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Can school nurses identify mental health needs early and provide effective advice and support?
Abstract
Aim
This article aims to explore and analyse primary research regarding the role of the school nurse in providing care for children and young people with mental health needs.
Background
Children and young people have unique mental health needs that can affect their emotional, educational and physical development. Early identification and support for mental health needs are advocated to improve health and wellbeing outcomes. There are few UK-based primary research papers that address what role the school nurse may have in providing mental health care.
Methods
A database search was conducted to identify research papers that discuss ‘school nurse’, ‘mental health’ with ‘children and young people’. Eight UK-based papers were identified, on which a thematic analysis was carried out.
Results
Four themes were identified as important indicators for school nurses working with children and young people with mental health needs: help seeking preferences of children and young people, training and support needs of school nurses, service provision and capacity, and wider socio-economic determinants.
Conclusions
School nurses can be effective when working with children and young people with mental health needs. As specialist public health nurses their primary area of work should be on the promotion of good mental health and the early identification and support for those who have poor mental health. To ensure effective support is given school nurses require further post-graduate training and regular supervision from a mental health specialist. However, workload structures would need to be managed to allow school nurses to be more visible and accessible within schools in order to build effective and trusting relationships.
Implications for practice
As the public health role of the school nurse begins to encompass mental health needs it will be increasingly important to reflect upon collaborative working practices to deliver care, which meets the need of children and young people. This may include the use of modern technology, a work schedule that allows for needs to be met year round and improved communication and discussion between health, education and social care professionals.
... Este apoyo puede explicar hasta un 16% de la variabilidad en el bienestar subjetivo de los y las estudiantes (Suldo et al., 2009) y en ciertos contextos, influye incluso más que el apoyo familiar (Chu et al., 2010). Se ha observado que profesionales no docentes, como el personal psicosocial, también juegan un rol relevante en el bienestar de los y las estudiantes (Bartlett, 2015;Zabek et al., 2023). ...
El documento presenta los principales hallazgos del programa PromoBIENdo, una intervención multidimensional y multicomponente desarrollada para promover el bienestar subjetivo en estudiantes de sexto y séptimo básico en Chile. El programa fue financiado por la Agencia Nacional de Investigación y Desarrollo (ANID) a través del concurso IDeA I+D 2022, y fue ejecutado por la Universidad del Desarrollo en colaboración con la Universidad San Sebastián.
Justificación y fundamentos teóricos:
Se destaca la urgencia de abordar el bienestar emocional y psicosocial de niños, niñas y adolescentes, especialmente en contextos de alta vulnerabilidad. PromoBIENdo se fundamenta en un enfoque positivo del desarrollo, apoyado en evidencia empírica internacional y nacional, que valora la escuela como un espacio estratégico para implementar acciones de promoción del bienestar.
Estructura y dimensiones del programa:
El programa trabaja simultáneamente en cinco dimensiones:
1. Personal (fortalezas personales como autoestima y afrontamiento).
2. Familiar (crianza basada en fortalezas).
3. Relaciones entre pares (sentido de comunidad en el grupo curso).
4. Comunidad escolar (relaciones de apoyo con el personal educativo).
5. Escuela (bienestar docente).
Estas dimensiones se operacionalizan en cuatro módulos de intervención, implementados posterior a la realización de una fase de capacitación de los agentes escolares. La metodología enfatiza la participación activa de la comunidad escolar, la inserción en la vida cotidiana de la escuela y la articulación con el currículo escolar.
Evaluación del programa:
Se empleó un diseño multi-métodos, que incluyó un estudio cuasi-experimental (dimensión cuantitativa) y una evaluación de proceso (dimensión cualitativa). La intervención se implementó en establecimientos con nivel medio-alto de vulnerabilidad según el Índice de Vulnerabilidad Escolar Multidimensional (IVEM). Los resultados indican efectos positivos en el bienestar subjetivo de los y las estudiantes, fortaleciendo factores protectores y reduciendo riesgos psicosociales.
