We were honoured to spend some time talking to Professor Jess Deighton, Professor of Child Mental Health and Wellbeing at University College London and Director of the Evidence Based Practice Unit at the Anna Freud National Centre for Children and Families, about the role schools can play in young people’s mental health, about school-based interventions, and some insights from her latest research.
Jess talks about why schools are such an important setting in child and adolescent mental health, and the roles they play, and how well equipped schools and teachers.
Jess details some of current intervention programmes that support mental health and well-being in school pupils, what the research shows, and highlights some of the important studies and findings.
We also hear how to translate research into practice, how to go about embedding good mental health across school communities, and what more can be done to support teachers and school leaders in creating mentally healthy schools.
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Jess Deighton is Professor in Child Mental Health and Wellbeing at UCL, Director of Innovation, Evaluation and Dissemination at the Anna Freud National Centre for Children and Families and Director of the Evidence Based Practice Unit. Her expertise focus on the evaluation of interventions and multifaceted programmes to support mental health and well-being in children, factors that promote resilience in children and young people, and the interplay between mental health and educational outcomes. She leads the national evaluation of the National Lottery Community Fund’s HeadStart programme and the Department for Education funded Children and Young People’s Mental Health Research and Evaluation Programme. She also co-leads the early intervention theme for the Department of Health’s Child Policy Research Unit.
Transcript
Interviewer: Hello, and welcome to the In-Conversation podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today I’m interviewing Jess Deighton, Professor of Child Mental Health and Wellbeing at University College London and Director of the Evidence Based Practice Unit at the Anna Freud National Centre for Children and Families. The focus of today’s podcast will be on the role schools play in mental health and on school based interventions. If you’re a fan of our In-Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Jess, thank you for joining me. Can you say a little about yourself by way of an introduction?
Professor Jess Deighton: Absolutely. Really grateful of the opportunity to talk to you. As you’ve mentioned, I have a couple of different hats or job titles and really that perhaps illustrates my background to where I come at this area from. As you said, I’m the director of the evidence-based practice unit which is sort of applied academic unit, which it sits across UCL as the university and the Anna Freud Centre as a child mental health charity. So I hope that allows us to sort of combine academic rigour, but also, sort of, a real world sense of it being very important to think in a very applied way about our research and think about how we can make it most useful for those people who might find the evidence either hard to find or would be best placed to implement if they were able to hear about it. So that’s very much our focus in our work and we’re very much focussed on children and young people and thinking about risk and resilience and interventions that best support their mental health.
Interviewer: How did you come to be interested in the field of child and adolescent mental health?
Professor Jess Deighton: Probably my interest galvanised, I would say, in my sort of late teens, early 20s. Probably a couple of things prompted the initial interest. I think one was while I was doing my university degree I, like many people, had sort of casual or sort of holiday jobs and I had bank shifts working in the local psychiatric unit, which was for adults and it was a job I really, really enjoyed, but it really struck me in my time working there that many of the adults who were there describes really ingrained, challenging difficulties that had often really started much earlier in their life, in childhood or adolescence, or at least had the origins in terms of challenges and triggers within that period of time that you could see playing out later.
And quite often they would describe not really getting support at that time. I often wondered for those adults what their life might have looked like actually if they did get back to school when they were younger and I suppose slightly closer to home in that I grew up in quite a rural area, which meant the school catchments covered quite a large geographical spread and with that came a really big, sort of, demographic mix, if you like, of people. So I grew up with a quite heterogeneous peer group, lots of different backgrounds, lots of different experiences.
I don’t think at the time growing up I really thought of them as that different from me, but as we grew up and as we all sort of got into our later teens and early 20s you could see different people taking quite different trajectories in life, and I suppose it wasn’t necessarily an interest in mental health as such, but sort of that interest in risk and resilience really grew from there, sort of seeing how these incremental changes that you don’t really notice as you go along, actually make a really big difference to where people end up in their lives and wanting to think more about how we sort of step in early and give people the best opportunities to have good wellbeing and function well in life really.
Interviewer: Jess, much of your research focuses on the role schools play in child and adolescent mental health. Why are schools such an important setting to consider in this regard.
