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Counseling within the school system and individual counseling.

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Counseling within the school system and individual counseling.

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My desired position is to become a school counselor and work towards creating my counseling practice where anyone of any age can seek mental health help. These three articles tie into finding the effectiveness of interventions in adolescents, clients' perceptions of therapist credibility in treatment, and how effective it is to display health information in the school system.

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Effectiveness of Individual Mental Health Interventions in Adolescents.

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Effectiveness of Individual Mental Health Interventions in Adolescents.

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URL:https://pmc.ncbi.nlm.nih.gov/articles/PMC8695927/#s5

In this mixed methods study, adolescents from ages 12-18 were given interventions with cognitive behavior therapy and Interpersonal therapy—349 Adolescent participants who had symptoms of anxiety and depression. After different interventions, symptom reductions occurred for a short period. All adolescents had individualized interventions, but everyone received psychoeducation, self-monitoring, symptom tracking, cognitive restructuring, behavioral action, and exposure.

References

Karukivi, J., Herrala, O., Säteri, E., Tornivuori, A., Salanterä, S., Aromaa, M., Kronström, K., & Karukivi, M. (2021). The Effectiveness of Individual Mental Health Interventions for Depressive, Anxiety, and Conduct Disorder Symptoms in School Environment for Adolescents Aged 12-18-A Systematic Review. Frontiers in psychiatry, 12, 779933. https://doi.org/10.3389/fpsyt.2021.779933

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The Effectiveness of Individual Mental Health Interventions for Depressive, Anxiety and Conduct Disorder Symptoms in School Environment for Adolescents Aged 12–18—A Systematic Review

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Background: Mental health problems are a major health issue for children and adolescents around the world. The school environment allows adolescents to be reached comprehensively and on a low threshold, making it a potential environment for mental…

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Effectiveness of prevention methods of mental health problems in a school setting in children and adolescents.

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Effectiveness of prevention methods of mental health problems in a school setting in children and adolescents.

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URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC4850518/

In this metal-analysis study, 10-20% of students experience a mental health problem that affects their scholastic development. With preventative measures such as school entrance examinations, and the working collaboration of school social workers/counselors and psychologist is proven to help children who experience hyperkinetic disorders, and depressive disorders, as well as other things such as stress to get the help they need while seeing positive changes in their academic life as well as their personal life.

References

Schulte-Körne G. (2016). Mental Health Problems in a School Setting in Children and Adolescents. Deutsches Arzteblatt international, 113(11), 183–190. https://doi.org/10.3238/arztebl.2016.0183

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Mental Health Problems in a School Setting in Children and Adolescents

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10–20% of children and adolescents have a mental health problem of some type. Manifestations such as attention deficits, cognitive disturbances, lack of motivation, and negative mood all adversely affect scholastic development. It is often unclear…

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Effectiveness of school-based mental health programs on mental health among adolescents.

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Effectiveness of school-based mental health programs on mental health among adolescents.

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URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC7377131/

In this quasi-experimental study, 420 girls in the 10th grade were given a 28-question health questionnaire asking about mental health and self-esteem. All of the participants were given interventions based on their responses in a 45-minute counseling session. After the interventions, the participants were given the same questionnaire, and it showed a decrease in physical problems, anxiety and sleep disorders, impaired social functioning, and a reduction in depression.

References:

Shahraki-Sanavi, F., Ansari-Moghaddam, A., Mohammadi, M., Bakhshani, N. M., & Salehiniya, H. (2020). Effectiveness of school-based mental health programs on mental health among adolescents. Journal of education and health promotion, 9, 142. https://doi.org/10.4103/jehp.jehp_421_19

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Abstract

AIM:

This study aimed to investigate the effect of school-based interventions on mental health among adolescents in the southeast of Iran.

METHODS:

This interventional quasi-experimental study included a total of 420 adolescent girls studying 10 th grade in the public schools of Zahedan, Iran. Data were collected using general health questionnaire-28 questionnaire. After pretest, multidimensional interventions (individual education, group education, individual consultations, modern education, and parents' educational packages) were given to the intervention group from October 2015 to June 2016. After a 3-month interval, the posttest was conducted in October 2016. Data were analyzed by covariance analysis.

RESULTS:

There was a significant statistical difference between the changes in the mental health scores after the intervention among the two study groups ( P < 0.05). Furthermore, after the intervention, moderate-to-severe mental health problems decreased considerably among the students in the intervention group compared to controls. The greatest impact was on individual psychological counseling.

CONCLUSIONS:

The results of the study showed that by applying group training and individual counseling in the schools improves mental health. Therefore, identifying student problems and parent-teacher cooperation as well as consulting with specialist counselors can be effective in providing practical and effective solutions in this regard. Therefore, findings suggest that prioritizing mental health and taking action on the field are of utmost importance.

