Title: A cluster randomised controlled trial of an intervention to improve the mental health support and training available to secondary school teachers – the WISE (Wellbeing in Secondary Education) project
Funder: Department of Health and Social Care

Abstract: Background: Secondary school teachers are at increased risk of stress, depression and anxiety compared to the general working population. Failure to support teachers adequately may lead to serious long-term mental disorders, poor performance at work (presenteeism), sickness absence and health-related exit from the profession. It also jeopardises student mental health, as distressed staff struggle to develop supportive relationships with students, and such relationships are protective against student depression. Further, teachers are rarely provided with training in supporting students with mental health problems, which in itself is a source of stress. A complex intervention that increases the support available to teachers, and provides training in supporting students may improve teacher mental health, with gains in student mental health via improved staff skills and staff-student relationships. Improved student wellbeing may lead to increased attainment, which in turn will be protective against poorer health in the future. This study builds on positive findings from an NIHR School for Public Health Research funded pilot cluster RCT, in which the intervention was found to be feasible, and intervention school students had better mental health at follow up compared to controls. The intervention: In each school, 8% of staff will be trained in Mental Health First Aid (MHFA) and will set up a peer support service for colleagues, offering confidential listening, advice and signposting to other services. A further 7-8% teachers will be trained in MHFA for Schools and Colleges, to develop their skills in supporting students. All remaining teachers will receive an hour’s mental health awareness raising session and introduction to the project. The MHFA training will be delivered by public health workers (Wales) or independent trainers (England). Control schools will follow usual practice. Research questions: i) Is the WISE intervention more effective than usual practice in improving teacher wellbeing? ii)Is the WISE intervention more effective than usual practice in reducing teacher depression, absence and presenteeism, improving student wellbeing and attainment, and reducing student psychological distress and absence? iii) Are any effects moderated according to the proportion of children receiving free school meals (FSM - an indicator of the socioeconomic catchment area) and region, or individual level baseline mental health, gender, ethnicity and FSM? iv) What is the cost of the WISE intervention, and is it justified by improvements to staff and student wellbeing? v) Is the WISE intervention feasible and acceptable, does it work according to the mechanisms of change hypothesised in the logic model, and is it sustainable? Sample: 24 non fee paying secondary schools, of varied size, socioeconomic catchment and attainment will be stratified according to free school meal eligibility and region, and randomly allocated to intervention or control group. Outcome measures: Primary: teachers’ mean score on the WEMWBS (wellbeing). Secondary: teachers' mean scores on the PHQ-8 (depression) year 8 students' mean scores on the WEMWBS and SDQ (mental health difficulties), teacher presenteeism (WPAI self-report measure), days absent among staff and all students, and student grades in GCSEs (year 11). Measures will be recorded at baseline, at one year (teacher self-report measures) and two year follow up. Process and economic evaluations will also be undertaken.

Lay abstract: Background: Health and Safety Executive figures show secondary school teachers have higher rates of stress, depression and anxiety compared to the general working population. Interviews with teachers have found that they often feel unsupported with regard to their own mental health needs. Failure to support them adequately is likely to lead to poor wellbeing, and more serious long-term mental disorders, poor performance at work (often called presenteeism), sickness absence and ill health retirement. Further, teachers are expected to develop supportive relationships with students, and studies have shown this is important for student mental health. However, staff report difficulties in fulfilling this role due to the lack of support for their own needs, and a lack of training. Therefore improving the mental health support and training available for teachers may equip them to provide better quality support for students, with long term gains for student mental health and academic attainment. The study: This study will introduce and evaluate an intervention that aims to equip teachers to support colleagues and students, assist them in coping with mental health difficulties and facilitate access to external help when required. In each school, 8% of staff will be trained in Mental Health First Aid (MHFA) and will then set up a peer support service for colleagues, offering confidential listening, advice and signposting to other services. A further 7-8% of teachers will be trained in MHFA for Schools and Colleges, to develop their knowledge and skills in supporting students. MHFA is a training course that equips people to recognise signs and symptoms of distress in others, and offer initial help and support. Twelve schools will receive this intervention, and a further twelve will form a comparison group, and will continue with usual practice. Methods: We will examine if the intervention has an effect on teacher mental health, teacher absence rates, teacher performance at work, student mental health, student absence rates, and student attainment. We will also consider if it provides good value for money. Before the intervention is delivered, we will collect questionnaire data from all teachers and students in year 8. In these questionnaires we will measure wellbeing and levels of depression/distress, numbers of teachers taking sickness absence, levels of presenteeism among teachers, and quality of teacher-student relationships. We will use routine data sources to look at student absence and attainment for the previous year. We will measure these things again after one year (staff mental health measures only) and two years after the intervention has been delivered (all measures). We will be looking to see if there are positive changes in wellbeing, attainment and relationships, and a reduction in depression, absence and staff presenteeism, and whether these changes are greater within the group of schools that received the intervention compared to the group that did not. We will also conduct interviews and focus groups with teachers, and observations of the training sessions, to explore what happened during the training, how the peer support service is being run, and in what ways participants feel the two aspects of the intervention are useful. Finally, we will calculate the cost of the intervention, and weigh this up against any benefits in terms of mental health, student attainment, and reduction in staff and student absences.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH