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Supporting the Mental Health of Children and Young People: A Survey of Scottish Educational Psychology Services

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Title: Supporting the Mental Health of Children and Young People: A Survey of Scottish Educational Psychology Services
Language: English
Authors: Greig, Anne, MacKay, Tommy, Ginter, Linden
Source: Educational Psychology in Practice. 2019 35(3):257-270.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 14
Publication Date: 2019
Document Type: Journal Articles
Reports - Research
Descriptors: Foreign Countries, Mental Health, Child Health, Youth, Educational Psychology, School Health Services, School Counseling, Social Bias, Barriers, Counseling Techniques, At Risk Students, School Psychologists, Role
Geographic Terms: United Kingdom (Scotland)
DOI: 10.1080/02667363.2019.1573720
ISSN: 0266-7363
Abstract: The mental health of children and young people is of increasing concern both to educational psychology and to the Government's priorities throughout the UK. This paper reports the results of a survey of Scottish educational psychology services regarding views and information about meeting the mental health needs of school children. Services overwhelmingly felt they are routinely involved in a certain amount of mental health work in schools, had confidence in their knowledge and skills and indicated a high demand from schools for their expertise. However, their actual involvement indicated that currently educational psychology is peripheral to this field both in service provision and in influencing policy and strategy. Time constraints and staffing were most frequently cited as reasons for limited involvement in this area. Often the role of services was restricted to indirect work, general advice and onward referral to other agencies. The implications for educational psychology services are discussed.
Abstractor: As Provided
Entry Date: 2019
Accession Number: EJ1223275
Database: ERIC
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  Value: <anid>AN0137679738;b8g01sep.19;2019Jul26.03:12;v2.2.500</anid> <title id="AN0137679738-1">Supporting the mental health of children and young people: a survey of Scottish educational psychology services </title> <p>The mental health of children and young people is of increasing concern both to educational psychology and to the Government's priorities throughout the UK. This paper reports the results of a survey of Scottish educational psychology services regarding views and information about meeting the mental health needs of school children. Services overwhelmingly felt they are routinely involved in a certain amount of mental health work in schools, had confidence in their knowledge and skills and indicated a high demand from schools for their expertise. However, their actual involvement indicated that currently educational psychology is peripheral to this field both in service provision and in influencing policy and strategy. Time constraints and staffing were most frequently cited as reasons for limited involvement in this area. Often the role of services was restricted to indirect work, general advice and onward referral to other agencies. The implications for educational psychology services are discussed.</p> <p>Keywords: mental health; schools; educational psychology services; children and young people; Scotland</p> <hd id="AN0137679738-2">Introduction</hd> <p>Mental health issues are of central interest to applied psychology. First, they are defined in essentially psychological terms. They are construed as "a clinically recognisable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions" (World Health Organization, [<reflink idref="bib50" id="ref1">50</reflink>], p. 5), and as such they fall within the remit of psychology. Second, while pharmacological and other medical interventions may play a key role in treatment, the principal treatment interventions are of a psychological nature, particularly in the longer term (see, for example, National Institute for Clinical Excellence, [<reflink idref="bib28" id="ref2">28</reflink>]; National Institute for Health and Clinical Excellence, [<reflink idref="bib32" id="ref3">32</reflink>], [<reflink idref="bib33" id="ref4">33</reflink>]; National Institute for Health and Care Excellence, [<reflink idref="bib29" id="ref5">29</reflink>]). Thus mental health issues fall within the remit of applied psychology.</p> <p>While more than one discipline of psychology has an involvement in issues relating to children and young people and to their mental health, these issues, particularly when they occur in relation to educational contexts, are clearly of relevance to the profession of educational and child psychology, and indeed it has been argued that educational psychologists may be regarded as "the most generic child psychologists" in terms of training, role, staffing, knowledge and experience (MacKay, [<reflink idref="bib21" id="ref6">21</reflink>], p.14).</p> <p>It is difficult to establish the prevalence of mental health issues because of the lack of uniform definitions and survey methodologies. By any definition, however, their prevalence is substantial, and there is evidence that it is rising. After a gap of 13 years the Office for National Statistics has published its survey of the mental health of children and young people age 2–19 in England, with a sample size of 9,117 (Office for National Statistics, [<reflink idref="bib36" id="ref7">36</reflink>]). In the 5–19 age group, 12.8% were reported to have at least one mental disorder. The prevalence for children age 2–4, who were surveyed for the first time, was 5.5%. Comparative figures were available for children age 5–15, with the prevalence of any disorder rising from 10.1% in 2004 to 11.2% in 2017.