Keywords: Adolescent, Iran, mental health

Background

At present, chronic non communicable diseases is a major cause of death, raising concerns in the healthcare systems worldwide. The World Health Organization (WHO) introduced "Healthy People 2020" within the framework of providing community healthcare, thus promoting health outcomes and establishing health equity. Accordingly, a number of leading health indicators, e.g., ensuring mental health, have been introduced for having healthy people.[ 1, 2]

Mental disorders of adolescents could be associated with a wide range of features, including physical and cognitive health, mental functioning, social environment, family features, and stressful life events.[ 3] To this end, it is essential to provide and develop mental health programs and services in schools for identifying the specific needs of students who face innumerable mental health issues every day.[ 4, 5] These programs not only identify mental health complaints but also offer diagnosis and treatment in schools. Therefore, schools must have counselors and psychiatrists to provide useful interventions for students with mental health problems.[ 6] In addition, they must refer these students to community mental health services for further care and treatment if it is needed.[ 7]

In addition, puberty and its specific crises, e.g., confusion and decreased self-esteem, further differentiate this period in terms of mental health.[ 8] Unfortunately, evidence suggests a high prevalence of mental disorders among adolescents.[ 9, 10, 11, 12] Fifty percent of adult mental disorders are originated in childhood and adolescence.[ 13] The UNICEF reported a prevalence of mental health disorders in adolescents as 20%;[ 14] according to the WHO, 12%-29% of adolescents suffer from mental disorders in different countries,[ 15] and the prevalence of mental disorders in Iran is also reported to be 10%-40% by various studies.[ 16, 17]

Consequently, schools should not ignore their determinant role in decreasing mental health problems. Schools can offer security and Privacy for students. It also provides parents and teachers partnerships for cognitive, behavioral, and emotional-functional supports for all students.[ 18] Studies demonstrated the effectiveness of school interventions in promoting mental health.[ 19, 20, 21] Moreover, the results of some studies emphasize direct educational methods and some indirect educational methods. According to this evidence, individual education and counseling were positive and had a great impact on the behavior of individuals.[ 22]

Further, data suggest a high prevalence of mental disorders in females compared to males due to biological factors, gender roles, environmental stress, and limitation of satisfaction source and social participation of females in society.[ 16] Furthermore, for girls, adolescence is the foundation of their future that guides the next stages throughout their lives and directly affects their future, family, and children. Then, investigating female adolescents' mental health status is essential because of their twofold role within the health of a community and impending generations' health.

Therefore, due to the importance of adolescence in human life as a basis for the present and future health, the present study was conducted to examine the effectiveness of school-based mental health programs on adolescents in Southeast Iran.

Methods

This interventional quasi-experimental study purposively included four public high schools that were similar in terms of social, economic, and environmental factors from among public girl's high schools in Zahedan, Iran.

Participants

Accordingly, selected schools were divided into experimental ( n = 2) and control groups ( n = 2). Using the census method, all the tenth-grade students were initially included in the study. Based on the early results of the study and the formula given below, in each group, 90-171 (total 342 students) sample size was estimated.

All 10 th-grade students attending school were enrolled in the study, and only students who moved from these schools or had long absences from school were excluded from the posttest phase. In the end, 420 students (300 in the experimental and 120 in the control groups) participated in the study.

Instruments

Mental health was assessed by a general health questionnaire-28 questionnaire with the most reliability, sensitivity, and specificity.[ 23, 24, 25] Persian version has also a criterion validity coefficient of 0.87 and reliability (α) of 0.90 of 0.97.[ 26] The questions were multiple-choice (no, a bit, high, and very high) which is scored based on the Likert scale (0-1-2-3). Finally, subscales based on the cut-off line for scores in each subscale were categorized into four categories of lowes (score 0-6), mild (score 7-11), moderate (score 12-16), and severe (score 17-21). The questionnaire was completed in 30 min.

Procedure

Before data collection, the participants were given information on the research method, questionnaire completion, collaboration, trust, and confidentiality of responses. After obtaining informed consent from the students and their parents according to the ethical codes (IR.ZAUMS.REC.1394.251), the students' were enrolled. Further, a code was assigned to each participant for the confidentiality of the information.First, we administered the pretest. After analyzing the pretest results, the experimental group of adolescents who belonged to the "severe" category in each subscale was identified based on their codes.

After arrangements were made with high-school principals and assistants, the students' names and class numbers were identified without the type of disorder. Afterward, counseling sessions in the high schools were planned according to the class schedules and the number of sessions required for each student (four individual sessions for each disorder) based on the date and time.

The main investigator and three counselors had a joint meeting to determine the number of students and sessions for each counselor. Then, they were provided with the session dates and schedules, as well as the students' codes and types of problems. To protect the student's anonymity, the counselors had access only to the codes.

In a meeting in each high school, teachers were encouraged to collaborate for the counseling sessions. During the counseling period, if some students were absent on the specified dates or the session overlapped with midterm examinations, a make-up session was scheduled.

Each counseling session lasted for 45 min. The questionnaires were self-administered, and to avoid response bias, based on the type of problems, the counselors administered more accurate psychological tests on the first sessions, and the sessions continued if the identified problem was confirmed.

Information on mental health, mental problems, and solutions to the problems was published on the websites of experimental-group high schools. Moreover, 150-min workshops were held on mental health in all the intervention high schools. Every workshop included theoretical education, PowerPoint presentation, and video clips (100 min); question and answer, role-playing (30 min); and overall evaluation (20 min). In addition, as most adolescents complained of stress-related problems, we displayed posters on how to control stress in the intervention of high schools.

Mental health programs were implemented for the intervention group from October 2015 to June 2016 and the posttest was administered 3 months later in October 2016.

Data analysis

The data were coded and then analyzed in SPSS 15 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to categorize the data and determine the level of mental disorders. In addition, the effectiveness of interventions was examined using ANCOVA with 95% of a confidence interval.

Results

In total, 420 tenth-grade students participated in the study. Half of the fathers were employees, while the mothers were homemakers and had high-school diplomas. In addition, most students in both groups lived with both parents and were the first to the third child. They described the socioeconomic status of their families as moderate to good.

