In March 2021, I had the absolute pleasure of joining University of Cambridge, Department of Psychiatry, as a Postdoctoral Research Associate. I worked with the excellent ChARM team (Child and Adolescent Resilience and Mental Health), and, in particular, Prof Tamsin Ford and Dr Anne-Marie Burn, who supported me in my postdoctoral research journey. I also joined a second research team, involving a small but extremely dedicated number of researchers working on the topic of children’s mental health, involving Tricia Jessiman (University of Bristol), Dr Judi Kidger (University of Bristol), Dr Mark Limmer (University of Lancaster), Emma Geijer-Simpson (Newcastle University), Liam Spencer (Newcastle University), and Naomi Leonard (University of Bristol). The project was funded by NIHR School of Public Health Research, and also involved other institutions, such as UCL, LiLaC & Fuse.
The experience of working with researchers from various institutions has been invaluable, and allowed me to understand the work involved in large-scale collaborative research projects in a completely new way. Although my post-doc lasted a little longer than a year (I have completed my work just this April 2022), in a way, it has provided knowledge, experience and connections that could be spread across a few years (I’d say it’s definitely comparable to another degree’s worth!)
Throughout this post-doc, my main task was to contribute to the qualitative research conducted within the “School culture and student mental health: a participatory action research (PAR) study” workstream. The project investigated how educational psychosocial and physical environments impact the mental health of children and young people, with a particular focus on identifying interventions that could improve mental health outcomes and inequalities. Prior to this post-doc, I have contributed to some research outputs focusing on young people’s mental health, and have spent a considerable amount of time teaching about child development and adolescent mental health issues to undergraduate and postgraduate university students. However, the public health research aspect was new to me, especially since all of my prior work had ties to psychotherapy and formal clinical interventions. It was, therefore, humbling and exciting to perceive the impact of interventions devised as part of our research project on a wider level (the school communities), since much of my other work is dedicated to understanding the betterment of mental health on an individual level.
This is also the first project that I have contributed to which involved participants as co-researchers, which is a unique facet of the participatory action research (PAR) method. It has been interesting to see students, but also teachers and pastoral support, as well as parents, take on a scientific task of reflecting about their environment and school culture, and making changes to this sphere.
Based on our current research outputs, I thought it would be valuable to provide a summary of the project, and the different ways in which it sought to tackle current issues in mental health support for young people in the UK.
Mental health service needs for young people remain unmet even in the economically wealthy societies (e.g. the UK, the USA, Australia, Switzerland, etc.) (Verhulst et al., 2003). In the UK, barriers to accessing mental health support amongst young people include lack of mental health practitioners and staff, concerns about confidentiality and trust, a preference for informal sources of help and mental health stigma (Salaheddin & Mason, 2016). In particular, young people from lower socio-economic backgrounds are disproportionally affected by both mental health issues as well as lack of mental health support (Brown & Carr, 2019).
Increasingly, supportive school environments have been suggested as playing an important role in addressing mental health concerns among young people. An earlier systematic review undertaken by our research team (Anderson et al., 2019) examined aspects of educational settings beyond the taught curriculum that were most important for mental health. Despite the unique opportunity that school environments present for the promotion of positive mental health among youth, it is at times also a ‘missed’ opportunity. Although there are a limited number of studies that have gone beyond pilot or cross-sectional designs, the review revealed that interventions which focus on creating positive relationships among students, and between students and teachers, and which include students actively in decisions relating to school life, have the potential to improve mental health (Bonell et al., 2019; Hampton et al., 2010). These socio-cultural elements of school life are increasingly understood to be important for student health and well-being, both of which contribute to and make up a positive school culture.
In the UK, school culture was recently the focus of research commissioned by the Department for Education as a potential means of improving the educational achievement of disadvantaged pupils. The research concluded that high-performing schools demonstrated greater cohesiveness, sense of shared purpose and values amongst all staff, pupils and parents, as well as high staff morale, suggesting that these aspects of school culture can influence school effectiveness (Baars, Mulcahy, Menzies, 2018). Similarly, there is compelling evidence for the impact that school culture has on substance use among students, which in turn affects health and education outcomes (Markham, Bonell, Fletcher, & Aveyard, 2017).
Our approach to the definition of school culture involves both psychological and anthropological factors specific to each school (e.g. student feelings and experiences of belonging to school community) as well as how the latter intertwine and/or relate to the demographic settings of the schools (e.g. information about the geographical and physical environment of schools and staff/student populations, including gender, ethnicity, culture, religion, mental health/well-being support needs, etc.).
Why PAR (participatory action research)?
It is important to acknowledge that creating cultural change (i.e., a lasting change that addresses a significant structural element within the school environment) is more complex and, often, more demanding in terms of resources and activities. However, interventions that actively address (by enabling but also by ‘disrupting’) the entirety of the school system (e.g., by introducing new activities, systems, interventions that change the school curriculum, pastoral and mental health support or value systems) have the potential to create significant and sustainable school culture changes and to improve mental health.
Participatory action research (PAR), a method positioned within the qualitative paradigm, has been identified as one such intervention that can transform, rather than merely inform, collaborative and participative processes within a specific environment, including education and schools (Baldwin, 2012). Early findings indicate that PAR can be utilised to promote mental health and creatively involve students in developing their own school culture (Berg et al., 2018).
The outline of the study
In our qualitative study, we developed PAR groups in three English secondary schools. The PAR groups facilitated a shared understanding of the culture in their school and developed activities or interventions intended to improve it. We collaborated with facilitators from a mental health charity, who helped lead the groups, which consisted of up to eight students and four members of staff with additional pastoral duties.