Conclusión:
PromoBIENdo constituye una propuesta innovadora, contextualizada y basada en evidencia científica que puede integrarse al sistema educativo chileno para fortalecer la salud mental escolar desde un enfoque preventivo y promocional. Se subraya la importancia de su escalamiento y adaptación a diversos contextos educativos en América Latina.
... Studies on the work of psychiatric nurses at schools in the United Kingdom have shown that their interventions have been effective in dealing with eating disorders, depression and self-harm behaviors. [48] A study in Finland revealed that psychiatric nurses employed at secondary schools had used psychoeducation (teaching the pupils about the nature of their illness), motivational interviewing, short therapy interventions, behavioral activation, information and various materials to support the pupils. [49] Secondly, a model developed and piloted in the west of Finland had involved pupils visiting the school psychiatric nurse ten times for assessment and planning of interventions. ...
Objective: The study purpose was to describe secondary school nurses’, subject teachers’, special needs teachers’, study counselors’ and school social workers’ (n = 60) experiences of stressors that contribute to the development of mental health problems in secondary school pupils. Another purpose was to describe the professionals’ educational needs regarding mental health problems of secondary school pupils. The study aimed at producing information that can promote the detection of mental health problems and facilitate early interventions in secondary schools. The information collected came from the professionals only, not from the pupils or their parents.Methods: Data were collected in Finland using a Webropol online survey and analyzed by inductive content analysis.Results: According to the results, secondary school pupils’ mental health problems are associated with physical and psychosocial stressors, and with stressors pertaining to learning and studying, lifestyle, family, friend relationships and socioeconomic factors. In addition, the pupils’ mental health problems are associated with stressors pertaining to social media. Professionals working at secondary schools need education on how to identify pupils’ mental health problems, how to take up the concern with the pupil and parents, and how to support and counsel youth with a mental health problem.Conclusions: Although information packages, recommendations, materials and tools are available, encouragement and more specific and concrete mental health education for both pupils and professionals is required. New structures and practices, and possibly re-allocation of resources, may be necessary. The teachers’ role in mental health promotion and prevention of mental health problems should be supported and resourced more effectively. Psychiatric nurses should be employed at schools.
... This initiative created SMHNs to provide care within the school settings (Ontario, 2020). Part of the role of the SMHN includes health promotion, clinical assessment, intervention, and education to school boards, including teachers (Bartlett, 2015;Ontario, 2020; Registered Nurses' Association of Ontario, 2017). Collaboration, such as referrals, between SMHNs and high school teachers is vital in the early identification of mental health issues in adolescents (Bohnenkamp et al., 2019). ...
Abstract
Background: Suicide is the leading cause of death among youth. Although school-aged youth are surrounded by
educators and professionals, little is known about what educators want to know regarding suicide.
Objective and Design: The purpose of this qualitative study was to explore the perceived learning needs of high
school educators in Northwestern Ontario (NWO) regarding suicide prevention using semi-structured interviews.
Results: The results yielded educators prefer learning based on a mixture of styles that is relevant to their student
needs; noting that time constraints are a barrier. Educators are interested in knowing what to say; however, limited
by the unknown legalities involved. Educators expressed being comfortable talking about suicide and understood basic
warning signs.
Conclusions: The findings can assist mental health professionals and school board administration in supporting
educators regarding suicide prevention. Future research can include the creation of a suicide prevention program that is
targeted exclusively for high school educators.
Keywords
Suicide prevention in schools, youth suicide, suicide prevention
... Our study highlights that whilst there are often many support options and resources available for young people, a lack of awareness of available services can impact upon helpseeking practices, which echoes previous findings [14,60,64]. The DHC acted to increase both knowledge of and access to resources and support. ...
