Teach Secondary 13.8

Unintended CONSEQUENCES Matilda Gosling looks at whether universal mental health interventions in schools may be inadvertently contributing to the very problem they’re trying to solve... statements apply to them, some of which concern quite trivial matters – whether they find it hard to calm down after something has upset them, for example, or how impatient they get when waiting at traffic lights. Most of the questions posed are arguably core parts of the human experience, especially during high-stakes exam periods. Those attaining high scores in the quiz are subsequently referred on to sources of external support, thus likely compounding these students’ belief that there’s something wrong with them. There’s increasing evidence too that universal mental health interventions in schools – those targeted at all students, not just those previously diagnosed with poor mental health –may sometimes create more problems than they solve. Some of these intervention have indeed shown positive outcomes (see tinyurl.com/ ts138-TP3), albeit more often those delivered by mental health professionals, rather than teachers. Others, however, have not. A trial of dialectical behaviour therapy (a form of talking therapy) previously found that the mental health of students involved in the intervention actually got worse , compared to those in the control arm of the study (see tinyurl.com/ ts138-TP4). A separate mindfulness- based intervention was meanwhile found to prompt higher levels of depression and depressed feelings in early adolescents who took part, compared with those who did not. ProfessorWillemKuyken was the lead researcher on a different trial examining school-based mindfulness (see tinyurl.com/ts138- TP5), which ultimately showed no significant positive or negative results, saying of the findings, “ Enthusiasmwas ahead of the evidence. ” His belief is that the complexities of mental health researchmean that we need to involve multidisciplinary teams, with different skills sets, if we’re to solve what is a difficult set of problems. Adverse consequences It’s not a stretch to argue that schools running their ownmental health programmes, or implementing off-the-peg programmes developed by external providers, are going to miss that important element of multidisciplinary expertise – without which, unforeseen, adverse consequences are far more likely. For many, it seems counter-intuitive that universal mental health programmes could be linked to worsened student mental health outcomes. This makes it challenging to filter findings down to schools. Those unfamiliar with the research are distracted by easy messages around wanting to make students more aware of their mental health, facilitate early interventions and reduce stigma. Beyond fostering feelings of vulnerability, why else might we be seeing these sometimes negative effects? Doctors Lucy Foulkes and Jack Andrews, both from the Department of Experimental Psychology at the University of Oxford, have advanced a theory they’ve termed the ‘prevalence inflation hypothesis’ (see tinyurl. com/ts138-TP6). According to them, mental health awareness-raising efforts may be linked to teenagers recognising and over- interpreting symptoms, which can then lead to higher incidence of mental health problems. A hypothetical example teenager – let’s call her Emma –might see, in class, a checklist of anxiety symptoms. She recognises some items from the list. Yes, she does sometimes feel irritable, restless and tired, and finds it hard to concentrate at times. These feelings are normal, but Emma doesn’t know “Students learnbetterwhen theyhave goodmental health, but teachers arenot trained psychotherapists” A fifth of children between the ages of 8 and 16 have a probable mental disorder, according to data fromNHS England (see tiny. cc/ts138-TP1) – a proportion that’s grown from a sixth since 2017. Some popular theories that attempt to explain this deterioration include social media use, climate change anxiety, COVID-19 and our expanding definitions of poor mental health, which seem to increasingly capture normal human worry and sadness within them. These statistics have put concerned adults and institutions on high alert. Mental health fluency is increasing among teenagers, who are taking in the messaging that’s being filtered to them through social media, and from teachers and health professionals. But is this awareness of mental health conditions, and the resulting propensity to think about them at length, actually part of the problem? There’s a risk here of making teenagers feel vulnerable, which could in turn erode their ability to cope with the problems everyday life throws at them. Toomuch stress? An NHS-endorsed resource for teachers – billed as a ‘stress quiz’ aimed at 14- to 18-year-olds (see tiny.cc/ ts138-TP2) – asks those completing it, ‘ Is there too much stress in your life? ’ Students are asked about the extent to which various 12 teachwire.net/secondary