It’s Saturday afternoon and my friend’s five-year-old daughter is lying next to me on her living room floor. She explains to me that she does this at school. She lies on her back with the rest of the class and they do something called the body scanner, where they all pay attention to various body parts in turn. I know she is describing a mindfulness exercise, because I’m a psychologist who researches mental-health lessons. I listen as she explains it all to me, but in my head I’m thinking something else: she shouldn’t be learning mindfulness at school.
On the face of it, mental-health lessons in schools seemed like an excellent idea. Young people’s mental health is worse now than it was in the past, and one-to-one treatment is hard to access. If you teach young people about mental health at school – which often includes teaching techniques based on therapies such as cognitive behavioural therapy (CBT) or mindfulness – it’s more accessible. If you teach these concepts to everyone in a class – so-called universal interventions – you avoid missing the under-the-radar kids who aren’t seeking help, and avoid the potential stigma of singling anyone out. If you teach the information when pupils are young enough, even better: you might prevent mental-health problems from starting in the first place.
At least, that was the idea. The reality is more sobering. Researchers have now run many studies testing the impact of universal school mental-health interventions and have found that they don’t really improve mental health. When improvements are found, they’re small – a tiny average shift on a symptom questionnaire – and the quality of the research is often poor, meaning it’s hard to trust the findings. The best-designed studies show that interventions don’t work at all: no improvement in mental health symptoms, either immediately after the course of lessons or later down the line.
In fact, some studies have found that universal mental-health lessons actually make things worse. There are now high-quality studies showing that school lessons based on CBT, mindfulness, dialectical behavioural therapy (DBT) and general mental-health awareness lead to a small increase in symptoms of mental-health difficulties. There is evidence of other bad outcomes too, such as decreased prosocial behaviour or decreased relationship quality with parents.
It is not every study, but it is enough that we should take this seriously – not least because all schools in England are now required to teach something about mental health. And these are the ones that have been tested: there are many, many interventions being sold to and taught in schools that haven’t been evaluated at all.
I have now reached the conclusion that we should stop these all-class mental-health lessons. My view is that the only information we should teach en masse is where a young person should get help, both inside and outside school, if they’re struggling. That’s it. Then we should focus the time, energy and money on supporting the smaller group of young people who are actually unwell.
I have not come to this conclusion lightly. Like so many others, I was once enthusiastic about the potential of the universal approach. It is a logical, intuitive idea that mental-health lessons in schools are a good idea, an obvious solution to an obvious need. But once you can accept the evidence, something surprising happens. It starts to become clear why all-class mental-health lessons don’t improve young people’s mental health, and why they were never going to.
In any one classroom, young people vary enormously. For starters, the majority of them do not have mental-health problems. This means some pupils are being asked to engage in effortful practices at home – mindfulness meditation, CBT-based thinking exercises – when they are not struggling in the first place. When you ask them in qualitative studies, where they can convey openly what they think, some young people say such lessons are irrelevant to them, and they are right. Proponents of these lessons would say that the exercises are still worth learning, that positive effects may appear later down the line – but this is not supported by the evidence.
At the other extreme, in every class there will be students who already have significant mental-health problems, and thus will need more than what is on offer in universal lessons. They will need focused one-to-one support: therapy tailored to their specific challenges, built on a meaningful, trusting relationship with a qualified adult. Others will need changes in their external circumstances, not guidance about how to cope better in their own minds. For these students, mental-health lessons will be far too light touch, like being given plasters and paracetamol when they have a broken leg.
Other students say that these lessons make them focus on negative feelings and memories, which then upsets them. Others simply do not understand what they are being taught, and find the exercises confusing and stressful. We have very little understanding about how specific groups – such as neurodivergent children or those with language difficulties – experience these all-class lessons and whether they are able to correctly implement what they are being told to do.
Another problem is that the classroom may not be the right setting to learn about mental health. Some young people feel socially secure at school and have good friends, but others are lonely or bullied. Many young people do not feel safe at school. In one study, several students said they didn’t want to do mindfulness meditation at school because they didn’t trust what their peers would do to them if they shut their eyes. Hearing this, it suddenly seemed obvious: without resolving these social challenges, the classroom is just not the right environment for a young person to do vulnerable work on their mental health.
Importantly, this doesn’t mean there should be no mental-health support in schools. School is a logical, equitable place to provide help, and there is evidence that one-to-one and small-group support in schools, given to those who need or want it, can work well, at least in the short term. But when it comes to all-class lessons, we should listen to the evidence, and to young people themselves. We came up with a good idea, we spent a lot of time and money testing it, and we have our answer. Given the evidence, we should now stop doing those lessons.
The people running this research, and those making decisions to teach these lessons in schools, really want a solution to this crisis. We all want to figure out what to tell young people about mental health, and how to best help them when they are struggling. Against a backdrop of ever rising mental-health problems, and lack of affordable alternatives, I completely understand why it feels wrong – unethical even – to call a halt to these lessons.
Yet it is also unethical to ignore evidence, and to continue delivering something that doesn’t work. At best, the universal lessons we have are a waste of time; at worst, they are harmful. The numbers tell us these lessons don’t improve mental health. The qualitative data tells us that many young people don’t like or want them. We need to listen.
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Dr Lucy Foulkes is an academic psychologist at the University of Oxford, where her group researches mental health and social development in adolescence. She is the author of What Mental Illness Really Is (and what it isn’t), and Coming of Age: How Adolescence Shapes Us