</p> <p>The most common disorders were "emotional disorders", comprising mainly anxiety and depression. For these the prevalence was 4.1% for ages 5–10, 9.0% for ages 11–16, and 14.9% for ages 17–19. Emotional disorders were almost three times more prevalent in girls aged 17–19 (22.4%) than in boys (10.3%). Young women were the most vulnerable group in the survey, with more than half of those with any mental disorder (52.7%) reporting attempted suicide. Some emerging issues were reported. The prevalence of mental disorder was very much higher in young people in the age group 14–19 years reporting non-heterosexual identity (34.9%) than for those reporting heterosexual identity (13.2%). Social media use was also a factor. For those with a disorder, 29.4% reported daily use for more than four hours, compared with 12.0% for those without a disorder.</p> <p>The impact of mental health difficulties is not upon emotional adjustment alone, but also includes: poor school attendance; problems with motivation, concentration and attention; difficulties with academic work, such as educational achievement in reading, writing and maths; poor behaviour regulation, and educational drop out (Beuhring, Blum, & Rinehart, [<reflink idref="bib4" id="ref8">4</reflink>]; Gall, Pagano, Desmond, Perrin, & Murphy, [<reflink idref="bib13" id="ref9">13</reflink>]; Stein & Kean, [<reflink idref="bib48" id="ref10">48</reflink>]; Masi et al., [<reflink idref="bib25" id="ref11">25</reflink>]; DeSocio & Hootman, [<reflink idref="bib12" id="ref12">12</reflink>]; Nelson, Benner, Lane, & Smith, [<reflink idref="bib34" id="ref13">34</reflink>]; Breslau et al., [<reflink idref="bib5" id="ref14">5</reflink>]; Humensky et al., [<reflink idref="bib18" id="ref15">18</reflink>]). There is also a link between suicidal ideation and academic outcomes. Those who have attempted suicide show significantly poorer performance and low sense of school connectedness, and pupils who perceive themselves as failing academically are three times more likely to report thoughts of suicide and 10 times more likely to report actual suicide attempts (Slap, Goodman, & Huang, [<reflink idref="bib45" id="ref16">45</reflink>]; Martin, Richardson, Bergen, Roeger, & Allison, [<reflink idref="bib24" id="ref17">24</reflink>]). A growing number of studies highlight long-term implications for life outcomes. Educational achievement is affected, and young people with anxiety disorders or depression are less likely to go on to college (Nelson et al., [<reflink idref="bib34" id="ref18">34</reflink>]; Breslau et al., [<reflink idref="bib5" id="ref19">5</reflink>]; Merigkangas et al., [<reflink idref="bib26" id="ref20">26</reflink>]). There are further negative outcomes in terms of employment and income in adult life (Goodman, Joyce, & Smith, [<reflink idref="bib14" id="ref21">14</reflink>]).</p> <p>There are effective psychological interventions for mental health difficulties in children and young people, supported where appropriate by pharmacological treatments. In general, cognitive behaviour therapy (CBT) is the first choice of treatment for anxiety (Compton et al., [<reflink idref="bib9" id="ref22">9</reflink>]; National Institute for Health and Care Excellence, [<reflink idref="bib29" id="ref23">29</reflink>], [<reflink idref="bib30" id="ref24">30</reflink>]), depression (Compton et al., [<reflink idref="bib9" id="ref25">9</reflink>]; National Institute for Health and Clinical Excellence, [<reflink idref="bib32" id="ref26">32</reflink>]; Weisz, McCarty, & Valeri, [<reflink idref="bib49" id="ref27">49</reflink>]; Munoz-Solomando, Kendall, & Whittington, [<reflink idref="bib27" id="ref28">27</reflink>]), and post-traumatic stress disorder (National Institute for Clinical Excellence, [<reflink idref="bib28" id="ref29">28</reflink>]; Silverman et al., [<reflink idref="bib44" id="ref30">44</reflink>]; Kowalik, Weller, Venter, & Drachman, [<reflink idref="bib19" id="ref31">19</reflink>]). There is also an evidence base to support family therapy for eating disorders in children and young people (Lock et al., [<reflink idref="bib20" id="ref32">20</reflink>]; National Institute for Health and Care Excellence, [<reflink idref="bib31" id="ref33">31</reflink>]).</p> <p>There is evidence that the use of therapeutic interventions by educational psychologists to support the mental health of children and young people has shown a marked increase (MacKay, [<reflink idref="bib22" id="ref34">22</reflink>]). A survey by Atkinson, Bragg, Squires, Wasilewski, and Muscutt ([<reflink idref="bib1" id="ref35">1</reflink>]) indicated that the most popular interventions in educational psychology were solution-focussed brief therapy, CBT, personal construct psychology and motivational interviewing. There has been a particular focus on the role of educational psychology in the delivery of CBT (Greig, [<reflink idref="bib15" id="ref36">15</reflink>]; Pugh, [<reflink idref="bib37" id="ref37">37</reflink>]; Rait, Monsen, & Squires, [<reflink idref="bib38" id="ref38">38</reflink>]).</p> <p>Despite these evidence-based interventions, significant gaps in provision and in availability of information on mental health services for children and young people have been reported (Care Quality Commission, [<reflink idref="bib7" id="ref39">7</reflink>]; Children's Commissioner for England, [<reflink idref="bib8" id="ref40">8</reflink>]; NHS National Services Scotland, [<reflink idref="bib35" id="ref41">35</reflink>]). In general, high percentages of children are being turned away and there are long waitlists of several months for those who are accepted for treatment. Of the few studies to consult children and young people themselves, <emph>How Safe are our Children?</emph> (Bentley, O'Hagan, Raff, & Bhatti, [<reflink idref="bib3" id="ref42">3</reflink>]) indicated that nearly one in three calls to Childline were on mental health issues.</p> <p>The centrality of mental health, not only to the interests of applied psychology but also to government priorities internationally, is also clear. Globally, and at levels beyond children and young people, the World Health Organization ([<reflink idref="bib51" id="ref43">51</reflink>]) produced a seven-year mental health action plan to address the need for improvement by authorities and agencies delivering a mental health service at policy and systemic levels. Within the context of the UK, in England the Government produced guidelines for schools in recognising and managing mental health and behaviour of children and young people (Department for Education, [<reflink idref="bib10" id="ref44">10</reflink>]) and the Scottish Government ([<reflink idref="bib41" id="ref45">41</reflink>]) launched its 10-year strategy for the improvement of mental health provision, including for children and young people. In <emph>Future in Mind</emph> (Department of Health, [<reflink idref="bib11" id="ref46">11</reflink>]) children's mental health and wellbeing is described as a concern for all, including the taxpayer and society. Guidelines for good psychological service provision in schools and colleges were also produced by the British Psychological Society ([<reflink idref="bib6" id="ref47">6</reflink>]).