Bullying and mental health in children: improving interventions

Note from UCL One-day policy workshop, 14th November 2019

Understanding the user

During the first activity, each group of participants was asked to think from the perspective of a user of anti-bullying policies: a young person (aged 14) who has previously been bullied, a head teacher and a civil servant. The activity was not designed to create stereotypes, rather to create empathy and encourage participants to extend their thinking beyond their own job roles.

This activity prompted interesting discussions which are summarised below:

A young person (aged 14) who has previously been bullied.

This young person might see their school teacher as having responsibility for dealing with bullying. They might value the importance of internet support groups to find people ‘like them’ which offer a chance to have a ‘double identity’ where they can be themselves. They may fear not being supported by teachers/parents, a hostile environment at school, not being offered support and feeling awkward about asking for it.

A head teacher who has responsibility for their school’s anti-bullying policy.

The head teacher’s issues may include how they manage the bullying dynamic: should they focus on the bully or the victim? Other factors include the time and resources involved in designing anti-bullying policies (there are many stages to creating a policy, other policies to deal with and “boxes to tick”). If they have personal investment/responsibility for the policy, they may find it harder to recognise when it is not working and to acknowledge this. The group noted that the policy and the interventions are two different things.

A civil servant working on improving mental health provision for young people or reducing bullying.

The civil servant might wish to avoid instructing schools what to do and allow them their own autonomy, as policies need to make sense for the school’s needs and what they can and want to do alongside other priorities for the school. The group discussed different Government departments: what are the roles for different departments (such as the Department for Education and Department of Health) and how do they work together? For a civil servant, decisions around funding can be challenging but working together between departments can help to identify a common purpose.

Ideas generation

Subsequent activities involved the three groups being asked to generate ideas based around the problem statement.

During the afternoon, they chose one idea to develop further into a five-minute pitch that was presented to the whole group. The three final ideas are summarised below, including some of the key discussions from each table.

‘School Life’ app

What is the idea?

An app designed to promote mental well-being and create opportunities for the early identification of mental health problems. It would be used throughout secondary school by all children (i.e. not only after mental health issues had been identified).

The app would be framed as a series of personality tests based on the SPECTRUM Database^[3] with engagement features and tools for leading the user to sources of information. Its design would be easy and fun to engage with, with the serious questions sitting behind the main interface. The tests would also signpost to further information where appropriate, such as resources on maintaining good mental health, or resources specific to the school attended by the user. The app would also be able to identify users in urgent need of support and present a ‘leave this page/SOS’ type prompt, to either within school (such as a safeguarding lead) or external organisations (such as Childline).

How would it work?

The app would be delivered by schools. Developers would advise schools on when to use the app (for example in class or outside) and share data. Schools would be able to fill in details on the app, such as who to ask for help from in the school setting and who the safeguarding lead in the school is. The app could also provide summary (anonymised) statistics to the school.

What needs to happen next?

A literature review on existing apps could be taken to evaluate what is working. Currently, apps in this space have specific functions and it can be hard for a child to navigate which app is most appropriate for them as they shift along the spectrum of mental well-being. The app would need to be tested by focus groups and be run as a pilot in the first instance.

How could we measure success?

The amount the app is used, the number (or proportion) of users seeking help, and a rating system by children of the advice provided (such as a thumbs up or thumbs down button).

Mental health week

What is the idea?

An annual ‘mental health week’ for schools, which would encourage the whole school community (including parents) to think about bullying, mental health and good practice. A week long programme of activities would include health education, mental health ‘check-ups’, talks and workshops. Parents, teachers, students and mental health professionals would be involved, with public figures invited to support the campaign.

The programme would include mandatory, regular check-ups with an option to combine this with other approaches, such as mandatory health education. The check-up would be created by educational psychologists (to provide a comprehensive view of the educational environment) and clinical psychologists (for treatment and diagnosis). Schools would arrange events for the ‘mental health week’ to suit the individual school’s agenda and their existing timetable commitments.

How would it work?

The check-ups would be regular and confidential and involve developing concrete plans for maintaining good mental health with young people, to be applied during the campaign week. Check-ups would take place at school as a reliable delivery and include school level management to identify systematic problems and enable the school to take responsibility. Students identified as being at risk would receive a referral and support.