Despite high levels of need, many young people who experience health issues do not seek, access or receive support. Between May and November 2021, using semi-structured interviews, we explored the perspectives of 51 young people (aged 13–14) from two schools who had taken part in a novel online health and wellbeing screening programme, the Digital Health Contact (DHC). One school delivered the DHC during home-learning due to COVID-19 restrictions, whilst the other delivered it in school when restrictions were lifted. The DHC was seen as a useful approach for identifying health need and providing support, and had high levels of acceptability. Young people appreciated the online format of the DHC screening questionnaire and thought this facilitated more honest responses than a face-to-face approach might generate. Completion at home, compared to school-based completion, was perceived as more private and less time-pressured, which young people thought facilitated more honest and detailed responses. Young people’s understanding of the screening process (including professional service involvement and confidentiality) influenced engagement and responses. Overall, our findings afford important insights around young people’s perspectives of participating in screening programmes, and highlight key considerations for the development and delivery of health screening approaches in (and out of) school.
... Since, if the service packages are not tailored to the patient's needs and responsiveness, they will not be effective and lead to service recipients' dissatisfaction and eventually reduce market share. In confirming the findings, in the field of healthcare in the U.K. [18] and U.S. health centers [19] the strategies for identifying and responding to needs by the medical staff have been pointed and it is considered as an important factor in the effectiveness of the treatment process. Furthermore, identifying strategic and high-demand medical services is also an important factor in brand target market analysis. ...
Medical centers need branding approach to improve their position in patients’ minds. This study was carried out using mixed method. The participants included main experts, hospital managers and headquarters of the Ministry of Health. The data collection tool was a semi-structured interview and a researcher-made questionnaire. Branding process was conceptualized in 5steps, including Market Identification, Brand Identity, Brand Positioning, Development and Consolidation Strategy. All path coefficients were defined in the range. The results of the indices showed that the fit was good and the final model was valid. The activities of Medical centers should be based on the identification of the target market. Unique services with new knowledge and equipment and experienced clinical staff to meet patients’ needs with appropriate price and quality have to be provided.
... In accordance with other authors [34, 38] , we recommend stronger collaboration between groups of staff (school administration, teachers, nurses, and special needs personnel). Furthermore , school health service systems could consider using new technologies to improve services for students, as proposed by Bartlett [39] . Finally, it would be useful to consider programs that provide help regardless of gender, such as the person-centred approach suggested by Ekman et al. [40] as an alternative to the DISA program. ...
Background
There has been an increase of reports describing mental health problems in adolescents, especially girls. School nurses play an important role in supporting young people with health problems. Few studies have considered how the nurses’ gender norms may influence their discussions. Methods
To investigate this issue, semi-structured interviews focusing on school nurses’ work with students who have mental health problems were conducted. Transcripts of interviews with Swedish school nurses (n = 15) from the Help overcoming pain early project (HOPE) were analysed using theories on gender as a theoretical framework and then organised into themes related to the school nurses’ provision of contact and intervention. The interviewees were all women, aged between 42–63 years, who had worked as nurses for 13–45 years, and as school nurses for 2–28 years. Five worked in upper secondary schools (for students aged 16–19) and 10 in secondary schools (for students aged 12–16). ResultsThe results show that school nurses more commonly associated mental health problems with girls. When the school nurses discussed students that were difficult to reach, boys in particular were mentioned. However, very few nurses mentioned specific intervention to address students’ mental health problems, and all of the mentioned interventions were focused on girls. Some of the school nurses reported that it was more difficult to initiate a health dialogue with boys, yet none of the nurses had organized interventions for the boys. Conclusions
We conclude that generalisations can sometimes be analytically helpful, facilitating, for instance, the identification of problems in school nurses’ work methods and interventions. However, the most important conclusion from our research, which applied a design that is not commonly used, is that more varied approaches, as well as a greater awareness of potential gender stereotype pitfalls, are necessary to meet the needs of diverse student groups.
