Intervention that helps students normalise everyday emotions the ‘most promising’ trialled in landmark mental health study

An intervention that helps students normalise everyday emotions is the ‘most promising’ out of several approaches for supporting mental health in schools, according to results from one of the world’s largest school-based mental health trials.

Led by the Evidence Based Practice Unit, a collaboration between Anna Freud and University College London (UCL), and funded by the Department for Education (DfE), Education for Wellbeing ran from 2018 to 2024 and involved 32,655 students in 513 schools across England.¹ The trial investigated five universal school-based interventions aimed at boosting mental health awareness and promoting mental health and wellbeing.

According to the results, three of the interventions – when implemented consistently and frequently – show promise for use in schools. However, experts stress that they should be considered as part of a ‘whole-school approach’ to mental health and wellbeing to achieve maximum benefits.

Since the study launched in 2018, the number of children and young people in contact with mental health services has more than doubled in England, underscoring the need for evidence-based interventions to tackle mental health challenges at an early stage.^2,3

The three interventions that showed signs of promise were Strategies for Safety and Wellbeing, Mindfulness-Based Exercises and Relaxation Techniques, which were trialled in primary (Years 4 and 5) and secondary schools (Years 7 and 8). The effectiveness of the interventions using mindfulness and relaxation techniques often depended on the age and background of the students involved. The results revealed:

Strategies for Safety and Wellbeing (SSW), a mental health awareness intervention, led to the most positive outcomes. The approach helps students normalise everyday emotions, like stress and sadness, better understand how to differentiate them from mental ill health and know where to access support if needed. In primary schools, SSW significantly improved mental health literacy – specifically intention to seek help if mental health problems arise in the future - and, when implemented in full, a significant rise in mental health literacy was seen in secondary schools.⁴

Through Relaxation Techniques, teachers were trained to deliver daily five-minute relaxation-based sessions. In primary schools, the intervention significantly reduced emotional difficulties when delivered frequently and consistently, and the intervention particularly benefitted children from minoritised ethnic groups compared with those from white groups.^5,6 However, in secondary school settings there was evidence that emotional difficulties increased significantly with the frequency of implementation.⁷

Mindfulness-Based Exercises, which involved training teachers to deliver daily five-minute mindfulness sessions in class, significantly reduced emotional difficulties when delivered frequently in secondary schools.⁸ However, in primary schools there was evidence that increasing levels of implementation significantly increased emotional difficulties^.9. The study also suggests the intervention can increase problems for specific groups of children in primary schools, including those with special educational needs and prior emotional difficulties.

Strategies for Safety and Wellbeing was developed for the trial by Anna Freud - a mental health charity that has been supporting children and young people for over 70 years - with sector experts, school staff and young people using DfE specifications. Following these results Anna Freud is rolling out training to support school staff across the UK in delivering the intervention in both primary and secondary schools.

The main analyses for Education for Wellbeing were carried out by an independent researcher from the University of Dundee, who was blinded to the trial intervention conditions. Other organisations involved in the research included the University of Manchester, the Care Policy Evaluation Centre at the London School of Economics and Political Science, and the University of Bath.

Chief Investigator Professor Jess Deighton, Director of Applied Research and Evaluation at Anna Freud, Director of the Evidence Based Practice Unit and Professor in Child Mental Health and Wellbeing at the UCL Division of Psychology and Language Sciences, said:

“Schools have a critical role to play in the wellbeing of children and young people and, with the right tools, can even help to prevent mental health challenges. However, there has been a real lack of clarity over which school-based mental health interventions work best. With results from this landmark study, staff now have much-needed guidance to support them in building the mental health and wellbeing of students.

“A key takeaway is for schools to pick evidence-based mental health approaches and monitor their impact. We found that some of the interventions trialled are only effective when delivered in full or for certain groups, but can cause unintended consequences for some. The most promising intervention – Strategies for Safety and Wellbeing – is designed to help children and young people before potential problems escalate into mental ill health by normalising everyday emotions and showing where to find support if needed. This taps into what schools are already doing, but provides structured and comprehensive guidance to support staff in delivering these messages.

“It’s important to remember the impact of these interventions alone is small, and should be part of a wider, whole-school approach to mental health and wellbeing, a priority for Anna Freud. This involves building supportive relationships and a sense of belonging across the whole school community, as well as ensuring more targeted support for those that need it. As this was the first time these interventions were trialled in England, more research is needed to help us understand potential negative consequences and how these can be negated.”

