Written evidence submitted by Professor Neil Humphrey, Manchester Institute of Education, The University of Manchester (CYP0036)
- I am a Professor of Psychology of Education at the University of Manchester. My research focuses on the mental health of children and young people, with particular reference to the role of schools in supporting children and young people’s mental health and wellbeing.
- I am submitting evidence based on a range of research that I have been involved in, which focuses on: trends in children and young people’s mental health, the provision of mental health support in schools, and training for mental health and allied professionals.
Children and young people’s mental health
- Longstanding estimates suggest that between one in ten1 and one in eight2 children and young people experience mental health difficulties in the UK. However, in a 2019 study of 28,000 children and young people in England, my co-authors and I found that 2 in 5 experience above ‘abnormal’ levels of emotional problems, conduct problems and hyperactivity.3
- Research repeatedly demonstrates that certain groups of children and young people are more likely to experience mental health problems. These groups are: girls, older children/young people, those with special educational needs (SEN), those who are eligible for free school meals (FSM), white children, and those designated as a child in need (CIN).4
- In 2018, I examined gender-specific developmental cascades alongside Margarita Panayiotou. The results of our research suggested that boys and girls typically experience mental health difficulties in different ways.5
- Boys tend to develop externalising problems, which means that their outward behaviour becomes more disruptive. Our findings suggested that this has a negative effect on their subsequent academic attainment
- Girls typically develop internalising symptoms wherein they become increasingly withdrawn and anxious. We found no link between internalising symptoms and later academic attainment; however, we did find that prior and ongoing academic incompetence increases internalising symptoms and externalising problems in girls. Based on this evidence, we suggested that the government’s policy on high-stakes academic testing might disproportionately affect girls’ mental health by exacerbating their internalising symptoms and externalising problems.
- Recent research from the HeadStart project further examined the gendered element to children and young people’s mental health.6 It demonstrated that girls disproportionately experience declines in mental health and wellbeing from early to mid-adolescence when compared to their male counterparts. Whilst boys’ mental health and wellbeing remains stable over time, girls experience a worsening of their mental health and wellbeing in almost every area.
- Between 2017 and 2020, there has been a 5% increase in probable mental health disorders among 5-16 year olds.7 The COVID-19 pandemic is likely to have had contributed to this growth.
- In light of these statistics and the promises to build back better from the COVID-19 pandemic, I will be participating in the Greater Manchester Young People’s Wellbeing Programme.8 The Manchester Institute of Education is leading the programme in partnership with the Anna Freud Centre and the Greater Manchester Combined Authority. We will assess efforts to improve children and young people’s mental health and wellbeing across all secondary schools in the city region for three years, beginning in Autumn 2021. We will survey children and young people, which will give them the chance to share their views anonymously about the factors of their lives that influence their mental health and wellbeing. We will then collate and disseminate this information to schools using an online dashboard. The Child Outcomes Research Consortium will provide expert support to schools to assist them in making improvements based on the evidence produced by the surveys. The overall aim of the project is to ensure that children and young people’s mental health and wellbeing is a priority for schools, equal to academic attainment.
Provision of mental health support in schools
- Evidence suggests that emerging mental health problems arise early in childhood, with one study demonstrating that the move to high school is a key time in children and young people’s lives.6
- Targeted interventions before and around this age can have positive and long-lasting effects for children and young people with regard to their mental health and wellbeing, and their academic attainment.
- In recent years, my colleagues and I have researched a number of mental health programmes within schools independently, and as part of the HeadStart project. From our research, we have identified several promising interventions and recommendations for each to maximise their efficiency.
Social and emotional learning interventions9, 10
- In 2019, I examined the use of the Promoting Alternative Thinking Strategies (PATHS) curriculum among 5,218 children aged 7-9 in Greater Manchester alongside my colleagues Margarita Panayiotou and Alexandra Hennessey. PATHS is a social and emotional learning (SEL) intervention, which aims to help children manage their behaviour, understand their emotions and work well with others.