Professor Jess Deighton: I mean, I think on a really basic level, as one of the first most common experiences that children have to learn about the world beyond their families, you know, they spend a lot of time in the school setting, and I think what’s said in schools, not just by teachers, but also by peers, has the ability to, sort of, set norms and expectations for children and young people about what to expect from life. What’s acceptable? What’s normal experience? What’s important and what’s not important?
So I think for that reason it’s a really good opportunity to introduce some sort of preventative messages about mental health to help young people build sort of skills and lay down good, solid foundations for good mental health. I think one of the other reasons really is looking at some of the recent prevalence studies that we’ve had, so one in 2017, they’re also asking people about where they go for help and that was focussing specifically on those that had identified as having sort of diagnosable mental disorders.
One in four were accessing, sort of, specialist mental health services, but actually almost double that were saying that they would talk to teachers or others within school about mental health challenges. So I think that says something about where young people go for help. They don’t necessarily seek the external expert, although sometimes they will, but what they often do is seek a school where they are and from people that they trust and the school is a really good context for that. So for me, that’s a good argument for putting the help where young people look for it.
Interviewer: Right. Well, given that, given that so many go to their teachers for support, how well equipped are schools and teachers when it comes to dealing with child and adolescent mental health issues?
Professor Jess Deighton: On the whole they try really hard, and I think the picture has changed a lot over the last ten or 12 years. I remember carrying out qualitative interviews with teachers probably about ten or 11 years ago. Even then, you know, lots of schools try to do things to support children’s mental health, but there was definitely a theme kind of coming through some of those interviews that was around teachers who felt they were there to teach and weren’t there to talk about mental health. I think that’s less and less what I hear now.
I don’t hear that being really emerging so much. I’m sure there’s the odd teacher, you know, some of that, but I think that battle has been won to a degree, but there’s still a lot of variability between schools. It really does vary hugely from one school to the next and that’s partly in terms of the school’s practices, but also in terms of the challenges that some schools face over other schools in terms of just the mix of challenges that young people face. So it’s a bigger job for some schools than it is for others. I spend quite a bit of time talking to schools and there’s some brilliant examples of work that schools are doing where they’ve threaded well-being absolutely through everything that they do.
You know, the whole school is really trying to gear towards supporting young people in that way, and particularly in the last year where they’ve been trying really hard to understand what the needs of their young people are, even when it’s been really tough, because they’ve not always had that contact time. All sorts of horrific things that children and young people have been through.
They’ve been trying to understand, you know, what traumatic bereavement looks like. Trying to help people manage their anxieties. Trying to support parents who themselves actually have a number of anxieties and worries over this period and real innovation and, sort of, a young people centred work. So some schools are absolutely brilliant. Some needs more help, and of course it’s been great that we have the green paper a few years back which has given a real, kind of, roadmap to how we build capacity in schools to support mental health and particularly to strengthen those links with health and specialist services.
And that’s great. But I guess there’s still some other challenges, like, it feels like there’s a lot of scope creep in schools for what they are now responsible for. The remit just grows and grows, doesn’t it, and that’s challenging from a teacher’s perspective, particularly in the last 12 months where that’s been a really tricky time when they’ve been squeezing themselves, trying to deliver even just the education part of their remits, it’s been tricky. So I think often the demand can really outstrip the support that they can give, and I think we always have to hold in mind we can’t expect school staff to be mental health specialists. So all of these things I talk about and about schools being a good environment is not to replace those specialist services and those mental health professionals are obviously crucial.
Right. I want to look at the current interventions in a moment that are occurring in schools, but I think there’s something to what you’re saying there about teachers. They may be very well-meaning and trying hard, but unless there’s training and tools are those teachers necessarily enough in some way to take on the mental health remit?
Yeah, and I think that’s a broad question. What is the mental health remit we’re trying to hand to them? So certainly I think it’s within a teacher’s gift and so many teachers do this so well already, to open up conversations, to own as a topic mental health and say this is what we talk about. We talk about physical health. We talk about education. We talk about mental health. These are the things that we put time into growing, making sure that young people flourish in all these respects, that we can give young people language about mental health and help them think about the distinctions between when they’re just having an awful day or an awful few days and when actually that’s something more ingrained that they might need support with.
