Social and Emotional Wellbeing and Mental Health

1. Social and Emotional Wellbeing and Mental Health What’s the point and the role schools must play?

2. “the purpose of psychology is to give us a completely different idea of the things we know best.” Paul Velěry

3. Philosopher Michael Foucault “people know what they do; they frequently know why they do what they do; but what they don’t know is what they do does.”

4. Sometimes we get a surprise when we discover what works to support change as it is not always intuitiveFor example- raising attainment is Kenya-. • plan a- supply booksplan b- supply visuals But the greatest impact was non-educational- providing de-worming medication

5. My themes • The current problem and why is it on the increase • Nature/Nurture and Neuroscience • Why the need to look at social and emotional wellbeing and Mental Health now • What advice do the DfE provide • What is it that an effective school can do- a four stage approach to help get you started • What is a connected relational school- one approach • Waves of intervention • What can’t you ignore doing- low cost • Positive Psychology and Resilience • Relationships and belonging

7. There is a problem • Not just with children but with adults too Health and Social Care Information Centre (HSCIC), the official provider of national health and social care statistics. The HSCIC was set up by the government in April 2013. Women (11%) were more likely than men (6%) to be taking antidepressants. Women also demonstrated a significant variation by income class. 7% of women in the highest two quintiles of income were taking antidepressants, which rose to 17% of women in the lowest quintiles. Nearly one in five women from economically deprived areas were taking antidepressants.

8. Deaths from suicide in the UK rose slightly from 6,122 deaths in 2014 to 6,188 deaths in 2015 with a subsequent increase in the rate from 10.8 to 10.9 deaths per 100,000 population. • UK male suicide rate decreases whilst female rate increases to its highest rate in a decade. • Across all broad age groups, the rate for males was around 3 times higher than females.

9. In 2015, the suicide rate in the UK rose slightly to 10.9 deaths per 100,000 population, up from 10.8 in 2014. This was made up of a decrease in the male suicide rate from 16.8 to 16.6 deaths per 100,000 population and an increase in the female rate from 5.2 to 5.4 deaths per 100,000, the highest female suicide rate since 2005. • Of the total number of suicides (6,188 deaths) registered in the UK in 2015, three-quarters (75%) were males and one-quarter (25%) were females.

10. Females aged 45 to 59 had the highest suicide rate for the 13th year running at 7.6 per 100,000 population in 2015 (see Figure 7). This rate was significantly higher compared with the other broad age groups. • Females aged 30 to 44 continued to have the second highest suicide rate at 6.0 per 100,000 population. This was the only broad age group for females to show a decline in rate since 2014. • Although the rates for females aged 10 to 29 remained the lowest, this was the only age group to have a slightly higher rate in 2015 compared with 1981 at 3.2 per 100,000 population. The rate for females aged 10 to 29 in 2015 was significantly lower compared with other broad age groups with the rate remaining the same as observed in 2014.

11. In 2015, males aged 45 to 59 continued to have the highest suicide rate of 22.3 deaths per 100,000 population (see Figure 6). Although it remains the highest rate amongst males, the rate has been steadily declining since 2013. Also, this rate was significantly higher than males in the other broad age groups, with the exception of males aged 30 to 44. • Males aged 30 to 44 had the second highest suicide rate, at 21.0 deaths per 100,000 population in 2015, which has also been declining since 2013. It appears that the gap between the rates in males aged 30 to 44 and 45 to 59 is beginning to narrow once again. • On the other hand, although the rate for the youngest males aged under 30 remains the smallest rate (as it has done since 2001), the rate has been steadily increasing over recent years. However, the rate was significantly lower compared with all other broad age groups for males.

12. A record number of people killed themselves in prisons in England and Wales in 2016, figures show. • The Ministry of Justice said there were 119 self-inflicted deaths - 29 more than the previous year and the highest number since records began in 1978. • It also reported a record high of 37,784 self-harm incidents and 25,049 assault incidents.

13. Teenagers in developed countries… • 25% have mental health difficulty • 10% with mental health disorder • Anti-social behaviour most common at 5% • Self harm & eating disorders increasing • Anxiety & depression affect 4% • Suicide rare but 1 of 3 most common causes of death in 15-24y old (Promoting Mental Health in Schools – EU report – 2011)

14. UK is rated 16th out of the world’s 19 richest countries in terms of wellbeing (UNICEF 2013) • About 10% of young people will experience serious emotional or behavioural difficulties ( and this group will struggle more in school. • Between 20-30% express worries about their school experiences which can affect their well being and achievement • There is a growing body of research on these experiences and on the schools role, albeit not a large body of research based knowledge

15. How much of a problem is there in England? Public Health England(PHE)- evidence suggests in an average class of thirty 15 year olds • 3 could have a MH disorder • 10 are likely to have witnessed their parents separate • 1 could have experienced the death of a parent • 7 are likely to have been bullied • 6 may be self harming

16. Why is it on the increase? Schools report increasing numbers and complexity of wellbeing and mental health issues among children, young people and staff. The causes Indications that include- • Pressures of exams and assessments • Social media • Ofsted We are not sure though

17. My own anecdotal evidence • The rise in primary children – struggling to ‘fit in’ with the school offer – 23 pex this year so far- some very young children • Trauma and attachment issues for the children- not being addressed sufficiently- they arrive at secondary still insecurely attached to adults and struggling • Parents really struggling with it all- there is a cycle of difficulties and we are not responding well enough to prevent this cycle from continuing • Enhanced primary provision not keeping up with demand

19. Nature or nurture or neither - or both? • Current thinking indicates the importance of the interaction of nature & nurture – or gene x environment interactions • This means that a genetic predisposition to a type of behaviour may only be triggered by certain ‘adverse’ environmental factors • Key precipitating factors for mental health difficulties include - childhood trauma - experiences of victimisation and powerlessness - high expressed emotions in close relationships - vague communications & disordered thoughts - insecure attachments to key adults What is clear- there is no linear route- it is very complex and multi-layered

20. What’s underneath the behaviour? Social Skills and relationships Emotional Awareness Cognition, Belief & Motivation Sense of self & personal identity, belonging Social environment - home, school, beyond These things determine our mental health

21. “Man is not fully conditioned and determined but rather determines himself whether he gives in to conditions or stands up to them. In other words, man is ultimately self-determining. Man does not exist but always decides what his existence will be, what he will become in the next moment. By the same token, every human being has the freedom to change at any instant.” Viktor Frankl (holocaust survivor and psychiatrist) “Man’s Search for Meaning”

22. Neuroscience around brain development • 90% of what we know about the brain ‘discovered’ in last 15yrs • Relationships change brains – born to be social - need others • Cortex 85% of brain mass - won’t develop fully without good-enough emotional experience - babies uniquely dependent on the carer(s)

23. What about Neuroscience? • Crying baby secretes cortisol - can harm brain - vagusnerve in brain stem controls pulse, respiration, digestion – needs calm to work A ‘good enough’ carer will be able to: • Anticipate a babies’ needs & be attuned to emotional changes • Be congruent with a babies’ activity & contain distress when it arises Eating breakfast- lifts dopamine levels – affects learning & behaviour Empathic listening – oxytocin – calms - ‘good vagal tone’ – well-being Adult attention – dopamine/noradrenaline – drive/capacity for joy Play – dopamine & opioids – energy, motivation, curiosity All this promotes healthy brain growth

25. DrBruce Perry, Senior Fellow of the Child Trauma Academy in Houston Texas, USA, is an internationally recognisedexpert on working with children who have been traumatized and in crisis. For over thirty years, he has been an active teacher, clinician, author and researcher in children's mental health and the neurosciences.

26. The Neurobiology of Healthy Relationships • Stress response system • Neural networks involved in bonding/attachment • The presence of familiar people who are loving, nurturing, and providing safety, calms the stress response system of the child

27. Dan Hughes “Nurturance means teaching the child hundreds of times how to ask for help, how to live with the consequences of one’s choices, how to learn to trust someone who has the power to abuse but will never do so and how to begin to feel intensely the range of emotions within a healthy school.”

28. Perry “Experiences profoundly influence the development of young children.” Adverse Childhood Experiences (ACEs) shape the brain’s organization, which, in turn, influences the emotional, social, cognitive, and physiological activities.”

29. Categories of Adverse Childhood Experiences • Emotional abuse • Physical abuse • Sexual abuse • Emotional neglect • Physical neglect • Family violence • Household substance abuse • Household mental illness • Parental separation or divorce • Household member incarceration

31. Dr Edward Tronick • Still face experiment Mums https://www.youtube.com/watch?v=Btg9PiT0sZg

32. Why look at social and emotional well being and mental health now? • The DfE and DH are committed to improving the mental health and wellbeing of children and young people In order to help their pupils succeed ,schools have a role to play in supporting them to be resilient and mentally healthy • Ofsted include consideration of wellbeing in the Personal development, behaviour and welfare section of the inspection framework

33. Why is mental health important?Research • Supporting children and young people’s social and emotional health and well being contributes to positive academic progress. • It helps them to manage their lives including, physical health, tackle any mental health problems early and develop high social and emotional as well as academic skills. • This enhances future employability • Supporting the well being of staff contributes to staff retention, whole school ethos and classroom effectiveness

