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A Framework for Promoting Mental Health in School

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A Framework for Promoting Mental Health in School
GARRY HORNBY, University of Hull
MARY ATKINSON, National Foundation for Educational Research
Schools have an important role to play in the
promotion of children’s mental health, as well
as in the identification and treatment of
children with mental health problems. This
article proposes a framework for a whole
school approach to mental health. The
framework focuses on four levels of involve-
ment. The most general level is concerned
with school ethos, which encompasses the
values shared by all staff and pupils. The next
level is whole-school organization, which
comprises a range of school policies. Then
there is pastoral provision, which concerns
procedures in place throughout the school.
The final level is classroom practice, which
involves the practical strategies used by
teachers. A model is presented in order to
illustrate visually the four levels in the
framework for the promotion of mental health
in schools. It is intended that the model will
provide schools with a useful framework with
which to review their provisions for children
with mental health problems and consider the
issue of mental health promotion.
Why Focus On Mental Health?
Increasing numbers of children are experiencing
mental health problems. A leading authority on mental
health in children in the UK has estimated that, in the
average secondary school of around a thousand pupils,
at any one time, there will be fifty students who are
clinically depressed, a further hundred with significant
emotional difficulties, ten affected by eating disorders
and up to ten who will attempt suicide in the next year
(Mind, 1997). Despite these factors, children’s mental
health has so far been paid insufficient attention in
schools; yet teachers are uniquely placed to influence
the mental health of children and young people
(YoungMinds, 1996). As well as being in a position
to ensure that mental health difficulties are quickly
recognized and treated, they can enhance the social
and emotional development of all children by creating
a climate that promotes their mental well-being.
PASTORAL CARE – JUNE 2003
r NAPCE 2003. Published by Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden MA 02148, USA.
According to the Mental Health Foundation (1999),
schools have ‘a critical role to play’ in these aspects of
mental health. Although some teachers may consider
that meeting the mental health needs of children does
not fall within their remit, unmet emotional needs
inevitably impact on children’s learning and, according
to the DfES (2001a, p. 7), ‘promoting children’s mental
health within schools has important educational pay-
offs’. Many mainstream teachers, however, lack the
necessary knowledge, understanding and skills for
fulfilling this role. It is with this in mind that the
authors have written a Mental Health Handbook for
Schools (Atkinson and Hornby, 2002). This handbook
provides detailed accounts of the childhood and
adolescent mental health problems which teachers
are likely to encounter. For each disorder strategies are
presented which teachers can employ by way of
prevention and early identification, as well as inter-
vention for pupils recognized as having mental health
problems. This is set within a framework for a whole-
school approach to the promotion of mental health in
schools, the delineation of which is the focus of this
article.
A Whole-School Approach to the Promotion of
Mental Health
The DfES (2001a) has recently advocated that schools
become mental health promoting organizations.
Schools provide an ideal setting for the promotion of
mental well-being, not only because children spend so
much time there, but also because they are the primary
setting for the development of relationships with peers
and adults (Dickinson, 1999). Also, schools allow
regular access to all children, which means that
preventative strategies can be adopted that avoid
stigmatizing those who are vulnerable to mental health
problems (DfES, 2001a). The DfES and the Mental
Health Foundation (1999) advocate that schools should
promote children’s mental well-being by having the
key characteristics of:
! a committed senior management team that focuses
on creating a climate based on trust, integrity,
democracy and equality of opportunity, within
which each child is valued regardless of ability;
! a culture that values teachers, non-teaching staff and
all those involved in the care and supervision of
pupils;
3
Figure 1. Framework for Promoting Mental Health in Schools (taken from Atkinson and Hornby (2002, p. 264), Routledge,
with permission).
! whole-school policies for important issues, such as
behaviour management and bullying, that are clearly
set out and accepted and implemented throughout
the school.