I think it’s where those challenges are clearly ingrained and, you know, there’s lots of examples of that within schools when they’re really, those young people are really, really struggling and need specialist help. It’s much more then about supporting teachers to think about how they get those young people to that extra support, not about asking them to be that extra support.
Interviewer: Yeah. Jess, can you talk through some of the current intervention programmes that support mental health and well-being in school pupils?
Professor Jess Deighton: One of the things, I mean, about that culture change that I’ve sort of described over the last ten years is that there’s absolutely a bewildering array of mental health and wellbeing interventions at their schools, and I think some of the problem is fighting through that sort of quite confusing landscape sometimes for schools to think about what will work best for them, and we have been doing some work actually at the Anne Freud Centre around how we get the most evidence based approaches to schools. So we’ve been developing the mentally healthy schools portal which started with primary schools, and now we have four secondary schools, which is a good way of schools finding that kind of evidence.
But yeah, often I think that there’s a worry for me that schools are in a position where they’re trying to make good choices, but they don’t have good information at their fingertips to do that. There’s all sorts of examples of everything from lots of schools with sort of counsellors in situ, lots of sort of peer mentoring programmes, lots of sort of imaginative, creative and physical activities and interventions. There’s even all sorts of other models where some schools have sort of pets for well-being in schools.
There’s anything you can imagine almost from one end of the spectrum to the other, but it’s just sort of trying to think through what makes a, sort of, coherent approach I suppose. We ourselves are trying to trial some interventions at the moment through quite a large scale programme of randomised control trials that’s funded by the Department for Education. So we’re not a point to say that they’re effective yet. That’s exactly what we’re testing, but the idea is that they might be interventions that could be embedded in schools as sort of universal interventions to support well-being.
And some of those are quite light touch. So things like just small sessions on sort of mindfulness or relaxation and others are much more sort of like mental health literacy programmes, that sort of thing. But there’s a lot more these days, sort of, training for teacher’s building capacity. Lots of approaches which are around sort of being trauma informed or mental health first aid. So, yeah, a whole variety out there the challenge, which ones work?
Interviewer: I mean, given that there is this wealth of programmes, where should the first port of call be then for schools that are looking for the best or most appropriate intervention for their pupils?
Professor Jess Deighton: So for me, it’s about first starting with understanding what the need is and I think that can be quite tricky for sometimes now and we have been working on, sort of, models of well-being measurements in schools, which are about trying to get a bit of a temperature check actually of the sort of people population, if you like, to say what are the particular strengths and not on an individual level, but what are the kinds of challenges that seem particular to our young people so that we can think about where we could bring in support that feels more targeted to those needs.
So I think it’s first starting with understanding what the needs are, and then I think it is about trying to look for where the evidence says certain approaches might be more effective. So if what you’ve identified is that there are particular challenges around anxiety and low mood then thinking about what are the school based interventions that might look most effective for that? I think often what schools do is borrow practice from other schools who found something to be effective, and that’s great.
But I think it’s good to step beyond that and think about what might have been trialled before, sort of, nationally or in other areas and, sort of, objectively shown to work, and that’s what we’re trying to do with things like the mentally healthy school’s website is often that’s in peer review journals and things that are behind paywalls or hard to access will take too much time to look through schools. So trying to give it to a form that’s accessible and practical I think is the key thing.
Interviewer: Well, let’s turn to the evidence. What does the research show with regard to the impact of school based interventions?
Professor Jess Deighton: There’s definitely, sort of, positives there in terms of impact. It’s fair to say the evidence is a bit equivocal in places. There are certainly gaps, especially in terms of sharing impacts over an extended period and often studies have quite short term follow ups, but there’s definitely some promising practices and we try to distil some of this in a review we did a couple of years back for Public Health England which was broader than schools, in fact it was more about sort of universal interventions generally for mental health and wellbeing.
So we try to distil from some of those promising interventions what were the sort of key elements that were coming out and they were around actually, yes, that they were provided in schools, but they tended to be sort of group based. So usually a class, but it could be smaller groups. They tended to be sort of discrete number of sessions. Quite often they focussed on skills based kind of approach. So building social emotional skills, for example. Quite a number of them have sort of cognitive behavioural sort of principles to them.
