Understanding opportunities for prevention in schools

Mental health issues for children and young people are increasing, this has been exacerbated by the covid pandemic. It is expected that 1.5 million young people will need mental health support in the next 3-5 years. Increasing capacity to provide early prevention is essential for schools and colleges to tackle this growing need and reduce mental health problems that not only impact on learning outcomes but also cause health inequalities that last a lifetime.

The introduction of the Senior Mental Health Lead in many schools and colleges has built much greater awareness for the need to identify and provide more early support to prevent the onset of mental health problems. However, the supply does not meet the increasing demand, leaving schools and colleges to develop their own early intervention and prevention offerings for pupils and students.

Approaches to supporting mental health in schools

There are two different approaches to supporting children or young people's mental health. Firstly, and probably the most prevalent being the development of programmes that assist with the removal or reduction of issues or problems. For example by reducing depression, reducing anxiety, removing negative factors that cause mental health problems, such as anti-bullying strategies and stress reduction.

This can also include mental health problem awareness raising such as mental health first aid and anti-stigma work. Essentially taking the problem ‘away’, however research from the field of positive psychology tells us that taking away or reducing the problem, does not increase health and wellbeing. Improving positive mental health requires a different set of tools and strategies to those that reduce the risk factors.

The second approach and our focus here at Worth-it is the development and promotion of embedded and sustainable capacities for wellbeing. A focus on wellbeing and a move towards flourishing protects mental health and prevents the onset of mental health problems. Strategies include supporting children and young people to cultivate positive feelings, develop positive behaviours for learning, and build positive ways of thinking, understanding and expressing emotions, recognising strengths and learning ways to be resilient and cope with challenges. This is known as Positive Education, applying the wellbeing science of positive psychology in school or educational settings.

This in-depth guide explores how senior mental health leads can provide early prevention in schools.

Different Types Of Early Prevention 

According to the early intervention foundation

‘ early intervention means identifying and providing effective early support to children and young people who are at risk of poor outcomes. Effective early intervention works to prevent problems occurring, or to tackle them head-on when they do, before problems get worse’

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The metaphor of the river is often used to describe the case for early prevention. Rather than fishing children and young people out of the river when they are floundering or struggling, we stop them from falling in the first place.

There are three different types and approaches to applying early mental health problem prevention in schools or colleges. It is important to be aware of which approach you are applying when increasing your settings range of early prevention as a Senior Mental Health Lead.

Downstream prevention, the support provided tries to cope with the consequences of harm and focuses on specific or individual children or young people to stop things from getting worse. This type of prevention assumes processes are in place to identify somebody is struggling with mental health needs or you are aware they are experiencing severe consequences as a result of these issues, and you want to stop it from getting worse. This will mean developing a referral pathway to local agencies such as CAMHS, Mental Health Support Teams or local charities that provide support for mental illness. With your aim as an SMHL to increase access to support and prevent the issue from becoming more severe and enduring. 

Unfortunately, downstream prevention relies on this access to specialist provision being available. Currently, in the UK there is a huge lack of capacity to meet the needs of young people with mental illness and only around a quarter of children referred to mental health services gain access to this support. 

This leaves schools and settings looking for mental health solutions further upstream to stop the onset of these severe mental health problems in the first place.

Preventative supporting at-risk cohorts

Midstream prevention aims to mitigate the effects of harm that's already happened and focuses on at-risk cohorts or vulnerable groups. Vulnerable groups can include young people who have been identified to have a number of risk factors. These at-risk cohorts can include being in care, being a young carer, LGBTQ+ young people, those with autism or special needs and disabilities or that have experienced bullying. Children that have had adverse childhood experiences are becoming an increasingly important cohort to provide early support for.

Providing midstream early prevention is a key area of support for young people we provide at Worth-it.  Through coaching and positive education programmes we have provided early intervention for thousands of targeted at-risk cohorts of young people who don't meet a threshold to access support for more severe mental health needs.

Upstream early prevention in schools 

The third focus of early prevention is to prevent harm before it occurs, stopping the onset of problems even developing. This is done through increasing capacity to provide more effective early intervention and prevention for all pupils or students. 

Thinking about the different levels of prevention helps us to consider not just the immediate causes of harm, but the causes of the causes

NEF Wisdom of Prevention Report 2014by

Both midstream and downstream prevention are more successful when they are offered within a school culture that increases capacities for wellbeing and stops as many young people needing targeted interventions. This is known as upstream prevention where the whole system or population increases capacity to promote wellbeing and protect mental health. As a SMHL it is important not only to increase access to targeted mental health provision but to plan and develop universal embedded strategies for wellbeing for all. 

To represent this approach to prevention we created our whole school system model. 

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We have developed our whole school approach to include upstream prevention through 

• Leadership and management that champions mental health and wellbeing
• Supporting staff to look after their own wellbeing so they are more able to support students with theirs
• Increasing staff capacity to support pupil and student wellbeing through classroom-based or pastoral strategies
• Supporting pupils to build resilience and cope with adversity and challenges they face
• Increasing awareness so all staff can signpost or make referrals to early prevention pathways
• Develop a day-to-day experience and atmosphere of wellbeing facilitated through connections, belonging, positive relationships and interactions
• Embedding a culture and ethos that priorities mental health and makes it core business through policy process and place including involving key stakeholders staff and pupil voice

An effective whole school system incorporates midstream prevention by offering a range of targeted prevention programmes to meet the needs of at-risk cohorts. This is combined with providing downstream prevention through referral pathways for children and young people who have more severe needs. This is a dynamic process or early prevention looks different in every school depending on the needs of their student body and localised offer of support. 

To truly make a difference and increase capacity for the whole community in your school it's important to develop a whole school approach as a SMHL that provides prevention further upstream and prevents the onset of many of the issues you are fire-fighting.

Find out more and next steps

We support schools and settings to develop their tailored approach to early prevention through applying our system and positive education framework and resources. Find out more about our approach to developing school mental health and wellbeing by accessing our free introductory workshop. Find out more how you can gain DfE funding to train an SMHL in your school or college by accessing our FREE DfE funding webinar. Find out more about our Wellbeing Club our DfE assured support and training for SMHLs.

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