Case Study
Schools can provide a good environment where support can be provided for children and young people to improve mental health. In 2014, local authority public health team and school nurses piloted a mental health promotion programme aimed at all the pupils in one secondary school. This programme was designed to be rolled out to all secondary schools as part of a city-wide initiative aimed at improving the mental health of children and young people.

The programme would consist of events where the public health team leader for mental health talked to the whole school about psychological wellbeing. This would be followed up by classroom discussions with the school nurse to increase understanding of mental health issues, substance misuse, stress and social skills and discuss issues raised.

The pilot, carried out in one school, commenced with an open meeting where parents were informed of the initiative and they and the teaching staff were supportive. The initiative was designed to run for a full year and resources for an outcome evaluation were included.

However, the evaluation report concluded that ‘there is little evidence that the scheme has changed pupils’ views about mental health or stigmas about mental illness’. On receiving this report, the Director of Public Health suggested the programme should be modified and highlighted an article about mental health promotion in comprehensive schools in Finland (Onnela et al., 2014) with the aim of improving collaboration between stakeholders.

Using the key principles of the Finnish approach, the public health team and the school nurse modified their plan accordingly. This included a proposal for school nurses and trained mental health nurses to provide drop-in sessions for individual students and run small group sessions to help build resilience as well as provide opportunities to discuss issues further if needed. Teachers would also be encouraged to get more involved and attend training days to help them better support their students. Public health resources were identified to take the work forward and to encourage collaboration between the various stakeholders involved in this initiative.

Although the head teacher had some misgivings about adopting the proposals for the Finnish approach, he was also under pressure to address mental health promotion and therefore agreed to hold an open meeting to inform parents of the proposed plans.

At the meeting, attended by parents and teachers, the public health lead for mental health promotion explained how the previous initiative had not worked and presented evidence from the Finnish programme to support their revised plans. She discussed how a mental health nurse intervention with increased teacher, parent and student involvement along with public health support would be more effective in promoting mental health and wellbeing. The school nurse also spoke in support of the revised plans, arguing the case for evidence-based practice and proposing a start date of the next academic year.

Although some parents supported the plans, most were quite critical, as were many of the teachers who attended. The head teacher was silent throughout the event, except to chair the meeting. Among the issues raised by parents were concerns about:

The study presented was based in Finland and they did not think that mental health issues in Finland were necessarily similar.
Involving mental health nurses would take them away from their clinical work.
Sessions taking place within the school might provide the potential for further stigmatisation.
Too much emphasis being put on mental health promotion at the expense of other health issues such as underage drinking and smoking, which were increasing in the local area.
The initiative presented was a worked-up plan, with little room for consultation.
Teachers also raised some concerns:

There was already intense pressure on the curriculum and this initiative would add to it.
Some students would miss lessons and might get behind with their work.
Teacher involvement would mean missing classes to attend training sessions, so other teachers would have to set and mark work to cover their absence, piling on more pressure.
The public health lead on mental health and the school nurse were surprised and disappointed by the discussion. They tried to address people’s concerns but had to agree to pause on the initiative and try to devise a further modified approach that would be less disruptive. The meeting ended with no agreement on a scheme or a start date.

Reference

Onnela, A.M., Vuokila, P., Hurtig, T. and Ebeling, H. (2014) ‘Mental health promotion in comprehensive schools’, Journal of Psychiatric and Mental Health Nursing, vol. 21, pp. 618–27.

Core text: Linda Jones and Jenny Douglas (2012) Public health: building innovative practice. The Open University, Milton Keynes, UK
Questions

Part 1. Evaluate the roles of the public health practitioner leading on mental health promotion and the school nurse in this policy-making process. Consider why their preferred way forward was not adopted, drawing on your understanding of power, stakeholder influence and resistance in policy-making theory to support your answer. (50% of the marks)

Part 2. Create a presentation of the case that you would present to the meeting if you were the public health lead in this case study, supporting this with explanatory notes. (30% of the marks)

Part 3. Reflect on the evidence you have gathered about how to influence policy development and apply it to a situation or an organisation with which you are involved. (20% of the marks

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