34. DfE research found (Gutman and Vorhaus 2012 : the impact of pupil behaviour and wellbeing on educational outcomes) • Children with higher levels of emotional, behavioural, social and school wellbeing, on average, have higher levels of academic achievement and are more engaged in school both concurrently and in later years • Children with better emotional wellbeing make more progress in primary school and are more engaged in secondary school

35. Positive mental health • Better transitions • Reduces risky behaviours • Improves academic outcomes • Lower costs to public services • Increases earning potential • Better resilience for life (Enhancing social & emotional learning - Durlak et al 2011)

36. The link between pupil health and wellbeing and attainment Key points from the evidence • Pupils with better health and well being are likely to achieve better academically • Effective social and emotional competencies are associated with greater health and wellbeing and better achievement • The culture, ethos and environment of a school influences the health and wellbeing of pupils and their readiness to learn. • A positive association exists between academic attainment and physical activity levels of pupils • Public Health England- the link between pupil health and wellbeing and attainment Nov 2014. A briefing for HTs governors and staff in education settings

37. What is the DfE advice on schools’ responsibilities? Prevention • Playing a role in supporting children to be resilient and mentally healthy • Drawing on resources and guidance to help staff support good mental health and emotional wellbeing including provision of school counselling services Early intervention and identification • understanding how to intervene early and strengthen resilience for all pupils, those with emerging problems and families exposed to several risk factors • Using the SDQ to flag possible diagnosable mental health problems for individuals causing concern Mental health and behaviour in schools departmental advice for school staff. DfE March 2016

38. Access to specialist support • Ensuring pupils and families participate as fully as possible in decisions • Expecting those with severe problems to get wider support as well • Influencing commissioning of health services through local Health and Wellbeing Boards

39. The centrality of wellbeing to learning and school improvement • Strong evidence (Public Health England 2014) on the links between wellbeing, learning and school improvement. • Children with greater wellbeing, lower levels of mental health problems and greater emotional attachment to school achieve higher grade scores, better exam results and better attendance • Social and emotional skills are a more significant determinant of academic attainment than IQ • Strong correlation between the quality of PSHE in a school and the school’s overall effectiveness

40. Schools can be confident that a focus on well-being and mental health not only enables them to provide healthy and happy school environments for pupils and staff and prepare citizens of tomorrow with sound character and values but also directly supports their more immediate mission: the promotions of effective learning.

41. PHE evidence of the impact of support shows • Social and emotional competencies are a more significant determinant of academic attainment than IQ • Teaching ‘Growth’ mindset is critical- these children do better • Children who can set goals, manage stress and organise themselves achieve higher grades • Students who have learnt to problem solve do better • DfE research finds that children with better emotional well being in primary school make more progress and then subsequently are more engaged in secondary

42. Medical model (focus on nature - problems are biological/genetic) Just for a few Done by outside experts For those with problems Refer to other agencies Evidence hotly debated Treatment/therapy/meds Social Model (focus on nurture - problems are environmental) For all including adults Done by all school staff Includes all of the school Part of the school culture Growing evidence base Growth & capacity Different models for dealing with mental health in schools

43. Which would you choose? Red Cape Green Cape (Stop Bad Things) (Grow Good Things)

44. Professor Katherine Weare Has reviewed the research into what works in schools to improve children and young people’s well being and mental health- She found that a whole school approach and commitment is the key to making a difference.

45. Schools have a wide variety of practice in their daily teaching and pastoral care that support social and emotional wellbeing. • If existing practices are systematically coordinated they can improve wellbeing and help prevent mental health issues. • Where needs and gaps in practice are then identified they addressed by careful selection of intervention programme, staff development and working with external health and social care partners

47. https://www.ncb.org.uk/sites/default/files/field/attachment/NCB%20School%20Well%20Being%20Framework%20Leaders%20Tool%20FINAL1_0.pdfhttps://www.ncb.org.uk/sites/default/files/field/attachment/NCB%20School%20Well%20Being%20Framework%20Leaders%20Tool%20FINAL1_0.pdf

48. Takes you through a 4 stage approach • deciding to act and identifying what is in place already 2) getting a shared understanding and commitment to change and development 3) Building relationships and developing practices 4) Implementation and evaluation

49. A four stage approach to well being and mental health Stage 1: deciding to act and identifying what is in place already Identifying what happens and what matters Stage 2: common language and commitment- based on evidence of what works Stage 3: Capacity and relationship building- consolidating what works, stopping what doesn’t and implementing proven new strategies to meet needs Stage 4: Tracking and evaluating progress, embedding and sustaining practice

50. Potential barriers to change - • Mental health has tended to be seen as the domain of experts and as such is outside the schools remit • Well being and mental health support are not high profile or seen as core business for everyone in schools • Issues that arise hit schools at different levels and ways meaning connections between them relate to the mental health and well being of individuals and groups From the research from the National Children’s Bureau (ncb)