Potential harm of universal, school-based mental health interventions
New paper in Nature Mental Health raises series concern that universally applying such measures as cognitive behavioural therapy (CBT) can be harmful to children.
A fundamental principle guiding those working in health is to ‘First, do no harm.’ That makes the new paper published in the journal Nature Mental Health a rather sobering read. The authors outline growing evidence that schools which apply interventions universally to all students can do them considerable harm.
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Schools obviously want to support their students in matters of mental health – so should heed the paper’s warnings and recommendations.
In any context, what may seem quite innocuous interventions in someone’s mental health can have harmful effects. But, say the authors of this paper, these effects are potentially much more harmful in schools. There is also currently no guidance for researchers designing and running such interventions about such potential harms.
Why is there this potential for harm? For one thing, children and young people have little say or choice in the intervention when it is administered universally by their school. That, of course, contradicts a key ethical principle but can mean the person is less likely to engage. What’s more, the paper uses simulated data to demonstrate that, even where trials show small negative effects, when interventions are scaled up across the school population it can produce much more pronounced adverse effects.
The authors also caution that students can feel that they, ‘have wasted their time doing something ineffective when they could have spent that time doing something more enjoyable or more productive for their education or mental health.’
Given all this, the paper makes five recommendations to those involved in such initiatives:
1) Acknowledge the possibility of potential harms
2) Identify types of potential harms
3) Measure and report potential harms in all outputs
4) Consider adverse events (for example, a suicide attempt)
5) Consider participant drop-out and disengagement.
The authors conclude that, ‘Furthering research in this area will help ensure the field delivers interventions that are most effective and least harmful for everyone.’
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