The moderate-to-severe mental health problems of the students showed 1.6% and 5% increase in physical problems, 6.1% decrease and 6.9% increase for anxiety and sleep disorders, 3.4%, and 0.5% decrease in impaired social functioning, and 4.8% and 3% decrease for depression among the experimental and control groups, respectively [ Table 1].

Table 1.

Mental subscales

Group and time

Intervention

Control

Pretest

Posttest

Pretest

Posttest

The mean scores of intervention group were pre-test and post-test, respectively 28.7 (15) and 26.7 (14.8) and for the control group 35.8 (17.8) and 37 (19.5) (Range of scores: 0-84). Based on Table 2, the mean and standard deviation of changes in the mental health scores of students significantly differed across groups, showing a decrease of 2 points in the experimental group.

Table 2.

Source

Type III sum of squares

Df

Mean square

F

Significant

Corrected model

904.524 a

1

904.524

3.836

0.051

Discussion

Schools are one of the most important human societies and one among the targets of healthcare systems. Along with families, schools play a role in preventing behavioral problems and enhancing the social capabilities of adolescents.[ 27, 28, 29] Therefore, the provision and development of mental health programs and services in schools seem to be essential for identifying the specific needs of students who face innumerable mental health issues every day.[ 30, 31]

Findings suggest that schools must be equipped with certain facilities to determine the students' emotional, behavioral, and social needs. Moreover, having counseling centers outside the schools is an important step toward realizing this goal.[ 32] School counseling activities aim to resolve the students' social, family, educational, behavioral, and mental problems and pathologies, with counselors' playing the central role in this regard.[ 33] Moreover, consultations can improve various aspects of their health including mental and physical health.[ 27, 34, 35] Some studies indicated the effectiveness of counseling services for the students.[ 36, 37]

Smith concluded that the students require real experiences and dislike being advised. Although advice may be actually helpful for them, they need tangible examples of real and difficult situations and counselors who would help them with encountering and understanding real-world situations.[ 38] In fact, students require guidance, encouragement, and practice, while no satisfaction is achieved if their needs are not structurally discovered.[ 39] Evidence suggests that individual education and counseling have a remarkable positive effect on individuals' behavior.[ 22] The results of the present study also demonstrated an improvement in the mental health scores of students who had received individual counseling.

A study on the effectiveness of brief school-based interventions on depression, anxiety, attention deficit hyperactivity disorder, and excessive alcohol consumption showed that the 12-month intervention positively affected emotion and negatively affected depression among students with negative thoughts. Depression was decreased in students with anxiety in both groups, although the effects were stronger in the intervention group.[ 21]

According to a meta-analysis, cognitive-behavioral approaches are more effective on people at risk of mental disorders.[ 40, 41, 42] In Chile, a clinical trial was conducted on adolescents from poor families. Results showed that school-based interventions based on a cognitive-behavioral model reduced the signs of depression in high-risk adolescents, such that after 3 months of intervention, the experimental group improved 10% more than the control group.[ 43]

In line with other studies, the present study offered a school-based intervention on mental health and individual counseling for students with specific mental health problems. Following the intervention, the moderate-to-severe anxiety and sleep disorders, impaired social functioning, and depression were significantly reduced in the experimental group compared to the controls.

Limitations

One limitation of the current study was the students who participated in this study were of the female public schools and grade 10 and therefore are not representative of all adolescents in this age group. In addition, the data collected were based on a self-administered questionnaire.

Weak and strong points of the study

Time management

Strong - Plans adequate time to completed assignments and study

Weak - Restrictions on making sustainable behavioral changes in students in this limited time period.

Collaboration

Strong - Good cooperation of the education organization, directors, teachers, and students

Weak - Poor parenting follow-up.

Conclusions

Authorities and health policymakers should acknowledge that the number of students suffers from severe mental health problems.

To sum up, the results indicated the high impact of minimum counseling sessions for each problem on students with mental health problems. In this regard, the education organization can benefit from the capacity of students' studying psychology.

On the other hand, given the importance of the family in Iran and due to the emotional dependency of adolescents to families in this age range, the strong impact of family in mental health is logical. Therefore, to provide mental health, the participation of school counselors and parent education seems necessary.

Financial support and sponsorship

Zahedan University of Medical Science.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

This article was part of Ph.D., thesis with code 2772 in Zahedan University of Medical Science We would like to express their gratitude to the Zahedan Medical Sciences University, the Health Promotion Research Center, the District Department of Education, and the school heads, teachers, and students who helped conduct this study.

References

Articles from Journal of Education and Health Promotion are provided here courtesy of Wolters Kluwer -- Medknow Publications

# data[].attributes.attachment_link.title
Effectiveness of school-based mental health programs on mental health among adolescents

# data[].attributes.attachment_link.description
This study aimed to investigate the effect of school-based interventions on mental health among adolescents in the southeast of Iran. This interventional quasi-experimental study included a total of 420 adolescent girls studying 10th grade in the ...

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Clients perceptions of face to face psychotherapies in therapist credibility in treatment.

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Clients perceptions of face to face psychotherapies in therapist credibility in treatment.

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URL: https://www.tandfonline.com/doi/full/10.1080/10503307.2023.2298000#abstract

In this meta-analysis study, treatments such as cognitive behavior therapy, counseling, psychodynamic therapy, dialectic behavioral therapy, and many other treatments were used to measure the outcome. This study was conducted in three levels and it showed a strong association between the therapist credibility and the therapeutic bond of the client in the effectiveness in treatment. The findings are stated being consistent with the common factors theory.