</p> <p>All of these documents make repeated references to the key role of schools in early detection, intervention and crisis management with respect to mental health problems amongst pupils in education. Priorities include improving and moving away from rigid health service tiers to the access of evidence-based interventions in non-stigmatising contexts such as schools, which are well positioned for identifying concerns and offering early support. However, with the exception of one passing reference in the Scottish mental health strategy, none of the documents cited mentions the role of the educational psychologist, who traditionally supports the individual child directly or indirectly through the school and family system.</p> <hd id="AN0137679738-3">Scottish context</hd> <p>Young people in Scotland have reported significant barriers in relation to stigma and age-appropriate approaches, with 74% of the 1,483 young respondents being unaware of mental health information, support and services in their area (Scottish Youth Parliament, [<reflink idref="bib43" id="ref48">43</reflink>]). NHS National Services Scotland ([<reflink idref="bib35" id="ref49">35</reflink>]) showed much longer waiting times to access CAMHS than elsewhere in the UK, with an average of 18 weeks across Scotland, as well as a 21% rejection rate of CAMHS referrals for the quarter ending 31 March 2017 (6,092 out of 8,370 referrals accepted).</p> <p>In recognition of the level of need, the Scottish Government ([<reflink idref="bib41" id="ref50">41</reflink>]) 10-year Mental Health Strategy aims to improve the mental health of Scotland's population, including the mental health of children and young people. While much of this strategy necessarily focusses on the availability of services for those with more severe mental health needs – for example, access to CAMHS for children with mental illness – there is also an emphasis on the role of universal services, and particularly the role of schools in terms of early intervention and curricular approaches.</p> <p>A particular focus in Scotland has been addressing the adverse impact of socioeconomic disadvantage. Sosu and Ellis ([<reflink idref="bib46" id="ref51">46</reflink>]) reported on the "clear and persistent gap in attainment between pupils from the richest and poorest households in Scotland" (p. 3). They noted that this gap is evident from the early years, that in most cases it widens through the school years and that it has a direct impact on school-leaver destinations and thus the potential to determine income levels in adulthood.</p> <p>Under the National Improvement Framework, the Scottish Government ([<reflink idref="bib42" id="ref52">42</reflink>]) aims to address this by initiatives such as providing £120 million through the Pupil Equity Funding scheme. This gives schools funds to spend as they see fit on projects to close the attainment gap for target pupils. When considering how to close the gap in attainment, interventions to improve literacy and numeracy are often at the forefront of teachers' minds. In addition to this, however, it is essential to consider children's emotional wellbeing and mental health. The link between achievement and mental health, in addition to the prominent placing of health and wellbeing as a key strand of the Scottish Curriculum for Excellence, enshrines this as a key priority for Scottish education.</p> <p>Educational psychology services across Scotland have a key role in contributing to the National Improvement Framework and related work streams through supporting "attainment challenge" schools and undertaking research as part of a National Action Enquiry project with Education Scotland. The current study focusses on mental health in order to explore how schools, in collaboration with educational psychology services, can meet their obligations to promote this aspect of health and wellbeing as a core area of the curriculum.</p> <hd id="AN0137679738-4">Method</hd> <p>This research reports on a survey of all educational psychology services in Scotland. It aimed to establish current practice in supporting the mental health of children and young people by identifying areas of best practice and key barriers to meeting mental health needs, and by exploring, developing and promoting the role of educational psychologists and identifying development needs.</p> <hd id="AN0137679738-5">Measures</hd> <p>The survey was piloted within a psychological service and modified before circulation to every educational psychology service in Scotland. The questions addressed the following themes: current policy, approaches and practice (research, development, assessment, intervention); the state of skills, knowledge and capacity; barriers to service delivery; what is working well; perceived roles and importance of addressing mental health issues; intervention types and levels of input (individual or group, family, peer etc.); links with agencies/voluntary bodies; CPD training and current/future needs; mental health related projects/research; role of initial training and CPD; risk assessment and models of mental health service delivery; demands placed on services by stakeholders/service users.</p> <hd id="AN0137679738-6">Procedures</hd> <p>The principal psychologists of all 32 Scottish local authorities were sent a copy of the survey. This stated that its purpose was to gather information on how their service supported pupils with mental health difficulties. The background information gave guidance on the scope and definition of mental health difficulties, these being more severe and persistent than everyday difficulties all pupils experience from time to time. It was expected that such difficulties would impact on pupils' functioning at school and be present on most, if not all, days of the week. Examples and definitions were given covering the areas of depression, anxiety, self-harm, anger management and other severe social and psychological adjustment issues.