Mental Health & School Attendance

Mental Health in Schools

• Schools play a crucial role in mental health prevention and intervention.
• Poor mental health can lead to reduced motivation, impaired concentration, lack of energy, impaired relationships, somatic symptoms, and poor attendance.

School Attendance Issues

• School refusal involves missing school due to emotional distress.
• Truancy involves a lack of interest or defiance.
• Depression, anxiety, and internalizing difficulties correlate with poor school attendance.
• Poor attendance can be associated with self-harm or suicidal ideation.
• Depression and anxiety (especially social anxiety) are high-risk factors for school drop-out.
• Exclusion rates are high among those with special education needs and psychiatric disorders like ADHD or conduct disorder.
• Experiencing bullying affects 1/3 of students and predicts depression, anxiety, psychosomatic symptoms, eating difficulties, and self-harm.

School-Based Interventions

• Universal interventions target the whole school or class.
• Targeted/selective interventions focus on individuals deemed at risk.
• Indicated interventions support pupils already experiencing mental health disorders.
• The CBT approach, known as "FRIENDS", can be applied.

Integrated Cognitive Antisocial Potential (ICAP) Theory

• Antisocial potential is the key construct underlying offending.
• This theory describes different levels of cognitive engagement in learning:
  • Passive: receiving information without processing it (lowest level).
  • Active: basic engagement, physically interacting with materials.
  • Constructive: generating new knowledge.
  • Interactive: meaningful dialogue and collaboration (highest level of engagement).
• Passive engagement correlates with a high risk of offending.

Administrative Data and Data Linkage

• Administrative data is created when people interact with public services like schools, the NHS, courts, and the benefits system.
• Data linkage joins records that pertain to the same entity, such as a person or business.
• Advantages of data linkage:
  • Near-whole population samples can be obtained.
  • A wide range of variables becomes available.
  • Variables that are of interest to public services are accessible.
  • It is inexpensive.
• Challenges of data linkage:
  • Preserving privacy and confidentiality.
  • Addressing linkage errors.
  • Overcoming linkage bias.

Mental Health & Education Data

• South London & Maudsley trust and the Department for Education collaborate.
• CAMHS data from electronic health records includes:
  • Referral details
  • Discharge details.
  • Mental health diagnosis
  • Diagnosis dates.
  • Appointment attendance.
  • Medication.
  • Therapy.
• Pupil database contains education records with:
  • Sociodemographic characteristics.
  • Special education needs (SEN) provision.
  • Free school meal eligibility (FSM).
  • Educational attainment.
  • School absence.
  • School exclusion.
  • Social care information.

Research Findings

• Study 1: School absence and CAMHS referrals.
  • Female pupils with high absence had 2.77 times increased odds of subsequent accepted referrals to CAMHS.
  • Male pupils with high absence had 1.58 times increased odds of subsequent accepted referrals to CAMHS.
  • An odds ratio greater than 1 means referral to CAMHS is more likely in students with high absence.
  • High absence is a stronger predictor of CAMHS referrals in girls than in boys.
• Why absence leads to CAMHS referral:
  • Mental health difficulties can lead to absences.
  • Absenteeism can worsen mental health.
  • Teachers recognize absence as a red flag, prompting referrals.
• Why the effect is stronger in females:
  • Girls report higher emotional distress.
  • Females are more likely to seek help.
  • Different social expectations exist.
  • Girls experience internalizing problems.
• Study 2: Autism and self-harm
  • Male pupils with autism spectrum disorders show higher rates of self-harm presentations to A&E.
• Why autism leads to increased self-harm:
  • Social difficulties and isolation.
  • Emotion regulation challenges.
  • Bullying and stigma.
• Why more in males:
  • Differences in autism presentation (females = more social masking).
  • Underdiagnosis of autism in girls.
• Study 3: Depression & attainment
  • Pupils with depression diagnosis had 40% lower odds of achieving five A*-C grades including English and Maths, compared to pupils without depression.
• Why depression impacts attainment:
  • Depression causes trouble concentrating, absence, and reduced engagement.
• Why the effect is seen in Year 11:
  • Increased academic pressure due to GCSE exams.
  • Accumulated impact of long-term effects as exams approach.
  • Lack of early interventions.

School Initiatives

• Green Paper 2017 led to the establishment of mental health support teams.
• In 2023/24, 34% of schools participate in the program, which:
  • Delivers evidence-based interventions.
  • Supports MH leads to introduce schools/colleges to MH and wellbeing.
  • Gives advice to staff and liaises with specialists.
• Schools play a role in identification, prevention, and intervention through:
  • Universal support, targeting all pupils.
  • Targeted/selective support for at-risk pupils.
  • Indicated support for pupils already experiencing MH symptoms.

Case Studies

• Place2be provides mental health and wellbeing services in partnered schools through:
  • Universal whole class work, resources, activities, and support services.
  • Targeted one-to-one and group sessions, CBT, and parent-child support.
• A study showed services like Place2be do not lead to a surge in CAMHS referrals.
• MYRIAD: an RCT (n=8,376) to evaluate the effectiveness of school-based mindfulness training (SMBT):
  • Teaches mindfulness.
  • Introduces skills like attentional control and self-regulation.
  • Combines psychoeducation, class discussion, and mindfulness practices.
  • Taught by schoolteachers across 10 manualised, structured lessons.
  • Acceptability was low at 4.7/10.
  • Resulted in increased hyperactivity, panic disorder, OCD, and emotional symptoms.
  • Overall, it showed low acceptability and was ineffective, and potentially harmful.

Challenges Faced by Schools

• Funding constraints.
• Stigma among pupils.
• Inconsistent provision across schools.
• Long CAMHS waiting lists.
• Varying levels of staff expertise and confidence.
• Continuity during transition points between schools.
• Understanding the needs of pupils.
• Knowing what services to commission in response.

Crime & Education

• Pupils receiving an offence conviction/caution show a decline in school performance.
• Administrative data links have shown:
  • Declining school performance is associated with depression diagnoses.
  • Declining school performance is associated with criminal offending.
• However, it cannot be inferred that declining school performance must cause criminal offending, or that depression is associated with criminal offending.
• This is related to the Integrated Cognitive Antisocial Potential (ICAP) Theory.