By Jane Hull, Deputy Headteacher at SS Peter & Paul’s Catholic Primary School. Jane is one of the first cohort on our MA in Leadership of School Mental Health & Wellbeing. This blog discusses her dissertation research that she did as part of the course and was supported with by the Minds Ahead and Leeds Beckett University Team.
Even before we began to deal with the aftermath of a global pandemic and its impact on the mental health and well-being of our pupils, our school was already trying to support an ever-increasing number of pupils experiencing social and emotional difficulties.
Significant amounts of data and reports including a large-scale NHS digital survey conducted in 2017, lay testament to this, but as a deputy headteacher in a metropolitan primary school, I was already aware of the growing number of pupils who were struggling to meet their potential because they were plagued by social and emotional difficulties.
Children mental health support at home
What soon became apparent, however, was that despite the interventions and support we were putting in place for these children, many of them were experiencing such difficulty and adversity in their home lives, that sometimes our help felt like merely a drop in an ocean of what was needed.
Many of these children were suffering from a range of hardships which were impacting on their mental health and well-being including: insecure, overcrowded housing, social deprivation, hunger and a variety of adverse childhood experiences such as abuse, domestic violence or parental separation.
Although our school did its best to support these families, it was very difficult to do anything that would fundamentally change their home life. Until some issues in their home environment had been resolved it felt like a tug of war, where improvements being made in terms of the children’s wellbeing and mental health were being negated as they returned home each evening.
This prompted me to start thinking about what really lay at the heart of children’s mental ill health. Much of the blame for this has tended to be attributed to social media, bullying, exam pressure and poor body image. Although many of these factors do play a role, I felt that these explanations were more pertinent to teenagers and older children and did not really explain the reason why much younger children were experiencing social and emotional difficulties.
I was keen to understand what reasons were at the root of the problem for younger children experiencing difficulties and concerns around their mental health and well-being because until we really understand what lies at the root of the problem, we cannot truly solve it. For that reason, I decided to research this question as my dissertation area for my Masters in Leadership of School Mental Health and Well-being.
Pupil mental health and adverse childhood experiences (ACEs)
I began by researching around the topic of adverse childhood experiences to see if there was any connection between children experiencing these adversities and developing problems with their mental health and well-being.
Although there are varying numbers and categorisations for ACEs the ten main ones which I focused on were: physical, emotional and sexual abuse, physical and emotional neglect and household dysfunction which includes mental illness, domestic violence, divorce, parental incarceration and substance abuse.
Although some ACE studies have been carried out in the UK, particularly in Scotland and Wales, very few have been conducted in England so much of my research was based on case studies from America.
Early ACE studies also tended to be carried out on adults and identified a link between ACEs and an increased risk of non-communicable diseases later in life like heart disease, cancer and diabetes. More recent research has, however, shown that ACEs do not only impact on adults in later life but can detrimentally affect children’s mental and physical health and behaviour.
The research showed a considerable link between children experiencing ACEs and the onset of a range of behavioural concerns. These could be behaviours such as anxiety, depression and a general feeling of being unwell to more overt behaviours such as aggression or attention issues. What also became apparent from the research was the more ACEs a child had experienced, the greater chance they had of experiencing mental ill health. For a child experiencing three or more ACEs, their risk of developing mental health problems quadrupled.
The research showed that as well as the number of ACEs affecting a child’s mental health, the type of ACE a child was experiencing was also significant. Those that affected the attachment between the child and their main care-giver (usually their mother) had more of an impact, particularly on younger children.
Body's stress management and child's mental heath
This links to John Bowlby’s attachment theory which found that a good strong attachment between a child and their primary caregiver was critical for developing a child’s psychological well-being and positive functioning.
If that bond was broken or disrupted in the child’s first five years of life through either physical separation or unpredictable or non-responsive parenting, it could severely affect the child, causing cognitive problems, emotional distress and personality disturbance, including anxiety, anger, depression, and emotional detachment.
Exposure to chronic uncontrollable events such as adverse childhood experiences, causes prolonged activation of the body’s stress management system which can disrupt the developing architecture of a child’s brain and impact on their long-term ability to respond and manage stress. This is particularly the case if they are not being appropriately buffered and supported by their caregivers.
