What are Mental Health Support Teams?
In 2017, the Government published a Green Paper on transforming children and young people’s mental health provision. This resulted in three core proposals: (1) Mental Health Support Teams (MHSTs) working in and around education settings to be established; (2) A Senior Lead for mental health to be identified and trained in every school or college; and, (3) Piloting of initiatives to reduce waiting times for access to specialist National Health Service (NHS) mental health services for children and young people to four weeks.
MHSTs are new teams designed to work in and around education settings. They are staffed by Educational Mental Health Practitioners as new entry level clinical roles supported by senior clinicians as they go through training. MHSTs are jointly funded by the Department for Education (DfE) and NHS England. The core functions of MHSTs are to (1) Deliver evidence-based interventions for young people with mild to moderate mental health issues; (2) Support the Senior Mental Health Lead in a given school or college to implement a whole school/college approach to mental health and wellbeing; and, (3) Provide timely advice to school/college staff, and liaise with external specialist services (e.g. NHS mental health services) to help young people get the right support and stay in education.
MHSTs were commissioned and rolled out in stages across England, beginning in 2018/19 with the Trailblazer Programme. By 2022, nearly 300 MHSTs were up and running, supporting nearly 5,000 schools and colleges and covering more than a quarter of children and young people in educational settings. It is estimated that up to 500 MHSTs will be operational by 2024. Further information can be found on the NHS MHST website.
In Greater Manchester (GM), two MHST pilot projects were mobilised in 2019, one voluntary and community sector (VCSE) led and one NHS led, reaching a small number of primary and secondary education settings. Learning from these pilot projects, the GM blended model of MHSTs (NHS led with embedded VCSE capacity) began mobilising during the pandemic in 2020. The first GM blended MHSTs went live in 4 GM localities from October 2020 to January 2021, with staff from the pilot projects transitioning into these teams. Each MHST met with Education leads in a given locality to review the needs of their education settings and which to support in the first year. Work with the remaining 6 GM localities progressed incrementally over the next two years, with the last 3 GM localities going live by January 2023.
What did we do?
While there has been some evaluation of MHSTs to date (e.g. the University of Birmingham’s analysis of the Trailblazer Programme, and the University of Sussex’s best practice review of the whole school approach within MHSTs), these have been primarily focused on early implementation progress, the factors affecting this, and perceptions of key stakeholders. To date, none have focused on the impact of MHSTs on young people’s wellbeing outcomes. A proposed Phase 2 evaluation of the implementation of the aforementioned Transforming Children and Young People’s Mental Health Provision Green Paper is anticipated to include a formal impact assessment, though it is not yet clear what this will look like (i.e., the overarching evaluation design and methods used to derive impact estimates).
Working in collaboration with the Greater Manchester Integrated Care Partnership (GMICP), we sought to investigate the impact of MHSTs through secondary analysis of the #BeeWell dataset. From the outset, it was recognised that this would be a necessarily pragmatic evaluation, as the #BeeWell survey was not specifically designed to investigate the impact of MHSTs. Our first step was to identify which #BeeWell schools had been working with MHSTs, using information provided by GMICP. We then identified a comparison group of non-MHST schools with similar characteristics (e.g. size, % of young people eligible for free school meals, ethnic composition) using the algorithm from our data dashboard that enables schools to compare their wellbeing data to ‘statistical neighbours’. We agreed to focus on the most recent #BeeWell data (2022) for Year 10 pupils specifically, since they had been attending their schools throughout the MHST implementation period. This resulted in a sample of 10,106 young people in 81 MHST schools, and 5,023 young people in 42 non-MHST schools across Greater Manchester.
Through discussion with GMICP, we agreed to focus on six wellbeing outcomes from the #BeeWell data that they felt could be impacted by MHSTs: internalising symptoms (also referred to as negative affect), positive affect, psychological wellbeing, self-esteem, emotion regulation, and stress and coping. Using a statistical approach called multi-level modelling, we conducted our analysis in three stages. First, we compared young people’s outcomes in MHST and non-MHST schools. Second, we extended our analysis to take account of implementation progress in a given MHST school, using information (red/amber/green ratings) provided by GMICP. This was done because we might reasonably expect better outcomes for young people in schools where implementation was more successful. Finally, we extended our analysis to take account of the year in which a given school began working with their MHST (2020-2022). This was done because we might reasonably expect better outcomes for young people in schools that had been working with MHSTs for longer. At each stage, our analysis also took account of the characteristics of both young people (e.g. gender, sexuality, ethnicity, free school meal eligibility) and schools (e.g. size, ethnic composition, and free school meal eligibility rate).
What are the limitations of what we did?
Before presenting our findings, it is important to recognise a number of limitations imposed by the fact that this was a pragmatic secondary analysis of existing data (as opposed to a prospectively designed impact evaluation). First, at the time of the 2022 #BeeWell survey, the incremental mobilisation of MHSTs was still in a relatively early stage. Work had been underway for less than 2 years in all cases, and for just over 2 terms in two GM localities.
Second, with regard to the 3 core functions of MHSTs:
What did we find?
In the first stage of our analysis, we found no overall difference between young people in MHST and non-MHST schools for any of the six wellbeing outcomes noted above. In the second stage, we found no evidence of an implementation moderator effect. That is, we found no difference in young people’s outcomes across schools rated as good, average, or poor in terms of their implementation progress, when compared to non-MHST schools. Finally, in the third stage, we found no evidence of a duration moderator effect. That is, we found no difference in young people’s outcomes across schools who began working with their MHST from 2020 to 2022, when compared to non-MHST schools. In sum, our analyses of the #BeeWell data found no evidence of any impact of MHSTs on young people’s wellbeing outcomes.
What does this mean?
Our evaluation benefitted from a large sample of schools and young people, and use of robust statistical techniques through which we were able to consider implementation progress and duration, in addition to key socio-demographic characteristics, in assessing the impact of MHSTs on young people’s wellbeing outcomes. It might be tempting to conclude, therefore, that MHSTs have been ineffective, but we must be cautious for several reasons, as noted above. Our analysis focused on outcomes for a particular group of young people (Year 10) at a particular point-in-time (autumn 2022). We did not have outcome data prior to the point at which their school began working with MHSTs. This means that we were unable to assess changes in young people’s wellbeing. It also means that we were unable to identify which young people were most ‘at risk’ (for example, those with emergent mental health problems) when their school began working with an MHST. This is important because it is a reasonable assumption, given the functions of MHSTs noted above, that we might only see measurable impact on wellbeing for those young people who are most in need.
A further issue is that the comparison group of schools will all also have been implementing a range of approaches to support mental health and wellbeing. It may simply be the case that MHSTs, when assessed ‘in isolation’, do not impact young people’s wellbeing. Rather, it may be better to view them as one contributory part of a complex and evolving ecosystem of wellbeing provision in schools. It should also be noted that the MHST school selection process was by no means random; rather, it was specifically designed to identify those with the highest levels of need. The lack of difference in outcomes noted above may therefore reflect the fact that working with MHSTs has enabled the schools to ‘catch up’ to those with lower levels of need, though of course we cannot be certain of this due to the lack of pre-MHST outcome data. Finally, it is impossible to ignore the influence of the Covid-19 pandemic, which will undoubtedly have impacted the implementation of MHSTs.
Collectively, our analyses do indicate that further work is required to rigorously determine what (if any) impact MHSTs are having on young people’s wellbeing outcomes. To address this, alongside the proposed national Phase 2 evaluation of MHSTs that will consider their longer-term impact, a system-wide review of the GM blended model of MHSTs is being planned. This review will consider performance and quality in delivery as well as identify strengths and areas for development.