Scotland's Mental Health First Aid – Young People – Year 1 report

The Pilot Project

Scotland's Mental Health First Aid: Young People (SMHFA: YP) is placed within Tier 1 of Child and Adolescent Mental Health Services: http://www.scotland.gov.uk/Publications/2004/12/20383/48321

It "offers basic general information about mental health problems. The knowledge presented and understanding developed in the course helps to remove stigma and fear and to give confidence in approaching a young person in distress." (http://youngpeople.smhfa.com)

Five Local Authorities were identified as being in most need of immediate support, based on the Scottish Index Of Multiple Deprivation (SIMD) and on figures provided by NHS on the number of professionals trained in 'Scotland's Mental Health First Aid: Young People' within the Authority:

• West Dunbartonshire
• North Ayrshire
• Renfrewshire
• Clackmannanshire
• North Lanarkshire

Each Local Authority was awarded a grant of £2400 to target support and training to school communities in most need, thus improving outcomes for learners in the most deprived areas or from particular vulnerable groups. Spending was as follows:

Authority	Spending
West Dunbartonshire	Staff cover £1025 Trainer £812.40 Facilities £160
North Ayrshire	Training for teachers Training for support staff £2400
Renfrewshire	Staff cover £1296 Facilities £250 Resources £854
Clackmannanshire	3 training sessions £2400
North Lanarkshire	Training sessions completed £2400

Those undertaking the training experience a 14 hour course, split into three sections:

• Part 1: 1-2 hours online session, covering relevant policies and procedures
• Part 2: 7 hours as a modular course, delivered face to face - a skills practice intervention training day (this can be delivered in 1.5 hour sessions, 2 half days or 1 full day)
• Part 3: 2-3 hours online session, using DVD clips with a reflective log to be completed

The main objectives were as follows

• those undertaking the training (identified members of secondary school staff and partners) will develop the knowledge, skills and confidence required to approach and give initial help to children and young people experiencing mental health problems
• a greater number of pupils experiencing mental health problems will receive initial support when needed
• support for learners from the most deprived areas and from particular vulnerable groups as local authorities will be able to target support to the school communities that need it most (support will be organised in such a way as to complement existing mental health and mental wellbeing training and initiatives within the local authority)

Implementation and Impact

The Local Authorities were asked to provide a summary of the implementation and a brief evaluation of the initial impact of project:

Authority	Implementation	Initial Impact
West Dunbartonshire	14 members of staff who either work in schools full time or support schools attended training course More staff trained who work in our 5 schools + 1 ASL school All of our secondary schools have young people from deprived areas - staff who were trained work in all these schools All schools reported that mental health was high on their agenda and needed support in this area. As we only have 5 secondary schools + 1 ASL school we were able to offer training to all of our schools	Staff – staff now trained and have new confidence in working with pupils on mental health issues Young people – young people now have trained staff who they can talk to Education Department – more staff trained on the topics they need more support in
North Ayrshire	The training was delivered to 12 key staff who identified themselves as being in need of training in this area Learners in deprived areas and vulnerable groups – we have some areas of extreme poverty and deprivation as evidenced through SIMD data. We targeted some of these schools Evaluation information will be gathered to evidence the impact on outcomes for learners in areas of deprivation	We are working hard in North Ayrshire through our work with external agencies and using in-house expertise to support young people facing mental health issues. This training has most certainly contributed to our programmes (including mindfulness work and suicide prevention) Practitioners – much better equipped to tackle sensitive issues around mental health with young people at an early stage. Their confidence was raised. This can be seen in their direct feedback from evaluations undertaken by the authority Young people – The results from the training will be monitored and evidence sought over time – seen in evaluation statements from the young people
Renfrewshire	Used the funding to train two members of staff who work with vulnerable young people in secondary to be trainers. Pupil support staff offered the opportunity to be trained and 6 Principal Teachers trained Used the funding to train staff who work with the most vulnerable groups, including a Home Link Worker who works with Looked After And Accommodated Children and a teacher who leads a team of staff who work with children with SEBN	Evaluations have been completed by staff who took part in the training Staff – trained from 5 different schools and a general increased awareness of the need to be trained in this area Young people in 5 secondary schools – they now have access to a Mental Health First Aider SMHFA will now be part of the CPD calendar for secondary teachers
Clackmannanshire	School staff who work in areas of SIMD were targeted in Clackmannanshire – the list of participants was mapped against SIMD data	School staff – increased awareness of impact of mental wellbeing and increased confidence in supporting young people, as seen in their evaluations Staff aware of the importance of early and effective intervention and are aware of locally based services and agencies seen in participants' evaluations Partners at CAMHS and NHS Health Promotion – identified a need to offer more specialised input Other partners who attended training (including Social Work, Housing etc) – greater understanding of how services can support a young person's mental wellbeing both within and beyond school
North Lanarkshire	NLC is committed to training staff to be able to deliver high quality Mental health First Aid to all our young people. This grant has provided an additional opportunity to train a number of secondary promoted staff Crucially, a member of the Continuous Improvement Service (CIS) has been trained as a trainer	All taking part gave feedback and evaluation Staff involved feel they have the skills necessary to provide SMHFA to young people in their establishments - thus building capacity in schools and across the area, thus the young people have been better supported with any mental health issues CIS member of staff will take responsibility for rolling programmes out to Pupil Support and other key staff across our 23 secondary schools In addition, one of the recipients from the training course supported by this grant is now on secondment with CIS as an Education Support Officer