- We found that PATHS contributed to small improvements in psychological wellbeing. When we adjusted our results to account for the number of sessions that schools had delivered, we found that PATHS led to substantial improvements when schools delivered at least half of the sessions.
- In another piece of research, Margarita Panayiotou, Michael Wigelsworth and I studied SEL among 1,626 children aged 9-12 in the northwest. We found that children with better social and emotional skills in Year 4 experienced fewer mental health difficulties and a stronger connection to school in Year 5. We then found that having fewer mental health difficulties led to better academic attainment in Year 6.
- Both of these studies demonstrate the importance of SEL interventions in primary schools, whether they follow the PATHS curriculum or not. For the highest impact, schools should dedicate sufficient time and resources to optimise the delivery of SEL interventions in the classroom.
- My co-authors and I examined the More than Mentors (MtM) scheme that schools within HeadStart Newham implemented. This scheme brought mentors from Years 9 and 10 together with mentees in Years 7 and 8. After successfully completing a two-day training course, mentors would meet weekly with their mentees for 10-12 weeks to explore different areas that the mentee wanted to focus on, including goal setting and problem solving.
- Quantitatively, we found no additional benefit for mentees in terms of their overall wellbeing or problem-solving skills compared to other interventions that were available to them. For mentors, we found a statistically significant positive effect on wellbeing but no effect on their problem-solving skills and goals and aspirations.
- Qualitatively, we found that both mentors and mentees valued the experience. Mentees described feeling more confident and more able to participate in school life, both in terms of their peer interactions and their classroom participation. During the scheme, mentees were able to set goals and achieve them. However, they had difficulty in applying the skills that they learnt once the scheme had ended. Mentors described a sense of achievement and an improvement in their self-confidence. Some mentors reported using their newfound skills outside of the MtM scheme amongst their own peers, and some used their experience to strengthen their ambitions to work in psychology or education.
- We concluded that schools using peer mentoring as a form of intervention should:
- Strive for consistent implementation of the scheme in line with recommendations.
- Improve mentee and mentor recruitment so that schools choose the most suitable and committed pupils.
- Have systems for addressing common challenges, such as absences.
- Alongside Margarita Panayiotou, I conducted a randomised trial of Bounce Back, which is a targeted intervention for children and young people with emergent mental health difficulties. Children taking part in the intervention receive ten one-hour group sessions with a trained youth practitioner in which they learn to build five core resilience skills. We studied a total of 326 children aged 9-11, with a nearly equal split between those receiving Bounce Back and those acting as the control group.
- We found that participation in Bounce Back led to significant reductions in emotional symptoms, with even greater effects for children who attended more sessions.
- Although our findings need to be replicated, we found that there is sufficient evidence of Bounce Back being a useful intervention for children and young people with emergent mental health difficulties. This is especially true when participating children are encouraged and supported to attend and engage fully with the intervention.
- Universal screening is not currently utilised in schools within the UK. The process of universal screening involves assessing students periodically throughout their schooling, starting as early as possible. Its aim is to detect emergent mental health problems among children and young people before they reach clinically significant levels. If screening identifies a child or young person as having an emergent mental health problem, schools can ensure that they receive appropriate interventions to prevent the problem from worsening.
- There are strong reasons to support universal screening. During childhood, poor mental health is associated with poor attendance at school and poor academic attainment. Children with mental health problems are then more likely to be unemployed as adults. In adulthood, poor mental health results in pressures upon health and social care, poor quality of life, and lost economic productivity. This results in an annual cost of around £105 billion in England alone. With around 50% of adult mental health problems originating in childhood and adolescence, there is a socio-economic imperative to dedicating resources to early prevention. However, preventative action cannot occur without detection, which is why universal screening is crucial.
- Michael Wigelsworth and I recommended using a secure online screening platform to screen children at least annually to monitor their mental health. During early childhood, parents and teachers would submit information on the child’s behalf until the child was able to complete the assessment unaided. Children identified during the first stage of screening would then complete an additional stage that would create a more detailed profile. If screening identified an emergent mental health problem, relevant stakeholders would act to refer the child to appropriate support services.
