The recent green paper ‘Transforming children and young people’s mental health provision’ (Department of Health and Department of Education, 2017) highlighted the need for the implementation of proactive and preventative measures within the education sector to promote mental wellbeing amongst students and to assist staff in spotting students who show signs of mental health problems. The authors of this paper encouraged and welcomed models for consideration of implementation: ‘we will test a range of models for putting the new teams [mental health support teams] at the heart of collaborative approaches… ’ (p. 22).
Introducing: ‘A model of good practice to promote mental health and wellbeing within the secondary school setting’
The model, as named above, followed on from a PhD thesis on student mental wellbeing (initially involving undergraduates) but, after further research, evolved into a model specific to secondary school education, with the aim being to provide a health-promoting environment in which students can thrive academically and emotionally. To this end, the model comprises seven steps and provides a template on which to base the aims, ambitions and ethos of the individual school (as reflected in the school’s mission statement) by identifying the measures necessary to fulfil these aspirations.
Steps 1 and 2 essentially pose the following questions. Step 1 begins with: ‘Are we doing what we should be doing?’ Perform a review of existing statutory obligations, to highlight any existing shortcomings in the school’s provision. Second is: ‘What is going on elsewhere?’ Conduct a literature review of the incidence and prevalence of mental health problems in young people and the prevailing types of strategies used to support such difficulties in other schools/institutions. Step 2 asks ‘What is currently happening here?’ Perform a school audit of the policies and strategies currently deployed within the school and record these. Then compare and contrast these with the other information extracted from Step 1.
Steps 3–5 involve the research element. The unique component of this model is attaining the ‘student voice’ on matters concerning students’ self-reported mental wellbeing, in order to ensure that the strategies/services provided are actually commensurate with students’ expressed needs. Although integral to the model’s design, Steps 3–5 lend themselves to a flexible approach, in particular regarding the individual school’s choice of research methodology and methods. Decisions about research design, data-collection methods and data analysis will depend on a number of variables: the demographic component and size of the school, the resources and level of expertise at its deposal, time availability and so on. Undertake the research (data-collection and analysis) and prepare this for Steps 6–7, which involve the processes needed to report and disseminate the research findings to the school’s community – governors, teaching staff, administrative staff, parents, the local education authority and the student body. Research findings should lead to an action plan and the compilation of a year planner to implement any changes that need to be made, to set new targets, to reaffirm the present status of existing strategies, to monitor progress and to guide future planning and policy-making. Such measures should provide a benchmark for future assessments and should be used as a platform to drive through new initiatives and to implement changes (where appropriate). It is also this section of the model that affirms the benefits of conducting a scientific approach to the gathering of data. This data will form the part of the process that will develop into the last and final stage to establish a baseline for future assessment and planning. Overall, the execution of the final processes of the model will help to consolidate a workable, sustainable programme that is commensurate with students’ expressed needs.
Most importantly, the model provides the vital interface between theory and practice by setting out a comprehensive template for schools to follow. Furthermore, it is underpinned by a sound, relevant philosophical base, which, according to Dooris (2001), is often lacking in the development of sustainable health-promoting frameworks – a view supported by Thorburn (2015): ‘there continues to be very little philosophical-informed policy elaboration on [pupil wellbeing] and specifically on how wellbeing values can articulate with curriculum planning and teachers’ pedagogical practices’ (p. 650). In this case, the philosophical base comprises aspects of the social model of health promotion, the concept of salutogenesis and the theory of social capital.
Putnam (1995) proposed that the level of social capital can be measured by an individual’s perception of his/her local environment and by high social capital characteristics – which equate with high levels of mental health – such as trust, a sense of belonging and, significantly, reciprocal social networks. A salutogenic approach to mental health promotion is accepted as meaning the creation of an all-encompassing pervasive atmosphere that encourages mental health to flourish; that places value on the individual; and that strives to achieve a sense of equality and fairness (Antonovsky, 1996). Jensen et al. (2017) argue that the salutogenic orientation (also known as the settings-based model) has the potential to enrich the health-promoting school initiative with an overall philosophy, by providing the school with its own supportive culture from which all within its remit will benefit.
As previously stated, the unique research component of this model consists of attaining ‘the student voice’ on matters appertaining to students’ self-reported mental wellbeing whilst in the secondary school setting. The model itself is explained by viewing mental health and mental illness along a continuum, as seen in Figure 1.
Figure 1: The Mental Health and Wellbeing Continuum (Rebholz, 2008, adapted from Antonovsky’s ease/dis-ease continuum, 1985, 1988)
A positioning along this continuum between the values of 0–5 equates with the ethos of the model’s objective. (Although it is the emphatic objective of the model to prevent students from progressing along the continuum towards the hypothetical value of ‘10’, it is nevertheless acknowledged that some young people will need additional support from specialist services beyond the remit of the educational sector.)
