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4 MENTAL HEALTH PROMOTION
4.1 Mental Health Promotion: Literature Reviews
There is a high rate of psychological distress and other emotional, behavioural and developmental problems in young people (International Union for Health Promotion and Education, 2000). Depression in particular is on the increase for young people in Northern Ireland (Department of Health, Social Services and Public Safety, 1999; Investing for Health, 2003). Poor mental health in children such as depression, anxiety and behavioural problems is a risk factor for poor school outcomes, poor physical health, and poor social skills (Mental Health Foundation, 1999). Classroom-based efforts can be successful in decreasing the likelihood of mental illness and promoting healthy coping skills. School-based mental health promotion efforts are most successful when taught as a part of coordinated efforts to teach social emotional learning (Greenberg, et al., 2003).
A review of selected successful school-based mental health promotion programmes was conducted for the Scottish Executive (Mentality, 2002). Programme topics reviewed included Health Promoting Schools, anti-bullying, body image, suicide prevention, prevention of depression, coping with transitions, participation in school, and substance abuse prevention programmes. A number of benefits for school-age population were mentioned, such as reducing body dissatisfaction and decreasing levels of depression compared to control students. Details of specific programmes from this review (Health Promoting Schools review; Everybody’s Different Program) can be found in Section 7.1.
Wells, Barlow and Stewart-Brown (2003) reviewed universal approaches to mental health promotion in schools. Programmes in the review which included students between the ages of 11-16 resulted in decreases in student violence in school (O’Donnell, Stueve & San Doval, 1998), absenteeism and drop out rates, and improvements in self-concept, school marks (Felner, Brand, Adan, Mulhall, Flowers & Sartain, 1993; Felner, Ginter & Primavera, 1982), social self-concept, academic self-concept (Eitan, Amir, Rich, 1992), problem-solving and social problem-solving skills (Snow, Gilchrist, Schilling, Schinke & Kelso, 1986).
Greenberg, Domitrovich, and Bumbarger (2001) investigated prevention programmes designed to reduce symptoms or risk of mental disorders in school-age children. The review clearly describes multiple programmes organized by type that have empirical evidence to support their use. Three programmes relevant to the KS3 age group are described in this paper in Section 3.2 (PATHS; CDP; SSDP) and one is described later in this Section (Improving Social Awareness – Social Problem Solving: ISA-SPS).
Projects promoting mental health may measure both direct health benefits and improvements in skills which are linked to mental or social health. For example, lack of problem-solving skills or conflict resolution skills is linked to problems in relationships and to poor mental health (Wells, et al., 2003), as these skills are vital elements of psychological health and adjustment (Hinde, 1979). A more positive coping strategy has been liked to improvements in motivation for learning, classroom behaviour and acquiring meta-cognitive skills (Boekaerts, 1996; Dweck & Sorich, 1999). Cunningham, Brandon and Frydenberg (2002) found that teaching coping skills to early adolescents led to improved coping efficacy and fewer depressive attributions.
Programmes aimed at helping students deal with school changes include elements teaching coping skills, problem solving skills (Coping with Junior High curriculum) and social competence and social problem solving skills (Improving Social Awareness – Social Problem Solving: ISA-SPS). These programmes led to improvements in self-reported ability to cope with school transition, teacher reports of behaviour, problem-solving and social problem-solving (Bruene-Butler, Hampson, Elias, Clabby & Schuyler, 1997; Elias, Gara, Schuyler, Branden-Muller & Sayette, 1991; Snow, Gilchrist, Schilling, Schinke & Kelso, 1986). Details of a specific transition programme, STEP can be found in Section 4.2
Teaching conflict resolution as a part of existing curriculum has been shown to have benefits to students’ ability to resolve conflicts and other school-related outcomes (Johnson & Johnson, 1995; Stevahn, 2004). Weissberg, Caplan & Benetto (1988) evaluated a project designed to enhance social-problem solving, involving students learning and applying an ordered approach to dealing with difficult situations. Students in the project compared to those not trained produced more cooperative solutions to hypothetical problems, selected more assertive and cooperative strategies for solving conflict between people andhad higher teacher-ratings of adjustment.
Powell, Muir-McClain & Halasyamani (1995) reviewed 9 conflict resolution and peer mediation programmes and reported improved student attitudes towards violence, decreases in referrals to the principal for behaviour problems, decreases in both in- and out-of-school suspensions for the target group and for the whole school and reduced absenteeism. Details of one successful conflict resolution programme in the UK, Leap Confronting Conflict, can be found in Section 4.2.
In their review, Johnson & Johnson (1996) found that teaching conflict resolution and peer mediation appear to have positive affects on school climate, increase student psychological health and self-esteem, decrease behaviour problems and even improve academic performance. Students that learn these skills seemed able to retain the skills for months after the programme ends, apply the skills to conflict situations and to spontaneously apply the skills to situations outside of the class and school. The authors note that the key to success of teaching conflict resolution is to practice the skill and not just learn about it. It is also important to promote a cooperative view of conflict resolution as opposed to individualistic or competitive.
Ingredients for Success
There are a number of factors identified by literature reviews which make school-based universal mental health programmes successful. A recurring theme across programmes is that teaching ideas alone is not enough to cause changes (e.g., Browne, Gafni, Roberts, Byrne & Majumdar, 2004; Moon, Mullee, Rogers, Thompson, Speller, & Roderick, 1999; Greenberg, et al., 2003). This is evident in the evaluation by Clarke, Hawkins, Murphy and Sheeber (1993), which showed that a project teaching about depression and the causes and symptoms did not result in changes in depressive symptoms or knowledge about seeking treatment.
Longer term interventions tend to work better than shorter ones, programmes that start earlier in education are more likely to be successful (Browne, et al., 2004; Greenberg, Domitrovich & Bumbarger, 2001). The most successful mental health promotion projects emphasized healthy behaviours, as opposed to trying to preventing negative behaviours (Wells, et al., 2003; Greenberg, Domitrovich & Bumbarger, 2001). Programmes which try to address multiple domains, including school environments and institutions, in addition to individuals, tend to show more positive outcomes (Browne, et al., 2004; Greenberg, Domitrovich & Bumbarger, 2001). Programmes for school-age children should focus on the school ecology and climate (Greenberg, et al., 2001). Teachers should have proper training to enable them to fully deliver programmes (Han & Weiss, 2005).
4.2 Mental Health Promotion: Selected Specific Programmes
STEP (transitions, school bonding)
STEP helps students who are transitioning from elementary school (primary school) to middle school (KS3), and from middle school (KS3) to high school (KS4). The programme aims to change the school environment and help with school transitions by improving bonding to prosocial adults and peers. Teachers receive training to improve their academic and social emotional counselling skills, and students’ opportunities are increased to be rewarded for academic success.
Positive outcomes of the STEP programme included better adjustment to changes in school, improved academic progress (Felner, et al., 1993), reductions in stress, anxiety and depression, fewer absences and drop-outs and higher school marks compared to peers not in the programme (Felner & Adan, 1988; ; Felner, et al., 1982; Felner, et al., 1993).
Leap Confronting Conflict
Through active group work and peer medication, the Leap project aims to help students and staff become more aware of conflict issues, work with diversity, work in teams and learn negotiation skills. The programme was evaluated in one school in England and was found to have had the following positive impacts (Inman & Turner, 2001):
Positive change in school culture and ethos
Significant reduction of high-level conflict, with bullying less likely to result in physical violence
Staff less threatened by conflicts and more confident in dealing with them
Greater self-confidence among young people to take responsibility for their behaviour and achievement
Decrease in number of permanent exclusions since start of the project
General improvement in GCSE exam results each year since the start of project
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