</p> <p>Twenty-one returns were received from 19 authorities (59%). It was decided to include the two additional surveys in the analysis as they were submitted by different participants expressing different views. The surveys were completed anonymously but each was given an identification number. This allowed them to be processed by an independent administrator who could follow up those who had not sent returns and who could provide a breakdown in terms of the urban and rural spread of returns, and the proportion of the overall population they represented. The data were then entered on Microsoft Excel using codes.</p> <hd id="AN0137679738-7">Results</hd> <p>Table 1 indicates that the actions educational psychology services are most unlikely to take include a direct mental health assessment and policy development work, while they were most likely to undertake direct work with the pupils and schools, and indirect work with the parents/carers.</p> <p>Table 1. EPS likely actions in response to a pupil with mental health problems.</p> <p> <ephtml> <table><thead><tr><td /><td>Provide a mental health assessment</td><td>Provide direct work with pupil</td><td>Provide direct work with school staff</td><td>Provide indirect work with parents/carers</td><td>Visit/review mental health policy with school</td></tr></thead><tbody><tr><td>Very unlikely</td><td>7</td><td>1</td><td>0</td><td>0</td><td>2</td></tr><tr><td>Quite unlikely</td><td>6</td><td>2</td><td>0</td><td>1</td><td>9</td></tr><tr><td>In between</td><td>5</td><td>9</td><td>2</td><td>9</td><td>4</td></tr><tr><td>Quite likely</td><td>3</td><td>8</td><td>6</td><td>9</td><td>3</td></tr><tr><td>Very likely</td><td>0</td><td>1</td><td>12</td><td>2</td><td>3</td></tr><tr><td>Total</td><td>21</td><td>21</td><td>21</td><td>21</td><td>21</td></tr></tbody></table> </ephtml> </p> <p>Table 2 shows that services felt least confident with mental health risk assessment, and most confident with delivery of training to school staff. Fourteen out of 20 respondents (70%) had low confidence in conducting mental health risk assessments. Twelve out of the 20 respondents (60%) were confident in conducting direct mental health interventions with pupils, while 17 (85%) had confidence in their abilities in providing interventions for parents and carers, and for supporting policy development.</p> <p>Table 2. EPS confidence levels in providing key mental health supports.</p> <p> <ephtml> <table><thead><tr><td /><td>Mental health risk assessment</td><td>Direct work with pupil/therapy</td><td>Training with school staff</td><td>Intervention with parents/carers</td><td>Review/support development of mental health policy with school</td></tr></thead><tbody><tr><td>1 = Not confident</td><td>5</td><td>1</td><td>0</td><td>0</td><td>0</td></tr><tr><td>2</td><td>9</td><td>2</td><td>0</td><td>3</td><td>3</td></tr><tr><td>3 = Somewhat confident</td><td>1</td><td>5</td><td>3</td><td>8</td><td>5</td></tr><tr><td>4</td><td>5</td><td>9</td><td>9</td><td>6</td><td>8</td></tr><tr><td>5 = Very confident</td><td>0</td><td>3</td><td>8</td><td>3</td><td>4</td></tr><tr><td>Total</td><td>20</td><td>20</td><td>20</td><td>20</td><td>20</td></tr></tbody></table> </ephtml> </p> <p>In terms of onward referral or other disposal for help and advice for individual children and young people with mental health issues, the most likely actions were referral to CAMHS or for specialist support in school. Referral for self-help was also a very likely outcome. Least likely was the provision of specialist support from within the educational psychology service itself. The results are shown in Table 3.</p> <p>Table 3. Likelihood of types of support advice for pupil mental health problems.</p> <p> <ephtml> <table><thead><tr><td /><td>Self help</td><td>Specialist support in school</td><td>Support within NHS CAMHS</td><td>Other specialist support (voluntary)</td><td>Specialist within your EPS</td><td>Websites sign- posting to local resources for support</td></tr></thead><tbody><tr><td>Very unlikely</td><td>0</td><td>0</td><td>0</td><td>0</td><td>7</td><td>0</td></tr><tr><td>Quite unlikely</td><td>1</td><td>2</td><td>0</td><td>1</td><td>2</td><td>4</td></tr><tr><td>In between</td><td>5</td><td>1</td><td>3</td><td>7</td><td>5</td><td>6</td></tr><tr><td>Quite likely</td><td>6</td><td>7</td><td>6</td><td>7</td><td>3</td><td>4</td></tr><tr><td>Very likely</td><td>9</td><td>10</td><td>12</td><td>6</td><td>2</td><td>7</td></tr><tr><td>Total</td><td>21</td><td>20</td><td>21</td><td>21</td><td>19</td><td>21</td></tr></tbody></table> </ephtml> </p> <p>Table 4 shows that services are of the view that both primary (95.2%) and secondary schools (100%) are interested in having educational psychology involvement in strategic mental health work. This fell to just over half of respondents (57%) viewing early years establishments as sharing this interest.</p> <p>Table 4. EPS views on establishments' interest in support for mental health at strategic levels.</p> <p> <ephtml> <table><thead><tr><td /><td>Early years</td><td>Primary</td><td>Secondary</td></tr></thead><tbody><tr><td>Strongly agree</td><td>8</td><td>11</td><td>11</td></tr><tr><td>Agree</td><td>4</td><td>9</td><td>10</td></tr><tr><td>Neither agree nor disagree</td><td>6</td><td>1</td><td>0</td></tr><tr><td>Disagree</td><td>3</td><td>0</td><td>0</td></tr><tr><td>Strongly disagree</td><td>0</td><td>0</td><td>0</td></tr><tr><td>Total</td><td>21</td><td>21</td><td>21</td></tr></tbody></table> </ephtml> </p> <p>In general, services considered it important that they should provide support for children and young people and guidance to schools regarding mental health issues, and that the national bodies representing educational psychology should have a strategy for addressing mental health needs in school and community contexts. They also viewed it as important that the schools in their area should have a mental health policy to guide assessment, intervention, training and onward referral. The results for these questions are shown in Table 5. However, despite the view of services that there should be a mental health policy in their schools, 13 of the 21 respondents stated that no or almost no schools in their area in fact had any mental health policy, and in the remaining eight cases they did not know whether they had or not. Indeed, only one educational psychology service claimed to have a mental health policy or strategy, while 13 respondents said they did not, and seven stated that such a policy or strategy was "in development".