Consolidating the model’s structure: The research element
A small case study was conducted within the last few years at a comprehensive secondary school in the South East of England, involving students from Years 7, 8, 9 and 10. The research design incorporated a flexible, multi-method case study (after Yin, 2003, 2013). Data-collection methods were derived from both the qualitative (focus groups) and quantitative (questionnaires) traditions (Robson, 2011). The focus group data findings were used to inform the compilation of the survey questions. The two datasets were then analysed according to a facilitative and complementary approach (Brannen, 2004) and in keeping with assumptions of the paradigm from which they originated. The focus group data was analysed manually (adapted from Miles and Huberman, 1994, 2014) and the survey was analysed using Survey Monkey, which was available at the school. Using a quota sample of 204 students for the survey allowed for cross-tabulation of the quantitative data to yield deeper, more insightful findings from the perspective of year groups and gender groupings. With respect to ethical considerations, the study’s design and objective were presented to the board of governors (including a parent representative), the SLT and the headteacher, and permission was granted to proceed. The welfare of the students participating was given the utmost consideration from the outset. Students participating in the focus groups were advised of the following prior to the focus-group session, whilst survey participants had the same message prefixed to the questionnaire:
“The purpose of this focus group is to find out how you, as students, feel about some aspects of your life at school: in particular, what things cause you to worry or become anxious; who you would turn to if you were worried/anxious or distressed; what type of support service you prefer and how you feel about your school environment – what you like about it and what you don’t. Please answer the questions honestly and do not hesitate to ask if you do not understand a question. You do not have to answer any of the questions if you don’t want to but we would appreciate your contribution to this piece of research. We have not asked for any personal details about you so your responses will be anonymous.”
Research findings and the implementation of new preventative measures
Noted together with many other research findings was the impression that students were lacking fundamental support service awareness: what services were available at school, how and when and with whom they could be accessed (Erasmus, 2019a). Furthermore, because students had indicated that they preferred face-to-face support, it was recognised that the creation of vital social networks and positive relationships would be facilitated through the provision of designated areas (or spaces) within the school for the specific purpose of supporting students in times of need.
Consequently, a Wellbeing Square (#wellbeingsquare), made up of five discreet wellbeing areas, was established. The wellbeing spaces fulfilled the criteria of the mental wellbeing continuum by providing pre-emptive and proactive services to support students in their school setting, where they have some control over what happens – a place where for a few moments they can press ‘pause’ and gather their thoughts and emotions, a place where they feel less threatened or overwhelmed, and a place where they can talk to someone without fear of being judged.
These specific spaces were achieved through mapping an entire zone into circular spaces. With the clever use of existing spaces, teaching classrooms have become wellbeing spaces during school break periods (no expensive décor change needed – just effective signposting). With rooms open five days a week, each space is occupied by peer mentors and/or staff, specially trained to deal with conversations and disclosures concerning mild to moderate mental health problems. There is a constant ‘buzz’ around the zone.
These ‘pop-up’ spaces are divided into five functional areas (the range of which will be dependent on each school’s individual needs):
- the Freedom 2B space, which focuses on encouraging discussions about difference and The recognition of individual differences in terms of race, ...
- the Q space for quiet personal reflection – something like the ‘quiet carriage’ on a train: no talking!
- the anti-bullying space to communicate about relationship breakdowns, especially when the relationships become unhealthy
- the YC space, which is to recognise the role and existence of young carers and provide a place for them to connect with each other and a space for speakers to come and offer support
- The wellbeing space, where young people can talk about matters that concern them.
Furthermore, these spaces fulfil the model’s continuum aims by providing different spaces for different ‘problems’ but with the ultimate aim of retaining students within the 0–5 range. Mental health problems need to be destigmatised in the same way as special needs support, and it is important to note that these pop-up spaces are seen as something separate from ‘SEN space’.
Next stage: Executing a scientific evaluation of the perceived benefits derived from the ‘Wellbeing Squares’
The current position is that, after a brief trial period, #wellbeingsquare has now been officially open since September 2018. Between 20 and 30 students use these spaces every day. Students have reported that they feel ‘listened to’, safe, valued and connected to the school. They state that this has helped to improve their self-esteem and sense of self-worth (supportive of Morrow’s 1999 view). Some visit the zone regularly, others may use one of the rooms once or twice in the school year, and others may never use it but suggest it to a friend. Importantly, students are made aware of the availability of this new student support service through the clear signposting around the school, on their TeenMind app (Erasmus, 2019b), in assemblies, by tutors or by ‘word of mouth’. If a teacher becomes aware of a student struggling emotionally, they may take them to the #wellbeingsquare and introduce them to a student ambassador, encourage them to have lunch there and encourage them to connect with the support available. What is critical to all students is that these wellbeing spaces are open every lunchtime; they do not move location and students are aware of what to expect in each room.
It is intended to carry out the model’s Steps 3–5 (the research component) before the end of this academic year, to ascertain students’ self-reported opinions on the benefits of this new measure. This will be achieved by undertaking a survey and/or focus groups, the results of which might lead to changes in the implementation of this innovative ‘support service’ and the fulfilment of the model’s final Steps (6 and 7), which involves the reporting and dissemination of the research findings to the school’s – and wider – community.
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