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Blog post Researching education and mental health: From ‘Where are we now?’ to ‘What next?’

Education practitioners’ and students’ perspectives on youth mental health first aid provision within education settings in England

Sveta Mayer, UCL Institute of Education

The Youth Mental Health First Aid in Schools programme (Youth MHFA) is a policy initiative intended to enable education practitioners to spot the signs of mental health issues in children and young people. The policy is focussed on providing early support to children and young people to help them seek help, develop self-help strategies or, where needed, referral to NHS mental health support and services (Kitchener & Jorm 2008). The initiative is guided by the government’s Transforming children and young people’s mental health provision green paper (DHSC & DfE, 2017), which acknowledges that all children and young people need access to high-quality mental health and wellbeing support within their schools or colleges. Training is available with MHFA England as half-, one-, two- or three-day programmes, and is not intended to position practitioners in administering medical health provision.

An effectiveness study of Youth MHFA’s one-day programme in England was conducted using a sequential mixed methods approach to ascertain perceived effectiveness in enhancing mental health provision within education settings. Purposive sampling enlisted education practitioners trained in Youth MHFA and six case study schools. The evaluation was undertaken in two phases. Phase one utilised the questionnaire method using a five-point Likert scale to gain education practitioners’ perceptions before Youth MHFA training and each term after the training for one school year (n = 825). Composite scores with median above 3 were deemed high, and those of 3 or below as low perception. The case study staff focus group method (n = 24) and questionnaire method with students (n = 112) were used to provide illustrative vignettes. Phase two utilised the questionnaire method to gain students’ perceptions of their experience of Youth MHFA (n = 436), and is ongoing.

Phase one evaluation focussed upon eliciting practitioner perception of six perceptual constructs.

  1. Knowledge and awareness of early and late signs of mental health conditions and environmental conditions influencing young people.
  2. Utilising the Youth MHFA ALGEE* dialogic process to support dialogue with young people.
  3. Evidence-based practice in provisioning preventative and protective factors for young people.
  4. Creating a more inclusive mentally healthy school.
  5. Meeting challenges related to barriers, stigma and discrimination.
  6. Looking after one’s own mental health through self-regulation (see details in Roberts-Holmes, Mayer, Jones, & Lee, 2018).

Before Youth MHFA training, 30 per cent of practitioners perceived high confidence in offering mental health first aid as a preventative intervention to support young people struggling with mental health. One school year after training this increased to 87 per cent. However, practitioners’ professional, contextual and personal characteristics influenced their perception of impact in enabling them to deliver mental health first aid to students as and when needed. Before Youth MHFA training, practitioners who did not hold mental health qualifications were less confident about their knowledge of mental health; however, after one school year they were equally as likely to have high confidence as participants who held mental health qualifications. Over one school year, practitioners holding pastoral, welfare or learning support roles perceived greater change in the extent they engaged in conversation with students about their mental health than practitioners holding special, alternative, social-emotional or medical support roles. Practitioners holding professional roles without leadership responsibility perceived less change in engagement in evidence-based practice in mental health than practitioners holding leadership responsibility. A greater change in perception of establishing inclusive mental health practice was reported by practitioners in academies, faith schools and free schools than those practising within special education, alternative, SEMH or hospital schools; where inclusive practices are governed by the special education, remedial, restorative or clinical provision. Furthermore, practitioners perceiving high mental health were more likely to report they were self-regulating to maintain good mental health. Focus groups revealed barriers to mental health provision within education settings pertained to tensions around academic performance and lack of funding for mental health professionals. However, the training was reported to further enable practitioners to raise whole-school awareness of mental health issues. Finally, students reported stigma associated with speaking about mental health and wanted their education setting to provide more opportunities to discuss mental health during the school day, including lessons.

‘Before Youth MHFA training, 30% of practitioners perceived high confidence in offering mental health first aid as a preventative intervention to support young people struggling with mental health. One school year after training this increased to 87%.’

Overall, while the utility of Youth MHFA is premised upon proximity of education settings within the lives of children and young people through formal education, this vantage is dependent upon how far education practitioners perceive that the Youth MHFA training enables them in supporting children and young people’s mental health issues within the bounds of their professional roles in educational settings. Given the purported close link between mental health and education attainment (PHE, 2014), implications of these findings for educational settings to provide academic and mental health provision needs to be considered.


Footnote

*ALGEE is an acronym that refers to a widely used five-point action plan for providing mental health first aid, the steps in which are: assess risk; listen non-judgmentally; give reassurance and information; encourage professional help; encourage informal support.


References

Department of Health [DHSC] & Department for Education [DfE]. (2017). Transforming children and young people’s mental health provision: A green paper. London. Retrieved from https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper

Kitchener, B. A., & Jorm, A. F. (2008). Mental Health First Aid: An international programme for early intervention. Early Intervention in Psychiatry, 2(1), 55–61. https://doi.org/10.1111/j.1751-7893.2007.00056.x

Public Health England (PHE). (2014). The link between student health and wellbeing and attainment: A briefing for head teachers, governors and staff in education settings. London. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/370686/HT_briefing_layoutvFINALvii.pdf

Roberts-Holmes, G., Mayer, S., Jones, P., & Lee, S. F. (2018). An evaluation of phase one of the Youth Mental Health First Aid (MHFA) in Schools programme: ‘The training has given us a vocabulary to use’. London. Retrieved from https://mhfaengland.org/mhfa-centre/research-and-evaluation/