Written evidence submitted by Dr Kristy Howells (CYP0014)

The following document focuses on in particular the right help in the right setting and the provision of mental health support in schools, including how individualised physical activity interventions within school to support mental health and wellbeing.  Also how whole class physical activity interventions within school to encourage wellbeing. It suggests that there is a need for more education and curriculum time to share the benefits of physical activity, sport and recreation to encourage wellbeing and mental health, as well as the need for more training within initial teacher education training and as continuous professional development.  This latter need was not in the Green Paper, and there is a need for this training to be addressed as teachers are the front line of support for children and young people. (Please note that the links to research are in the document as hyperlinks).

Provision of mental health support in schools

Individualised physical activity interventions within school to support mental health and wellbeing.

Children and young people can be supported with their mental health and wellbeing both in and outside school. Jonny’s story is an example of good practice of the impact of wellbeing through individualised physical activity interventions. The research focuses on one case study child who was tracked over a 5-month period to examine the extent of a physical activity intervention.  Jonny was a 10 year old who measured very low on the school wellbeing scale, his very low self-esteem had hindered his ability to make and develop relationships with adults and peers and was in the lowest ability set for numeracy and literacy. An athletics based intervention was implemented for 30 mins over 20 weeks for 5 months, (600 mins total), Jonny choose the activities of shot put and hammer throwing. His physical ability in the two throws developed, as well as dramatic increases in self-esteem, and a positive change in behaviour linked to specifically undertaking the physical activity intervention. He was able to develop relationships with his peers; he was invited to be part of sports teams for throwing activities e.g. cricket, rounders and rugby. He developed his speech and language communication skills, which enabled him to be confident enough to speak in assembly and became house sports captain. He also improved in both numeracy and literacy skills. In terms of wider reach and impact of the intervention, Jonny was selected for the county’s athletic team for both shot put and hammer and continues to be part of this sport team outside of school. It is acknowledge that this research is just one child, but the class teacher reported that they did not feel that Jonny’s increase in his participation levels would ever have happened had Jonny not been able to have the opportunity to participate in the physical activity interventions within the school setting.

Whole class physical activity interventions within school to encourage wellbeing.

The ‘Daily Mile’ has been used as a physical activity intervention to support whole class wellbeing (following the recommendation from the Childhood Obesity plan of action) for a whole class within primary schools to help promote and lead an active lifestyle. The challenges and successes of this physical activity intervention were investigated by asking the children’s and teachers’ voices. The researchers found that the principles of the ‘Daily Mile’ needed adjusting in some schools, as the principles suggest to make it manageable and successful in schools that it should happen at least 3 times a week and take just 15 mins. The children could not understand these principles their responses included - “why is it called the Daily Mile, if we don’t go daily and we don’t go a mile?” So adaptations therefore were made, including mapping out the mile distance so the children could achieve the title of the physical activity intervention to help support and encourage them to participate in sport. The children were keen to undertake the physical activity and within the research it was found that children wanted to know when they were going to do it within the school day and they wanted to know every day when they would undertake it and felt lost if they did not participate in this.  They also wanted to know how they were going to do it when they weren’t at school, for example during holiday time, as this caused them worry and the school and teachers set up family and community daily mile to ensure that children were able to continue their participation. The research also found that for some children and teachers, they did not know why they were doing it. They responded that ‘it was just part of the school policy’, the authors (Howells et al. 2019) recommended that there is a need for teachers to share more with their children (and for them to know themselves) the importance of such initiatives to ensure life-long and life wide wellbeing through physical activity inside and outside of school.

More education and curriculum time is needed to share the benefits of physical activity, sport and recreation to encourage wellbeing and mental health.

Physical activity has the power to be life changing; it has the potential to improve the mental health and wellbeing of children. Engaging in physical activity, including through sport, recreation, movement and physical education, can be a positive experience that can help increase confidence and self-esteem through regular participation, prevent mental health difficulties and improve the quality of life of individuals experiencing mental health issues. More education and more dedicated curriculum time are needed to ensure that children and young people understand and meet the recommended guidelines for daily physical activity to support positive mental health. The All Party Parliamentary Group on Fit and Healthy Childhood report on Mental Health through Movement in 2019 identified good practice and the importance of movement in a holistic way to improve and maintain positive physical, social and emotional health. Movement can help remove distress, help develop a positive sense of identify and positive wellbeing. Physical activities through sport and recreation both inside and outside of school, can also help improve sleep, especially for children, we found in our 2018 that movement through both physical education and physical activity could help aid children who were having sleep difficulties overall enabling children to lead active lifestyles. Bailey et al. (2018) in their international rapid review of physical activity and mental health of school aged children and adolescents found that “school based physical activity has an important role to play in protecting young children from mental illness, and has the potential to save lives through helping to reduce feelings of hopelessness, suicide and self harm. Social interactions and resilience are particular important and could be supported through a provision of appropriately devised physical activities, and especially team sports.  Physical activity is especially valuable for girls in combatting mild to moderate depressive symptoms.” (p.2).

