Mental health promotion and problem prevention in schools: what does the evidence say?

The European Union Dataprev project reviewed work on mental health in four areas, parenting, schools, the workplace and older people. The schools workpackage carried out a systematic review of reviews of work on mental health in schools from which it identified evidence-based interventions and programmes and extracted the general principles from evidence-based work. A systematic search of the literature uncovered 52 systematic reviews and meta-analyses of mental health in schools. The interventions identified by the reviews had a wide range of beneficial effects on children, families and communities and on a range of mental health, social, emotional and educational outcomes. The effect sizes associated with most interventions were generally small to moderate in statistical terms, but large in terms of real-world impacts. The effects associated with interventions were variable and their effectiveness could not always be relied on. The characteristics of more effective interventions included: teaching skills, focusing on positive mental health; balancing universal and targeted approaches; starting early with the youngest children and continuing with older ones; operating for a lengthy period of time and embedding work within a multi-modal/whole-school approach which included such features as changes to the curriculum including teaching skills and linking with academic learning, improving school ethos, teacher education, liaison with parents, parenting education, community involvement and coordinated work with outside agencies. Interventions were only effective if they were completely and accurately implemented: this applied particularly to whole-school interventions which could be ineffective if not implemented with clarity, intensity and fidelity. The implications for policy and practice around mental health in schools are discussed, including the suggestion of some rebalancing of priorities and emphases.     

‘Coalition’1 – what does it mean for schools?

Since the formation of a coalition government in May 2010, there have been substantial changes in government policies relating to the education system in England and Wales. The previous Labour administration strengthened education in food and nutrition and promoted healthy eating in schools. The National Curriculum relating to food technology states what pupils should learn, making reference to practical cooking skills, food safety and hygiene and nutrition and healthy eating. This remains a statutory requirement. The Comprehensive Spending Review (CSR), announced in October 2010, meant that substantial financial cuts would be made across government, including the Department for Education. A huge swathe of quangos has already been cut, including the Qualifications and Curriculum Development Agency (QCDA) and the National Healthy Schools Programme (NHSP). The School Food Trust (SFT) has faced budget cuts, and further massive savings will come from the scrapping of Building Schools for the Future (BSF). The White Paper and Education and Children's Bill will provide greater freedom for schools and academies to determine their own curriculum, length of the school day and lesson times. David Cameron's vision of a ‘Big Society’ will require greater collaboration from a wide range of organisations, including industry and charitable organisations to support high quality education in food and nutrition in schools. Individual Headteachers will be freed to make decisions at a local level. This will leave individual schools with greater decision making and funding responsibility.     

Contingent valuation in health care: does it matter how the ‘good’ is described?

A general population sample of 104 Australian respondents completed an interviewer-administered contingent valuation (CV) survey that asked them to value five scenarios representing the same core improvement in health status. These scenarios varied only in the degree of narrative used to describe the condition causing the health problem being valued and labeling of this health problem. Results indicate no significant difference in willingness to pay (WTP) between expressing symptoms as a brief or moderate narrative, but a significantly lower WTP value when expressed in an extensive narrative. WTP also differed significantly according to condition 'labels'. Possible implications for CV research are outlined.     

Mixed gender wards: what does the evidence indicate?

Would adoption of a mixed gender ward policy at the University Health Network accelerate the admission of patients to a ward bed, thereby positively influencing patient care and improving patient satisfaction? Would reducing transfers positively impact staff satisfaction by eliminating an onerous burden? How would patients and staff react to the idea of mixed gender rooms? Would eliminating transfers have a positive financial impact on the organization?     

‘Occasional’ and ‘social’ smokers: potential target groups for smoking cessation campaigns?

OBJECTIVE: To describe the characteristics of self-described 'occasional' and 'social' Australian smokers. DESIGN: Analysis of a national cross-sectional survey of smoking patterns, conducted in Australia in 2004. SETTING AND PARTICIPANTS: Australian adults in 2004 who responded to a survey question about self-described smoking status. MAIN OUTCOME MEASURES: Demographic characteristics, patterns of alcohol and tobacco use, smoking cessation attempts in the past year, and interest in cessation. RESULTS: Smokers who described themselves as 'occasional' and 'social' smokers comprised 29% of all smokers. A significant proportion of occasional and social smokers had been daily smokers, but the majority either believed that they had 'already quit' or had no intention of quitting smoking. CONCLUSIONS: Self-ascribed occasional and social smokers potentially represent an important target group for cessation. These types of smokers may be more resistant to public health messages regarding cessation because they do not view their smoking behaviour as presenting a high risk.     

How common is the ‘prominence effect’? Additional evidence to Whynes et al.

In a recent issue of Health Economics Letters, Whynes et al. report an observation not previously reported in the willingness-to-pay (WTP) literature; that when people are asked to provide an estimate using payment scales they tend to disproportionately select prominent values (that is, 1, 2, 5, 10, 20, 50, 100, etc.). However, it remains an open question just how common this prominence effect actually is. Here we present data from several additional contingent valuation (CV) studies, which suggest that although prominence occurs, it does not reach statistical significance, as found by Whynes et al. A number of reasons are outlined to explain this.     

Faculty development: a ‘Field of Dreams’?

Objectives  Participants in faculty development workshops often comment that 'those who need faculty development the most attend the least'. The goals of this study were to explore the reasons why some clinical teachers do not participate in centralised faculty development activities and to learn how we can make faculty development programmes more relevant to teachers' needs.
Methods  In 2006, we conducted focus groups with 16 clinical teachers, who had not participated in faculty development activities, to ascertain their perceptions of faculty development, reasons for non-participation and perceived barriers to involvement. Content analysis and team consensus guided the data interpretation.
Results  Focus group participants were aware of faculty development offerings and valued the goals of these activities. Important reasons for non-participation emerged: clinical reality, which included volume of work and lack of (protected) time; logistical issues, such as timing and the central location of organised activities; a perceived lack of financial reward and recognition for teaching, and a perceived lack of direction from, and connection to, the university.
Conclusions  Clinical reality and logistical issues appeared to be greater deterrents to participation than faculty development goals, content or strategies. Moreover, when asked to discuss faculty development, teachers referred to their development as faculty members in the broadest sense, which included personal and career development. They also expressed the desire for clear guidance from the university, financial rewards and recognition for teaching, and a sense of 'belonging'. Faculty development programmes should try to address these organisational issues as well as teachers' personal and professional needs.