Strengthening Mental Health Support Teams in Schools: Evidence for Impact and Implementation
Key Messages
Mental Health Support Teams (MHSTs) in schools are one way to address growing demand for mental health services among young people.
There is evidence to suggest that MHSTs may improve behavioural outcomes.
Whole school approaches, which are supported by MHSTs, can improve young people’s mental health through building connectedness, reducing stigma and developing trusting relationships.
Findings from the realist review suggest meaningful consultation with young people and strong leadership are key to successfully delivering whole school approaches to mental health and embedding a school culture that values wellbeing.
There are a wide range of commissioning and delivery models for MHSTs. More robust research evidence is needed to support implementation.
The Challenge
More than one million CYP (children and young people) seek help for mental health problems each year, while schools report record levels of absence. At the same time, specialist services struggle to meet growing demand.
Poor mental health in childhood and adolescence can have lasting consequences. It is linked to worse physical health, lower educational attainment, higher absence rates, reduced employment prospects and poorer life choices in adulthood.
Since 2019, Mental Health Support Teams (MHSTs) have been introduced in schools in England to help address this challenge. These teams support the delivery of whole-school approaches to mental health. They provide early intervention support, including therapy, counselling, and group or one-to-one support for issues such as exam stress, bullying, learning difficulties and eating disorders. MHSTs also liaise with external services including CAMHS.
However, questions remain about how effective MHSTs are and how they work best.
The Research
Researchers from the University of Sheffield, the and the NIHR School for Public Health Research analysed the effectiveness and cost-effectiveness of MHSTs across three longitudinal, cohort-based studies.
Together, these studies examine the impact of MHSTs on attendance, behaviour and long-term outcomes.
Impact on School Absence
Using routinely collected national data from the MHST rollout, researchers compared absence rates before and after MHST implementation across multiple sites.
The study did not find evidence that MHSTs affect the overall absence rate. However, 4.3% of delivery teams reduce absence rates by 1 percentage point or more. We did find evidence that MHSTs reduced the risk of our secondary outcome of persistent absence (defined as missing 10% of sessions or more), though the effect was small. There was evidence of considerable variation in the effect of MHSTs on school absences, indicating that local context and implementation may influence outcomes.
Impact on Behaviour and Conduct
Researchers also examined the effect of MHSTs on behaviour and conduct using the Born in Bradford dataset. This follows 13,000 children from birth.
BiB data includes responses to the Strengths and Difficulties Questionnaire (SDQ), a widely used 25-item behavioural screening tool for assessing children’s emotional and social wellbeing.
Baseline SDQ data were collected during childhood (average age 8.5), using parent and teacher reports. These were compared with self-reported SDQ responses in Year 9.
Measure of behaviour indicated worsening behaviour over time between these two timepoints. However, in schools with MHSTs, this change occurred at a slower rate, resulting in fewer behavioural problems.
Long-Term Outcomes and Cost-Effectiveness
The research also examined longer-term impacts of MHST exposure. The analysis suggests that MHSTs are cost-effective when the effects are projected across the life course.
Based on simulations that forecast health and social outcomes, we anticipate that young people who attended schools with MHSTs were less likely to experience:*
• Conduct disorders at age 18
• Unemployment
• Poverty
• Imprisonment
• Premature mortality
These findings suggest that early mental health support in schools may generate significant long-term benefits for individuals and society.
How and Why Whole-School Approaches Work
A realist review examined how whole-school approaches to mental health support operate in practice. The review analysed qualitative and quantitative evidence from UK primary and secondary schools to understand what works, for whom, and under what conditions.
The review identified mechanisms underlying whole school approaches, that lead to certain outcomes, within particular contexts.
*These are all based on the estimated effect on conduct, and that the effect on unemployment, death, etc., is all extrapolated from that.
Contexts
Whole school approaches are more likely to operate successfully where:
Students have a voice in school decision-making
Staff have capacity to deliver mental health support
School leaders actively promote wellbeing
Outcomes
When these conditions are in place, schools see:
Greater awareness of mental health needs
Increased help-seeking among students
Mechanisms
Whole school approaches appear to work through several mechanisms, including:
Improved access to support
Reduced bullying and improved wellbeing among students and staff
Recommendations
Recommendations
Increased sense of school connectedness
Trust between staff and students
Greater confidence and self-efficacy
Reduced stigma around mental health
Improved staff motivation to support wellbeing
1. 3. 2.
Strengthen evaluation and evidence generation to better understand impacts on attendance and behaviour, and longer-term lifecourse benefits.
Support schools in implementing whole-school approaches, recognising that leadership, school culture, and student voice are key to MHST success.
Allow flexibility for local implementation and learning between MHSTs, recognising that contextual factors influence outcomes.
To find out more about the research, visit: https://bit.ly/school-mental-health-nihr
Born in Bradford Programme was funded by National Institute for Health and Care Research Programme Grant for Applied Research [NIHR205448]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Designed
by Nifty Fox, 2026
