School nurses could play an even greater role in supporting primary-school-aged children’s mental health, University of Stirling research has found.
However, the role of the school nurse must be more clearly defined, and integrated within whole-school mental health approaches, according to the study.
Mental health problems in children and young people are a global public health issue. A World Health Organization report estimates that up to 20% of children and young people will experience a mental health problem, with half of these developing before the age of 14, however there are long waiting lists for Child and Adolescent Mental Health Services in Scotland.
The mixed-methods study, led by the University of Stirling’s Dr Alison Hackett, is the most comprehensive examination of how school nurses support primary-school-aged children’s mental health.
Comprehensive findings
It used a national survey of school nurses in Scotland alongside qualitative interviews with nurses, parents, teachers, and primary-aged children to explore perceptions of school nurses’ mental health work.
Despite recent role developments intended to maximise school nurses’ contribution to wellbeing, the study reveals that their impact is limited.
Dr Alison Hackett said: “Our findings show that school nurses’ mental health work is often reactive and lacks visibility in whole-school approaches to mental health.
“This underlines the urgent need for a clearly articulated role within whole-school mental health frameworks that recognises their contribution to early identification, support, and coordination of care.”
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Dr Alison Hackett of the University of Stirling led the study
School nurses described a lack of clarity about their responsibilities in mental health support, with their work often overshadowed by expectations related to safeguarding and child protection concerns.
Rather than proactively promoting mental wellbeing, school nurses described their work as reactive and expressed frustration and disillusionment at the constraints on their practice – particularly workload capacity and lack of resources targeted at primary-aged children. They also said there was a lack of primary prevention and early-intervention programmes.
Educators, families, and nurses alike emphasised that integrating school nursing into whole-school approaches to mental health could enhance early detection and build the resilience of children, families and their communities.
The authors argue that rising mental health needs among school-aged children call for investment, not only in staffing, but in formalising the school nurse’s mental health role within education systems, training pathways, and policy guidelines.
Dr Hackett added: “It is hoped the results will inform education leaders, health policymakers, and commissioners of school nursing services about the potential that better supported and clearly defined school nurse roles have for improving children’s mental health outcomes and educational attainment, potentially contributing to safer and healthier schools.”
Evolving understanding
The study, Understanding School Nurses’ Role in Supporting Children’s Mental Health From the Perspective of Children, Parents, Teachers, and School Nurses: A Mixed Methods Study in Scotland, was published in The Journal of School Nursing.
It was co-authored by the University of Stirling’s Dr Alison Hackett, Dr Kathleen Stoddart and Professor Greg Mannion.
Professor Greg Mannion said: “This study shows that school nursing practice must evolve as children’s mental health continues to need support. This study shows that school nurses’ work is supported and shaped by whole-school developments across curriculum, culture, and community. Evidence here shows that school nursing practice will become more relational and responsive to the distinctive setting in a given school.
“Creating welcoming school environments both indoors and out and embedding school nurses within whole-school approaches are essential to enabling more preventative, visible, and effective mental health support.”