... Moreover, despite the drive for school nurses to support young peoples' emotional well-being, in the U.K. there are no national guidelines pertaining to their role in assessing young peoples' mental health. Indeed, a recent review of U.K.-based studies (Bartlett, 2015) found a lack of literature specifically related to the school nurse role and mental health provision. Thus, the purpose of this review was to examine international literature to determine school nurses' experiences of managing young people who are experiencing or displaying symptoms of mental health disorder, with the aim of determining how the experiences gained may influence the further development of the role of the school nurse within the U.K. ...
Prevalence of mental health disorder is increasing among young people. It is recognized that early intervention is essential in supporting young people, and care provided within schools to support emotional well-being is recommended as part of this process. A scoping review was undertaken examining school nurses' experiences of supporting the mental health of schoolchildren. Findings suggest that school nurses have a central role in supporting young peoples' mental health, although a number of barriers exist which impact on school nurses' preparedness for this aspect of their role. While there are inconsistencies in the provision of mental health training available to support school nurses, when training is implemented it has positive outcomes for service provision and quality of care. A number of challenges for school nurses were also identified, and recommendations for practice are suggested in the article.
The school nursing service is pivotal in supporting the health and wellbeing of children and young people. The management of this universal resource is imperative to the provision of safe and effective care delivery. This scoping review aimed to critically analyse literature pertaining to school nursing workload. A systematic database search was conducted for papers published in English from 2017–2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) tool. The 20 papers included were appraised using the Critical Appraisal Skills Programmes Checklists (CASP) tool. Four main themes emerged from the literature namely: workload tools, student outcomes, gaps and barriers to practice, and environmental factors. There was no substantial evidence base to justify the selection of any particular workload approach or tool and with minimal programmatic research directed towards establishing the reliability and validity of such tools. Further consideration is required to determine how the tools might inform school nursing workforce planning.
In the context of rising mental disorder prevalence among school-age children and increasing pressures on services to deliver effective and efficient interventions, school nurses have been identified as a key workforce to clinically support school-age children with emerging mental health difficulties and existing mental health diagnoses.
Aims
This review aims to identify and critically analyse existing academic literature, in order to ascertain the current role of the school nurse in supporting school-age children with emerging mental health difficulties and existing mental health disorders. In doing so, this integrative review makes recommendations for future research and discusses implications for nursing practice.
Methods
An integrative review methodology was used in order to conduct a systematic review of the literature, in conjunction with the PRISMA (2009) guidelines. CASP tools were used to critically appraise the selected papers, and the findings were tabulated in order to identify emerging themes.
Results
289 papers were found through database searches, and six papers were identified as relevant to this literature review. Although these papers were preliminary in nature, clear themes were identified across the selected papers. School nurses were found to be uniquely placed to support school-age children with emerging mental health difficulties and existing mental health diagnoses. However, barriers to effective interventions included school nurses' lack of knowledge and lack of resources within school nurse teams.
Conclusions
The lack of training and knowledge for school nurses within this clinical subject area is an urgent cause for concern, and future research and practice development is strongly recommended.
Mental health disorders in school-aged children are on the rise. The need for mental health care is well recognized, and the provision of this care in schools is recommended. An integrative review explored how school nurses view their role in addressing students' mental health. Fourteen articles were identified, eleven using a qualitative design and three using a quantitative design. Findings suggest that school nurses see their role as trusted members of the school community. They perceive upholding standards of practice as an integral part of their position and recognize competence in mental health care to be highly important. Practice recommendations include providing school nurses with evidence-based training on managing the mental health needs of students, as well as ensuring access to school nurses who can provide mental health supervision in the community.
This paper reports an evaluation of a training programme to enhance the skills and confidence of school nurses in addressing mental health and emotional wellbeing issues among school children. The training was offered to school nurses and nursery nurses in one school health service in London. The evaluation drew on face-to-face semi-structured interviews with, and online contributions from, school health staff members. There was evidence of considerable satisfaction with training; of attitude change; of increased confidence, knowledge and skills in addressing mental health issues; and of changes in practice. The evaluation illustrates how, in a favourable context where staff feel respected and supported, well-designed training programmes can deliver changes in practice.