</p> <p>Table 5. Perceived importance of the role of EPSs, schools and ASPEP in strategic, direct and indirect support for children and young people with mental health problems in educational establishments.</p> <p> <ephtml> <table><thead><tr><td>How important do you think it is for:</td><td>EPS to support children and young people's mental health problems and guidance for the establishment settings that they attend?</td><td>Schools in your authority to have a mental health policy/strategy to guide assessment/intervention/training and onward referral?</td><td>Scottish EPs through ASPEP/SDEP to have a protocol and strategy for addressing the mental health needs of children and young people?</td></tr></thead><tbody><tr><td>Very important</td><td>18</td><td>17</td><td>13</td></tr><tr><td>Important</td><td>3</td><td>2</td><td>8</td></tr><tr><td>In between</td><td>0</td><td>2</td><td>0</td></tr><tr><td>Not very important</td><td>0</td><td>0</td><td>0</td></tr><tr><td>Not important</td><td>0</td><td>0</td><td>0</td></tr><tr><td>Total</td><td>21</td><td>21</td><td>21</td></tr></tbody></table> </ephtml> </p> <p>Regarding their own contribution to supporting the mental health needs of children and young people, all services considered that they should at least have some involvement. Most (12 respondents) felt that the involvement should be "variable", while seven thought it should be "considerable". Only two thought it should only be "some" involvement.</p> <p>In terms of how well training and supervision have equipped them, Table 6 shows that between initial training and CPD the majority of services felt they were either "very well equipped" or "well equipped" to deal with mental health issues. However, a significant minority described themselves as "in between" or "not very well equipped". Just over a third of respondents felt that they were well or very well equipped in terms of supervision.</p> <p>Table 6. Preparedness of EPSs to deal with mental health problems in terms of training and supervision.</p> <p> <ephtml> <table><thead><tr><td /><td>Initial training</td><td>CPD</td><td>Supervision</td></tr></thead><tbody><tr><td>Very well equipped</td><td>7</td><td>4</td><td>4</td></tr><tr><td>Well equipped</td><td>5</td><td>11</td><td>4</td></tr><tr><td>In between</td><td>6</td><td>4</td><td>9</td></tr><tr><td>Not very well equipped</td><td>3</td><td>2</td><td>3</td></tr><tr><td>Not equipped</td><td>0</td><td>0</td><td>1</td></tr><tr><td>Total</td><td>21</td><td>21</td><td>21</td></tr></tbody></table> </ephtml> </p> <p>Table 7 indicates that 15 out of 21 respondents (71%) reported that their capacity in terms of knowledge and skills presented little or no barrier to meeting mental health needs. Only one service reported this to be a considerable barrier. However, the majority of respondents reported that capacity in terms of time and levels of staffing (16 out of 21, 76%) would be a considerable or very considerable barrier. Results were more mixed in relation to the barriers presented in terms of referral links and communications with other agencies.</p> <p>Table 7. EPS's views on potential barriers to delivering mental health and wellbeing support in schools.</p> <p> <ephtml> <table><thead><tr><td /><td>Referral links with other agencies/mental health services</td><td>Ongoing communication with other agencies/mental health services</td><td>Capacity in terms of staffing levels</td><td>Capacity in terms of time</td><td>Capacity in terms of knowledge/skills</td></tr></thead><tbody><tr><td>1 = no barrier at all</td><td>1</td><td>2</td><td>0</td><td>0</td><td>2</td></tr><tr><td>2</td><td>5</td><td>2</td><td>0</td><td>0</td><td>13</td></tr><tr><td>3</td><td>8</td><td>9</td><td>5</td><td>5</td><td>5</td></tr><tr><td>4</td><td>6</td><td>6</td><td>6</td><td>6</td><td>1</td></tr><tr><td>5 = a very considerable barrier</td><td>1</td><td>2</td><td>10</td><td>10</td><td>0</td></tr><tr><td>Total</td><td>21</td><td>21</td><td>21</td><td>21</td><td>21</td></tr></tbody></table> </ephtml> </p> <p>Respondents were asked what mental health or emotional wellbeing supports for children and young people or for schools were provided by their service. Table 8 shows that almost all respondents (<reflink idref="bib20" id="ref53">20</reflink>, 95%) provided support for nurture groups or nurturing approaches, school training on universal approaches such as <emph>Friends for Life</emph> (Barrett, [<reflink idref="bib2" id="ref54">2</reflink>]), CBT packages or solution-focussed approaches, or educational psychology representation on local mental health forums with other agencies. This was followed closely by provision of one-to-one therapy, linking with primary mental health workers, providing information for parents and engaging with group or whole-class interventions. Minority responses included whole school training or provision of information for school staff on mental health issues, parent training or having educational psychology staff with a specialist mental health role.</p> <p>Table 8. Types of mental health supports and frequency of use (N = 21).</p> <p> <ephtml> <table><thead><tr><td><italic>"What mental health/emotional wellbeing support for children and young people/educational establishments is provided by your service? (tick all that apply)"</italic></td><td>Number of responses</td></tr></thead><tbody><tr><td>Support for nurture groups/approaches</td><td>20</td></tr><tr><td>School training on universal approaches such as FRIENDS, CBT packages, solution-focussed approaches etc.</td><td>19</td></tr><tr><td>EP representation on local mental health forums with other agencies</td><td>18</td></tr><tr><td>1-1 therapies (CBT, EMDR, SF, narrative etc.)