References

Kumpasoğlu, G. B., Campbell, C., Saunders, R., & Fonagy, P. (2024). Therapist and treatment credibility in treatment outcomes: A systematic review and meta-analysis of clients’ perceptions in individual and face-to-face psychotherapies. Psychotherapy Research, 1–16. https://doi.org/10.1080/10503307.2023.2298000

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Therapist and treatment credibility in treatment outcomes.

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Therapist and treatment credibility in treatment outcomes.

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URL: https://www.tandfonline.com/doi/full/10.1080/10503307.2023.2298000#abstract

In this meta-analysis study, a three-model method was used to determine the outcome of treatment and therapist credibility. The findings indicate a strong positive association between therapist credibility and therapeutic change. Findings also include a client's perception and evaluation of the therapist's trustworthiness and expertise, an essential factor in therapeutic change.

References:

Kumpasoğlu, G. B., Campbell, C., Saunders, R., & Fonagy, P. (2024). Therapist and treatment credibility in treatment outcomes: A systematic review and meta-analysis of clients’ perceptions in individual and face-to-face psychotherapies. Psychotherapy Research, 1–16. https://doi.org/10.1080/10503307.2023.2298000

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Why some psychotherapist benefit from feedback on treatment progress.

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Why some psychotherapist benefit from feedback on treatment progress.

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URL: https://psycnet.apa.org/fulltext/2024-12689-001.html

In this qualitative study, monitoring patients and providing therapist feedback has been proven to be beneficial for treatment outcomes. When providing feedback to therapist, they are able to see if their method of treatment/counseling is effective for that particular clients. When given feedback therapist are able to see what can be improved upon or a need for a different approach when a certain intervention is not working as expected.

References:

Herzog, P., Kube, T., & Rubel, J. (2023). Why some psychotherapists benefit from feedback on treatment progress more than others: A belief updating perspective.Clinical Psychology: Science and Practice, 30(4), 468–479. https://doi.org/10.1037/cps0000174

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Effectiveness of displaying posters about health/mental health.

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Effectiveness of displaying posters about health/mental health.

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URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC7428890/

In this quantitative study, a total of 120 participants were given posters about health topics to provide data on the effectiveness of printed health materials. The distribution method was a leaflet and a poster for school-aged kids. Although the distribution of the information had no significant effect, having the kids see the information did have an influence on living healthier lifestyles. This can be important for reaching large numbers of people without having to talk with them individually.

References:

Hasanica, N., Ramic-Catak, A., Mujezinovic, A., Begagic, S., Galijasevic, K., & Oruc, M. (2020). The Effectiveness of Leaflets and Posters as a Health Education Method. Materia socio-medica, 32(2), 135–139. https://doi.org/10.5455/msm.2020.32.135-139

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The Effectiveness of Leaflets and Posters as a Health Education Method

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Health education is a process of acquiring knowledge and skills in order to improve the health of the individual and the community. It is considered the most effective, most economical and most rational aspect of health care and health culture. To…

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School culture and student mental health.

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School culture and student mental health.

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URL: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13034-x

In this qualitative study, 27 staff members and seven parents were interviewed in depth at three schools, and 28 students participated in four focus groups. The results concluded that there is strong evidence of the correlation of organizational, academic, community, safety, and support. In the school setting, the staff that actively promotes mental health by putting up posters or having classroom discussions about it has proven to improve the school culture and the students.

References:

Jessiman, P., Kidger, J., Spencer, L. et al. School culture and student mental health: a qualitative study in UK secondary schools. BMC Public Health 22, 619 (2022). https://doi.org/10.1186/s12889-022-13034-x

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Sample

Information about the sample schools and participants is shown in Table 1.

Table 1 Participating schools, staff, parents and students

Across all three schools, 27 school staff participated in an interview for the study. Staff interviewed included members of the senior leadership teams, teaching staff, learning and support assistants, pastoral support staff, and staff with particular responsibility for the Year group which was taking part in PAR in each school. The parent sample was comprised of seven parents of students in the relevant year groups across the three schools (five mothers, two fathers).

Four student focus groups were held in total; one from each of the year groups participating in PAR across the three schools. Twenty-eight students took part across the four groups; student demographics and online/in school data collection method are outlined in Table 2.

The findings are presented under four overarching dimensions of school culture that emerged from the data and were perceived by respondents to impact on student mental health. These are structure and context, organisational and academic, community, and safety and support (see Fig. 1). Anonymised quotations are included from a wide range of participants in order to illustrate the responses rather than indicate representativeness. Where differences between participant groups were apparent (e.g. parents, school staff and students) we highlight these in the findings.

Dimensions of school culture

Dimension 1. Structure and context

Local environment and geography

School staff noted the impact of geographical location on school culture, with pupils often not living in the immediate locality. This resulted in students living socially deprived areas attending a school in an affluent area, and vice versa. As a result any sense of a school sited within a 'neighbourhood' or 'local community' setting was depleted. However the impact of the wider locality was recognised. Public events and demonstrations that had occurred in the South-West of England in the 12 months preceding the study generated publicity and awareness amongst the students at all three schools, which staff tried to reflect and respond to.

Student diversity

Almost all respondents referred to the three schools as having a very ethnically diverse student body, bringing both opportunities and challenges. Ethnic diversity was perceived by most respondents as one of the key influences over school culture. Parents often spoke of valuing it as a learning opportunity for their children, and a source of high cultural capital. Many staff shared this view and enjoyed working with such a diverse cohort.