Purpose
Adolescent mental health issues are on the increase, in particular depression, which is now a major public health concern globally. Mental health education is important and young people’s awareness of mental health is potentially limited. This is one factor that creates barriers to seeking support. School nurses and educational professionals recognise that they do not necessarily have the required skill base to support emotional health concerns with young people. The purpose of this paper is to synthesise qualitative evidence related to the nurse’s role in supporting adolescents.
Design/methodology/approach
A literature review using a systematic approach was undertaken, predominantly through collection of primary qualitative research studies. In total, 22 published studies are included in this review, extracted from four databases – CINAHL, Embase, Medline and Scopus.
Findings
This review shows that awareness of mental health is needed early in adolescence, while at school, to encourage young people to access support and have knowledge of their own emotional health. The need for further mental health education and provision is asserted.
Practical implications
Young people benefit from someone who is accessible and familiar to them in schools so that they can access emotional support as and when needed. Careful involvement of families (including extended families) is noted. It is proposed that this role should be a mental health nurse role, who should be accessible within the school environment.
Originality/value
This paper is original and adds to existing knowledge that mental health challenges are increasing, and more needs to be done in schools to promote mental health and reduce the stigma associated with seeking support.
This study aimed to explore university students' understandings of mental health issues, mental health labels, and their attitudes towards these concepts. Five participants (four women aged 18–20, and one 24-year-old man) discussed in a focus group aspects of their childhood that they considered had affected their attitudes towards mental health and labelling. The three themes produced by inductive thematic analysis were ‘the language and context of labelling’, ‘stereotypes and social stigma’, and ‘personal experiences’. Findings have important implications for school nurses who work in primary schools, and who need to be aware of language use.
School nurses are often described as the ‘best placed’ professionals to provide early mental health interventions. Maya Motamedi asks whether this is really the case and discusses the changes needed to ensure they are.
Mental health problems affect many children and young people, but the social stigma attached to these issues may stop help being sought when it is most needed. The school nurse has an important role to play, working as an interface between education and social work.
Background
Mental health interventions for young people are increasingly being delivered online. This is occurring due to an assumption that young people prefer online interventions because they address some of the well-established help-seeking barriers. MethodA self-report questionnaire investigating preferences for mental health care delivery was administered to a nonclinical sample of 231 young people aged 15-19. ResultsThe strongest help-seeking intention in response to a scenario describing symptoms of depression was for face-to-face services, followed by not seeking help at all. Only 16% expressed a preference for online treatment. Conclusion
The assumption that a majority of young people will prefer online delivery of mental health treatment was not supported, although boys showed a stronger relative preference for online modes. Key Practitioner Message The assumption that the majority of young people want services online is not supported with only 16% of an Australian nonclinical sample holding this preference Although two-thirds of participants state a preference for seeking help face-to-face, the highest behavioural intention was to not seek help at all An intention to seek help online was directly predicted by an intention to seek help face-to-face and indirectly predicted by higher mental health literacy Males showed a stronger relative preference for online help Simply providing services online is unlikely to improve help-seeking rates for mental health problems among young people
This paper is a report of a research study to explore specialist community public health nurses’ views of their public health role. Three key objectives were set: to identify what their public health role was; to explore what the influences are on that role are; to investigate what they felt the solutions were to enhance this aspect of their role.
The study design consisted of a small qualitative study that used three focus groups to collect data from practice teachers from health visiting, occupational health nursing and school nursing. The data was combined for thematic analysis of their responses to the three key topics identified. The results showed that the participants were somewhat knowledgeable about their role as public health nurses; were influenced by lack of resources, poor understanding from others of their role and tensions with managers and the wider team as to the importance of their public health role; and they offered solutions that included role clarity for effective skill mix, a shared vision for practice and debated the role of a specific public health nurse in the team. Recommendations for clear roles and responsibilities, clear protocols for assessing need and identifying priorities and performance management frameworks are offered.
