The importance of prevention in childhood and adolescence

Healthcare professionals have long recognised that childhood and adolescence can be a key period for the development of mental health problems. Yet they tended in the past to focus more on reacting to symptoms, instead of exploring ways to identify and prevent psychological or behavioural difficulties.1 However, increasingly research has been conducted to look at approaches that deal with problems before they become significant challenges. An understanding has grown that heading off potential problems in young people’s mental health would be beneficial for young people and also reduce treatment costs. In the absence of preventative measures to support the mental wellbeing of young people there have been increasing levels of mental health problems in children and adolescents, evident for many years according to the children’s charity Barnardo’s.2 One recent example has been a tripling of the number of university students dropping out due to mental health problems in the five years up to 2014-2015.3

The conclusions from many of these reports is that such approaches are promising. However, what they often suggest as the way forward is simply further research, instead of concrete steps towards adopting a real preventative mental health programme. One reason why little has been done so far may be the perceived high cost of providing such services (although this should be seen in the context of the savings in treatment costs where mental health can be maintained).

Some of the challenges

As well as the potential costs, a viable programme to identify potential mental health problems across a school-age population is faced with the challenges presented by the multifaceted nature of conditions that fall under the heading of ‘mental health’. They range from the biologically based, such as autism, to mainly environmentally-linked, such as post-traumatic stress disorder. Between these lie a range of conditions that may result from a combination of environmental and biological factors. Meanwhile, there is still debate among those within the mental health profession about the symptoms that characterise disorders such as schizophrenia and borderline personality disorder.

Further potential challenges have included changes in schools, technology and society which impact on childhood and adolescence. For example the increased focus on testing in schools in the UK4 and the narrowing of the curriculum (including reducing the role of the creative and performing arts, subjects which may have therapeutic as well as educational value) have been seen as factors leading to an increase in mental health problems among children, while the influence of social media, including online bullying, has been identified as another potential factor5

However, these challenges are not a valid reason to do nothing. Indeed, much encouraging recent research has shown the benefit, if done properly, of what preventative mental health strategies might achieve.

School-based preventative programmes

There has already been extensive research into how school-based preventative mental health programmes might work. A number of studies taking such an approach have shown that identifying potential problems among children and young adults who have problems such as depression and anxiety, using targeted group-based interventions and cognitive based therapy, have had beneficial results, at least in the short to medium term.1

As reported in another article in this section, media literacy programmes in schools may also be helpful here.6

The potential value of screening

Some researchers have looked at an alternative to providing a programme of preventative measures that cover all children, as research has suggested this probably isn’t cost-effective. Instead they considered a universal screening programme in schools to identify those young people who seemed likely to benefit from a pre-emptive approach(Albers et al, 2007).7

A recent article suggested that such an approach might well be the way forward .8 The authors concluded that a universal screening consultation model that would collect information on participants’ mental health would provide a useful preventative approach. In their research project, school psychologists, working with multidisciplinary student care teams in schools, used screening data to help identify and support students likely to need help – including not only those in urgent distress but also those also not thriving and so also at risk. This approach had the potential to develop and implement a comprehensive school-based mental health strategy.

A partial step forward?

While generally positive, the authors of the study did express some caveats about such an approach. They stressed that universal screening could not be the sole determinant of need for support among young people, but could only be part of the answer in addressing the specific needs of individual students. Nor could universal screening offer a complete answer to determine which students might be in the greatest need or to set priorities for dealing with mental health issues. It was also stressed that it could not be seen as a replacement for the critical role that school personnel play in being alert to other signs of distress among students. A particular concern noted was that for universal screening to be fully effective, all students would need to participate.

Despite these reservations, such a programme was seen as a positive step forward in answering the need for a pre-emptive approach to promoting mental health among young people. As a member of the student support team participating in the project commented, ‘We are so grateful… this partnership is definitely a positive force on our campus. We are all on board and see the benefits of the information that is shared through the assessments.’

Alec Anderson, August 218

 

References 

1. Das, J. K., Salam, R. A., Lassi, Z. S., Khan, M. N., Mahmood, W., Patel, V., & Bhutta, Z. A. Interventions for adolescent mental health: an overview of systematic reviews. Journal of Adolescent Health. 2016.  59(4), S49-S60. 

2. Newman T. Promoting Resilience: A Review of Effective Strategies for Child Care Services. Barnardo's Research and Development 2002 Available online at: http://www.barnardos.org.uk/resilsum.pdf 

3. Marsh S. Number of University Dropouts Due to Mental Health Problems Trebles: The Guardian. Available online at: https://www.theguardian.com/society/2017/may/23/number-universitydropouts-due-to-mental-health-problems-trebles

4. Burns J. Children as young as six 'stressed' about exams and tests. BBC. Available online at https://www.bbc.co.uk/news/education-35940084 

5. #StatusOfMind Social media and young people's mental health and wellbeing. Royal Society for Public Health 2017 Available online at: https://www.rsph.org.uk/uploads/assets/uploaded/62be270a-a55f-4719-ad668c2ec7a74c2a.pdf  

6. Jamieson J. Combating the stigma of mental illness – the role of education and media literacy. Health Action Campaign. Available online at: https://www.healthactioncampaign.org.uk/mental-health-project/combating-the-stigma-of-mental/ 

7. Albers, C. A., Glover, T. A., & Kratochwill, T. R. (2007). Where are we, and where do we go now? Universal screening for enhanced educational and mental health outcomes Journal of School Psychology, 45(2), 257-263. 

8. Dowdy, E., Furlong, M., Raines, T. C., Bovery, B., Kauffman, B., Kamphaus, R. W., & Murdock, J. (2015). Enhancing school-based mental health services with a preventive and promotive approach to universal screening for complete mental health. Journal of Educational and Psychological Consultation25(2-3), 178-197.