Many staff noted however that while students may integrate during school hours, they often fell back into homogenous groups at the end of the school day, reflecting the reality of the wider community.

There was also diversity across the socio-economic status of students. Staff reflected on the severe poverty faced by many of their students, exacerbated during the COVID19 pandemic, and the efforts made to ensure that students were able to access the same educational and wider opportunities as more affluent students. Staff also reported examples of where ethnicity and socio-economic status intersect, impacting the engagement of students and their families with the school.

Finally staff also noted the influence of students with SEND on school culture. Two schools in particular were perceived to have a high proportion of students with SEND, and staff adapted the curriculum and employed additional support staff to ensure the school environment and offer was inclusive. This included working with all students to promote greater awareness and acceptance of disability.

Physical environment

Many staff spoke about the impact of the physical environment of the school on student interactions and wellbeing, and in particular the impact of being quite constrained in a small space. Although efforts were made to create private and safe spaces during break times, often both the number of people, and building and grounds design made it difficult for students to find quiet or perceived safer places to be. This finding emerged in all schools, despite one being an older, traditional building and two being more recently rebuilt to incorporate more light and space.

Students' capacity to navigate school buildings was further constrained during the pandemic by social distancing measures. Students were often confined to one classroom all day while teachers moved round the school, one-way systems were put in place, and dining areas and school grounds segregated by year group to limit social mixing. Staff perceived this impacted on the school culture, making small incidents amongst students more likely to escalate, and removing teachers' sense of control in classrooms that no longer felt like their own.

Dimension 2. Organisational and academic

Leadership and management of school culture

The role of the school senior leadership team in shaping school culture was mediated through their support for staff, visibility and transparency to students, and active management of school culture. School staff reported that having a leadership team that listened to and empowered staff was important. This was especially important during the pandemic and related mitigation measures resulting in schools being closed to most pupils and a move to online learning, although for some staff this made the leadership teams less visible. Visibility to students was also seen as key to promoting a welcoming culture in schools; availability and presence during the school day was frequently mentioned by both staff and students.

The importance of senior staff being present and welcoming students to school each morning was also perceived by student focus group participants as a reason for valuing their school.

Culture emerged as a key priority amongst the leadership team in all three schools, which all take a proactive stance on leading and shaping it, including having senior leaders responsible for it. Stated reasons for prioritising culture included to reflect the needs of a diverse student intake (particularly across ethnicity and socioeconomic status); mitigate the impact of Covid mitigation measures on student wellbeing; and in response to the UK national government's push for better mental health provision in schools. There was also a sense that newer staff, and staff recently promoted to managerial posts, were more likely to prioritise culture (and student wellbeing).

Despite the active management of school culture, there were staff in all schools who questioned whether a narrative of prioritising school culture was tokenistic, without implementing real changes or having noticeable impact.

Staff composition

School staff composition was perceived to influence the culture of the school, and mental health of students, through dedicated pastoral and inclusion roles, their ethnic and gender diversity (or lack of), and staff turnover rates.

All three schools had non-teaching staff with roles dedicated to supporting student mental health and wellbeing, including safeguarding (promoting child welfare and protection from harm), pastoral support, mental health support (counsellors), and support and inclusion for pupils with special educational needs and disabilities (SEND). Staff and parents from two schools perceived the wellbeing teams as unusually large compared to other secondary schools. These staff were especially busy monitoring and supporting students during school closures. The importance of staff dedicated to mental health and wider wellbeing support was recognized by all stakeholder groups, including parents.

Beyond dedicated non-teaching staff, many school respondents recognised the role that staff diversity had in shaping and informing school culture. Respondents in all schools were conscious that school staff did not reflect the ethnic diversity of students. Gender representation across teaching subjects and leadership roles was also of concern. There was recognition amongst school teaching staff and leadership teams that students need to see ethnic minority and female role models in all roles, and effort is needed to address this through better recruitment practice.

Parent respondents highlighted staff turnover and consistency as important. When staff consistency was low, this had a negative impact on students' wellbeing and school culture as they struggled to build relationships with ever-changing staff. This was particularly important to students who needed additional pastoral and/or inclusion support for SEND or mental health reasons, and also impacted on parents' ability to build trust and confidence with their child's key staff contacts in school.

Staff development and training

Few respondents mentioned staff development and training as an important aspect of school culture, although some school staff did raise training in specific areas that would influence their capacity to support student mental health and wider wellbeing (including on safeguarding, mental health promotion and prevention, inclusion, and support for students with SEND). Some reported training in new behaviour management policies specifically intended to impact school culture, including restorative justice and holistic approaches. In one school effort had been made to train staff in anti-discriminatory practice, to give them greater confidence in addressing diversity-related issues and supporting students.

Curriculum

Respondents across all schools described ongoing changes towards a more inclusive, holistic curriculum, reflective of the diverse student body. The most prominent changes to emerge from interviews were efforts to decolonialise the curriculum across all taught subjects, the inclusion of more content about Black history, and inclusive and diverse content with regard to gender and sexuality. In one school, changes to the curriculum were informed by feedback from student Black and Minority Ethnicity (BAME) and lesbian, gay, bisexual, transgender (LGBTQ +) groups. Staff respondents noted the importance of embedding minority role models across all subject areas, and not simply providing one-off lessons about minority groups. The lack of diversity amongst staff increased the difficulties of delivering a diverse and inclusive curriculum as many reported lacking expert insight, knowledge and confidence. There was consensus however that continuing to work on the curriculum offer was likely to facilitate a more supportive school culture.

