Body Language (2019). He supports schools in developing appropriate responses to mental distress in children and young people. These are his top tips for talking about mental health:
- Encourage curiosity around emotions. Too often we ask children to pick an emotion so we can move on and we hope that it will help them rationalise and process. We do not feel emotions singularly so when you ask a child how they are feeling, if they come back with an emotion, ask them “what else?”. This way they get used to articulating a few. If they cannot articulate it there and then, ask them to come back in a few days and let you know if they can.
- Words matter. When you ask people what they think when you say the words “mental health”, they come back with “depression”, “anxiety”, etc. Humanising the language around mental health is important and reminds everyone that we are all human and have a brain – use terms like “low mood”, “overwhelm” and “distress”. It also encourages staff in their conversations with pupils, instead of feeling fear when they hear the term “mental health”.
- Suicide is one of those things we often do not talk about, mainly because it is a scary thought and also a complex subject. But if you are going to talk about it, please bear in mind:
- Use the word “hope”. A sense of the future and of hope is something we all need and often we feel it is missing.
- Talk about vulnerability. If we encouraged our students to talk about vulnerability, self-doubt, insecurities, we would discover many more barriers to learning and growth, around which we could provide support. Talking about vulnerability is uncomfortable but it is also full of truth and courage, and ultimately it is liberating to know that others feel the same way.
- Suicide was decriminalised in 1961 and referring to “committing suicide” means you are referring to a crime being committed. Let’s say “died by suicide”, “took their own life” or “made an attempt on their life”.
- Safety plans are a brilliant tool for anyone experiencing overwhelming distress. Essentially it is about planning for “what happens next time” and helping someone identify what they can do to stay safe.
Clare Stafford is the CEO of the Charlie Waller Memorial Trust. Visit www.cwmt.org.uk.
Further information & resources
- DfE: Relationships education, relationships and sex education (RSE) and health education, June 2019: http://bit.ly/2kQwtgL
- Ofsted: Not yet good enough: PSHE in schools, May 2013: http://bit.ly/2jb1jhp
- Macdonald: Teen Substance Use, Mental Health and Body Image: Practical strategies for support, Jessica Kingsley Publishers, 2019.
- PSHE Association: A curriculum for life: The case for statutory PSHE, 2017: http://bit.ly/31TyOZq
- Public Health England: Promoting children and young people’s health and emotional wellbeing, 2015: http://bit.ly/38tz6bL
- Time to Change: www.time-to-change.org.uk