Mental Wellbeing in Schools, and the Global Mental Health Crisis

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In this podcast, we talk to Lauren Cross, a Research Assistant with CHARM, which stands for Child and Adolescent Resilience and Mental Health at the University of Cambridge.

We hear about Lauren’s work as a research assistant with CHARM, plus her research on mental health and wellbeing in schools and inequalities during childhood and adolescence.

Lauren also discusses her co-authored CAMH debate paper, ‘Is there a true global children and young people’s mental health crisis, fact or fiction?’ (doi.org/10.1111/camh.12483), including her concerns regarding particular groups being missed from research, and elaborates more about the lack of data on the impact of COVID and young people’s wellbeing.

Furthermore, Lauren talks about the fact that COVID-19 has magnified health, educational and social inequalities and what policymakers, and mental health professionals who work with young people, can take from the paper.

Lauren Cross
Lauren Cross

I am an aspiring epidemiologist with a specific research interest in mental health in schools in the UK. Prior to becoming a research assistant I worked as a qualified teacher of Psychology in London and the East of England. This experience fostered an enduring interest and commitment to understanding the links between education and mental health, and how we can translate this knowledge to inform best practice. (Bio from University of Cambridge)

Transcript

[00:00:27.717] – Jo Carlowe: Hello and welcome to the In-Conversation Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today I’m interviewing Lauren Cross, a Research Assistant with CHARM, which stands for Child and Adolescent Resilience and Mental Health at the University of Cambridge. In this podcast we’ll focus on some of Lauren’s research interests around mental health and wellbeing in schools and inequalities during childhood and adolescence. Lauren has also co-authored the debate paper, ‘Is There a True Global Children and Young People’s Mental Health Crisis Fact or Fiction?’ recently published in CAMH which we’ll also look at in today’s conversation.

[00:01:11.317] If you’re a fan of our In-Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Lauren, welcome. Thanks for joining me. Can you start with a brief introduction about yourself?

[00:01:27.114] – Lauren Cross: Yeah, of course. So I actually come from a background in education. Starting out my career as a secondary school teacher and eventually working as a Head of Department. However, following a Master’s degree, I made a conscious pivot back into the world of research and from that point specifically began exploring my interest in school based mental health, first taking a role as a research at the IoPPN King’s College, London before taking up my job here at Cambridge in the Department of Psychiatry.

[00:02:03.265] – Jo Carlowe: Your background probably partially answers my next question which is what prompted your interest in child and adolescent mental health?

[00:02:11.606] – Lauren Cross: I think I have always had a fundamental fascination with what it is to be human. If that’s not kind of too grand a statement. So kind of how we think, feel, express and operate, but what led me to take… and that’s kind of what led me to initially explore psychology as an undergraduate, but as kind of implicit in the introduction. It wasn’t until I was a teacher of psychology that I really became interested in child and adolescent mental health, and I think that was just through an increasing awareness of my student’s mental health associated inequalities and just how much of a barrier to learning and life that can be.

[00:02:55.227] – Jo Carlowe: As mentioned in the intro you’re a research assistant with CHARM. Can you tell us a little about CHARM and your research focus within this group?

[00:03:03.866] – Lauren Cross: The Child and Adolescent Resilience and Mental Health, or CHARM Research Group is based within the Department of Psychiatry at the University of Cambridge. It’s expertly led by Professor Tamsin Ford, with the ultimate aim of conducting research to optimise the mental health of children and young people, and there’s so much exciting and quality research coming out of that group, particularly within the field of school-based mental health. So it’s a really exciting space to be. In terms of my specific research focus within the group I am part of a UKRI funded project called Reshape, which is all about reflecting on the impacts of COVID-19 on children and young people in England.

[00:03:50.326] And this project is also led by Professor Tamsin Ford and in particular we are doing work with colleagues in both Exeter and King’s College London to explore experiences of lockdown, service access, and education following restrictions and the pandemic.

[00:04:08.826] – Jo Carlowe: Is there anything more you can tell us about your research on mental health and wellbeing in schools, anything in particular that you’d like to highlight?

[00:04:16.795] – Lauren Cross: I think the main piece of work which I’m most proud of or have found most rewarding was MRC Pathfinder Funded Co-design Project. So within this work we were tasked with creating a mobile application which could be used within a school setting to provide a temperature check of students’ mental health and then to kind of feed that back into the school ecosystem, and that was just an amazing kind of collaborative experience which I think is really important. That when it comes to research we should be working with schools and we should be working with children and young people to help co-create and co-design a space and make sure that the research that we are collecting is really representative but also is going to work in practice.

[00:05:07.812] – Jo Carlowe: It sounds great. How did it work from the user perspective, the app itself?