PSHE education was highly valued by both staff and students as an important means of addressing diversity, inclusion, and health. PSHE time was used to deliver universal mental health provision including education, advice, and interventions such as meditation or mindfulness. Students reported that alongside Relationships and Sex Education (RSE), this helped them to develop an understanding of different cultures and to be mindful and respectful of them.

For some students, the opportunity to discuss mental health during PHSE was welcomed but could feel tokenistic, without enough time to cover issues in depth, and some stigma around discussing mental health remained.

Staff, parents and students all discussed the importance of non-academic subjects such as Physical Education (PE), Music, Dance and Art, and the ability for students to access these formally through lessons and through lunchtime and after-school clubs. The noted benefits of these include providing an opportunity for self-expression and creativity, a focus on processes rather than outcomes (an important part of mental health), and 'safe' spaces to take risks and use failures as opportunities. Staff perceived that having a wider range of music, arts and sports on offer to students allowed them an opportunity to find something they enjoy and may excel in, which may be particularly important for the self-esteem of less academically able students. Respondents across all schools noted that although schools make efforts, there was still not enough emphasis on these wider curriculum areas, and this was exacerbated by the curtailment of after-school and extra-curriculum activities during the pandemic.

Teaching and learning

Most respondents' comments on teaching styles focused on teachers' attitudes to discipline in the classroom. Where teachers were perceived as overly strict, students and parents worried that this had a detrimental effect on student mental health. Some students and parents perceived that teachers' focus on academic performance meant they were more likely to overlook student anxiety and stress.

The COVID-19 pandemic may have alleviated this problem and encouraged teaching staff to afford greater consideration of student mental health. Staff were aware that not all students coped well with the closure of schools and move to online teaching and learning for extended periods of time alongside the other stressors of the pandemic.

Academic performance

Pressure on schools to be 'high performing' was driven both by external regulators and national performance measures (Office for Standards in Education, Children's Services and Skills (Ofsted); Progress 8 scores (progress a pupil makes from the end of primary school to the end of secondary school), and school staff's ambition to equip individual students with the skills and qualifications for later life. Respondents also noted the impact of schools' local and historical context; comparisons with other schools in the area (e.g. higher performing schools more attractive to prospective students and parents) and prior status (e.g. as a grammar school, private school or under-performing school) also influenced how the schools' current academic performance was perceived by parents and staff. All of this influenced how 'high performance' was conceptualised. In one school, staff and parents describe the school as highly academic with an expectation that most students would achieve high academic grades and proceed to higher education. In contrast, staff from a school with lower academic outcomes noted that they are driven to maintain year on year improvements in Progress 8 scores, (a 'value added' measure) and equip students for a wider range of next steps, including further education, and vocational routes.

Respondents of all types were aware of the impact of high academic expectations on school culture and consequently, student mental health. In school B, which is known for high academic standards, staff reported high levels of anxiety and stress-related disorders amongst students, including eating disorders and self-harming behaviour. School staff acknowledged that expectations of high achievement can cause students stress and anxiety, but addressing this is challenging because it is not always driven by the school culture but by parents or the students themselves.

Dimension 3: Community

Quality of relationships in school

The quality of interactions and relationships with others in school was perceived as another key element of school culture important to student mental health. Staff respondents distinguished between 'staff' and 'student' culture, though also recognized that the relationships between staff and students would impact on the school culture overall. Relationships amongst staff were generally described as friendly, supportive and collaborative. This was especially important during the past months when school closures necessitated the move to online teaching, with repercussions for students through better practice, and better support.

There was some disagreement over the role of the senior leadership team in reinforcing positive staff culture. Some respondents described working with an empowering leadership team that actively supported good staff relationships. For others, leadership influence over high workloads, pressure to maintain high academic performance, pandemic-related changes and recent staffing decisions (including redundancies) had damaged relationships amongst staff. There was also some stigma around disclosing mental health concerns, particularly those caused or exacerbated by work pressures, although this may be improving.

The quality of interactions between students and staff were perceived as highly influential over how students experienced school culture, and to their mental health. There was recognition amongst school staff that while those in pastoral or other support roles would prioritise maintaining good relationships with students, teaching staff may differ in their perception of their role; some would focus on teaching and learning only, while others would see the creation of positive and trusting relationships with students as important and conducive to better learning and healthy development. Other influences on the quality of relationships between staff and students included pressure on staff and students to maintain high academic standards. Staff willingness to be accessible and approachable to students was also important, and this had been adversely been affected by school closures and subsequent social distancing measures in place in school.

Inclusion and diversity-related factors were key; staff from schools with a more ethnically diverse student intake reported that the lack of diversity amongst staff damaged relationships with students from minority groups. There was also concern that Black and Minority Ethnicity students were over-represented in disciplinary statistics, possibly a result of unconscious bias or prejudice from staff.

Friendships with peers and the quality of interactions between students in school were also recognized as having an important influence on school culture and student mental health by all stakeholders. Respondents across all schools generally described peer relationships as positive, though there was recognition that individual students would have different experiences.

Diversity, particularly ethnic diversity, was seen as very influential over peer relationships by staff and parent respondents. As noted earlier, it is valued as a key attribute of a school and there is an expectation amongst staff and parents that students will benefit from relationships with peers from different backgrounds. They also report that peer support is strong amongst minority groups, and students with SEND and minority ethnic groups looking out for and supporting each other. However, where problems arise in student relations this is generally attributed to differences across ethnicity, age, gender or disability (with SEND students at particular disadvantage). Respondents describe concerns with discrimination amongst peers in all three schools, which can manifest in a lack of integration during social and break times, and bullying.