Two mental health awareness interventions developed outside the UK were also trialled in secondary schools (Year 9): Youth Aware of Mental Health (YAM) and High School Curriculum Guide (The Guide).¹⁰ Findings indicated some improvements in mental health outcomes for both interventions in the short term, including improved mental health literacy for the Guide and reduced emotional difficulties for schools that implemented YAM. However, in the longer term, both approaches were associated with a small increase in emotional difficulties.¹¹

As YAM and the Guide were initially developed and tested for school systems outside of England, researchers say that despite adaptations, this affected the ability of some schools to fully implement the interventions, which may have impacted the results.

Find out more

Access the full results from Education for Wellbeing. Primary and secondary school staff interested in delivering Strategies of Safety and Wellbeing can sign-up to training through Anna Freud.

Learn more about Anna Freud’s mental health and wellbeing support, resources and training for schools and colleges.

References:

¹ Results from Education for Wellbeing were calculated and converted into standardised effect size. The effect size is a standardised difference score between the intervention group and the control group. All interventions trialled were compared with usual practice. Standardised effect sizes for universal preventative interventions for school-aged children are most commonly of a magnitude between 0.10 and 0.27 for emotional difficulties. These are often described as small effect sizes but when amplified across the population still translate into meaningful change. For example, the impact of SSW in primary schools had an effect size of 0.09 on mental health literacy, which was not further improved by high implementation. In secondary schools the effect of SSW was not significant overall but improved to an effect size of 0.24 with high implementation.

² Mental health services monthly statistics, performance August 2024 | NHS Digital. (2024, October 10)

³ Mental health services monthly statistics - Final July, provisional August 2018. | NHS Digital. (2018, October 11)

⁴ Strategies for Safety and Wellbeing (SSW), Relaxation Techniques and Mindfulness-Based Exercises were investigated through the INSPIRE (Interventions in Schools for Promoting Wellbeing: Research in Education) arm of Education for Wellbeing. The impact of SSW on the mental health literacy of primary school children was significant (effect size 0.09). In secondary schools, the overall impact of SSW on mental health literacy was not significant (effect size 0.07); however, when the intervention was delivered in full it led to significant increases in mental health literacy (effect size 0.24).

⁵ The term ‘emotional difficulties’ in the study relates to low mood and depressive symptoms.

⁶ The impact of Relaxation Techniques on reducing emotional difficulties for primary school children overall was not statistically significant (effect size –0.01) but however, at higher levels of implementation (i.e., moderate compliance) the effect size was -1.52.

⁷ The overall effect size of Relaxation Techniques on reducing emotional difficulties for secondary school children was –0.10 - which is not statistically significant – but when implemented frequently and consistently both moderate and high compliance significantly increased emotional difficulties (effect sizes of 0.67 and 0.83 respectively).

⁸ In secondary schools, Mindfulness-Based Exercises had no statistically significant impact on young people’s emotional difficulties – the effect size was -0.07 overall – but moderate and high level of implementation led to increasingly significant improvements in emotional difficulties (effect sizes of -1.15 and -1.40 respectively).

⁹ The overall effect of Mindfulness-Based Exercises on emotional difficulties in primary schools was not significant (effect size 0.002) but, when delivered frequently, it led to an increase in emotional difficulties for moderate and high compliers (effect sizes of 0.32 and 0.48 respectively).

¹⁰ YAM and the Guide were investigated through the AWARE (Approaches for Wellbeing and Mental Health Literacy: Research in Education) arm of Education for Wellbeing.

¹¹ High implementation of YAM led to a decrease in emotional difficulties at 3-6 months (effect size 0.97) but there was a small but significant overall increase in emotional difficulties at 9-12 months (effect size 0.08). The Guide led to improved mental health literacy (effect size .10) and high levels of implementation led to an even greater increase in mental health literacy at 3-6 months (effect size 0.17) but also led to a small increase in emotional difficulties (effect size 0.09) for all analysed at 9-12 months.

About Anna Freud

Anna Freud is a mental health charity and we’ve been supporting children and young people for over 70 years. We listen to and learn from their diverse voices and integrate this with learnings from our science and practice to develop and deliver mental health care. This holistic approach has world-changing potential – our training, schools support, networks, partnerships and resources equip those who impact children and young people’s lives with the knowledge and skills to support their mental health.

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About the Evidence Based Practice Unit (EBPU)

Founded in 2006, the Evidence Based Practice Unit is a partnership between Anna Freud and the UCL Faculty of Brain Sciences. The unit bridges cutting-edge research and innovative practice in children’s mental health. EBPU’s vision is for all children and young people's wellbeing support to be informed by real-world evidence so that every child thrives. The unit conducts research, develops tools, provides training, evaluates interventions and disseminates evidence across four themes: risk, resilience, change and choice.

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