And this one sounds obvious, but sometimes isn’t the case. So they were particularly designed to be engaging for young people and what I mean by that was they weren’t just taught or told, it was very much about role play or discussion or engaging young people in the sort of debate around what the sort of materials were. So that’s not to say that everything that fits that description works, but they were certainly common themes that came out and there were specific interventions that we could have picked out, which are probably ones that get named quite a lot, things like Friends and the Incredible Years, Webster-Stratton. Zippy’s friends.
I mean, I would say though I think often some interventions gain momentum in terms of the research evidence and others don’t. So some of that is just about we need to spend more time contributing to the efforts for these interventions because they’re just under researched, if that makes sense.
Interviewer: Right, Right. Can you highlight some of the studies and findings that have had the greatest influence or that you feel are especially important?
Professor Jess Deighton: Yes, so I think maybe these aren’t always intervention studies. So, one, I think has had a very big influence on me in recent years is the one I mentioned before, which is actually that prevalence study that was carried out in 2017 about the mental health of children and young people in England, and that’s because we waited so long to have an update on what the extent of the difficulties were for young people. So it felt really important to have that confirmed that there was some increase and also understanding what was driving this increase so we could see particularly for young women in that sort of older adolescent and young adult, kind of, end of the spectrum was really, you know, where some of the problems were really escalating, particularly in terms of emotional difficulties.
I think it’s really important for us to know those things, but for the reasons I say it is for us to just be able to identify where the need is really, and I think that study highlighting that young people will go to school staff for help was really helpful. I think another one, which is intervention focussed in a way, is actually a review study carried out quite a while ago now by Durlak and DuPre called Implementation Matters.
Although it’s older I think it was one of the first times that the evidence was really collated about the fact that we can talk about effective interventions, but actually there’s so much about the context and how interventions are rolled out that has a bearing on their effectiveness. Those are crucial considerations. So as much as I say schools should start with what’s evidence based. We also know that schools and in the context too, we sometimes need to adapt interventions a bit to fit the context.
But we need to be mindful of not adapting so much that there’s no fidelity to the original model and therefore we risk them not being effective. Even in the trial that I mentioned that we’re running at the moment we’ve taken interventions that were developed in other countries and trying to make them work in an English school setting is really tricky. So adaptation to them has to happen. So I think what that really tells me is that we have to keep evaluating in situ and sometimes that’s not perfect and it’s quite pragmatic, but it is crucial for schools and for researchers to know actually what’s working on the ground.
So they’re a couple. The other one that I, again it’s not about interventions, but I think is really fascinating and is a really helpful public health message is a paper from 2017 led by Schaffer about enduring mental health and that was taking the longitudinal study and looking at each sweep of that study from sort of mid-childhood, I think right through into later adulthood. Of all those sweeps they could look at those who had a sort of potentially diagnosable mental disorder, and they were interested to see what proportion of the population didn’t have a diagnosable mental disorder at any point in their life course.
And I think it was a really nice, systematic approach and what they identified was actually only 17% of people in that cohort didn’t have a mental health problem anywhere in time, and I think that’s just such an important normalising message, because I think what it tells us is it’s the norm. So it’s a nice non-stigmatising message that you’re not in the minority. If you’re struggling with a mental health problem, you’re actually in the majority but also for young people it’s a really important message because it may not be a problem at any one point in time, but it’s likely that at some point in your life you’ll encounter challenges that really do undermine your mental health.
So it makes sense to develop those skills, those self-care strategies, those support networks to help you manage when those things come along.
Interviewer: Jess, how do you disseminate your findings to have the greatest impact?
Professor Jess Deighton: I mean, I think it’s still a work in progress, but we try to work really hard on this for the reason I mentioned really, because we are very minded that we want our research to be relevant and usable. So we do spend a lot of time producing, sort of, lay summaries of evidence and we spent a lot of time in the last year trying to do that with evidence about the impact of Covid on mental health, for example, we’ve been synthesising every couple of months what evidence is emerging and sharing it with what we hope is a lay audience.
So a lot of that kind of distilling to disseminate, we’re really looking forward to have really strong networks. So we have a Schools in Mind Network, which is well over 23,000members now, sort of, school based or school interested professionals. So we can share learning with those groups, which is great, and we’re trying to be a bit more creative about using videos and blogs and other ways of sharing learning, but also spending a lot of time speaking to schools and going to conferences that aren’t academic conferences, but are actually school leaders or school teachers or others who actually are the ones working directly with the young people to share what we’re learning, really.