Children entering school need to build healthy peer relationships; school, however, is the central place for bullying. School nurses have a growing focus on providing care for students with social, emotional and behavioural problems. We examined the relational development of children at school entry in regard to aggression and empathy, showing that teacher-reported aggression decreased between Pre-primary and Year One, while empathy increased between Year One and Year Two classes. No gender difference was found in teacher-reported total, or covert aggression. Understanding how development of empathy can be supported in children at school entry is important, thereby supporting development of pro-social behaviour and decreasing bullying. School nurses must understand the importance of surrounding children with safety in relationships as they begin school.
Help-seeking among young people is complicated, often determined vicariously by the ability of adults, family or professionals, to recognize, and respond to, their difficulties. We know very little about the complex concerns of teenage young people and how they impact on help-seeking preferences. We aimed to ascertain the help-seeking preferences for a range of mental health problems among adolescents attending schools in an inner-city area of London. In particular we sought to examine the relationship between such adolescents and their family doctor. Using a mixed methods approach we explored help-seeking attitudes of young people. Emotional and mental health problems are not seen by young people as the domain of General practitioners. Moreover, there is a worrying lack of confidence and trust placed in family doctor and other professionals by young people. Young people do not tend easily to trust adults to help them with emotional difficulties.
This paper draws on recent research examining the contexts in which school nurses have worked to date, and highlights some of the tensions they have faced in striving to meet a range of national health targets, which at times have lacked synergy and coherence. It first considers the findings from the study in relation to the vision for public health recently outlined by Andrew Lansley, Secretary of State for Health. It then goes on to reflect on the challenges that will need to be addressed at national and local levels if nurses are to work to their full potential in promoting the health of children, young people and their families, in line with this vision.
Young people and children need to be able to access health services easily if they are to learn how to take care of their own health as they enter adulthood. School nurses are in an ideal position to provide a service to young people that could help them talk about their health needs.
Many children and young people will suffer from mental health problems at different stages during their school years.It is very important for school nurses to be able to offer advice and build relationships with those who need it
When their mental health needs are not met, the consequences for young people’s academic achievement, employment opportunities, social and economic status and the mental health of society as a whole may be grave. Although there are isolated excellent examples of good practice, services generally lack consistency and resources. School nurses may be best placed among healthcare personnel who have responsibilities for young people to recognise the early signs of mental ill health and initiate appropriate interventions.
A national screening programme might be an equitable way to enable early identification of mental health problems and it could save money, says Simon Nicholas Williams
A recent BMJ study suggested that school based cognitive behavioural therapy programmes may not be effective in reducing depressive symptoms.1 I agree with the authors that further research and evaluation of such programmes are necessary. However, although school might not be the most appropriate setting for the treatment of childhood and adolescent mental health problems, it is the most appropriate setting for the identification of mental health problems in this population.
There are great benefits to be had from the provision of routine mental health checks for all schoolchildren, not only those who have traditionally been deemed most at risk. The UK government’s current mental health outcomes strategy focuses on “prevention of mental illness and early identification and intervention,” emphasising a more “localised approach.”2 However, when it comes to prevention and early identification, a more standardised approach would be more equitable and effective. Physical health checks have been done in schools for more than a century, so why not mental health checks?
Mental health problems cost the UK an estimated £105bn (€125bn; $166bn) annually. Of this, £21.3 billion is spent on health and social care,3 more than double the total annual cost of cancer diagnosis and treatment in the UK (£9.4 billion).4 About three quarters of adult mental disorders are extensions of juvenile disorders (50% …
Objective This paper explores young peoples' health concerns and their knowledge and views of school nurse drop-in clinics (drop-ins) held in their schools.