[00:05:12.518] – Lauren Cross: In terms of literally the content of the app?

[00:05:16.458] – Jo Carlowe: Yeah. What did it do?

[00:05:18.091] – Lauren Cross: So there were two elements of it. The first is a survey element, and that is very similar to, kind of, traditional surveys you might do on paper or online, but it was delivered through the app, and then there was a diary and mood monitoring element. So over, for example, a two-week period students could use it to enter, kind of key events and rate how they’re feeling. There are some words which they would go through and say how relevant that was to their day and then it would all be anonymised, so Mrs or Mr X, Y and Z wouldn’t know that a specific student had entered anything in particular, but we would then produce a report and say, for year nine this is what it looks like. Then the school could go up. Okay. So year nine are feeling a bit anxious. They’ve got exams coming up. So let’s do some work to help bring down that anxiety.

[00:06:15.129] – Jo Carlowe: That sounds fantastic. Lauren, let’s turn to the debate paper now. So the paper is ‘Is there a true global children and young people’s mental health crisis, fact or fiction’ published in CAMH. In the paper you point to a lack of robust data on the impact of Covid and young people’s wellbeing. Can you elaborate? What are your concerns around data?

[00:06:37.147] – Lauren Cross: So it might sound surprising that we have that concern that when we initially looked at the evidence which was out there and particularly in the context of the UK there were two core concerns which we had about the evidence base, and I think firstly we were concerned about the lack of pre and post data. So information collected before and after the pandemic which meant making comparisons really difficult to understand where children and young people’s mental health is at now compared to before, and the second main issue which came up was issues with who we are actually including within the research samples.

[00:07:22.164] So if you’re not including everyone within the research profile then [a] there is scope for bias. So we’re not capturing the opinions and experiences of everyone within the population which means we don’t truly have a full big picture understanding of what’s going on and that’s really important, but I am pleased to say that it is slowly improving and there are some really good examples out there of quality research. So it’s not that we don’t have any evidence. So there’s some really good stuff going on, for example, with the Co-Space project. There was a study by Withnell et el. coming out of Bristol very early on and also the National Survey work. So we do have some evidence. We just need more of it.

[00:08:05.250] – Jo Carlowe: I was going to ask if there were any particular groups who were being missed from research.

[00:08:10.140] – Lauren Cross: So I think the ones which we are more concerned about are those which classically come up in conversations about minorities. So whether that is ethnic minorities or those from lower socio-economic status, those are the ones that we kind of really want to find out the experiences of.

[00:08:30.825] – Jo Carlowe: The debate paper describes lurid headlines in the British press suggesting the pandemic has unleashed a tsunami of mental health problems among children and young people. Yet we know that the mental health of children and young people was deteriorating before COVID-19. So, Lauren, how do you go about unpicking this?

[00:08:50.819] – Lauren Cross: So it’s not very easy.

[00:08:52.805] – Jo Carlowe: I’m sure.

[00:08:54.053] – Lauren Cross: It’s really difficult to disentangle those two things, and I think to a certain extent we can’t, but more quality research is really important. So we need to go back, reflect, unpick experiences but we also need to do that alongside additional follow up research to continue to see what is happening to children and young people’s mental health. So looking at it before, during, after and in the future following the pandemic that will help us go back and fill in understanding, but I also think the main thing is really understanding and meeting children and young people’s mental health where it is at and identifying where and what we need to prioritise now in terms of resources and support to help our young people both now and moving forward.

[00:09:48.556] So to a certain extent it doesn’t matter whether it is something which is already deteriorating or because of the pandemic. It’s what really matters is where are we at and what can we do to help?

[00:10:00.762] – Jo Carlowe: Lauren, interestingly, the research shows that 43% of young people reported that the first lockdown had made their lives worse. Approximately a quarter said it made their lives better. What do you make of that finding?

[00:10:16.160] – Lauren Cross: I think this statistic really nicely encapsulates one of the main points of this article. Children and young people’s experiences are different. Some environments suit different people, but also children and young people face different challenges in their life, and so the pandemic will have impacted them differently. School is a really good example of this. For some students school is a haven. So when we went into lockdown removing that lifeline was really problematic. For others unfortunately school can be a considerable source of stress, so not having to go in every day, being able to work at your own pace, avoid issues with peers, all of these things can be a boost to mental health and there’s lots of other factors going on there as well.

[00:11:07.452] So I think that is key. It’s key to understand who is struggling and when, but also to reflect on what lessons have been learned from the pandemic and how do we need to rebuild to ensure that all our children and young people have access to provision services and the same space which they can succeed from, but it’s difficult.