Interviewer: Right, and is the idea also to share the learning with young people themselves, given what you said before about sort of breaking the stigma and demonization of the fact that people will often struggle?
Professor Jess Deighton: Yeah, absolutely, and we’ve had a nice opportunity in some projects recently, a project called Head Start which is quite a long-term one of ours which is funded by the National Lottery Community Fund, where we’ve carried out interviews with young people about the kinds of things that challenge their mental health and wellbeing. What helps them to manage, but we’ve also been able to work with some of the young people involved in that programme as, sort of, young ambassadors to develop sort of briefings that are aimed at young people about what we found from that research.
So that feels really nice when you can co-produce that with young people. It then sort of better meets the needs of young people directly.
Interviewer: I want to turn to translating research into practice and I know you’ve touched on the importance of this already, but how do you go about embedding good mental health across school communities? So how do you translate that research into practice?
Professor Jess Deighton: I think as many ways as you can and as far down the pipeline as you can take it, if that makes sense? So it’s great to be able to translate things so they’re accessible and understandable, but it’s also creating things that are actionable.
For example, where I’ve been talking about understanding needs through our research projects we’ve developed measurement frameworks which help us to understand the impact of interventions, but then it’s also occurred to us through that process that’s really useful information to schools. So we’ve developed well-being measurement frameworks that we’ve shared with schools and we’ve developed systems that allow them to collect that information and we can feedback to them then about what their population looks like in terms of strengths and challenges and give them some support and thinking about what they might do about that.
We’ve tried to develop sort of evaluation tools, mindful of those implementation matters kind of points I mentioned before about how schools can pragmatically think about whether their support is having the effect they were hoping it might, and also another good example of where we did this and definitely can’t take credit for this. This was colleagues of mine, but we were quite interested in self-care strategies. So we carried out a systematic review about that but then that has since gone through many different guises but it’s now become part of the Anna Freud Centre’s web page and it’s very interactive, sort of, materials around self-care that young people can access that gives them ideas about what self-care strategies they could use. How other young people have found them, that sort of thing.
Then the other crucial thing is obviously just making sure we have those networks to make sure the information doesn’t just stop short of getting to the people we think might be able to use it. So the health care pages on the Anna Freud Centre websites, if you go to www.annafreud.org and then you’ll see something that says self-care pages on there.
Interviewer: Brilliant. Thank you. Jess, what more can be done to support teachers and school leaders in creating mentally healthy schools?
Professor Jess Deighton: Some of the things I’ve been describing, but more so in a way. So giving schools more information about what works, even really equipping schools with some questions that allow them to interrogate with a bit of scrutiny what people are trying to offer them in terms of mental health support. So I think often schools can get bombarded by these, sort of, here’s this bright, shiny new approach, but to be able to give you a way to question where is the evidence about this. Can you share with me something that shows, you know, that this has been effective elsewhere? I think even things like that would be quite helpful. I think helping schools to think through whole school approaches.
And quite often we end up talking about interventions, but it really is just the tip of the iceberg in terms of thinking about what support should be put in place. So how do we embed sort of, well-being right at the heart of the curriculum? How do we ensure that we’re supporting staff with their well-being so that they can most effectively support children and young people? How do we understand needs? How do we introduce interventions? So that whole set of sort of layers I think it’s really crucial to have that as part of the piece.
I mean, I think what I’d really like to see as well is, you know, some capacity building. I feel it should be in initial teacher training, even if it features in a small way that there should be some kind of learning in there about mental health, because most of the teachers I speak to and I might be in a bit of an echo chamber will say it’s so much part of their everyday life in schools that it’s quite crucial.
Interviewer: Is it included in the training at all?
Professor Jess Deighton: Not at this point or it may feature in some but it’s certainly not common.
Interviewer: What changes then still need to happen in training, but also in terms of policy decisions and resources?
