Nick Rose is a ‘Leading Practitioner’ for psychology and research, and teaches at a comprehensive secondary school in Hertfordshire. His blog can be found here and he occasionally tweets as @Nick_J_Rose.
Congratulations on your recent appointment as ‘mental health champion’ for schools. From what I’ve read, you appear passionate about helping young people with mental health issues and as concerned about the cuts to children’s services as I am. However, some of the things you have written have left me deeply worried about how you might exercise your new role. Before you pour your “expertise into policies that will affect everyone”, I’d like to take this opportunity to express those concerns and pose some questions to you.
I assume from your work with the ‘Self-Esteem Team’ that you’re already aware of the significant problems associated with attempts to raise children’s self-esteem. For example, how interventions intended to improve self-esteem can backfire and have a negative effect on students, or how using praise to try and build self-esteem can actually stifle motivation. From your work with the ‘Body Gossip Education Programme’ you’ve clearly gained insight into some of the complexities related to children’s mental health. In your manifesto, you correctly identify an important problem with ‘amateurs’ tackling issues like eating disorders:
“In the wrong hands, classes on these highly-sensitive issues can become instructional – teens (who are already by their very nature angst-ridden) are taught the most negative and destructive ways to express their inner turmoil. Mental health lessons should talk about ‘whys’, not ‘hows’ and they should always leave pupils feeling positive and empowered.”
You’re right to be cautious as there’s evidence that some attempts at the prevention of obesity and eating disorders may be ineffective, and some may be potentially harmful. The problem is that a lack of a positive outcome from a therapy-like intervention isn’t the worst possible outcome for pupils. Therapy can be harmful, with research showing that, on average, approximately 10 per cent of clients actually get worse after starting therapy.
How will you ensure that the “Daily mental health ‘exercises’” you think we should be doing with students will be effective? You suggest that just ten minutes per day learning a skill to nurture mental wellbeing will significantly improve the health and productivity of school children: Will you be publishing good quality evidence to support this claim? More importantly, how will you ensure that the skills you think children should learn will not cause harm?
What evidence is there to support your “Mental ‘5 a day’” initiative? You suggest examples of these as a minimum of two hours per day with one’s smart phone turned off and ten minutes per day in quiet contemplation/meditation. Are you aware that meditation can have negative effects for some individuals?
My confidence in your judgement and expertise is undermined by your apparent support of Neuro Linguistic Programming (NLP); a therapy which lacks any good evidence of effectiveness. For instance, in a recent article for Cosmopolitan you said:
“Laura found CBT (Cognitive Behavioural Therapy) useful – a type of therapy which gives patients habit-changing tools to help break toxic patterns of behaviour. I used NLP (Neuro-linguistic Programming) to kick-start my recovery, which is similar to CBT but works on changing patterns of thought, rather than behaviours.”
The fact you appear to equate CBT and NLP worries me gravely!
NLP involves the idea that you can change a person’s thinking by matching communication to an individual’s preferred sensory mode, whether that be visual, auditory or kinaesthetic. Are you aware that ideas about such learning styles are flawed? Some versions of NLP treat all mental health conditions (including things like autism and epilepsy) as entirely psychosomatic; does this represent your view?
The fact that NLP is listed on Quackwatch (Your Guide to Quackery, Health Fraud, and Intelligent Decisions) should be enough to raise some alarm bells: NLP is listed as one of the ‘Procedures to Avoid’. A review of the use of NLP in healthcare concluded that “there is little evidence of its success in improving outcomes for patients” despite £800,000 spent on NLP by the NHS between 2006-9 (plus an additional £105,000 on training costs). Not so long ago, Healing the Wounds in Porthcawl was asked to stop using Neuro Linguistic Programming (NLP) with war veterans because of concerns that the unregulated therapy (which doesn’t have NICE approval) might make patients worse.
Your apparent enthusiasm for a ‘therapy’ which lacks evidence of effectiveness, undermines the credibility of your judgement when it comes to guiding policy related to the mental health of children. One of the drivers for the expansion of proliferation of ineffective and unproven therapies is the belief that such informal forms of therapy are innocuous -when many may be harmful and best avoided. So the big question is this: How do you plan to ensure that the policies you recommend to schools and teachers will not do more harm than good?