This chronic stress can lead to heightened alertness so even though this fright, flight, freeze response is good in the short term and can help a child to deal with threats in a dangerous home environment, over a period of time if this level is sustained, it can lead to children becoming hyper vigilant.
This can then cause the child to misinterpret situations or ambiguous cues as overtly threatening, prompting them to over respond, increasing conflict with their peers and other adults and possibly result in their exclusion from school.
Although ACEs can and do occur to children from all social economic backgrounds, the research has shown that they are more prevalent in children experiencing social deprivation and are often intergenerational.
Families who are experiencing problems such as alcohol and drug misuse, parental mental ill health or separation are also more likely to be faced with lots of other stressful factors such as poverty and low quality, overcrowded, insecure housing which can exacerbate tension in the household, potentially triggering other issues such as domestic violence.
Mental health inequalities and children's well-being
The more unequal the distribution of wealth, the greater the levels of mental illness. This could in part explain some of the problems affecting young people who experience considerable peer pressure to have the latest designer clothing, trainers and up to date mobile phones. It also highlights the harsh way in which youngsters judge themselves and others by what they have, rather than who they are.
This constant pressure on families to give their children these material possessions to make them feel popular and fit in so they are not exposed to being bullied or ridiculed for not having these things is overwhelming.
Although my research recognised that childhood adversity and social disadvantage are not the only reasons behind child mental ill health, adversity and social disadvantage have a considerable impact on their well-being.
What can be done then to try and reduce the number of children experiencing mental ill health?
In my dissertation, I argued that the problem primarily needed to be tackled at a national level through Government Policy to reduce societal inequalities which have been exacerbated by the last ten years of austerity. Furthermore, these policies need to be rooted in scientific research and the lessons learnt from it.
This should also involve greater investment in early help services such as health visitors and children’s centres which provide crucial help and guidance for parents to give their children the best start in life.
This work can then be continued in schools as they can play a key role in buffering children against the negative impact of these adversities and develop their resilience.
One of the most significant ways in which they can do this is by nurturing positive, supportive relationships between pupils and school staff. Research on attachment theory has proven that even if a child has not got a caring adult at home, if they have a caring, supportive adult at school, this can mitigate some of the risk factors caused by poor attachment in the home environment, particularly in primary schools.
Through effective training on mental health awareness, staff should then be able to identify children needing more additional support and targeted interventions can be put in place for those pupils.
Improving and developing strong, supportive and trusting relationships with parents is also fundamental and enables schools to identify which families may be struggling and need additional help. By providing a range of effective workshops for parents on areas such mental health awareness, the impact of adverse childhood experiences, emotion coaching, managing children’s behaviour and key transition points for children, schools can help to advert a lot of potential problems.
Having a good Family Support Work who can identify and engage with parents who are having difficulties and provide them with more tailored support, is vital in preventing problems from escalating and negating the need for social services involvement, as once referrals are made, the trust between the school and home often breaks down.
Vigorous safeguarding procedures, attentive and caring school staff, along with effective FSWs can mean early warning signs are spotted quickly and appropriate support put in place for struggling families. Many of these problems can then be prevented from escalating, reducing the need for social services intervention, thus preserving that crucial relationship between the school and the family.
Unfortunately, dwindling school budgets have forced many schools to cut this role which is a real tragedy as they provide a crucial link with families, particularly those who are reluctant to engage with school.
Schools can also play a key role in identifying pupils who need more tailored support and either train their own staff or employ external providers to deliver a range of interventions such as nurture groups, counselling or play and art therapy. It is particularly important that schools can offer support in school because the threshold for Children and Adolescent Mental Health Services is so high, most pupils do not meet the threshold.
Our school, like others, have provided a range of pastoral support for our pupils which has had a considerable impact on pupils’ mental health and well-being but again schools are expected to fund these vital services without additional Government funding and are struggling to meet the ever-growing demand for help.
Schools do have a key role to play in supporting children who are experiencing difficulties both in terms of prevention, promotion and intervention and should provide a range of protective factors to improve pupils’ resilience. They should not, however, be the sole guardians of children’s mental health and well-being as the issue is too complex.
So much more should be done in the first instance through national government policies, which based on scientific research, tackle the root causes of their problems by reducing childhood adversity and poverty and improving their life chances even before they start their schooling.
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