A number of individual participants gave feedback in May 2015 through Survey Monkey, covering

three of the Local Authorities.

The general feedback on the training is very positive. Comments include:

• Informative
• Interesting
• Worthwhile
• Enjoyed the course
• An excellent course full of practical work
• Beneficial to my client group and my job role
• Think it is worthwhile for teachers who have no previous background in Pupil Support

Before taking part in the training there was a clear need to support participants in developing the skills to approach young people with a mental health problem and to develop confidence in what to say and ask:

• 82% of participants agreed or strongly agreed that they had very good knowledge and understanding of mental health/wellbeing of young people
• 82% of participants agreed or strongly agreed that they felt confident at identifying when a young person is struggling with a mental health problem
• 73% of participants agreed or strongly agreed that they felt confident to approach a young person in this situation
• 64% of participants agreed or strongly agreed that they felt confident about what to say or how to ask questions to give the young person initial support

After taking part in the training there was a rise in the number of participants who felt confident in approaching young people and felt confident in what to say and what questions to ask:

• 82% of participants agreed or strongly agreed that they had very good knowledge and understanding of mental health/wellbeing of young people
• 82% of participants agreed or strongly agreed that they felt confident at identifying when a young person is struggling with a mental health problem
• 82% of participants agreed or strongly agreed that they felt confident to approach a young person in this situation
• 82% of participants agreed or strongly agreed that they felt confident about what to say or how to ask questions to give the young person initial support

With regard to Curriculum for Excellence:

• 91% of participants agreed or strongly agreed that the training met their perceived responsibility to ensure that young people will receive suitable and appropriate support for good mental health now and in the future.

With regard to Getting It Right For Every Child (GIRFEC):

• 82% of participants are more aware of how their role can support a young person who is experiencing a mental health problem
• 82% have shared their knowledge and understanding of mental health/wellbeing of young people with another member of staff

At the time of completing the survey (May 2015, around two months after the training):

• 27% of participants had approached a young person who they thought may have a mental health problem
• 36% of participants had used their new skills to provide initial support to a young person in this situation
• 36% of participants had used the confidence and skills they had acquired to support a member of staff

When self-assessing the impact this training has had on participants' practice with young people, comments included:

• I am now more aware of my response to young people experiencing mental health issues and how to address these in a sensitive and professional manner
• It made me more aware of the approach that I am taking with my clients is a positive one and also gave me the confidence to ask the question that I probably would not have asked previously relating to suicide
• Has given me confidence in terminology when working with a young person with issues and a framework to work to
• An increase in confidence is the main benefit so far
• Gave excellent advice and sound knowledge of an area I knew very little about
• Has given my assurance that what I already know was correct

This feedback is very positive. It is clear the Local Authorities have identified mental health and wellbeing as an issue for young people and thus an area of development for staff. All the authorities have used the funding to complete the training for targeted staff in areas of need. Staff evaluations appear to be positive with a growth in knowledge, understanding and confidence. The objective of the project to support staff training, especially in areas of deprivation has been met in all five Local Authorities.

