An Evaluation of the Implementation and Impact of England's Mandated School-Based Mental Health Initiative in Elementary Schools

By Wolpert, Miranda; Humphrey, Neil et al. | School Psychology Review, March 2015 | Go to article overview

An Evaluation of the Implementation and Impact of England's Mandated School-Based Mental Health Initiative in Elementary Schools


Wolpert, Miranda, Humphrey, Neil, Deighton, Jessica, Patalay, Praveetha, Fugard, Andrew J. B., Fonagy, Peter, Belsky, Jay, Vostanis, Panos, School Psychology Review


Internationally, up to 20% of the youth population experiences clinically recognizable mental health difficulties (Belfer, 2008). At the broadest level, a distinction is typically drawn between behavioral problems or externalizing symptoms (e.g., conduct disorders) and emotional problems or internalizing symptoms (e.g., anxiety, depression). The long-term consequences of these difficulties can include poorer academic achievement (Colman et al., 2009), unemployment (Healey, Knapp, & Farrington, 2004), family and relationship instability (Colman et al., 2009), and an increased likelihood of disorders in adulthood (Belfer, 2008), with staggering associated costs estimated to be almost $250 billion annually in the United States (O'Connell, Boat, & Warner, 2009) and $80,000 per child in the United Kingdom (Clark, O'Malley, Woodham, Barrett, & Byford, 2005).

Schools can play a central and highly effective role in early intervention and mental health promotion (Adi, Killoran, Janmohamed, & Stewart-Brown, 2007a; 2007b; Weare & Nind, 2011), which has been increasingly acknowledged in education policy. For example, the No Child Left Behind Act of 2001 mandated a number of mental health-related provisions in the United States, including expanded counseling services in schools, closer integration between schools and community mental health service providers, and social and emotional learning interventions in early childhood (Daly et al., 2006).

In light of such efforts, schools have developed a range of approaches to support the mental health of their students (Vostanis, Humphrey, Fitzgerald, Deighton, & Wolpert, 2013). Evidence of the efficacy of school-based mental health services in elementary schools is promising (e.g., Shucksmith, Summerbell, Jones, & Whittaker, 2007; Wilson & Lipsey, 2007). The implementation of multifaceted mental health interventions over a significant period, with adequate whole-school support, has been shown to lead to positive behavioral and emotional outcomes (Adi et al., 2007a and b; Domitrovich et al., 2010). The meta-analysis of Durlak et al. (2011) of 213 interventions published from 1970-2007 discerned moderate effects on social and emotional skills, with an average standardized mean difference effect size (ES) of 0.57 (equal to a 22-percentile-point improvement; Durlak, 2009) and small effects on attitudes (ES = 0.23, equal to a 9-percentile-point improvement), social behavior (ES = 0.24, equal to a 9-percentile-point improvement), conduct problems (ES = 0.22, equal to a 9-percentilepoint improvement), emotional distress (ES = 0.24, equal to a 9-percentile-point improvement), and academic performance (ES = 0.27, equal to an 11-percentile-point improvement).

Key elements of multifaceted mental health interventions are direct and indirect interventions, comprising work with students to support social problem-solving and emotional regulation skill development (Adi et al., 2007a and b; Department for Children, Schools and Families [DCSF], 2008), education and support in parenting, or staff training and support (Humphrey, 2013; Reyes, Brackett, Rivers, Elbertson, & Salovey, 2012; Shectman & Leichtentritt, 2004). In addition, the success of schools working with other agencies such as specialist mental health providers in hospitals or clinics, as well as voluntary sector provision and social care specialists, has had a moderate impact on outcomes in child and adolescent mental health (Meyers & Swerdlik, 2003). Research has indicated that the tradi tionally poor collaboration between health and education services may have contributed to a lack of effective high-quality provision in schools for children with specific mental health difficulties (Pettit, 2003). Therefore, schools need a more collaborative working method and improved integration between school and education providers to facilitate high-quality provision that combines evidence-based practice with constant review of the impact in a local context (Fitzgerald, 2005). …

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