Poverty, Mental Health, and Schools: A Drop in the Ocean?
By Claire Pass
Small moments make a huge difference when it comes to establishing trust and connectedness. We should focus on these if we are to tackle the societal and mental health issues facing our students in schools today.
Around 10 years ago, I was a parent-helper on a library visit with a class of Year 1 children. As a secondary teacher, I watched the process with curiosity – there were some embedded routines in place. The thing that stayed with me most was the process of ‘book-approval’, where each child needed to get the OK from the class teacher before checking out their library book.
It was a seemingly innocuous element, but even then – without the knowledge I have now – I knew I was witnessing something important. Every child in that class felt seen, felt listened to, and felt important during that process. It was a small moment that has influenced both my personal and professional interactions for the best part of a decade.
Now, of course, the research highlights how small moments such as this serve to establish and maintain a climate of trust and connectedness, which are protective factors for mental health and an important part of creating an ethos and environment that promotes good mental health.
Move forward 10 years and the importance of such moments is more significant than ever. However, with the financial crisis showing no signs of abating, and the well-established links between poverty and poor mental health– are such things simply drops in the ocean?
All the way back in the pre-Covid world of 2019, a study involving over 28,000 Year 7 and Year 9 pupils across 97 schools found that mental health issues in pupils were much more prevalent than previously believed, with 2 in 5 pupils scoring above the thresholds for emotional disorders, conduct problems or inattention/hyperactivity in the Strengths and Difficulties Questionnaire (SDQ). Those from deprived backgrounds were significantly more likely to experience issues.
This is underlined by reports indicating that children on the lowest income quintiles are twice as likely to be diagnosed with an emotional disorder and 4.5 times more likes to experience serious mental health problems. These are staggering numbers, with huge implications for equality in our society, and they could be explained by what Mind refers to as the ‘mental health trap’, where mental health negatively impacts on income and relationships, which in turn makes mental health problems more severe and long-lasting for those in poverty.
The irony is that at a time when schools are looking to safeguard mental health, the very act of getting children to school is a major household expense, putting more pressure on those already struggling financially. On average, it costs a minimum of £864.87 each year for primary school children and £1,755.97 for secondary school pupils.
Pupil Premium funding is not enough to level the financial playing field when it comes to the cost of school – and there are a lot of demands on this pot of money. Other support on offer is means-tested and accessed by only a small proportion of low-income families.
Many schools try to mitigate costs, for example by fundraising for school trips, providing uniform, or providing resources for homework. There are also schools who wash and dry school uniform, provide free breakfasts, or even offer no-questions-asked ‘grab bags’ of food essentials for parents. The dedication of schools to their communities cannot be questioned – but schools simply cannot do everything. A national approach is needed. In the absence of this, what many see as ‘normal’ school experiences, or rites of passage, are not open to all pupils and ultimately impact on both outcomes and life chances. A consistent national policy is vital if we are to create equity of experience.
The Place of Schools
In this context, when the bigger picture feels outside of our control, it’s tempting to focus on what we can potentially ‘fix’, but we must be careful not to focus on a within-child deficit model. This is different to the library scenario when each child felt ‘seen’. A within-child deficit model concentrates on the problem, not the child.
It’s reminiscent of the cartoon of a koala clinging to a tree stump in a sea of felled trees, while officials stand focused on the koala (rather than the surroundings) and authoritatively state “This young koala has a mental health condition”. Sometimes, people find things difficult because they are in difficult circumstances. It might be tough and uncomfortable to acknowledge these – particularly when we can’t ‘fix’ the issues – but truly ‘seeing’ the child means seeing them in context, and if we are to foster that sense of trust and connectedness so important to mental health, it’s crucial that we do so.
In 2021, research by Mind found that whilst the conversation about mental health is opening up, those in poverty feel excluded from it. This was reinforced by a perception of certain types of mental ill health being ‘acceptable’ but people not wanting to talk about the ‘mental health trap’ of poverty. In other words, there’s a perception that people are willing to look at the koala but don’t want to look at the felled forest surrounding it, and this consolidates feelings of isolation and shame.
This might explain why so many 11–16-year-olds with a mental health condition were less likely to feel safe either at school or online, and less likely to feel as though they had a friend to turn to. Considering ways of removing these barriers and fostering connectedness and belonging for these pupils is something that schools can do.
A Systemic Approach
Creating a whole school approach that removes such barriers is part of the remit of a senior mental health lead (SMHL) – one of the elements of the wider systems approach that has been taking shape for quite some time now. It also includes mental health support teams (MHSTs) and educational mental health practitioners (EMHPs), whose role is to bridge the gap between schools and mental health services, ultimately reducing the burden on CAMHS.
There is still a way to go, however, with many SMHLs reporting that they do not have the time or capacity to do their role justice. Also, the University of Birmingham’s ‘Trailblazer’s’ evaluation, focusing on the first 25 sites for MHSTs and EMHPs, found that there were issues with retention and professional development for EMHPs (for example, in supporting neurodiverse pupils for whom the CBT-based techniques might need adapting).
Add to this the somewhat woolly remit of EMHPs supporting those with “mild to moderate” mental health difficulties, with no national consensus about what constitutes a “mild” or a “moderate” difficulty, and the danger is that many pupils still fall through the net.
It’s likely that these approaches are facing such challenges because the proposals for them drew on data from ten years ago. At that time, the figures suggested that 1 in 10 children would suffer from a mental health condition. However, the NHS report in 2022 highlighted that the number of children aged 7-16 with a probable mental health condition had risen from 1 in 9 in 2017, to more than 1 in 6. There are simply more demands on both schools and services than were ever anticipated.
Making the Difference
Despite these challenges, the systems now in place form a major step forward in promoting and protecting the mental health of all pupils. Together with mental health becoming an established element of PSHE curriculums and spotting the signs of mental ill health-forming part of schools’ statutory safeguarding duties, mental health has been placed firmly on the agenda in schools. These steps are a significant part in the journey towards ending the ‘mental health trap’ faced by those in poverty.
Even though schools may feel like they are drops in a very large ocean, they do make a significant difference – huge in fact – to the wellbeing of children. The HOW is a trickier question to answer, although there have been some studies in recent years about social and emotional learning (SEL) that provide some food for thought.
A meta-analysis of 200 SEL Programmes reveals that programmes work better when manualised (provide materials and teacher notes for each lesson) and when they focus on what to do rather than what to avoid. Even though they improve wellbeing for those whose wellbeing was initially low, the aim is also to reduce stigma and change the overall ethos of the class. A universal rather than targeted approach is therefore very important.
An important point to note is that the positive effects of such programmes are only short-term unless they are maintained – so building a long-term curriculum is crucial. The four-year Healthy Minds experiment pulled these elements together into a curriculum for 11–15-year-olds and was shown to raise life satisfaction by 10 percentile points and this is a structure that has since been adopted by many schools.
The thing that struck me most about the findings about the difference schools make to wellbeing, is that it’s not just schools that make the difference. Individual teachers do too. A primary school teacher who knows how to support and raise levels of wellbeing has as much impact as a pupil’s parents and improves their life chances – even making them more likely to go to university.
This brings us back to the teacher doing the ‘book approval’ check during the library visit and the significance of this seemingly small interaction. And to answer the question ‘Are schools just a drop in the ocean?’ No. If individual teachers are more than a drop in the ocean, schools are so much more.
xii Layard and DeNeve (2023) Wellbeing Science and Policy. Cambridge University Press.
xiii Layard and DeNeve (2023) Wellbeing Science and Policy. Cambridge University Press.