Inclusion

Efforts to promote inclusion were apparent in all schools, as this was perceived to be another key influence on school culture and student mental health. Across all schools, respondents describe a diverse student intake with regard to ethnicity, socio-economic status, geography, and religion. This was highly valued; forming peer relationships across these divides is seen as an opportunity for students to learn from each other and encourage acceptance and valuing difference. Staff from all schools reported an emphasis on inclusive practices, driven by both the need to ensure that all students felt safe and welcomed in school, and by recent Black Lives matters protests that have highlighted awareness of prejudice and discrimination amongst students.

School staff were conscious that for many students, time in such a diverse environment was limited, and hence the opportunity to gain the most advantage should be optimised.

Staff were keen to emphasise the activities undertaken promote inclusion, such as running groups for under-represented or minority students, (e.g. BAME and LGBTQ + students), increased pastoral support for minority groups, events/displays to celebrate diversity and difference; 'stamping down' on issues of intolerance and bullying, and the provision of unisex toilets. There was some recognition of the intersectionality of race, gender and sexuality.

School staff perceived some improvements were still to be made, including increasing the ethnic diversity of staff, and addressing potential staff bias that may result in BAME groups being over-represented in disciplinary actions. Staff also report increasing incidences of misogynistic language and bullying amongst students, and this may be the next inclusion issue to be targeted. Students recognise the work that schools are doing around inclusion and value it, although agree that there is still some progress to be made.

Student voice

Student voice and empowerment mechanisms and the success of these varied across the schools and again, were impacted by the pandemic mitigation measures. There was consensus amongst school staff that the degree to which students felt listened to was a key aspect of school culture which would impact on student-staff relationships and student mental health. All schools had systems in place for consultation with and engagement of students (for example student councils). Staff also reported using surveys as a regular means of monitoring student health and wellbeing and gaining feedback on specific issues. There were examples of student-led groups, for example BAME or gender equality groups, being involved in changes to the curriculum or school rules that which particularly affected these groups.

School staff varied in their perception of effectiveness of these mechanisms, with some reporting that school leadership teams were responsive to student feedback and willing to reflect student views. Student councils and surveys had been disrupted during school closures, although respondents across all schools reported that changes had been made to practice (for example, how online learning was delivered), as a result of student feedback. This was a minority view however; the majority of respondents perceived that student views were often ignored and had little tangible impact on the how the school was run. Some attributed this to a lack of staff resource devoted to facilitating and supporting student engagement; conversely other staff report that too much engagement work is staff-led, rather than student-led.

The overwhelming perception of students and parents is that school leadership teams are unwilling to engage with and reflect student views.

Parent engagement

Parental engagement was perceived as good across all three schools. Mechanisms included parent forums, parent teacher association (PTA), email newsletters and social media groups. School staff also liaised with parents of students over specific issues (typically about academic, behavioural, health or SEND support). The degree of communication and engagement with parents increased during the pandemic, as staff conducted additional and regular welfare checks while most students were not attending school in person.

There was recognition that some parents were more willing and easier to engage with than others; factors influencing this include parents' motivation for their child's academic success, concern about student support needs, and 'second generation' students whose parents also attended the school. The relationship with some parents could be challenging for school staff, either because parents are reluctant to engage, may blame school staff for their child's behavioural issues or be critical over the perceived lack of support for their child. Engagement was also perceived to vary across socio-demographic status and ethnicity. Some staff reported that higher earning families may have greater expectations of their child's academic success and will seek out opportunities to engage with school staff to facilitate this. In one school, concerns about problematic disengagement of parents from one particular community was addressed by the employment of a family support worker to liaise between families and schools to help overcome language and cultural barriers.

Most parents were pleased with the level of engagement they had with school staff, particularly where their child had additional needs or existing mental health issues. They report feeling listened to by school staff, who were quick to respond to issues and make necessary changes, making parents feel like they are working together with staff in the child's best interests.

Students were aware of parental communication, especially where this was concerned with behaviour or achievement. Many appreciated school staff contacting their parents with positive feedback about them. Students were clear about the links between positive feedback from the school, their parents, and their mental health.

Dimension 4: Safety and support

Pastoral support

As previously noted, schools all had designated staff for student wellbeing and pastoral support.

Most staff were confident that students would know who to approach, usually a tutor or a member of the pastoral support team. Pastoral staff report being especially busy during school closures, conducting regular welfare checks on all students, and providing additional support for those in need. The pandemic mitigation measures made providing pastoral support harder, by limiting in-person contact while schools were closed, and use of face masks making communication harder.

Parents were universal in their praise for the pastoral support provided to their children, with staff seen as skilled and responsive to both student and parental needs. Students' views were more mixed, with concerns about anonymity, embarrassment about raising mental health issues in school, unwillingness to approach pastoral staff where they were also teaching staff, and having better support systems in peer groups or at home.

Primary prevention

Most school staff describe two main mechanisms for mental health promotion; speaking often about the importance of good mental health, and ensuring students in need of support know who to approach for help and guidance at the earliest opportunity. Mental health is addressed during assemblies, as part of the PHSE curriculum. and in tutor time. School staff also used these opportunities to communicate support available to students both within the school from external agencies (via face to face, telephone or online). Teaching staff also have a role in promoting good mental health by having an accessible 'open door' policy for students, and being aware of, and not putting further pressure on, students with known mental health issues. Schools also frequently used noticeboards, websites and student newsletters to communicate about mental health.

