Adolescence is a time of great change, increasing mental vulnerability. Additional challenges such as family discord or bullying significantly heighten vulnerability, and risk is higher for certain groups, such as those identifying as non-binary. These are all issues the recent research from the COVID Social Mobility and Opportunities study powerfully illustrates.
Hard on the heels of this research came NHS Digital’s report Mental Health and Wellbeing of Children and Young People in England - 2022, showing that the proportion of 17-19-year-olds with a probable mental disorder has increased from 17.4% in 2021 to 25.7% in 2022.
It is well-evidenced that people’s social and economic conditions strongly influence their mental and physical health. We need to listen carefully to what adolescents are telling us and think seriously about preventing mental distress.
Efforts to reduce mental distress among children and young people must improve the circumstances of their lives, including their experiences of the places they spend their time. The Mental Health Foundation’s Young Leaders group (14–25-year-olds from diverse backgrounds, with a range of lived experiences of mental ill-health, hosted by Leaders Unlocked), has told us that improving school experience is the most important thing we can do to reduce the number of children and young people who experience mental ill-health.
They spoke of a lack of mental health support in secondary schools, insufficient mental health education and difficulty engaging with counsellors unrepresentative of their background and experience. They felt all teachers need better training in recognising signs of mental distress and should have the knowledge and confidence to intervene.
There is a clear need to ensure that mental health support staff are available in all schools, and to increase the diversity of the workforce.
Forthcoming evaluation of the government’s welcome children and young people’s mental health Trailblazer Programme (due for publication January 31st on the University of Birmingham’s website) has shown universally positive experiences for children and young people who have had contact with a Mental Health Support Team. However, it also indicates limited ability to meet the full range of mental health needs, and the programme will benefit pupils in only 500 schools by 2024, not in all schools.
The term ‘whole-school approach’ to mental health and wellbeing has appeared in several government publications (including updated guidance on implementation), but the concept is not fully apparent in actual policy.
The government should commit to putting the whole-school approach on a statutory footing, requiring schools to have a ‘mental health and wellbeing policy’ setting out how they are promoting mental health. This would be a low-cost intervention to codify the concept in practice.
DfE and Ofsted should review accountability systems to prioritise wellbeing, ensuring that the drive to perform well in exams is not pursued at the expense of children’s wellbeing.
There is strong evidence that frequent bullying can negatively affect mental health and increase the likelihood of using mental-health services for years later. Whole-school approaches should include evidence-based anti-bullying programmes, to help reduce mental health problems among children and young people, including into adulthood.
Anti-bullying programmes can also improve the school atmosphere, behaviour and attainment, in which schools and the government have a keen interest. Their widespread provision would valuably extend the current joint working between the Department of Health and Social care and the Department for Education to address mental health problems in education settings.
There is some evidence that peer-led mental-health education is more acceptable to young people than that offered by adults, and can be more effective in maintaining their engagement with the material and the delivery. The government, schools and local councils can support children and young people to improve their own mental health by facilitating greater access to peer support and peer education.
Strengthening the Curriculum
Research shows that understanding and managing our mood is protective of our mental health. Children and young people can improve their own wellbeing if they have an understanding of their own mental health, emotions, and healthy coping strategies.
While there is an expectation that schools teach some of these topics through the Relationships, Sex and Health Education (RSHE) curriculum, the current curriculum is too flexible - risking wide variation in their content and prioritisation. There should be clearer expectations of the time schools dedicate to different aspects of the curriculum and a more detailed core curriculum – especially for mental health – sequenced by year group and key stage.
Body image issues warrant urgent attention. Research shows that body dissatisfaction is linked with a poorer quality of life and psychological distress, greater likelihood of depression, and the risk of developing unhealthy eating habits and eating disorders. MHF research found that 37% of teenagers felt upset about and 31% ashamed of their body image in the past week.
Our Young Leaders identified the sources of their body-image distress as: social media, advertising, family influences and school, and worked with us to produce a resource for young people on body image.
The Department for Education should promote body-positivity in the Health Education curriculum, and act on the Health and Social Care Committee’s Body Image Inquiry recommendation to ensure that Body Dysmorphic Disorder (BDD) is included in the PSHE (personal, social, health and economic) education curriculum within the section on body image, to promote early detection and early intervention in schools.
The Committee also recommended a stronger focus in education settings on self-worth, critical thinking and appraising images.
Educators as partners in integrated planning
The new Integrated Care Systems arrangements provide a significant opportunity for school leaders to work with Directors of Children’s Services, Health and the Voluntary and Community sector to take joined-up action to improve children’s mental health, using an evidence-based public mental health approach - in schools, in families, and in the wider community. But the starting point must be what children and young people are telling us they need, so that – with their involvement – we can resourcefully and effectively respond.
For children and young people to thrive in our communities and in our schools, the government has to listen to them and to the evidence. It must make their mental health a priority in its forthcoming Mental Health and Wellbeing Plan, and commit to the actions that we know can support and protect this most precious resource.
Lucy Thorpe is Head of Policy at Mental Health Foundation.
The opinions of guest authors do not necessarily reflect the opinions of COSMO.