Promoting Mental, Emotional and Social Health

A Whole School Approach

Katherine Weare

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134702626
• Edition: 1
• Topic: Education
• Subtopic: Education General

Schools are now seen as being one of the key agents which can help redress society's most fundamental problems, create more cohesive communities and promote citizenship and a sense of social conscience in the young. Promoting Mental, Emotional and Social Health: A Whole School Approach provides a clear and practical overview of ways in which mainstream schools can promote the health of all those who work and learn in them.Supported by the latest new evidence from the UK and Europe as well as findings from the USA, it outlines and examines: * evidence that social and emotional learning and academic achievement can go hand in hand and that the same key factors underlie both happy and effective schools
* the areas of school life that are the key to promoting social and affective health, including relationships with families and the community, management and the curriculum
* the competencies that we all need to become more emotionally literate and relate to more effectively.

1 Definitions, concepts and
principles

Goals of this chapter

This chapter provides a keynote and a guide to the rest of the book. It examines the nature of mental, emotional and social health, suggests that we need a framework of concepts and principles for examining these matters, and that the approaches of health promotion in general and the health promoting school in particular are currently the most coherent, comprehensive, ethically sound and well-proven. The concepts and principles that underlie health promotion and the health promoting school idea are set out, their relevance to social and affective health in schools suggested, and indications given of where they will be explored in more detail in the chapters that follow.

Choosing and defining terms

Mental/emotional/social

It may help at this early stage to make some observations about the choice of the three terms—mental, emotional and social—which frame the book. At first sight it may seem tautological: almost all definitions of mental health include emotional well-being, and for some the two are simply synonymous, while most definitions of mental health also include social well-being, as the ability to make relationships and be part of a social group are generally seen as essential to mental health. In theory, then, this book could have just used the term ‘mental health’ on the grounds that it subsumes the other two terms. The reasons not to restrict ourselves in this way are pragmatic rather than conceptual, and are to do with the way the terms tend to be used in practice.

The book uses the term ‘mental health’ in order to speak to those people who come to these issues from the health service, health education, health promotion, and international agencies such as the WHO, who tend to use this term, often in a broad, positive and holistic sense. But although many who use the term in these contexts strive to give it a positive spin, mental health tends so often in practice to be used as a synonym for mental illness that to use it on its own would be too narrowing and negative for the more positive orientation of this inquiry. Furthermore, the term ‘mental health’ does not conjure up for those from educational backgrounds the wealth of work that exists in their field, which takes place under the labels of emotional, social or personal education, but which is in fact central to mental health. Nor does it have helpful connotations to those who come from the worlds of therapy and counselling, for whom the term often has an overwhelmingly psychiatric and medical colouration. So the book also uses the term ‘emotional health’, not to distinguish it from mental health, but simply because it is a term more often used by those who come to the issue through mainstream school education and the therapeutic professions. It adds the term ‘social health’ because it is a familiar one to educators and also to those who come to these issues from work in the community. Using the term ‘social health’ also has the advantage of making it clear from the outset that the focus of this book is not on the individual, but also on social aspects of mental health. It reminds us, for example, that the mental and emotional health of individuals depend on the social support they receive, that communities can be more or less healthy, and that the concepts of mental and emotional health are not neutral and obvious, but are to some extent socially defined and contextualised.

Mental health is too complex to define simply

We will begin by making some comments on the problems of definition, and will for now, for simplicity's sake, focus only on the term ‘mental health’, partly because that is the more inclusive term, and partly because it is one that a good deal of effort has been devoted to defining. So there are several issues with which we must deal.

This book will not attempt a single-sentence definition of mental health: most who have made a serious attempt to define it have concluded that to attempt to sum up such a complex and multifaceted concept in a short, simple statement is just not appropriate or possible. Those who have tried end up either coming up with something pithy but so banal as to be meaningless, or inclusive but so packed with nouns as to be impossible to follow. Many who tackled the problem have concluded that it is more helpful to suggest a range of elements (Macdonald and O'Hara 1998) or descriptions (HEA 1997) that constitute the concept. But saying that we need to use a multifaceted approach does not mean that we should attempt to define mental health as a ‘shopping list’ of disconnected attributes and features: such approaches have rightly been described as reductionist and atomistic (Secker 1998) and give no guidance as to which approaches are to be preferred to others.

