School Health in the United Kingdom
For over a decade, community schools, or “extended schools” as they are called in England, have proliferated in the United Kingdom. In England and Scotland the strategy has been implemented more systemically than in Wales and Northern Ireland; however, since the UK has Universal Health Care, the health strategy at most schools is geared toward the concept of the Health-Promoting School (HPS), which embodies a school-wide approach to health education and promotion, and which often includes courses in Personal, Social and Health Education as part of the curriculum. These courses often involve health professionals from the community. When schools do offer health services, the work often takes place through school nurses, who may serve as many as 8-10 sites. However, mental health services are often delivered through school-based centers.
The UK’s rates of teenage pregnancy, binge drinking and smoking are the highest in Europe. One of the responses to this growing problem has been to establish school-based counseling services and sexual health clinics, which could soon be open in every secondary school and college (the equivalent of America’s middle and high schools); this means schools must either set up clinics or refer youngsters to similar services in the community. All students would have easy access to confidential contraception and pregnancy testing and choices without parent permission.
Around a third of middle and high schools in England already have these clinics. Some are mobile units shared by a number of schools. The British Department for Education and Schools, and the Department for Children’s Services and Public Health recently announced that improving services in schools is a priority; together they plan to improve the Healthy Schools Programme and support schools to develop or expand existing school-based health advice services.
Universal post-elementary school counseling has been established in Northern Ireland and in secondary schools in Wales in recent years; and there is policy commitment to providing access to school counseling to all pupils in Scotland by 2015. Unfortunately counseling is not enough. For instance, more than one in 10 of Ireland’s youngsters suffers from serious mental health problems; many of them are experiencing posttraumatic stress as a result of long years of war and sectarianism. The Bamford Report on mental health in Northern Ireland, which has been used to shape recent policy, states that “It is vital teachers have a support mechanism if they are to cope with the emotional crises facing our children. Policy makers need to use joined-up thinking to allow the Departments of Health and Education to tackle this issue together.”
There seems to be growing agreement that school-based centers, considered by experts as one of the most effective and efficient ways to provide comprehensive preventive health care, can be an important addition to the Health-Promoting School framework, which promotes the holistic development of health and well-being of all UK pupils.