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An Investigation of the Role of School Nurses in Supporting Mental Health and Well-being

Background

It is generally agreed that good mental health, or well-being, is not simply about the absence of mental illness, but it is about promoting positive mental health in its own right. The reframing of what is understood by mental health has given rise to an awareness that large numbers of children and young people experience mental health difficulties.

Policy responses call for all professionals who work with young people to take responsibility for the mental health of those in their charge. The role of the school nurse is important in this context. As health professionals in an educational setting, they occupy a unique place in the spectrum of children's services.

At the time of writing the school nursing service is undergoing reorganisation as a result of some key changes in policy within the NHS Scotland. The review of the contribution of nurses, midwives and health visitors, Nursing for Health has recommended that, to serve the needs of young people, teams of public health nurses should be developed, which would incorporate the roles of both school nurses and health visitors ( NHS Scotland 2001).

The study reported here explored how school nurse managers across Scotland view their role in promoting and supporting the mental health of young people and identifies those functions which they believe should be maintained beyond the reorganisation of the service.

Aims and objectives

Aim: To investigate the different roles of nurses in supporting and promoting mental health and well-being of children and young people in schools.

Objectives:

• To conduct a scoping study of mental health related activities of nurses in schools in Scotland
• To identify innovative approaches to mental health promotion and support taken by nurses in school
• To highlight perceived advantages for schools of using nurses as a support for interventions designed to support mental health of pupils
• To identify the challenges and tensions for nurses in adopting a mental health promoting/supporting role in schools.

Methods

This study took the form of telephone interviews of 25 school nurse managers/co-ordinators across Scotland. Thirteen of Scotland's 14 health boards were involved. Interviews were semi-structured.

Key findings

This report demonstrates that school nurses believe that they play an important role in supporting the mental health of children and young people through mental health promotion, prevention and support. Interviewees felt very strongly that school nurses offered a service to children and young people that was distinct from other services.

Key features were characterised as; developing a relationship with children and young people over a sustained period of time, being accessible, offering non-judgemental support, being comfortable with discussions of 'sensitive' topics, being able to give guarantees of confidentiality (with exceptions around issues of Child Protection), and bringing a 'holistic' perspective to dealing with young people's issues.

Issues of mental health and well-being underpin much of the work of school nurses, both explicitly and implicitly. School nurses undertook a variety of tasks including input to the PSE curriculum, targeted group work with vulnerable pupils, one-to-one support, self referral drop-in centres and making appropriate referrals.

However, it was widely acknowledged that the school nurse service was overstretched and underfunded in many areas, and lacked the capacity to offer as comprehensive a support to mental health as some would have liked. School nurses were thought to be better able to support the mental health of children and young people if they themselves are supported by effective links to other mental health services, such as CAMHS. Access to high quality training on mental health was variable across the country. This led many health boards to highlight a need for further training for school nurses.

Discussion: Implications of reorganisation of community public health nursing

School nurses and health visitors are to be amalgamated into teams of public health nurses. However, this involves merging the school nurse role (which has no specialist qualification beyond basic training) with the health visitor role (which does involve a specialist training component). There are clear status issues here within the team, as is reflected in some cases by the grading system. Equally there is potential for the duties traditionally undertaken by school nurses to be seen as lower priority, or less skilled, and therefore to be sidelined to make way for other activities.

Teams of public health nurses may be managed by personnel with no knowledge of the school nursing service. As school nurses often develop their skills through experience rather than qualification, it may be difficult for someone outside of the service to fully appreciate the complexities of their role. There is a fear amongst school nurse managers that this may, again, undermine some of the school-based activities which currently take place.

Public health nurses are likely to be organised into 'corporate' teams, rather than a single nurse taking responsibility for a school cluster. This carries a number of advantages including reducing the isolation of school nurses, equity of distribution of workload, flexibility to redirect the workforce to places of greatest need, and eliminating problems of transition encountered when school nurses leave their posts. However, this will also change the type of relationship nurses can develop with school staff and young people. Rather than a single well-known face, there will be a team of faces, and without careful management this may impact negatively on the one-to-one work currently in place.

The new model will offer a nursing service to young people, which is not impeded by the boundaries that currently exist around schools. This carries some advantages over the traditional models of school nurse and health visitor. However, for some young people there is a value in being able to access a school-based service which is unconnected to their family and allows confidential support. It would be a significant loss if this was not maintained in some format, particularly in rural areas where young people have few opportunities to access confidential services.

Conclusions

As the changes in community nursing are rolled out across the country, it is important to ensure that the best of the existing system is maintained and transferred to the modern context. This report offers some insights into the valuable work which school nurses believe they undertake in the field of mental health, and highlights some activities that would merit conservation through the period of change.

Further details from:

Jenny Spratt
The Rowan Group

Email address: j.spratt@abdn.ac.uk

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