Trust in the system would need to be built to facilitate honest answers. The tension between safeguarding and confidentiality needs to be recognized: how to handle the information acquired from the child, balancing between immediate risk and confidentiality, referral system and support after identification. Parents could be offered an optional check-up to be provided information regarding children’s mental health and ways to help. Students and parents would be invited to provide feedback to schools.

How could we measure success?

The long term success indicator would be a reduction in bully victimization and subsequent mental health problems.

Student-led pro-social behaviour contract

What is the idea?

The intervention is designed to make bullies less relevant, and take a classroom level approach to create ‘social referents’ in a peer-led intervention. Students create a ‘judgement system’ held together by adults, involving a behaviour ‘contract’ which they must all sign. The idea being that because children created it, they are more likely to adhere to it. It also creates a channel for talking about bullying and raise awareness.

How would it work?

Ideas for the contract content could be developed from homework assignments asking children questions, such as around what friendships should look like, what they believe to be appropriate behaviour, and which rewards and sanctions should be in place. The homework element enables all children to get involved.

The system would involve changing norms by agreeing on rules, measures and establishing pro-social rewards for proactive behaviour. ‘Punishments’ would be determined for bullies. A space for social-emotion learning where children can discuss anti-bullying matters, teach social skills and discuss problems and include activities with the aim of increasing class connectedness. 

What needs to happen next?

A pilot study and a Cluster Randomized control trial in different schools. Feedback could be gained from student, teacher and parent surveys.

How could we measure success?

Network models could measure the degree of increased communication, integration and connectedness. Student, teacher and parent reports could measure levels of perpetration and victimization at a classroom level, the extent to which pro-social behaviour has increased and levels of improved behaviour.

Next steps

Participants were asked to vote on their favourite of the three ideas at the end of the workshop. The app idea received the most votes, with a 54% share of 13 participant votes.  Participants were asked at the end of the workshop about the most important next steps following this event. They suggested the following:

• Establish a firm action plan
• Write a public report summarising the discussions
• Use the ideas to develop the interventions proposed during this workshop
• Conduct research on the difference between bullies and leaders
• Use the participants to share data and forward thinking in the future

Participants also highlighted a number of existing interventions and initiatives that might have potential to be included in plans for new research projects:

• A pledge from the Government that mental health training will be offered to all secondary school teachers.
• Mental health charity Mind has introduced a Mental Health Awareness Week. There may be potential for academic partners to engage with this work, for example in evaluating the impact of the project.
• The Government announced in February that all children in England will be taught how to look after their mental wellbeing and recognise when classmates may be struggling, as part of new compulsory health education to be introduced from September 2020.

Dr Jean-Baptiste Pingault and Dr Jessie Baldwin are keen to collaborate with workshop participants who are interested in securing funding to trial these exciting new ideas for interventions, including the ‘School Life’ app, the Mental Health Week, or the pro-social behaviour contract.

They will actively monitor funding calls to see if any relevant opportunities arise, and encourage workshop participants to get in touch with them if they would like to collaborate in grant applications focused on these interventions.

Workshop participants

• Dr Jessie Baldwin                      UCL 
• Jenny Bird                                UCL 
• Prof Lucy Bowes                       University of Oxford  
• Athena Chow                            UCL 
• Victoria Floyd                            MQ Mental Health 
• Dr Anouk Goemans                   Leiden University 
• Dr Richard Graham                   Good Thinking 
• Florence Greatrix                      UCL 
• Carolina Guzman Holst              University of Oxford 
• Dr Carrie Herbert                      Red Balloon 
• Matthew Hopkinson                   DfE
• Jon Howard                              BBC 
• Kai Lim                                     KCL 
• Kate Liu                                    UCL 
• Shelly Masters                          Minds Ahead 
• Lena Milosevic                          Red Balloon 
• Dr Jean-Baptiste Pingault          UCL 
• Tilda Simpson                           YPMHAG
• Loretta Sollars                           Public Health England 
• Dr Abigail Thompson                 UCL  
• Hannah Wilson                         EIF 
• Prof Dieter Wolke                      University of Warwick 

Authors

Dr Jessie Baldwin, Jenny Bird, Florence Greatrix, Carolina Guzman-Holst, Kai Lim, Kate Liu, Dr Jean-Baptiste Pingault.