These findings are also reflected in Mechele Wimble's (NHS Health Scotland) Dissertation. Her summary of the impact is as follows:

It would seem from figure one and two that the programme matched participants' expectations and they fulfilled the required outcome of increasing people's understanding of both policies. Question 1 reveals that at least half those who completed the questionnaire have already put the skills learnt into practice to support a young person with mental health problems. Question 2 demonstrates participants' awareness of their responsibility to support a young person to have good mental health within CfE.

Reflective Accounts

Using a thematic analysis the table below identifies the main themes which were explicitly mentioned from the reflective accounts. There were two deliveries of the course to two areas, each course had twelve participants.

Figure 3 Themes from Reflective Accounts

Themes	Group 1 Nth Ayrshire	Group 2 Nth Ayrshire	Group 1 Nth Lanarkshire	Group 2 Nth Lanarkshire
Delivery methods used	1	3	4	2
Relevance of materials/tools	4	5	5	3
Increase in awareness	4	5	5	5
Increase in confidence	5	4	4	5
Have used the skills since attending	2	3	2	5
Would recommend to others	2	4	2	3

Generic findings and discussion

SMHFA:YP contributes to skilling up secondary school staff by increasing their knowledge which influences their attitude and changes their behaviour in responding to a young person with mental health problems. It would seem that the delivery is in line with the adult learning style of reflecting and discussing; this is quite evident from both the reflective accounts and the focus groups and backed by the following quote on the delivery; "During the interactive face to face module I appreciated getting direct feedback from the trainers and support from the group" (North Ayrshire)

From all three methods of collecting data one thing which stood out was the increase in awareness of mental health and in particular roles within GIRFEC and CfE below is a number of quotes from each area highlight the immediate increase in knowledge; "Completing the SMHFA: YP course I have greater awareness of the wellbeing needs of students and risk factors" (North Ayrshire) "As a classroom teacher I feel more confident to help and offer appropriate advice" (North Ayrshire) "I feel my practice has improved already, not a day goes by when I don't apply the skills learnt" (North Ayrshire) "I now feel prepared and confident".

Next Steps

Local Authorities were also asked to provide brief information on what next steps have been identified after being involved in this project:

Authority	Plans
West Dunbartonshire	It is hoped that some of the participants go on and take part in the training for trainers course to make the SMHFA:YP more sustainable locally
North Ayrshire	We have more trained Psychologists working towards extended delivery of the programmes in North Ayrshire. The programmes do not only target teachers but also support staff The main barrier to progressing the programme is the cost of cover for teachers which this grant helped to address for this cohort
Renfrewshire	The two staff trained in SMHFA:YP plan to deliver the course next session to increase the number of trained staff in secondary schools and to ensure each secondary has a minimum of one member of staff trained in this approach Each school will then have access to the handbook and reading materials which will also increase the awareness and understanding of mental health issues faced by young people When every school has at least one member of staff trained the course will be opened up to other staff The trainers have also linked with a Community Education trainer to offer joint training to reach staff beyond teachers who also work with young people
Clackmannanshire	Feedback from staff indicated a need to provide more in-depth professional learning opportunities split into development stages Partners at Health Promotion Forth Valley are currently planning to develop a further 2 training modules – one for Primary and one for Secondary to focus on highlighted need. These are being piloted with schools in Clackmannanshire from August 2015
North Lanarkshire	Already planning with our partners in NHS Lanarkshire how we can repeat training sessions, utilising a joint approach and our own trained staff to build capacity