[00:11:31.975] – Jo Carlowe: The debate paper points to the fact that Covid-19 has magnified health, educational and social inequalities. Can you tell us more about this?

[00:11:42.119] – Lauren Cross: We have some pretty big existing divides and inequalities in society pre pandemic, but for many people this was amplified by the pandemic. For example, although many families were able to settle into a routine which bought many benefits, others did not, and among other factors, financial difficulties were a really big part of this, if you look at the evidence. So whether it was physical barriers, for example, lack of access to technology, which was problematic in terms of accessing school work or increasing isolation, or whether it was kind of financial issues which led to increase tensions in the home environment through uncertainty, falling into debt.

[00:12:33.708] All of those pressures, for some families there did appear to be the sort of downward cycle of various inequalities and almost a melting pot and an outcome of that was poorer mental health, which then of course fed back into the cycle.

[00:12:49.799] – Jo Carlowe: The debate paper asked, is there a true global children and young people’s mental health crisis, fact or fiction. Lauren, what did you conclude? Is it fact or is it fiction?

[00:13:01.956] – Lauren Cross: It is neither and it is both. So we concluded that most of the children in the UK are probably okay, but there are whole groups of people who are perhaps more vulnerable now than ever and it’s vital that we put provisions in place for them to access support.

[00:13:22.311] – Jo Carlowe: Is there a message to policymakers that you’d like to put across?

[00:13:26.140] – Lauren Cross: Yes, there is definitely a message to policymakers. I think that we need to continue to understand who these vulnerable groups are and we need to work out what is going to be most effective in order to target provision for these children and young people, and that will be essential and should be built into all recovery policies.

[00:13:56.753] – Jo Carlowe: Is there anything that mental health professionals who work with young people can take from the paper?

[00:14:02.206] – Lauren Cross: A key message for mental health professionals and indeed educational professionals as well is understanding, which they’ll probably already be aware of, the layers of vulnerability and the complexities in the cycles which are associated at times with poor mental health.

[00:14:24.730] – Jo Carlowe: Lauren, is there anything else in the debate paper that you’d like to highlight?

[00:14:28.634] – Lauren Cross: So this does relate to the clinical provision side. I think access to services during the pandemic is an important point to explore, and we do touch upon it within the article. So we highlight that service access initially dropped during the early stages of the pandemic. So that is the amount of children and young people who were presenting to child and adolescent mental health services, but then when schools reopened that rapidly increased and specifically there is some evidence to suggest that eating disorders are a particular area of concern during this time.

[00:15:10.148] So I think it’s again that message about provision being mindful of where we need to target resources in terms of supporting those vulnerable groups, and that’s particularly important given how much pressure services already are. So again, it’s that message of understanding who is the most vulnerable and where we can help best.

[00:15:33.286] – Jo Carlowe: That’s interesting, that point about eating disorders. Is that thought to be some kind of consequence of the pandemic, or was it something that was hidden and has come out as a consequence?

[00:15:45.262] – Lauren Cross: This is something that we are about to go into the field to explore. At the moment we just are aware of increases of presentation within eating disorders, but at this point we’re not sure exactly why. There are guesses which I think could be made but until we go out and do that bit of research I probably can’t answer that question.

[00:16:12.151] – Jo Carlowe: Lauren, what else is in the pipeline for you?

[00:16:15.084] – Lauren Cross: In terms of our research with reshape, we are continuing to explore the impact of the pandemic. So we’re going to continue to talk to children, young people and parents, and we should be able to share our findings from this soon, but in terms of for me personally, I feel like a next natural step of progression would be for myself to undertake further study in the form of a PhD and within I would hope to further extend my research skills and interests within the field of school-based mental health and in particular thinking about access to education. So lots of exciting things hopefully to come.

[00:16:57.641] – Jo Carlowe: Fantastic, and Lauren finally, what is your take home message for those listening to our conversation?

[00:17:04.576] – Lauren Cross: Probably to remember that although it feels like we are coming out the other end of the pandemic in many ways and normality is slowly, kind of, creeping back in to remember that everyone’s experiences whether that is child, adult, teacher, family, colleague has been different and to continue to practice and promote kindness. So even though most of people are okay, even if you are okay, someone else might not be and I think that’s really important to remember, but also I think a final take home message would be that it’s really important that we continue to study this as an experience, continue to collect quality data and understand where to go next and how we can rebuild a system for all.

[00:17:58.301] – Jo Carlowe: Brilliant. Lauren, thank you so much. For more details on Lauren Cross please visit the ACAMH website, www.acamh.org and Twitter at @acamh. ACAMH is spelt A-C-A-M-H and don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues.

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