Respondents often commented on the stigma attached to mental health difficulties, and like staff, students may be reluctant to talk about them in school. This was perceived as particularly true for students from some ethnic minority communities. Staff believed that talking often about the important of mental health would encourage students to ask for support if they needed it. Some staff report that as mental health awareness increased, students were becoming more likely to report issues about themselves, or for other students.

All schools had processes in place to monitor student mental health though the degree to which this was formally structured varied. One had a range of pre-emptive measures in place including regular face-to-face monitoring by safeguarding leads or tutors, and monitoring through proxy measures such as attendance and engagement. School staff also mentioned the importance of staff communication to spot and support students needing support. Student feedback on this was mixed; not all students agreed that it is the role of teaching staff to monitor student mental health.

Targeted support

Targeted mental health support was mainly comprised of access to a school counsellor or a mentor. School respondents often said they would have more targeted support available but this was unaffordable. Staff from two schools also mentioned targeted group interventions for anger management, stress and anxiety, body image, and understanding emotions. Again it was stated than this would be useful for all students as health promotion activities, but the resources were not available. Other barriers to accessing targeted support included pressure on curriculum time; staff reported difficulty in removing a child from a taught class to take part in a mental health intervention. Learning support assistants (LSA) for students with SEND were also perceived to provide high levels of mental health support. Students in all schools were aware of these support systems.

There were some inequalities in which students are more likely to request, or be offered, targeted support. Staff respondents perceived that BAME groups are under-represented amongst students who access counselling, while white, middle-class students may be more likely to come forward and ask for help with stress or anxiety. There may also be differences in school support provided that are dependent on how the mental health issue manifests; one parent noted that her child may be more likely to receive support because she is 'likeable and polite' and hence perceived by school staff as more deserving of support than students with mental health needs that manifest themselves in more challenging behaviours.

School staff also reported signposting or referring students for support from external agencies though waiting lists were often long and may have worsened during the pandemic.

Parents mostly reported satisfaction with the level of support put in place by schools for their children, many of whom had required targeted mental health support. For some, there was a preference to manage mental health support within the school where possible to benefit from existing trusted relationships, even if this meant some delay.

Safeguarding

Safeguarding was prioritised by staff, but did not emerge as a prominent element of school culture. All schools had designated safeguarding leads and protocols in place. There were some differences between school staff and students in the understanding around safeguarding protocols. Some believed that students understood the importance of safeguarding, and if disclosures (of risk or harm) are made, then staff had a duty of care to act upon them. However this had the potential to damage trust and limit how much students were willing to share with school staff.

Bullying

For many school staff, issues with bullying were closely linked with diversity and inclusion. Misogyny, and prejudice against students with SEND were perceived to be the more pressing underlying causes of bullying. As such, many anti-bullying initiatives in schools were also inclusion initiatives, such as support groups for minority and vulnerable students, addressing inclusion and diversity in the curriculum, and celebrating diversity during tutor time and assemblies. Students often perceived these approaches to bullying as too simplistic, and not addressing the more coercive types of behaviour they experienced.

Staff described anti-bullying messages displayed around the school, and students were taught about bystander apathy and to challenge bullying behaviour. One school had anonymous reporting for students to report bullying. For many students however, recognizing and reporting bullying to school staff remained problematic.

Discipline

Staff respondents discussed changes in disciplinary procedures over recent years, with a shift away from punitive disciplinary systems which appeared to no longer work (or have an even more negative outcome on existing behavioural issues) towards restorative approaches and building relationships/rapport between staff and students.

As noted, some staff reported concerns that BAME students were more likely to be subject to disciplinary measures, which may be due to real differences in behaviour or, conscious or unconscious bias amongst (predominantly) white staff. Two schools had adopted systems emphasising 'rewards before sanctions'; students could win points through positive behaviours. Students with challenging and disruptive behaviours at risk of sanctions were also offered additional contact, monitoring and support from staff, to promote positive relationships. Staff reported some implementation issues, with staff training on restorative justice approaches disrupted by the pandemic, and some inconsistency in how discipline was applied. Some staff perceived that students themselves have a key role to play in maintaining discipline and modelling good behaviour.

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School culture and student mental health: a qualitative study in UK secondary schools - BMC Public Health

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Background There is consistency of evidence on the link between school culture and student health. A positive school culture has been associated with positive child and youth development, effective risk prevention and health promotion efforts, with extensive evidence for the impact on student mental health.

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Mental health education and awareness in college students.

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Mental health education and awareness in college students.

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URL: https://www.researchgate.net/publication/363177949_Mental_Health_Education_Awareness_and_Stigma_Regarding_Mental_Illness_Among_College_Students

In this quantitative study, 147 students took an Abnormal Psychology course. After completing the course, students were given the Beliefs Toward Mental Illness Scale (BTMI) and the Stig-9 questionnaire. The findings conclude that there is a direct impact on educational experience and student attitudes toward mental health. Mental health education in schools, no matter what type of school it is, is proven to help students learn and understand issues with mental health and how to seek help.

References:

Shim, Y., Eaker, R., & Park, J. (2022). Mental Health Education, Awareness and Stigma Regarding Mental Illness Among College Students. Journal of Mental Health & Clinical Psychology. 6. 6-15. 10.29245/2578-2959/2022/2.1258.