Mental health depends on the perspective or paradigm

In deciding how to define mental health we need first to decide what are our basic assumptions and values. Exploring the concept of mental health can never be a culture-free or morally and ethically neutral activity (Caplan and Holland 1990; Tudor 1996). What we understand by mental health will depend on our values, preconceptions and assumptions, for example about the nature of health and illness, the nature of society, the place of the individual within society, what constitutes normality, desirable behaviour and attitudes, and so on. Tudor (1996) has identified four different basic ‘paradigms’ in the field, all of which lead to quite different definitions of mental health and goals for mental health promotion. So we need to recognise that mental health is socially constructed and socially defined: different professions, communities, societies and cultures have very different ways of conceptualising its nature and causes, determining what is mentally healthy, deciding what interventions are appropriate, and so on. We need not conclude from this, however, that mental health is so socially contextualised that it is impossible to define or explore, and that one paradigm is as good as any other: to do so is to collapse into an unhelpful state of relativism. It is also to misunderstand the theory of the populariser of the concept of paradigms, Kuhn (1962), who suggested that new paradigms succeed earlier ones not just because they are held by more powerful groups, but also because they fit and work better by providing a more comprehensive and convincing account of what is known about the world. But we do need to be aware that all statements we read about mental health come from a particular perspective, even if the originator is not consciously aware of this, and be reflective and explicit ourselves about the assumptions and values behind any approach we propose.

To date most work in mental health has been dominated by the health services; in particular the medical, psychiatric and psychological professions. Without wishing to disregard the humanistic and radical perspectives that have often been taken by some who work in these fields, health service approaches, on the whole, tend to have a particular slant. They tend to focus on illness not health, to conceptualise mental health and illness as an individual rather than a social issue, and to see understanding and action on mental health as properly emanating from professionals ‘on top’ rather than from lay people ‘below’. If we wish to challenge such assumptions, we need a different framework which starts from different premises, which makes sense of the concept in a coherent, holistic, practical and ethically sound way, as well as fitting the available evidence.

A coherent and ethical framework

WHO concepts and principles

The WHO, and several academic theorists and professional practitioners, have spent the last fifteen years or so developing an ethically sound set of principles for health promotion, which makes explicit the values and assumptions on which they are based, and which provides a coherent, well-developed and evidence-based framework for thinking about what is potentially an overwhelmingly complex and highly contentious area. Through the work of the WHO, and others at the forefront of the field, health promotion has been able to bring the different issues and perspectives of a wide range of other disciplines together in a highly effective and practical way (Bunton and Macdonald 1992). This book will apply these key concepts and principles to the promotion of mental, emotional and social health in schools. The desirability of this approach is justifiable not on ethical and ideological grounds alone: it stands up to empirical testing too, as we shall see in the course of the book.

Applying a health promoting framework to mental, emotional and social health in schools will be largely unexplored territory, although there are many partial maps to guide us. Health promotion as a framework is only just starting to be applied to mental heath promotion (Tudor 1996; Macdonald and O'Hara, 1998; HEA, 1997; Secker, 1998), and has not yet been systematically applied to mental health in schools. Until very recently, work in mental health has been fairly isolated from developments in the wider field of health promotion. There has generally been a singular lack of communication between health promotion and the theory and practice of mental health, the origins of which operate in both directions. It has been caused partly, as we have said, by the individualistic perspective on mental health taken by the health professions, and also by a lack of identification by those working in schools with the medicalised and rather frightening term ‘mental health’. But those working in health promotion have contributed to the rift by tending to use obscure jargon, and, in their concern to promote the wider vision, not always taking into account the needs and constraints of the professions with which they deal or linking with the frameworks and terminologies the professions use. Much seminal work in health promotion is published in official documents and specialist academic textbooks that are hard for practical professionals to access. Even parts of the WHO itself have not made the links, and the global Division of Mental Health appears somewhat to restrict itself to its vision of mental health promotion in schools to the teaching of psycho-social skills (Bosma and Hosman 1991; Lee 1994) without reference to the wider concepts of health promotion used by the health promoting school that is being developed in other parts of the WHO.

So, in exploring what we mean by mental, emotional and social health and their promotion in schools we will attempt to show how the sometimes abstract concepts that inspire heath promotion can be brought alive and applied in the context of schools, and to link the terminology and concepts of health promotion with the language and issues of education.

Using ‘the health promoting school’ as a framework

Just as the WHO concept of health promotion is considered by those at the forefront of the discipline to be the most useful one for understanding mental health in general, so health promotion and, in particular, the ‘health promoting schools’ idea is considered by many of those who have devoted much effort to considering the issue to be the most useful framework for exploring health promotion in schools. Health promotion and the health promoting schools idea have been applied as a core perspective to a range of issues in schools right across the world and its breadth has proved to be supportive of and compatible with other frameworks (Elias et al. 1996) and adaptable to a wide range of cultures (Rowling 1996; WHO 1998a). Given that mental, emotional and social health are also generally considered to be at the heart of school health promotion, it was surely only a matter of time before an effort was made to apply a health promoting school framework to them. The need for a holistic framework to make sense of this field has already been recognised, and other frameworks such as ‘emotional literacy’, ‘conflict resolution’, ‘problem solving’, ‘social competence’ and ‘community building’ have all been used with some success, and this book will most certainly make use of the considerable body of work they have inspired. But none of these frameworks is as comprehensive, as adaptable and as ethically sound as the health promoting school idea. So, while recognising that the health promoting school concept is by no means the only framework that has been used to provide coherence in this field, we suggest that it has more to offer than any other, and we therefore use it as an overall perspective within which the contribution of other disciplines, perspectives and frameworks will be located.