These three characteristics should be key components
of a whole-school approach to the promotion of
positive mental health, the various elements of which
are outlined in the model presented in Figure 1. This
sets out a framework which provides guidance on the
development of procedures for identification, preven-
tion and intervention for mental health issues in
schools. At the same time, it is important to recognize
the initiatives already being undertaken by some
schools to promote pupils’ mental well-being and to
realize that much of this work can be achieved through
existing policies and practices (Dickinson, 1999). Many
schools, for example, are implementing the National
Healthy School Standard (DfES, 2001b) which offers
schools an ideal opportunity to address health issues in
a whole-school way and to focus on the emotional
health and well-being of its pupils, as well as other
aspects of health.
Within the model for mental health promotion there
are four levels which are:
! school ethos: which encompasses the values shared
by all staff and pupils;
! whole-school organization: which comprises a range of
school policies;
! pastoral provision: which concerns procedures in
place throughout the school;
! classroom practice: which involves the practical strat-
egies used by teachers.
The various aspects which comprise each of the
four levels are discussed below and examples of
4 r NAPCE 2003.
questions are provided to help schools audit their
provision.
School Ethos
To be effective the value of mental health promotion
needs to be recognized and established as an integral
component of the way that the school functions
(Dickinson, 1999). The aim is to develop an ethos
such that everyone involved with the school – pupils,
teachers and parents – has a role and responsibility to
promote mental health. Mental health promotion
should be the business of all teachers, who need to
be conscious of their own emotional needs as well as
being supportive of those of others. With a positive,
caring ethos in place the school can create a safer and
more productive learning environment and one that is
more facilitative and therapeutic for pupils, thereby
preventing the development of mental health
problems. This might encompass the following
aspects:
Caring for all
It is important for their mental well-being that all
children are valued (Young Minds, 1996) and that
children with emotional problems are seen as ‘needy’,
rather than ‘difficult’ (Parsons, 1999).
! To what extent does the school communicate to all
its pupils that they are valuable?
! Are children encouraged to care for each other?
! Are children with emotional or behavioural difficul-
ties perceived to be in need of help rather than
problems to be got rid?
PASTORAL CARE – JUNE 2003
Valuing diversity
A key aspect of the school ethos is the extent to which
the diversity of pupils is valued (Weare, 2000). A
history of victimization can lead to the development of
mental health problems (Resnick, Harris and Blum,
1993).
! Are all pupils valued and treated equally?
! Do teachers communicate positive attitudes about
children with mental health problems?
Building self-esteem
A low sense of self-worth is a common risk factor for
mental health problems so the development of a
positive self-esteem is important for the health of all
children (Rutter, Giller and Hagell, 1998).
! Does the school environment encourage a positive
self-esteem and help build pupils’ confidence?
! To what extent do teachers enhance a sense of self-
worth in their pupils?
! Do teachers focus on pupils’ strengths and assets
rather than their weaknesses?
Relationships
Children’s confidence and ability thrive, even in
adverse circumstances, if they come into contact with
adults who they can trust and who offer them a
positive relationship (Dickinson, 1999).
! Do teachers convey caring, understanding and
respect?
! Are they prepared to listen and able to establish
safety and trust for pupils?
! Are cooperative relationships amongst pupils en-
couraged?
Safety
It is important that children feel emotionally as well as
physically safe in the school setting. Aggressive
behaviour can make children feel threatened and
cause them to withdraw (Peterson and Skiba, 2000).
! Do teachers convey high expectations of behaviour,
along with firm guidance and structure?
! Does the school management recognize and actively
work to reduce stress?
Continuity
A sense of consistency is required for children to feel
secure in the school setting. Having well thought out
and well-established procedures for providing pastoral
care can facilitate this (YoungMinds, 1996).
! Do Heads of Year move up through the school with
their cohort of pupils?
! Do teachers employ sanctions fairly and consis-
tently?
PASTORAL CARE – JUNE 2003
Participation
Pupils need to be encouraged to participate fully in the
life of the school to promote their social development
and prevent isolation. This is facilitated when pupils
and parents are consulted about issues concerning the
school (Weare, 2000).
! Does the school provide opportunities for mean-
ingful participation and contribution?
! Does the school foster a sense of community and
active involvement in school processes?
! Does the school openly challenge any form of social
exclusion and exploitation?
Fostering independence
Research shows that mental well-being is promoted
and learning more effective when pupils are encour-
aged to think for themselves and allowed to be
independent (Weare, 2000).
