Interventions aimed at boosting pupils’ understanding of mental health led to longer-term “increased emotional difficulties” when trialled in schools in England, a study has found.
In fact, four out of five interventions trialled as part of the government-funded Education for Wellbeing programme led to “adverse” or “negative” effects on some pupils.
Launched in 2018 and run by the Anna Freud Centre, the programme was England’s “largest research trial of school-based mental health interventions” and aimed to “evaluate pioneering ways of supporting the mental wellbeing of pupils”.
One of the interventions tested was Youth Aware Mental Health (YAM), a programme of five lessons for secondary school pupils that was developed in Sweden and the US.
The trial involved 12,166 pupils across 153 schools.
YAM involves lessons delivered by a professional from outside the school, “using role play designed to improve pupils’ understanding of mental health and reduce suicide rates”.
Negative finding ‘unexpected’
An evaluation report, published on Friday, found YAM had “no overall statistically significant impact on young people’s emotional difficulties at the short-term follow up”, though “several schools asked to deliver YAM did not implement the intervention”.
Further analysis “suggested that YAM did lead to an initial reduction in emotional difficulties, directly after delivery, in schools that were able to implement the intervention”.
But “unexpectedly, we found that YAM led to increased emotional difficulties at the long term follow up, 9 to 12 months after intervention delivery”.
Due to the “risk of increasing emotional difficulties found, this study does not recommend the delivery of YAM in English secondary schools until more is known about how to mitigate risk of longer term harm”.
Dr Camilla Wasserman, YAM’s creator, told Schools Week that studies in Europe, the US and Australia had showed “significant reductions in depressive symptoms, anxiety symptoms, and suicidal ideation”.
But she said it was “very difficult to interpret differences between countries and how adaptations, implementation questions, cultural factors and school climates can influence results of these kinds of studies”.
“The fact that YAM does show positive effects when implemented in full draws our attention to the barriers towards full implementation.
“We will reflect on these barriers and try to better understand which factors lead to successful/unsuccessful implementation of the programme.”
‘Potential negative long-term effects’
Also trialled in (different) secondary schools was “The Mental Health and High School Curriculum Guide”, or “The Guide”, a teacher training programme from Canada aimed at developing understanding of mental health.
It trains teachers to deliver a “six-session programme to pupils, outlining common mental disorders, tackling stigma and improving knowledge of sources of support for mental health”.
In the short term, The Guide was “associated with improvements on some other outcomes (attitudes towards mental health, knowledge of mental health and mental health behaviours).
“However, it was also associated with increased emotional difficulties and decreased life satisfaction at the long term follow up.”
The report said the “potential negative long terms effects mean this study does not recommend The Guide as an intervention for use in English secondary schools, at least until further research can explore mechanisms for these negative impacts and how they can be protected against.
“As with YAM, future studies should further explore the long-term outcomes of this intervention.”
The evaluation report noted that “adaptations” were made to both YAM and The Guide to “ensure greater feasibility of implementation in English schools”.
“While these adaptations were agreed with intervention developers, it is possible that some of these adaptations may have had an impact of the effectiveness of the interventions.”
‘More research is needed’
Wasserman said the findings “lead us to speculate that calling attention to and inviting young people to learn more and become aware of their mental health might make it more likely that participants report emotional difficulties at follow-up they were not aware of or able to put into words before participating in such programmes”.
“We do agree with the British researchers that more research is needed about these programmes. Research should not only focus on effectiveness but also on implementation facilitators and on the methodological challenges that these studies entail.”
The Anna Freud Centre told Schools Week there were “safeguarding measures in place” for the study.
Pupils were provided with “detailed guidance about further help and support, which was locally tailored”, and parents and carers were made aware of the intervention before it was rolled out.
Mindfulness and relaxation benefit some, but not all
Other interventions tested were found to increase emotional difficulties among some age groups.
For example, a trial of mindfulness-based exercises showed “promise” in secondary schools when “delivered consistently and regularly on an ongoing basis”.
But in primary “the opposite was observed with moderate compliance increasing emotional difficulties, which increased further still with high levels of compliance”.
A test of relaxation techniques suggests they “can lead to reduced emotional difficulties if delivered regularly and consistently in primary school settings.
“However, in secondary schools, more frequent use of relaxation techniques is associated with higher levels of emotional difficulties; an effect that was observed at both moderate and high levels of compliance.”
Literacy programme more positive
One intervention yielded much more positive results, however.
Strategies for Safety & Wellbeing, an eight-lesson mental health literacy programme, was found to have a “statistically significant impact on children and young people’s intended help-seeking in primary schools”, but not in secondary schools.
However, implementation findings suggest that in secondary schools, the programme “can lead to increased intended help-seeking if all sessions are delivered”.
“Based on these findings, SSW is a recommended intervention for primary schools, although it may require ‘refresher sessions’ in subsequent years to sustain effects.
“It also shows promise as an intervention in secondary schools, but only if it is implemented in full.”