- Although universal screening would require additional resources, it is not impossible. The Greater Manchester Young People’s Wellbeing Programme will survey tens of thousands of children and young people about their mental health and wellbeing. The responses will be available to schools through a dynamic online data dashboard, which will enable leadership teams and teachers to identify the specific challenges that their students face. The Programme will then support schools to improve their approach to mental health and wellbeing. Ultimately, the Programme demonstrates that universal screening is an achievable goal for schools and government.
Provision of training for mental health and allied professionals14
- Budget cuts to specialist mental health services, like CAMHS, mean that children and young people increasingly have to rely upon non-specialist services. In 2005/06, 38% of children and young people made direct contact with specialist services for their mental disorder. However, in 2014/15 this figure dropped to 25%. Over this period, specialist services experienced budget losses of 5.4%.
- When children and young people are unable to access specialist services, they turn to non-specialist allied services. These include schools, GPs, and accident and emergency departments.
- Teachers in particular perceive themselves to be front line workers when it comes to dealing with children and young people’s mental health
- Yet, there is evidence that professionals within allied services do not feel adequately trained to deal with children and young people’s mental health problems effectively. This includes professionals who work within medical fields, like GPs.
- In order to support children and young people effectively, professionals working within non-specialist allied services need training. Initial mental health literacy training should aim to help trainees understand mental health problems, know how to improve mental health, and have the confidence in knowing when, where, and how to provide or signpost to assistance. Additional training, like youth mental health first aider training, may also be beneficial.
- Research conducted by Emily Banwell, Pamela Qualter and myself revealed several elements of successful training; some pertain to the training itself, whereas others concern the implementation of the training.
- In terms of the training process, training needs to:
- Be tailored to the profession and group of trainees to which it is addressed.
- Continue beyond the initial session, with support and additional training available to trainees.
- Provide opportunities to ask questions and receive feedback in the moment.
- Build the competence and confidence of trainees to deal with challenges that they will face.
- Contain sufficient challenge without overburdening trainees with too much knowledge.
- In terms of implementation, the training needs to:
- Have the support of senior leadership teams and other members of staff.
- Be adaptable to the specific circumstances of the environment in which trainees will implement it.
- Provide improvements to trainees’ current systems and ways of working.
- All of these considerations are important regardless of whether the training is aimed towards non-specialist allied professionals, or those who already work within the area of children and young people’s mental health
- In the education context specifically, the ‘Transforming children and young people’s mental health provision: a Green Paper’ recommended that schools should have a designated mental health lead, who would receive training to support the school and its staff to support children and young people’s mental health.
- However, in one case study that I conducted with Ola Demkowicz for the HeadStart project, we found that having one trained senior mental health lead is not always sufficient, especially in larger schools.15 The schools that we examined instead began work to establish diverse teams of staff who would receive training and would be responsible for mental health provision within their schools.
Recommendations for government
- The government should adopt an approach that focuses on early intervention in children and young people’s mental health. This should include:
- Encouraging and assisting schools to deliver comprehensive social and emotional learning lessons to children from an early age.
- Monitoring children and young people’s mental health regularly to determine which individuals are most at risk of developing problems. Targeted interventions should then aim to prevent the development or deterioration of the individual’s mental health.
- Encouraging schools to implement programmes that are proven to be beneficial for children and young people, such as the Bounce Back scheme.
- Addressing factors that are common contributors to children and young people’s mental health problems, such as socio-economic deprivation, SEN and child in need status, and disparities between genders and ethnicities.
- The government should rethink its emphasis on high-stakes testing, which carries negative consequences for children and young people’s mental health. Instead, the government should regard children and young people’s wellbeing as being equal to their academic attainment.
- Teachers (as well as other allied professionals) should receive training to give them the ability and confidence to deal with children and young people’s mental health problems. This training should be tailored, easy to implement, and it should provide ongoing support for trainees.