! Does the school provide opportunities for pupils to
take responsibility and make decisions?
! Does the school encourage the development of self-
management skills?
Whole-School Organization
The second level of the framework, whole-school
organization, involves getting mental health onto the
agenda of the school so that it is taken into account
when considering policies and the way that the school
functions (Dickinson, 1999). It focuses on the need to
develop clear policies in key areas of school function-
ing, including, for example, pastoral care, the curricu-
lum, pupils with special educational needs (SEN),
home–school liaison, behaviour management and
bullying (DfES, 2001a). These aspects of school
organization are particularly important in promoting
mental well-being and dealing effectively with chil-
dren’s mental health problems.
Pastoral care
Effective pastoral care is essential for the prevention of
mental health problems and for early intervention with
children who develop such problems. Schools there-
fore need to have a comprehensive policy and well-
established procedures for delivering it (Calvert and
Henderson, 1998).
! Are staff aware of their responsibility for the
promotion of mental health and prevention of
problems?
! Are there policies and procedures for mental health
promotion and for addressing mental health issues?
Curriculum
Aspects of the school curriculum can be used to
promote mental health (DFES, 2001a). It is important
r NAPCE 2003. 5
that the curriculum strikes a balance between academic
content and a strong focus on personal, social and
moral development in order to facilitate the develop-
ment of positive mental health in pupils (Best, 2000).
! Does the school curriculum focus sufficiently on
personal and social development?
! Does it directly address the promotion of mental
health, the prevention of mental health problems?
! Does it help pupils to learn of strategies for coping
with such problems?
Special educational needs
Children with SEN are at greater risk of developing
mental health problems than other pupils and early
intervention with learning difficulties can prevent
associated mental health problems. Schools should
have a comprehensive policy based on the require-
ments of the Code of Practice for SEN (DfES, 2001c).
! Does the policy include procedures for early
identification and assessment of children with SEN?
! Does the policy include procedures for designing
and reviewing individual education plans?
! Does the policy encourage collaboration with
parents and outside specialists?
Home–school liaison
Parental attitudes and good parent–child relations are
key factors in children’s mental well-being, as well as
their education, and are influential in the prevention of
mental health problems (Resnick et al., 1993). Links
with home are important in understanding children’s
behaviour, as well as providing opportunities to
establish mutual goals and to develop strategies that
can be implemented both within the home and the
school setting (Hornby, 2000). Many parents with
children who have mental health problems feel that
they are left to cope alone, so the school can often play
a vital support role.
! Does the school have a policy that encourages and
facilitates parental involvement?
! Do teachers convey messages to parents that
support the mental health of young people, such
as listening to children and setting clear boundaries?
Behaviour management
Mental health difficulties may manifest themselves in
the form of challenging behaviour that is difficult to
deal with in the school setting. Whilst children may
require individual treatment, effort also needs to be put
into improving behaviour management within the
school (Cooper, Smith and Upton, 1994).
! Does the school have a behaviour policy that is
known to all school staff, pupils and parents?
! Is the policy agreed to, and adopted, by all staff and
understood by all pupils?
6 r NAPCE 2003.
! Does it focus on encouraging positive behaviour, as
well as sanctions, and setting clear boundaries?
Bullying
A history of victimization and the witnessing of
violence are both risk factors for the development of
mental health problems (Resnick et al., 1993) and
bullying can lead to more serious mental health
difficulties. In addressing the emotional health and
well-being of its pupils, therefore, as the National
Healthy School Standard (DfES, 2001b) and others
(e.g. Jenner and Greetham, 1995 and Smith, 2000)
indicate, schools should have a clear policy and code of
practice for dealing with bullying and should focus on
the development of positive relationships among
pupils (Peterson and Skiba, 2000).
! Are all teachers and non-teaching staff aware of the
policy and procedures in place for dealing with
bullying incidents when they are encountered?
! Do the procedures ensure that incidents are dealt
with quickly, consistently and effectively?
! Does the policy encourage all teachers to take
responsibility for bullying?
! Are there clear rules and appropriate sanctions, as
well as having systems in place to support victims?
! Do teachers focus on promoting cooperation and
non-violent resolution of conflict amongst pupils?