Professor Jess Deighton: So I think that what about training is definitely one of them, but I think more-clear, accessible information for schools. So great that we have the Mentally Healthy Schools website. That’s just one. I think there needs to be much more like that. Also, I think a wider consideration of what prevention and universal interventions should look like. So I think we’re good at thinking about the things I mentioned, you know, the kind of mental health literacy, all those discrete sessions and that’s great.
But we need to think about the wider system and how sometimes the way we put structures in place can actually undermine young people’s mental health and well-being. I think particularly recently, we’ve seen a real escalation in young people reporting that school can be a really stressful environment for them. The pressure really feels like it’s on and I think we need to spend much more time considering how we have structured school and learning that has piled so much pressure on children and young people and how we can address some of that.
So some of it’s about adding in. Some of it’s about potentially taking away or rethinking.
Interviewer: You’re optimistic that will happen?
Professor Jess Deighton: I think certainly for me, I would like to spend more time thinking about what the evidence base looks like for changing some of those structural aspects, not just about which interventions we can put in schools. Sometimes we try and look at adding interventions in schools and you can see schools having a real dilemma about what they take out to fit this into the curriculum and that’s really tricky and sometimes what is suggested to come out is things like PE and I think, oh, no, please don’t take PE out.
That might be one of the most helpful things that’s in there. So I think we do need to think really carefully about how we put these things together. I do just think the scope creep and the hacking of the school day with so many things needs to be thought about. It’s not the answer to everything but I do think that there’s a worry that schools really don’t have the budgets to commission some of the supports that they would like to see in place in their schools and I think that is part of the picture and also, I think better support for teachers. They carry so much of the burden of the young people that they work with. They worry about them. They have sleepless nights. They try their best to manage things. They feel it beyond their expertise. So I think some of that is about building teacher’s capacity and expertise. Some of it is about giving them, sort of, supervision and reflection space for their own well-being and some guidance. I think that’s really too.
Interviewer: So a lot to do. Jess, what else is in the pipeline that you would like to mention?
Professor Jess Deighton: Some of the things I’ve mentioned already are obviously still in the pipeline. I’m really looking forward to when we’re able to report on these trials we’re working on, but that will be a little while yet. The Head Start project I mentioned is ongoing and the nice thing about that one is we’re able to drip feed learning as we go. So we are often, sort of, disseminating briefings from that project. We’re learning not just from those young people we’re interviewing, but actually around about 30,000 children and young people year on year who are completing well-being surveys.
Another exciting project we’ve just started with colleagues in University of Manchester and the Greater Manchester Combined Authority is around embedding this well-being measurement across schools, across the Manchester City region to try and use that as a basis to, sort of, pivot the system towards well-being. So not just to get the schools talking about that, but to get voluntary sector and community organisations thinking about how they can support those endeavours in schools and how they can sort of link better to ensure well-being is prioritised. So that one has just started really. It’s very exciting.
Interviewer: Great, and finally, Jess, what is your takeaway message for those listening to our conversation?
Professor Jess Deighton: So I think one is the one that I mentioned to do with enduring mental health about all of us remembering really that mental health problems are a lot more common across the lifespan than we sometimes think they are. So reminding those who are experiencing mental health difficulties that they are in the majority, not the minority. Thinking about embedding support in schools. It’s a series of steps. So starting with evidence based approaches, as I’ve said, but being aware of the role that context and implementation has and that makes big differences.
So remembering the work isn’t done just by selecting evidence based intervention. It requires sort of constant checking really, to see if that’s helping, particularly speaking with young people about how they feel it’s working within the school, and that bit, I suppose I just said which I think you think you feel is quite ambitious about supporting mental health, you know, from that universal standpoint is about more than just thinking about adding in interventions, but also thinking about what’s already embedded that might be undermining mental health or potentially contributing to distress and how we can have a rethink around those things.
And also, I suppose we’re talking about schools and, of course, that’s the topic, but just as a reminder that the solution, of course, isn’t all about schools. It’s about layering support across the system, across communities and families, across all of those contexts by young people are, so the ask is of the whole community, because they all have a role in supporting children and young people’s mental health.
Interviewer: Brilliant. Thank you ever so much. For more details on Professor Jess Deighton please visit the ACAMH website www.acamh.org and Twitter at ACAMH. ACAMH is spelt ACAMH and don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review and do you share with friends and colleagues.