Design Cross section survey of adolescents using questionnaires delivered in schools to 10 per cent of the population, and school drop-in monitoring data from the Primary Care Trust (PCT).
Setting 11 secondary schools in a suburban south-east London borough.
Method Data from 590 11-17 year olds were used to determine their health concerns, sources of advice for health concerns, views and peceptions of their school based drop-in clinics, and attendance at these clinics.
Results Young people have a number of health concerns, notably in the area of inter-personal issues, emotional heath and well-being; however, few had sought help with these. Awareness of school based drop-ins was high but knowledge of times and locations was patchy. The droins were viewed positively, especially by users. Issues such as timing of drop-ins, their location and confidentiality were raised by students. Most consultations were dealt with by support or advice from the school nurse. Monitoring data suggested the service may be under-used but those who did attend often returned. Sixty-two per cent of students felt drop-ins were an important service in schools, this rose to 92 per cent among those who had accessed the service.
Conclusion: School based drop-ins offer a valuable service but need planing and promotion to achieve good attendance figures. A school droin may be the first time a young person has accessed any health care setting by themselves and valuable transferable skills may be learnt.
Aim:
This paper is a report of a study to describe the workload of health visitors and school nurses in relation to children and young people with psychological, emotional or behavioural problems, and to identify perceived challenges, obstacles and sources of satisfaction associated with this aspect of their work.
Background:
There is little published information on the work performed by non-specialist community nurses with children and young people who have psychological, emotional and behavioural problems.
Method:
We analysed data from a survey conducted in 2002 - 2003 of 1049 Scottish professionals working with children and young people. Data included quantitative responses and free-text describing the cases seen by respondents. Responses from a sub-sample of 71 health visitors and 100 school nurses were analysed using a combination of descriptive statistics and analysis of themes emerging from the text.
Findings:
Although community-based nurses saw a relatively small number of children with psychological, emotional or behavioural problems each week, dealing with these problems took up a disproportionate amount of time. The commonest types of problem were self-harm, externalizing behaviours and family difficulties. Few respondents had received specific training in child and adolescent mental health but most expressed a wish to receive such training.
Conclusion:
The work of health visitors and school nurses in caring for children with mental health problems is substantial and important. Development of their public health role should not be at the expense of this important contribution. There is a need for rigorous evaluation of nursing mental health interventions among children and young people.
Mental health affects one in five young people, with the majority avoiding help due to stigma. In this study, young people's (n = 49) perception of stigma as a barrier to accessing school-based mental health services was compared with that of service providers (n = 63), along with the perceived extent of mental health problems and availability of school-based mental health resources.
Participants completed a survey or interview. EBSCO and PubMed databases were used for the duration of this study, from August 2010 to September 2011.
A greater proportion of young people versus providers reported stigma as the largest barrier to accessing mental health services. In addition, most young people reported that school-based mental health resources were scarce.
These results emphasize the need for young people's involvement in mental health initiatives.
Background
Quantifying diagnostic transitions across development is needed to estimate the long-term burden of mental illness. This study estimated patterns of diagnostic transitions from childhood to adolescence and from adolescence to early adulthood.Methods
Patterns of diagnostic transitions were estimated using data from three prospective, longitudinal studies involving close to 20,000 observations of 3,722 participants followed across multiple developmental periods covering ages 9-30. Common DSM psychiatric disorders were assessed in childhood (ages 9-12; two samples), adolescence (ages 13-18; three samples), and early adulthood (ages 19 to age 32; three samples) with structured psychiatric interviews and questionnaires.ResultsHaving a disorder at an early period was associated with at least a threefold increase in odds for having a disorder at a later period. Homotypic and heterotypic transitions were observed for every disorder category. The strongest evidence of continuity was seen for behavioral disorders (particularly ADHD) with less evidence for emotional disorders such as depression and anxiety. Limited evidence was found in adjusted models for behavioral disorders predicting later emotional disorders. Adult substance disorders were preceded by behavioral disorders, but not anxiety or depression.Conclusions
Having a disorder in childhood or adolescence is a potent risk factor for a range of psychiatric problems later in development. These findings provide further support for prevention and early life intervention efforts and suggest that treatment at younger ages, while justified in its own right, may also have potential to reduce the risk for disorders later in development.