Pastoral Provision
The third level of the framework focuses on the need to
develop effective provision of pastoral care within
schools as a requirement for promoting mental health
and supporting pupils with mental health problems.
This involves having in place programmes for preven-
tion of mental health problems, procedures for
identification of disorders and strategies for interven-
tion to remediate the various problems likely to be
encountered in schools. This requires schools to have a
clear policy and a comprehensive set of procedures for
addressing mental health issues. Effective support can
be an important means of reducing distress, isolation
and helplessness for students who are attempting to
cope with some form of problem. This involves having
the following elements in place:
Pastoral system
The way that the pastoral system is set up is important
in helping pupils to settle into the school environment,
providing vulnerable pupils with a sense of security
and in helping them to address any difficulties they
may encounter. The National Healthy School Standard
(DfES, 2001b) advocates that a healthy school needs to
ensure that, when pupils are unhappy, anxious,
disturbed or depressed, there are open channels for
them to seek or be offered support, without stigma and
with appropriate confidentiality.
PASTORAL CARE – JUNE 2003
! Is there an effective pastoral system in place and are
all teachers aware of their pastoral responsibilities?
! Are pastoral support plans (DfEE, 1999) used in a
positive way to support pupils in school?
! Is the pastoral system seen as supportive rather than
disciplinarian in nature?
Early intervention
Schools need to be able to identify problems early so
that more serious mental health problems can be
averted. Raising the awareness of teachers to potential
problem situations is therefore important (Atkinson
and Hornby, 2002). The SEN Code of Practice (DfES,
2001c) provides a framework for identification, assess-
ment and provision of support for pupils at different
stages.
! Are children screened at an early age for social and
emotional difficulties?
! Are learning difficulties picked up early so as to
prevent secondary mental health problems?
Support for vulnerable pupils
Personal counselling is a fundamental part of effective
pastoral care that can help prevent more serious
mental health problems from developing (Beynon
and Wright, 1997). As part of the pastoral system,
therefore, pastoral staff, such as heads of year and form
tutors, need to be able to use counselling skills to help
pupils with day-to-day problems (Hamblin, 1993). A
trained specialist within the school, who can offer more
in-depth counselling on an individual or small group
basis when required is also helpful. In addition, it is
important to recognize that children may be particu-
larly vulnerable at certain periods of their life or
particular stages in their education and may require
extra support at this time.
! Does the pastoral team use counselling skills
effectively to support pupils with personal
problems?
! Are pupils supported through potentially difficult
periods, such as the transition to secondary
school?
! Is there a trained specialist in the school who can
support pupils with more serious problems?
Organization of PSE
By having a comprehensive personal and social
education programme, which focuses on social and
emotional development, schools can have a positive
influence on their pupils’ mental well-being. This
involves addressing the issue of mental health through
the process, as well as the content, of PSE so as to
enhance pupils’ social skills, coping strategies and
emotional literacy. The National Healthy School
Standard (DfES, 2001b) stresses that a healthy school
programme recognizes that personal, social and health
issues in all facets of school life are interlinked and this
PASTORAL CARE – JUNE 2003
can provide a useful framework through which schools
can focus on such issues.
! Are all teachers involved in delivering PSE?
! Do they all have the necessary skills for effective
teaching of PSE, e.g. for group work?
! Do tutors use counselling skills effectively to
facilitate group activities as part of the PSE
programme?
! Is the issue of mental well-being infused into all
subjects across the curriculum, as well as being
included in the tutorial work programme?
Support and training for teachers
It is unrealistic to expect teachers to be able to achieve
their role in preventing mental health problems alone.
It is important that they have some knowledge and
understanding of the types of difficulties they may
encounter (DfES, 2001a) and receive adequate training.
Working with emotionally disturbed children can be
particularly stressful and challenging as it can involve
high levels of emotion. This can lead to debilitating
levels of stress, so it is important that they are given
supervision and support.
! Do pastoral staff have the relevant training to help
them recognize mental health problems and enable
them to offer support and counselling?
! Do teachers have a good understanding of mental
health problems and know when to refer on?
! Are teachers supported in pastoral work through
supervision, training, and links with external agen-
cies?