The European Network of Health Promoting Schools

Regional networks of health promoting schools can now be found throughout the world (WHO 1998a) especially in the western Pacific region, Australia and North America (St Leger 1999). Perhaps the most conceptually sound and best-evaluated manifestation of the idea, and one that has given it a notable level of official support, is the European Network of Health Promoting Schools (ENHPS).

The ENHPS is funded by the European Union and the Council of Europe, and managed by the WHO, who have provided a core team to lead it and whose philosophy and principles, derived originally from the Ottawa Charter, officially underpin it (WHO et al. 1993; McDonald and Ziglio 1994). Some forty European countries, in eastern and central as well as western Europe, including (separately) England, Wales, Scotland and Northern Ireland, have joined the ENHPS since 1992 in a series of staggered starts. Over 500 schools are now directly involved in the network, with a further 2,000 able to participate through specific national arrangements. The Network has been heavily supported by international development meetings, by research and by education for coordinators and teachers from schools, including a teacher education project on mental and emotional health (Weare and Gray 1994). The Network has been subjected to systematic evaluation across Europe (Piette 1995; Parsons et al. 1997) and within countries (HEA and NFER 1997a), the results of which are now being published. This book will therefore be one of the first easily available commercially published texts to be able to include examples of work in promoting mental, emotional and social health that has resulted from work within the ENHPS—examples that can start to provide a balance to the vast amount of work on social and affective education that has come from the US.

The first conference of the ENHPS at Thessaloniki in Greece in 1997 (WHO 1997a) brought almost all of the coordinators of the Network together. It summarised the key values and principles that underlie the health promoting school concept, namely positive health, empowerment, democracy, equity and partnerships with communities, and emphasised the importance of the school environment, the community context, the curriculum, teacher education and evaluation—all issues that this book will explore.

There has inevitably been something of a rift between theory and practice, even in committed ENHPS schools (Nutbeam 1992). In the UK, in particular, some ENHPS schools have reported that they find the holistic ideal to be out of touch with their everyday realities and constraints, and some schools have proved to be uncomfortable with some of the more radical principles such as democracy (HEA 1995a). It may be that other countries have had similar difficulties, and not had the opportunity to report them, but on the whole the ENHPS would appear to have been a greater success in other parts of Europe than the UK. So if we are to retain the term ‘health promoting school’ and its central concepts and principles, and link them with other educational and social initiatives, it is imperative that the health promoting school idea should be made clearly relevant to the everyday context of schools in the UK and elsewhere.

With the need to make the discussion relevant and appropriate to schools very much in mind, the next sections make some attempt to define mental, emotional and social health within a health promoting framework.

Defining mental, emotional and social health within a health promotion framework

Mental, emotional and social health can be positive

Work that describes itself as being about ‘mental health’, especially in the context of the health service, usually turns out on examination to be concerned solely with mental illness, while work described as ‘mental health promotion’ very often turns out to be restricted to the prevention of mental illness. Similarly, work that describes itself as health promotion in schools sometimes focuses only on the prevention of problems of individual pupils, such as depression, drug abuse, anti-social behaviour and unwanted pregnancy. In so far as schools have taken a whole school perspective on mental, emotional and social health, they sometimes tend to focus on the prevention of problems, such as violence, bullying and conflict.

It is however possible to have models of mental health that are more than euphemisms for its alternative, and models of emotional and social health that promote wellness in individuals and positive practices and relationships in organisations. Given its well-known definition of health as ‘a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity’ (WHO 1946), which has stood for over half a century now, the WHO has always preferred to take an approach that starts from a positive basis, sometimes called the ‘salutogenic’ or wellness model (Antonovsky 1987). For example, the Ottawa Charter suggested that health is ‘a positive concept, emphasising social and personal resources, as well as physical capabilities’ (WHO 1986).

If we apply a positive, salutogenic perspective to mental, emotional and social health, we shift the focus from mental illness and emotional and social pro...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Contents
• Acknowledgements
• Introduction
• 1 Definitions, concepts and principles
• 2 Creating a supportive whole school environment
• 3 Developing self-esteem and emotional competency
• 4 Developing social competency
• 5 Classroom and curriculum issues
• Appendix: Some agencies concerned with mental, emotional and social health in schools
• References
• Index