Mindfulness and contemplative approaches in education.

There is a growing and promising quantitative evidence base on mindfulness in schools, which has continued to emerge over the last two years and which consistently suggests small to moderate impacts across a range of outcomes, most strongly and reliably on psycho-social health and well-being, especially mental health problems, with less definitive but promising evidence for small effects on behaviour, cognition, learning, and physical health. The overlapping field of 'contemplative education' is less concerned with measurable outcomes, aiming instead to put the learner, and their self-reflective mindfulness at the heart of the teaching and learning process. Interest is growing on how best to implement mindfulness and integrate it into the policies, practice and ethos of the whole institution, with some promising early findings, mainly from qualitative data. There is a particular and growing emphasis, supported by some emerging quantitative evidence, on the need for teachers to learn mindfulness themselves and establish their own practice if they are to cultivate mindfulness in schools effectively.

Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled feasibility study.

BACKGROUND: Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness among young people. AIMS: To assess the acceptability and efficacy of a schools-based universal mindfulness intervention to enhance mental health and well-being. METHOD: A total of 522 young people aged 12-16 in 12 secondary schools either participated in the Mindfulness in Schools Programme (intervention) or took part in the usual school curriculum (control). RESULTS: Rates of acceptability were high. Relative to the controls, and after adjusting for baseline imbalances, children who participated in the intervention reported fewer depressive symptoms post-treatment (P = 0.004) and at follow-up (P = 0.005) and lower stress (P = 0.05) and greater well-being (P = 0.05) at follow-up. The degree to which students in the intervention group practised the mindfulness skills was associated with better well-being (P<0.001) and less stress (P = 0.03) at 3-month follow-up. CONCLUSIONS: The findings provide promising evidence of the programme's acceptability and efficacy.

Child and adolescent mental health in schools.

It is a pleasure to write the editorial for this issue of the journal, which also highlights the publication of a Virtual Issue (VI)1 which brings together some of the most influential articles published on child and adolescent mental health in schools over the last 10 years. The retrospective by David Galloway, written 2001, is an interesting starting point for commentary, looking back over what is now 30 years. Its themes about UK educational policies and their impacts resonate through the articles collected here from across the world and are in most cases are as relevant today as ever (Galloway, 2001*)2 .

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.

Reducing the silent burden of impaired mental health.

Mental and behavioral disorders account for about one third of the world's disability caused by all ill health among adults, with unipolar depressive disorders set to be the world's number one cause of illhealth and premature death in 2030, affecting high- and low-income countries. There is a range of evidence-based cost-effective interventions that can be implemented in parenting, at schools, at the workplace, and in older age that can promote health and well-being, reduce mental disorders, lead to improved productivity, and increase resilience to cope with many of the stressors in the world. These facts need to be better communicated to policymakers to ensure that the silent burden of impaired mental health is adequately heard and reduced.

Child mental health practitioners' knowledge and experiences of children's educational needs and services.

The improved joint working between child and adolescent mental health services (CAMHS) and schools is a policy priority. Although there have been a range of school-based initiatives and studies on teachers' awareness of mental health issues, there has been limited evidence on the training needs of CAMHS practitioners. The aim of this study was to explore how much CAMHS staff know about educational issues and how confident they feel working collaboratively with education colleagues. Ninety-six staff from four specialist CAMHS completed a questionnaire with 40 items on perceptions of knowledge, practice and attitudes towards educational issues and services, and three case vignettes. Despite the fact that participants reported frequent contact with children with education-related needs and with education services, they also highlighted concerns about their level of training and skills in this regard. Perceptions of knowledge and attitudes significantly predicted response to case vignettes. Previous training and experience were associated with knowledge, but did not predict case vignettes scores. The results suggest that training of CAMHS staff should be integral to all services in helping improve their understanding of school and education systems, improve clinical skills in detecting education-related mental health problems, and develop strategies in increasing joint working.

What do we know about promoting mental health through schools?

There is a growing evidence base on what schools need to do to promote mental health effectively. There is strong evidence that they need first and foremost to use a whole school approach. This shapes the social contexts which promote mental health and which provide a backdrop of measures to prevent mental health disorders. In this context the targeting of those with particular needs and the work of the specialist services can be much more effective. Schools need to use positive models of mental health, which emphasise well being and competence not just illness--this will help overcome problems of stigma and denial and promote the idea of mental health as 'everyone's business'. The most effective programmes in schools which address mental health have the following characteristics: They provide a backdrop of universal provision to promote the mental health of all and then target those with special needs effectively. They are multi-dimensional and coherent. They create supportive climates that promote warmth, empathy, positive expectations and clear boundaries. They tackle mental health problems early when they first manifest themselves and then take a long term, developmental approach which does not expect immediate answers. They identify and target vulnerable and at risk groups and help people to acquire the skills and competences that underlie mental health. They involve end users and their families in ways that encourage a feeling of ownership and participation, and provide effective training for those who run the programmes, including helping them to promote their own mental health. Using these starting points, we need to develop a rigorous evidence-based approach on this issue. We also require the facilitation of the dissemination of such research findings while encouraging new and innovative approaches.

The prevalence and management of asthma in primary-aged schoolchildren in the south of England.

A postal questionnaire survey of headteachers in 149 Infant, Junior and Primary schools (response rate: 63.8%) indicated poor asthma record keeping and a need for regular staff training in asthma. Dealing with an emergency was a major concern of headteachers. In 25 of the schools surveyed, an International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was distributed to parents of children in Years 3 and 4 (7-9 years). Headteacher-reported asthma prevalence was 11.9% in these schools, while ISAAC parental reports indicated a current or previous diagnosis of asthma in 24.3% children, with 17.8% receiving asthma treatment and 18.9% reporting wheeze in the previous 12 months. Of six wheezing children per Year 3/4 class, one was receiving no treatment for asthma, three had experienced four or more attacks of wheeze in the previous year with one wheezing child per two Year 3/4 classes experiencing more than 12 such attacks. Four in six children experienced exercise-related wheeze, while only one in five schools allowed asthma medication at Physical Education lessons. A whole school policy on asthma together with some regularly updated staff education and training by an asthma-trained nurse would address many of the issues raised in this study.

Promoting mental and emotional health in the European Network of Health Promoting Schools: a training manual for teachers and others working with young people

This project is part of the European Network of Health Promoting Schools (ENHPS), which is a joint and co-operative activity between the World Health Organisation, the Commission for the European Communities and the Council of Europe (1993).The courses and the manual have been developed in close consultation with ENHPS co-ordinators, teachers and others involved in school health education in central and eastern Europe. Mental and emotional health have always been central to the ENHPS philosophy, and were identified by those working in central and eastern Europe as essential priorities in their task of developing healthy schools. The sheer amount and accelerating nature of the change that these countries have experienced in a very short time has meant that issues concerning mental health, relationships, communication between generations, the management of stress and the management of change are seen as especially key.