Liaison with external agencies
Teachers often have limited training, time and re-
sources with which to deal with pupils’ mental health
difficulties, or to provide effective counselling for
distressed students or their parents (Branwhite, 1994).
For this reason, in many cases, teachers may need to
refer pupils and their parents to other agencies, such as
the Educational Psychology Service or Child and
Adolescent Mental Health Services (CAMHS). These
services can also offer teachers support and training.
! Are students directed to other forms of appropriate
help outside the school, such as CAMHS?
! Are pupils in need referred efficiently and effectively
to external agencies for specialist help?
! Are there effective links with the local CAMHS team
so that teachers can receive consultation, training
and support with mental health issues?
Classroom Practice
The fourth level of the framework focuses on the need
to develop effective classroom practice for promoting
the development of children’s mental health. This
practice needs to be based on a thorough under-
r NAPCE 2003. 7
standing of children’s development and the mental
health problems to which they may be susceptible.
Classroom practices for the promotion of mental
health focus on the following areas:
Facilitative teaching
A key factor in promoting children’s mental health in
schools is the rapport which teachers develop with
their pupils and the way that they use their skills to
facilitate cooperative relationships amongst pupils.
Strategies, such as peer tutoring (Topping, 1995) and
cooperative learning (Johnson and Johnson, 1999), can
be used to encourage pupils to help one another.
! Are teachers approachable and do they develop
constructive relationships with their pupils?
! Do teachers motivate pupils through the use of
encouragement and rewards?
! Are teachers fair and consistent in their enforcement
of sanctions and in setting behavioural limits?
! Do teachers foster cooperation among their pupils?
Personal and social education
Teachers have an important role to play in the personal
and social education of their pupils, in teaching them
to become emotionally literate (Goleman, 1998; Sharp,
2000), as well as preventing emotions being built up
with the potential for later problems. The National
Healthy School Standard (DfES, 2001b) states that
pupils should be encouraged to express and under-
stand their feelings and that issues of emotional health
and well-being should be addressed openly. This can
be achieved through the use of Circle Time (DfEE,
1999; Lang, 1998; Mosely, 1996) and other approaches,
such as nurture groups (DfEE, 1999), peer support
(Cowie and Wallace, 2000) and personal development
programmes (Bell, 1998).
! Do teachers provide their pupils with opportunities
to talk about their feelings?
! Are such opportunities structured into the school
day?
! Are there strategies in place for developing pupils’
self-confidence and promoting their social skills?
Guidance
Guidance involves helping students make personal,
educational or vocational choices. At classroom level
this involves the provision of information by classroom
teachers as part of a wide range of subjects in the
curriculum in order to provide pupils with the know-
ledge to make such choices (Hornby, Hall and Hall,
2002).
! Is this form of guidance infused throughout the
curriculum?
! Do all teachers actively support pupils on a day-to-
day basis with these types of decisions?
8 r NAPCE 2003.
Counselling
Whilst all teachers cannot be expected to be trained
counsellors, they can be trained to use counselling
skills (Lane, 1996; Lloyd, 1999). A key aspect of
counselling for classroom teachers is the use of active
listening (Hornby, 1994) which, it has been suggested,
is the single best way to help those with emotional
difficulties (Weare, 2000).
! Are teachers trained to use counselling skills to
advantage both inside and outside of the classroom?
! Do teachers use counselling skills effectively within
the classroom in order to provide a positive learning
environment and promote high levels of pupil self-
esteem?
Conclusion
Schools have a vital role to play in the promotion of
children’s mental well-being and the prevention of
mental health problems. Teachers need to be aware
of the importance of fulfilling their roles in providing a
whole-school approach to mental health. They also
need to understand the influence of factors at each of
the four levels involved: school ethos; whole-school
organization; pastoral provision; and, classroom prac-
tice. Schools need to address the various aspects of the
model at each of the four levels described in this article.
It is also important for all teachers to be able to identify
the different mental health problems and disorders
they may encounter and to be able to implement
effective strategies for dealing with them. Further
information on children’s mental health problems
and what teachers can do to help can be found in
the Mental Health Handbook for Schools (Atkinson and
Hornby, 2002).
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