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Supporting children’s mental health and wellbeing in schools

Last year’s State of the nation 2019 report (DfE, 2019a) on children and young people’s wellbeing indicated that the majority were relatively happy with their lives; however, many were not. This is starkly illustrated by the revelation from 155 English schools that 191 of their primary-aged pupils had self-harmed on school premises in the previous four years (Thomas & Titheradge, 2019). From September 2020, the new relationships and health curriculum (DfE, 2019b) places the onus firmly on schools to promote wellbeing and mental health, and support those experiencing difficulties. Interventions that help increase children’s emotional literacy and promote wellbeing are a crucial component of school-based mental health strategies.

The Book of Beasties intervention

The aim of Book of Beasties (BoB) – a mental wellness card game – is ‘to inspire the conversation, normalise the subject [of mental health] and make it less daunting when experiencing difficulties’ (Book of Beasties, 2019, p. 2). BoB’s ethos is underpinned by the belief that every child should have the confidence to talk openly about their emotions and mental health.

Book of Beasties’ ethos is underpinned by the belief that every child should have the confidence to talk openly about their emotions and mental health.’

BoB is a manualised programme, delivered by trained school staff to small groups of (up to five) children and can be implemented as a universal intervention or with selected pupils. Five, one-hour sessions are run consecutively with the same cohort on a weekly basis. Core elements of the game are standard, but there is flexibility to adapt play to suit the needs of each unique group. The game introduces 10 characters – the ‘beasties’ – each one of whom embodies features (for example, self-consciousness or lack of energy) that may be associated with emotional difficulties (for example, anxiety or depression). The objective of the game is to help as many beasties as possible to overcome their worries by collecting special cards depicting ‘items’ that can be of assistance (for example, ‘Bellows’ help with calmer breathing); or a particular ‘comfort’, which can be a person, place or object (for example, ‘French rabbit’ is a cuddly toy, reminiscent of a favourite teddy a child would typically have). There are linked wellbeing activities (‘action’ cards) embedded in the game, such as deep breathing exercises (practised in a fun way by making paper boats and blowing through straws to race them). Other activities include yoga, origami, arts and crafts, and mindfulness exercises; these are sensory-focussed and involve active learning.

The pilot study research

This was exploratory, comprising a single case school. Four children (two boys and two girls) attended the five-week programme. The researchers’ main interest was to investigate the social validity of the programme; the acceptability, fitness of purpose, and satisfaction with the sessions perceived by the children, school staff and parents/carers. This type of preliminary research into a new and emerging approach utilises an exploratory method to help form the foundations for future studies investigating intervention effectiveness.

BoB’s “playful-learning” approach encouraged empathy and pro-social behaviours towards the beasties and between players.’

A focus group with the four BoB recipients was undertaken. Focus groups can offer a less intimidating and a more supportive research encounter for children than one-to-one interviews, because a group scenario can help mitigate perceived power differentials. A drawing activity was also incorporated so that children were not limited to verbal responses. Observational data from the five BoB sessions and interview data from school staff and parents/carers were also collected. Thematic analyses of pupil and adult data revealed consistent findings. Overall, BoB was perceived as ‘fun’ and ‘valuable’; its ‘playful-learning’ approach encouraged empathy and pro-social behaviours towards the beasties and between players. Greater emotional awareness and ability to regulate emotions was reported; children had adopted some of the calming exercises practised in the sessions in everyday situations (e.g. deep breathing before a test). Findings will help inform the design of a full-scale evaluation to examine BoB’s effectiveness and explore underlying processes.

‘Real-world’ outcomes

Evidence-informed practice, derived from quality research, should be embedded in whole-school approaches to promote and support the mental health and wellbeing of all children and young people. This requires the proliferation of robust evaluation case studies to share with schools to facilitate best practice and evidence-informed commissioning. The pilot study discussed in this article is a step in this direction and planned, further research on Book of Beasties will continue to address this research agenda.