Emotional disorders in children are common and although effective interventions are available comparatively few receive specialist help. School nurses were trained to deliver an evidence-based emotional health cognitive behaviour therapy programme, FRIENDS, to 106 non-referred children aged 9–10 attending three schools. Levels of anxiety and self-esteem were stable in the 6-month period before FRIENDS. Three months after completing FRIENDS, anxiety had significantly decreased and self-esteem increased. Children with the most severe emotional problems benefited from the programme. The value of delivering standardised evidence based programmes in schools by school nurses is discussed and the need for further research highlighted.
The emotional health and wellbeing of children and young people is of fundamental importance. Unmet mental health needs during childhood lead to difficulties in adolescence and problems in adulthood. The need to develop comprehensive prevention, early recognition and timely intervention services is essential. Despite this, many mental health problems go unnoticed or are only treated when advanced. Late intervention can often be associated with severe impairments for children and young people as well as their families. This article aims to improve nurses' understanding of children's emotional wellbeing and mental health, and identifies some of the risk and protective factors that combine to produce positive or negative outcomes. Individual and family-based psychological treatments that are available to support children are summarised. The learning activities offer nurses helpful interpersonal and practical strategies to promote emotional wellbeing and mental health in children.
To explore the views of school nurses regarding mental health problems in young people and their potential for engaging in mental health work with this client group.
Mental health problems in children and young people are an important public health issue. Universal children's services play a key role in identifying and managing these problems and, while school nurses have an important function in this work, little is known about their views on this aspect of their role.
A qualitative research design employing focus group methodology.
School nurses (n = 33) were purposively sampled from four school nursing teams in two English cities for a series of focus groups. The focus group data were audio-recorded, transcribed and subsequently analysed using 'framework'.
Four principal themes emerged from the data. In these themes, school nurses were found to value their involvement with the mental health of young people, recognising this as an important area of practice. Several obstacles to their work in this area were identified: heavy workloads, professional rivalries, a lack of confidence and limited education and training opportunities. The importance of support from local specialist mental health teams was emphasised.
School nurses can be engaged in mental health work though, as public health specialists, their role should focus on health promotion, assessment, signposting and early intervention activities. To facilitate mental health work, school nurses are able to draw on established interpersonal skills and supportive networks; however, workload and a lack of confidence need to be managed and it is important that they are supported by constructive relationships with local specialist mental health teams.
This study has implications for nurses and healthcare practitioners interested in enhancing the mental health of children and young people in school settings.
The aim of this study was to identify school nurses' views concerning the mental health aspects of their role, training requirements and attitudes towards depression in young people.
Mental health problems in children and young people have high prevalence worldwide; in the United Kingdom they affect nearly 12% of secondary school pupils. School nurses have a wide-ranging role, and identifying and managing mental health problems is an important part of their work.
A cross-sectional study was conducted using a postal questionnaire sent to a random sample of 700 school nurses throughout the United Kingdom in 2008. Questions concerned involvement in mental health work and training needs for this work. Attitudes were measured using the Depression Attitude Questionnaire.
Questionnaires were returned by 258 (37%) nurses. Nearly half of respondents (46%) had not received any postregistration training in mental health, yet 93% agreed that this was an integral part of their job. Most (55%) noted that involvement with young people's psychological problems occupied more than a quarter of their work time. Staff attitudes were broadly similar to those of other primary care professionals, and indicated a rejection of stigmatizing views of depression and strong acknowledgement of the role of the school nurse in providing support.
Working with young people who self-harm, and recognizing and being better equipped to assist in managing depression and anxiety are key topics for staff development programmes.