A qualitative study was conducted alongside the PAR groups to address our research questions. This included qualitative semi-structured interviews with school staff, parents and members of PAR groups, focus groups with students, observations of PAR groups and a review of school documents pertaining to mental health and inclusion.
For a step-by-step summary of our data collection and methodology, see Figure 1.
Our study sought to address the following research questions:
- What are the key components of school culture that impact on student mental health?
- What changes or interventions can be made to improve school culture and mental health outcomes for students?
- What is the process by which school culture impacts on young people’s mental health?
- Is a PAR approach feasible and effective as a methodology for instigating positive change to school culture?
Respondents from three schools identified elements of school culture that align into four dimensions: structure and context, organisational and academic, community, and safety and support. Structure and context includes physical aspects of the school buildings, the geographical setting, and the diversity of these on the student intake, particularly around ethnicity and socio-economic status. The academic and organisational dimension includes how culture is led and prioritised by school leaders, pedagogical aspects including teaching and learning styles and the curriculum, academic performance, and staff composition. Community refers to the quality of the relationships within and across key stakeholders in any school; students, parents (or carers), and school staff. Safety and support primarily refers to how schools support student emotional and psychological wellbeing, including through the provision of both primary and targeted support for mental health, although some aspects of physical safety (for example, bullying) may also be important.
A secondary aim was to explore which elements of school culture are perceived to be most important to student mental health. While elements across all four dimensions have influence, respondents were most likely to discuss diversity (across ethnicity, socio-economic status, gender and sexuality) in both the student and staff population as a key element of school culture likely to influence student mental health. Other elements of school culture that emerged as key influencers of student mental health were inclusive practice as an important element of mental health promotion, pastoral support, the quality of relationships and interactions in the school, and student voice, although mechanisms to promote student voice were regarded as unsatisfactory by most respondents, particularly students.
This study also demonstrates how culture was prioritised by staff in the participating schools. Senior leaders recognised the importance of culture and took a proactive stance on leading and shaping it. This was driven by their belief that it will influence student mental health, and the UK Government’s emphasis on the role of schools in supporting mental health. It is also apparent in our data how school staff were influenced by wider events, including the COVID-19 pandemic and the subsequent impact on mental health, and the Black Lives Matters protests of 2020. School leaders (and all school staff) reflected on the impact of these events on student mental health and the need to respond and adapt aspects of school culture in response.
Participants in our study placed little emphasis on the quality of the physical environment (school buildings, maintenance, cleanliness etc.) although building design did feature. Instead, this dimension included greater emphasis on contextual factors including the school’s geographical setting and the diversity of the student cohort. In particular, stakeholders in our study perceived that the ethnicity, socio-economic status and to a lesser extent, intellectual disability (SEND) characteristics of the student intake had a profound effect on the culture of the school and staff efforts to manage it. Unlike other models of school culture (or climate), which consider the social composition of the student body as outside the construct of school culture but hugely influential over it, in our study the social demographics of the student intake was one of the defining features both of the school culture and of efforts to manage and improve it.
The boundaries between the four dimensions identified in our study are not distinct, but factors within each one have influence across all dimensions. Diversity of the student intake, in particular ethnicity, is a key factor in the structure and context dimension but also hugely influential over factors in the other three dimensions. It was particularly salient to our respondents when describing delivering and adapting the curriculum (including efforts to decolonialize it), and their concerns about staff composition. Ethnicity also influences community factors; lack of minority representation amongst staff is seen to damage relationships with BAME students, and drives the emphasis on inclusive practice evident in all three schools. Staff were also cognisant of the influence of ethnicity on disciplinary practice, and student perception of the equity of this. Another illustration of influence across dimensional boundaries is how efforts to create a safe and supportive environment influence factors within the academic and organisational domain, such as staff training on inclusive practice and the inclusion of mental health in the curriculum. This study makes clear the interdependence of the four dimensions in shaping the culture of a school. School staff who seek to shape and improve school culture as a means of promoting student mental health may have better results if this interdependence is acknowledged, and improvements are addressed across all four dimensions rather than prioritising one or two.
The future of the project
As the PAR intervention is implemented in our study schools, we plan further research with school-based participants to explore how the active involvement of students as co-researchers working to improve school culture for the benefit of student mental health works in practice. This methodology reflects the importance identified in the literature of active engagement and the promotion of autonomy in health promoting schools. Studies are also needed that identify effective ways in which to influence all the different dimensions of school culture, to ensure safe and inclusive environments that are supportive of and not detrimental to student mental health.
If you are interested in reading more about our study, please see the following research outputs. We anticipate that our upcoming papers will demonstrate the effectiveness of PAR approach in schools (and the variations in interventions/success of PAR outcomes between the participating schools).
Jessiman, P., Kidger, J., Spencer, L., Geijer-Simpson, E., Kaluzeviciute, G., Burn. A., Leonard, N., Limmer, M. (2022). School culture and student mental health; A qualitative study in UK secondary schools. BMC Public Health, 22, 619. https://doi.org/10.1186/s12889-022-13034-x
Kaluzeviciute, G., Jessiman, T., Burn, A., Ford, T., Kidger, J., Leonard, N., Limmer, M., Spencer, L. (2022). Studying Mental Health in Schools: A Participatory Action Research (PAR) Approach in Public Mental Health. Journal of Concurrent Disorders. https://concurrentdisorders.ca/download/4335/
Kaluzeviciute, G., Jessiman, T., Burn, A., Ford, T., Geijer-Simpson, E., Kidger, J., Limmer, M., Ramsay, S. E., Spencer, L. (2021). Participatory action research (PAR) on school culture and student mental health: a study protocol. International Journal of Qualitative Methods, 20, 1-13. https://doi.org/10.1177/16094069211047753