- The government should base any changes to its level of support, funding, and resources for children and young people’s mental health upon up-to-date estimates regarding the prevalence and nature of children and young people’s mental health problems since the use of out-of-date figures would lead to underfunding and under-resourcing.
- Green, H., McGinnity, A., Meltzer, H., Ford, T., & Goodman, R. (2005). Mental Health of Children and Young People in Great Britain, 2004. Report No.: 1403986371. Office for National Statistics. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/mental-health-of-children-and-young-people-in-great-britain-2004
- NHS Digital. (2018). Mental Health of Children and Young People in England, 2017: Summary of Key Findings. Government Statistical Service. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017
- Deighton, J., Lereya, S. T., Casey, P., Patalay, P., Humphrey, N., & Wolpert, M. (2019). Prevalence of mental health problems in schools: Poverty and other risk factors among 28,000 adolescents in England. British Journal of Psychiatry, 215(3), 565-567. https://doi.org/10.1192/bjp.2019.19
- Deighton, J., Lereya, T., Patalay, P., Casey, P., Humphrey, N., & Wolpert, M. (2018). Mental health problems in young people, aged 11 to 14: Results from the first HeadStart annual survey of 30,000 children. London: CAMHS Press. https://www.ucl.ac.uk/evidence-based-practice-unit/sites/evidence-based-practice-unit/files/headstart_briefing_1_pdf.pdf
- Panayiotou, M., & Humphrey, N. (2018). Mental health difficulties and academic attainment: Evidence for gender-specific developmental cascades in middle childhood. Development and Psychopathology, 30(2), 523-538. https://doi.org/10.1017/S095457941700102X
- Deighton, J., Yoon, Y., & Garland, L. (2020). Learning from HeadStart: the mental health and wellbeing of adolescent boys and girls. London: EBPU. https://www.ucl.ac.uk/evidence-based-practice-unit/sites/evidence-based-practice-unit/files/evidencebriefing7_february_2020_eversion_final.pdf
- NHS Digital. (2020). Mental Health of Children and Young People in England, 2020: Main report. Government Statistical Service. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up
- Panayiotou, M., Humphrey, N., & Hennessey, A. (2019). Implementation matters: Using complier average causal effect estimation to determine the impact of the PATHS curriculum on children’s quality of life. Journal of Educational Psychology. https://doi.org/10.1037/edu0000360
- Panayiotou, M., Humphrey, N., & Wigelsworth, M. (2019). An empirical basis of linking social and emotional learning to academic performance. Contemporary Educational Psychology, 56, 193-204. https://doi.org/10.1016/j.cedpsych.2019.01.009
- Panayiotou, M., Ville, E., Poole, L., Gill, V., & Humphrey, N. (2020). Learning from HeadStart: Does cross-age peer mentoring help young people with emerging mental health difficulties? London: EBPU. https://www.ucl.ac.uk/evidence-based-practice-unit/sites/evidence-based-practice-unit/files/cross-age_peer_mentoring_final.pdf
- Humphrey, N., & Panayiotou, M. (2020). Bounce Back: randomised trial of a brief, school-based group intervention for children with emergent mental health difficulties. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01612-6
- Humphrey, N., & Wigelsworth, M. (2016) Making the case for universal school-based mental health screening. Emotional and Behavioural Difficulties, 21:1, 22-42. https://doi.org/10.1080/13632752.2015.1120051
- Banwell, E., Humphrey, N., & Qualter, P. (2021). Delivering and implementing child and adolescent mental health training for mental health and allied professionals: a systematic review and qualitative meta-aggregation. BMC Medical Education, 21, 103. https://doi.org/10.1186/s12909-021-02530-0
- Demkowicz, O., & Humphrey, N. (2019). Whole school approaches to promoting mental health: what does the evidence say? London: EBPU. https://www.ucl.ac.uk/evidence-based-practice-unit/sites/evidence-based-practice-unit/files/evidencebriefing5_v1d7_completed_06.01.20.pdf