</td><td>17</td></tr><tr><td>Linking with Primary Mental Health workers</td><td>16</td></tr><tr><td>Information for parents</td><td>15</td></tr><tr><td>Groups/whole class interventions</td><td>15</td></tr><tr><td>Strategic LA level guidance and recommendations/policy</td><td>14</td></tr><tr><td>Curriculum approaches (e.g. PATHS)</td><td>14</td></tr><tr><td>Family intervention</td><td>12</td></tr><tr><td>Supervision for EPS staff</td><td>12</td></tr><tr><td>Social skills training in establishments</td><td>12</td></tr><tr><td>Information for parents</td><td>10</td></tr><tr><td>Information for pupils</td><td>10</td></tr><tr><td>Training/CPD for EPS staff</td><td>10</td></tr><tr><td>Whole school training on recognising, assessing, supporting and referring mental health problems</td><td>7</td></tr><tr><td>Training for parents</td><td>7</td></tr><tr><td>Mental Health Coordinator Role/Health and Wellbeing specialist EP</td><td>3</td></tr><tr><td>Information for establishment staff</td><td>3</td></tr><tr><td>Training for therapeutic support/interventions for voluntary organisations (e.g. Place2Be, Here4U)</td><td>2</td></tr></tbody></table> </ephtml> </p> <p>The principal CBT-based mental health programmes for which the 21 respondents stated that they offered implementation were: <emph>Think Good Feel Good</emph> (<reflink idref="bib12" id="ref55">12</reflink>) (Stallard, [<reflink idref="bib47" id="ref56">47</reflink>]), <emph>Living Life to the Full</emph> (<reflink idref="bib12" id="ref57">12</reflink>) (https://llttf.com/) <emph>Seasons for Growth</emph> (<reflink idref="bib12" id="ref58">12</reflink>) (Robertson et al., [<reflink idref="bib39" id="ref59">39</reflink>]), <emph>The Homunculi</emph> (<reflink idref="bib10" id="ref60">10</reflink>) (Greig & MacKay, [<reflink idref="bib16" id="ref61">16</reflink>]) and <emph>Friends for Life</emph> (<reflink idref="bib9" id="ref62">9</reflink>) (Barrett, [<reflink idref="bib2" id="ref63">2</reflink>]). Individual respondents mentioned a wide range of other programmes, some of which were developed locally.</p> <hd id="AN0137679738-8">Discussion</hd> <p></p> <hd id="AN0137679738-9">Current practice in mental health</hd> <p>This survey has highlighted the fact that educational psychology services see themselves as having a role in relation to the mental health of children and young people. Overwhelmingly they viewed it as very important that they should be supporting those who have mental health problems, and that they should be providing guidance for the schools they attend. All services also considered it important that the profession at national level should have a protocol and strategy for addressing mental health needs. They also were of the view that primary and secondary schools wished to have educational psychology support for mental health at strategic levels, with more than half also holding this view regarding pre-school establishments.</p> <p>Most viewed themselves as well equipped to provide services in this area, more through CPD than initial training. They showed considerable confidence in their ability to provide key mental health supports, particularly in relation to training for school staff, interventions with parents and carers and supporting the development of schools' mental health policy. They were reasonably confident in terms of direct therapeutic and other work with individual pupils. They saw their main current role as a supportive one in working with teachers and others who were in regular contact with the child or young person. It was only in the area of mental health risk assessment that they showed neither confidence nor significant involvement.</p> <p>There is, however, a significant gap between how educational psychologists view their role in relation to the mental health of children and young people and how that role is seen in wider society and, in particular, by those who have the greatest influence on policy and provision of services, namely, Government departments and funders and commissioners of services. As noted above, most of the key Government and other major policy documents on mental health make no mention of educational psychologists, despite frequent references to the place of schools in any overall mental health strategy.</p> <p>In the Scottish context in which this study was conducted, it is of note that in the Scottish Parliament, questions and debates on the mental health of children and young people have been a very prominent and constantly recurrent feature, but the existence of educational psychology has been almost altogether absent from these discussions. Child and Adolescent Mental Health Services are seen as being the default providers of mental health support and almost the entire focus has been on how to increase their capacity and reduce waiting times. Any discussion of psychological services has been about the extent of the additional funding provided to increase the number of clinical psychologists, and the small number of references to educational psychology has been in the context of questions regarding the impact of an earlier cut in the funding for their training, and the resultant reduced intake to postgraduate training programmes.</p> <p>This raises the question of just how central the provision of mental health services to children and young people should be to the delivery of educational psychology services, and that is something on which there are varying views within the profession. While all services stated that they should have involvement in the delivery of mental health services, only a third said that their involvement should be "considerable". Few services saw themselves as the likely providers of specialist mental health support, and CAMHS was seen by almost all services as the most likely source of support for a young person with mental health problems.