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Child and adolescent mental health

Taking a whole-school approach to mental health in Wales – Zoe Haslam and Dr Rachel Brown

21 September 2023

A growing number of nations are advocating for a whole school approach to emotional and mental wellbeing. In 2021, Welsh Government published a framework outlining their model for embedding this approach in primary and secondary schools across Wales. Our research looks to explore how such a policy plays out on the ground.

Why a whole school approach?

It is well known that children and young people’s mental health across the UK and beyond is appearing to worsen.

According to research from the School Health Research Network (SHRN), increasing numbers of young people across Wales are experiencing emotional distress, with a notable difference between rates from before and after the coronavirus (COVID-19) pandemic. Significantly, there is an increase in the numbers of young people reporting moderate mental health difficulties, while not necessarily having a diagnosable mental health condition.

There are also concerns around the extreme pressure Child and Adolescent Mental Health Services (CAMHS) are under, affecting waiting times, thresholds for care, and the support available once a young person has made it through the door. There is a worry, therefore, for the growing numbers of children and young people with moderate difficulties who are more likely to fall through gaps in services.

To reduce the pressure on mental health services and to improve the wellbeing of children and young people, schools are increasingly being considered as a site for delivering interventions which promote good emotional wellbeing and prevent the occurrence or escalation of mental health difficulties. Schools are viewed as well placed to deliver such support as most children and young people are based within mainstream schools for a considerable proportion of their time.

Research in recent years has shown that school-based health interventions are most likely to bring about change when applied across the whole school system. That is to say, when changes are embedded within the curriculum, the school culture, the social and physical environment, and when the whole school community is invited to contribute ideas for change. Examples include: Learn it, Live it, Teach it, Embed it, a whole school programme fostering positive mental health; and the INCLUSIVE programme, which sought to address bullying and aggression in secondary schools. As such, the current national guidance is first and foremost to implement a whole school approach to emotional and mental health.

What is in the Welsh Government Framework?

The Welsh Government Framework on Embedding a Whole School Approach to Emotional and Mental Wellbeing (referred to as “the Framework” from here onwards) outlines the reasoning behind the implementation of a whole school approach to mental wellbeing. It highlights the role for everyone in the school community to consider their own and others’ sense of belonging, efficacy, and voice. More specifically, it encourages schools to consider what they have in place to support emotional and mental wellbeing in terms of 16 different areas, including domains such as curriculum, leadership, staff training and wellbeing, and the physical school environment.

All schools in Wales are required to consider the Framework in the development of their vision, strategy and policies. Welsh Government are also clear in the Framework that they do not intend to give rigid guidelines for schools to follow. This is to allow for schools to incorporate existing practice into their approach to mental wellbeing, and to tailor the guidance in the Framework to meet the wellbeing needs of their learners and staff.

To support this, Public Health Wales have developed an accompanying self-assessment tool to help schools reflect on their current practice and consider areas for improvement. Each school also has access to an assigned co-ordinator from Public Health Wales to assist them in this process.

What is our evaluation seeking to achieve?

Funded by the Wolfson Centre for Young People’s Mental Health, our team within the DECIPHer Research Centre are conducting an evaluation of the Framework. This seeks to understand not only the Framework’s impact on mental wellbeing, but also the nuances of which school systems and practices work well, in what context, and for whom.

The research will involve interviews with children, young people, teaching staff and relevant professionals working within education. These will take place on two occasions: once in the academic year 2022/23 and again in 2023/24. We will also carry out analysis of SHRN survey data collected nationally within schools between 2002 and 2025.

We hope to gain insight into how schools have made use of the Framework in the development of their strategies, policies and school environment to support learner and staff wellbeing. We will also look at whether there are any changes in the way that learners in schools describe their own mental wellbeing, using the national SHRN survey data and tracking changes over time. Then, by considering these things together, we will explore whether school developments might explain any changes in learners’ mental wellbeing.

The study has multiple complicating factors, with the Framework being implemented alongside the new Curriculum for Wales, Additional Learning Needs reforms, and COVID-19 recovery strategies to name a few. We will aim to explore how schools implement the Framework in amongst these other new policies, to understand what changes this leads to in the way that schools support mental and emotional wellbeing. Ultimately, our aim is to contribute to understanding of how school systems can effectively promote the mental and emotional wellbeing of their community members.

This study commenced in August 2022 and is projected to be completed in Spring 2026.

For more information on the study and its progress, readers can access the full protocol online, follow DECIPHer on Twitter or LinkedIn, or visit the DECIPHer website.