Acceptability and identification in universal mental health and wellbeing screening in schools

This thesis explores the acceptability and impact that identification may have on universal mental health screening (UMHS) in schools, which to date is an under-researched area. Using a mixed methods research design, it examines stakeholders’ views on the how identification and data sharing may influence pupil responses. Initially a systematic review analysed stakeholder acceptability. Building iteratively on the findings of this review cross-sectional data for 3892 primary pupils and 8485 secondary pupils across 55 schools were assessed for changes in assessment response behaviour, using a universal wellbeing assessment as a proxy for screening. Mixed-effects regression analyses examined groups differences while controlling for the random effect of schools. Additionally, focus groups further explored the perspectives of several key stakeholder groups. To integrate quantitative and qualitative data from the studies a Pillars of Integration (PIP) analysis was performed to assess mixed data in greater depth. Findings suggested that identification increased negative responses, particularly among secondary pupils. Pupils were more likely to provide inauthentic answers rather than disengage, affecting data validity. Those with poorer mental health were more likely to avoid identification, and willingness to participate depended on data sharing practices, with age related preferences apparent. Females were more likely to respond negatively to identification than males. School connectedness influenced primary pupil engagement, but at secondary level, this was replaced by the effect of poorer mental health. PIP analysis generated themes around risk and response, proximity to support givers and control and autonomy, amongst others. Overall, stakeholders were generally positive about screening in principle, concerns were evident around identification, potential stigma, and integration with youth mental health services. This large-scale assessment of pupil acceptability offers a series of key recommendations for future research and implementation of UMHS practices in schools.