</p> <p>While only a small minority of services felt that they were not very well equipped to address mental health issues in terms of their knowledge, skills, training and supervision, and most saw the main barrier to service provision as being lack of time and staffing resources, fewer than two thirds stated that they were confident in carrying out direct mental health interventions. Onward referral to CAMHS services is therefore likely to reflect not only a lack of capacity in educational psychology services, but also a recognition of the distinctive skills and knowledge of CAMHS staff and the specialist interventions they are highly experienced in delivering.</p> <p>At the same time, there is a dilemma for educational psychology in fulfilling their partnership with other mental health providers in terms of being generic child and adolescent psychologists working in educational settings. If the profession is not seen by Government and by commissioners of services as being a key resource for delivering mental health services in schools, then it will not attract the staffing and resources it requires to occupy this role. Unless educational psychology is proactive in promoting how its own distinctive skills and knowledge, and its embedded position in schools throughout the country, can define it as a key contributor to the mental health agenda then its position will always be a peripheral one, and its role will largely be that of onward referrer rather than of collaborative service provider.</p> <hd id="AN0137679738-10">Limitations</hd> <p>In seeking to elucidate current educational psychology practice in relation to mental health, this study has a number of limitations. Firstly, there is the question of the extent to which it is representative of practice with regards both to the profession in Scotland and also more widely to practice elsewhere in the UK. As to Scotland, a good proportion of services responded, with 19 out of 32 services representing a response rate of 59%. These were drawn from a wide range of urban, rural and semi-rural contexts and from areas of both high and low socioeconomic status. As three of the four largest cities did not respond, the proportion of the total population represented was a little lower at 54%. It is not known whether there may be systematic differences between services which did and which did not respond. For example, while some principal psychologists may simply have felt too busy to fill in a very detailed questionnaire, some may have felt that the issue of mental health should largely be in the hands of other agencies and that it was not a priority for their services. As to practice elsewhere, there are several distinctive features of Scottish educational psychology services. These have been described by MacKay and Boyle ([<reflink idref="bib23" id="ref64">23</reflink>]) as including a much wider range of statutory functions than elsewhere in the UK and historically a strong clinical as well as educational focus, perhaps leading to mental health interests being more central amongst many Scottish educational psychologists.</p> <p>Secondly, the survey is based on self-report data and not on any objective measures of practice or collateral information from other parties. It is therefore subject to the various factors which may define a gap between practice as it is perceived and presented by the practitioner, and practice as it really takes place. These factors include social desirability in terms of the imperative to present practice in a favourable light. There is also the issue that in self-report data there may be a lack of accurate information to inform responses to questions, and a viewpoint of "how likely" it is that a psychological service would engage in a particular course of action may reflect a position statement by principal psychologists on how they see, or would like to see, their services operating, rather than a factual reflection of what is actually happening. It is also the case that the person filling in the survey speaks on behalf of all staff in the service, and must make judgements on their levels of confidence and skill and on how they respond to different contexts. While some services will have quality procedures which cover these areas, including having centralised policies about how psychologists operate, in other services there is considerable professional autonomy and variation in practice amongst staff.</p> <p>A third and related issue is that on some survey questions the same answer may mean quite different things. For example, seven services which did not currently have a mental health policy claimed that such a policy was "in development". This might mean that it had form and substance, having been worked up as part of a service development plan over a period of time, or on the other hand it might mean "we do not have a mental health policy, but now that you mention it, it's something that we really ought to have".</p> <p>While these limitations are acknowledged, there are also moderating factors. As to representativeness, there are responses covering somewhat more than half of Scotland in terms both of total population and of total number of psychological services. Despite differences in emphasis, Scottish educational psychologists face the same range of issues as are faced by colleagues elsewhere in the UK, and there has been a shared interest in the increasing prominence of mental health issues in children and adolescents, as reflected in two recent issues of <emph>Educational and Child Psychology</emph> on mental health and wellbeing in schools (Greig, MacKay, Roffey, & Williams, [<reflink idref="bib17" id="ref65">17</reflink>]; Roffey, Williams, Greig, & MacKay, [<reflink idref="bib40" id="ref66">40</reflink>]).</p> <p>As to the limitations of self-report data, the survey was anonymous, so that respondents knew that their service would not be identified. The only information passed from the independent administrator to the researchers was the list of responding areas, so that figures for representativeness and population size would be available. While that would not eliminate the social desirability factor, it would have the effect of mitigating it. As to the meaning of any individual response, while some responses allowed for a range of possible interpretations, most questions were relatively straightforward in terms of their significance.</p> <hd id="AN0137679738-11">Further research</hd> <p>While the current survey provides some evidence of the practice of Scottish educational psychologists in relation to mental health concerns, the field of educational psychology stands to benefit from more detailed research into its current practice in relation to the support of mental health issues in the educational context. Approaches that better ensure a response from all, or the significant majority, of services should be considered, alongside a broadening of questions to specifically include experiences and links with other mental health providers, such as CAMHS, social work and third sector providers. As the current survey was completed only by principal psychologists, a questionnaire that seeks the views of a range of educational psychologists in terms of career stage and other factors could be informative for building the capacity of the profession.</p> <hd id="AN0137679738-12">Acknowledgements</hd> <p>This work was supported by the Scottish Government National Action Enquiry Project with Education Scotland.</p> <hd id="AN0137679738-13">Disclosure statement</hd> <p>No potential conflict of interest was reported by the authors.</p> <ref id="AN0137679738-14"> <title> References </title> <blist> <bibl id="bib1" idref="ref35" type="bt">1</bibl> <bibtext> Atkinson, C., Bragg, J., Squires, G., Wasilewski, D., & Muscutt, J. (2012). Educational psychologists and therapeutic intervention: Enabling effective practice. Assessment and Development Matters, 4 (2), 22 – 25.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref54" type="bt">2</bibl> <bibtext> Barrett, P. M. (2005). 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  Data: Supporting the Mental Health of Children and Young People: A Survey of Scottish Educational Psychology Services
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– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Greig%2C+Anne%22">Greig, Anne</searchLink><br /><searchLink fieldCode="AR" term="%22MacKay%2C+Tommy%22">MacKay, Tommy</searchLink><br /><searchLink fieldCode="AR" term="%22Ginter%2C+Linden%22">Ginter, Linden</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Educational+Psychology+in+Practice%22"><i>Educational Psychology in Practice</i></searchLink>. 2019 35(3):257-270.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 14
– Name: DatePubCY
  Label: Publication Date
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  Data: 2019
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  Data: Journal Articles<br />Reports - Research
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  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Health%22">Child Health</searchLink><br /><searchLink fieldCode="DE" term="%22Youth%22">Youth</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Psychology%22">Educational Psychology</searchLink><br /><searchLink fieldCode="DE" term="%22School+Health+Services%22">School Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22School+Counseling%22">School Counseling</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Counseling+Techniques%22">Counseling Techniques</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Students%22">At Risk Students</searchLink><br /><searchLink fieldCode="DE" term="%22School+Psychologists%22">School Psychologists</searchLink><br /><searchLink fieldCode="DE" term="%22Role%22">Role</searchLink>
– Name: Subject
  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22United+Kingdom+%28Scotland%29%22">United Kingdom (Scotland)</searchLink>
– Name: DOI
  Label: DOI
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  Data: 10.1080/02667363.2019.1573720
– Name: ISSN
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  Data: 0266-7363
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The mental health of children and young people is of increasing concern both to educational psychology and to the Government's priorities throughout the UK. This paper reports the results of a survey of Scottish educational psychology services regarding views and information about meeting the mental health needs of school children. Services overwhelmingly felt they are routinely involved in a certain amount of mental health work in schools, had confidence in their knowledge and skills and indicated a high demand from schools for their expertise. However, their actual involvement indicated that currently educational psychology is peripheral to this field both in service provision and in influencing policy and strategy. Time constraints and staffing were most frequently cited as reasons for limited involvement in this area. Often the role of services was restricted to indirect work, general advice and onward referral to other agencies. The implications for educational psychology services are discussed.
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  Data: EJ1223275
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      – Type: doi
        Value: 10.1080/02667363.2019.1573720
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 257
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Child Health
        Type: general
      – SubjectFull: Youth
        Type: general
      – SubjectFull: Educational Psychology
        Type: general
      – SubjectFull: School Health Services
        Type: general
      – SubjectFull: School Counseling
        Type: general
      – SubjectFull: Social Bias
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Counseling Techniques
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      – SubjectFull: At Risk Students
        Type: general
      – SubjectFull: School Psychologists
        Type: general
      – SubjectFull: Role
        Type: general
      – SubjectFull: United Kingdom (Scotland)
        Type: general
    Titles:
      – TitleFull: Supporting the Mental Health of Children and Young People: A Survey of Scottish Educational Psychology Services
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            NameFull: Greig, Anne
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            NameFull: MacKay, Tommy
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            NameFull: Ginter, Linden
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            – TitleFull: Educational Psychology in Practice
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