Early intervention in children and young people’s mental health and training issues

Howells and Coppinger (2020) considered the wider implications of leading an active lifestyle and the importance of young children understanding and knowing how they can support their own mental health through ensuring children are fully hydrated.  There are links to the new part of the National Curriculum in England on Health Education, of which part of the curriculum is dedicated to physical health and fitness and understanding healthy lifestyles including physically active lifestyle. Drinking fluids is often the forgotten element of diet. Howells and Coppinger (2020) focused on teachers’ perceptions and understanding of children’s fluid intake as previously no public health data existed on elementary teachers’ perceptions of both their own fluid intake and of their elementary school aged children’s fluid intake. They found that the majority of teachers lacked active encouragement of drinking water throughout the school day for the children and also did not drink themselves enough. They recommended as a public health measure that all school children consume an extra cup of water during lunch times in those schools where water intake was recognized as sub optimal. Furthermore, depending on weather conditions, a cup of water before, during and after Physical Education lessons should be encouraged by teachers. Water coolers or bottles may be used as a supplementary resource, provided that hygiene is maintained. From an educational perspective, more professional development needs to be provided to teachers on the importance of regular water consumption, and more time dedicated across the elementary curriculum to educational understanding of fluid consumption. The All Party Parliamentary Group (APPG) on Fit and Healthy Childhood (2020) also discussed the need for “healthy eating, hydration and frequent physical activity” (p.9) as this was essential to health and wellbeing. The report proposed it should be explicitly taught in schools in a holistic manner to help children be encouraged to participate in sport and recreation both at school and outside school to lead a holistically healthy lifestyle. The Association of Physical Education within the APPG (2020) report emphasised the need to incorporate physical activity into daily life to reap a broad range of physical, mental and social benefits that would assist with healthy weight management and enhance quality of life. The APPG report draws on Howells and Coppinger (2020) as well as Williamson and Howells’ (2019) research who all emphasised the importance of developing “hydration alongside physical activity to achieve best outcomes for health and wellbeing of children” (p.54). It is proposed that more time is needed within initial teacher education to help support both practitioners and teachers to be on the front line of support within educational settings.

Learning from examples of best practice, including other countries.

Bailey et al. (2018) highlighted that mental health problems among children and young people are recognised as major threats to their wellbeing and are associated with significant costs to them and the wider society.  From the international analysis, most countries reported that physical activity builds young people’s resilience and eases mild to moderate mental health conditions.  Sports team are associated with lower depressive symptoms, lower perceived stress and better self-rated mental health in the young and is protective against feelings of hopeless and suicide risk in adolescents.  School based physical activity can play a valuable role in protecting young people from mental illness and potential to save lives, therefore it is important to increase the importance and value of physical education, physical activity, play within school and educational settings. There is a need and call for physical education to become a core daily subject.

It is also important to consider and address Intellectual disability (ID) and the impact of having intellectual disability and mental health.  It is an area that is not often discussed or researched, and it is proposed that children and adults with ID are in particular the forgotten voices in the pandemic and the tier approach lockdowns that continue throughout the UK. Children and adults with ID currently find the changes in the ‘new world’ complex and difficult to comprehend and access. ID includes those who have had a trauma to the central nervous system either before birth or during birth, or after birth caused by early childhood illness, accidents or seizures, or certain genetic differences. ID is defined by the World Health Organisation (WHO, 1996) as the “condition of arrested or incomplete development of mind, which is characterised by impairment of skills manifested during the developmental period, which is characterised by impairment of skills manifested during the developmental period which contribute to overall level of intelligence, i.e. cognitive, language, motor and social skills’ (p.9). The impact for these children and adults with ID means a reduced “ability to understand new or complex information” (p.14) (such as our current COVID-19 world) and “too few opportunities to participate in sport” (p.30) (Department of Health, 2001). More opportunities are needed for children and adults with ID, there is a distinct lack of funding for such opportunities currently. Burns (2020) identifies that sport can have very positive impact for individuals with ID as well as their families, including improved fitness, improved friendship networks, social inclusion, self-esteem, wellbeing, decreased isolation and a sense of community for family members. The Sport Physical Education and Activity Research Centre (2020) evaluated MENCAP’s Round the World Challenge designed to support and encourage physical activity among people with learning disabilities (phase 1). The results demonstrated that participating in physical activity translated into skills used in everyday life including work and social skills, highlighting the importance of sport, recreation and physical activity for all. Sport England has invested into evaluating phase 2.

March 2021