Module: Health Promotion

Title: ‘Health Promotion is as much dependent on an ethos as it is

on particular skills’

Student: Lee Cassidy (Level 9)

Extension granted by Professor Denis Ryan

When examining how health promotion is linked to a

specific health promoting ethos and a particular skill set

needed to achieve this, one needs to contextualise the exact

setting for promotion, its development and how that affects

what is being promoted. This essay deals with schools as a

natural health promotional setting or social milieu for health

promotion with a special emphasis on mental health promotion.

The essay focuses on the importance of schools as a ‘setting’

for the development of an ethos of detection, monitoring and

aversion in relation to mental health issues in schools and

larger society and how schools can serve as agents of

intervention according to the ethos and particular skill set

therein.

“. . . all staff working with children and youngpeople in any service are able to recognise thecontribution they can make to children’s emotionalwell being and social development, and use theirown professional skills in supporting them, whenthere is a concern about their well being.” 1.

This statement is indeed valid when looking at the role

and function of a school as an active platform for positive

mental health promotion, as the school is a live setting for

social presentation and, as such, a setting where a child’s

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behaviour or appearance is first perceived outside the family.

In light of this, schools represent a locus for health

promotion and have significant value as a non traditional

health environment which can be seen by means of the non

direct health care they provide. Schools represent a setting

for education and cater for the so called ‘well rounded’

citizen within society, and therefore play a vital role in

imparting life skills, unifying communities to promote meaning

and purpose in young lives. Schools as a setting for health

promotion and development in this regard cannot be under

considered in their value and:

“In the case of school-age children, school is a source of

key experiences (positive or negative) and school life will

usually need to be an integral part of any intervention” 2.

Firstly, when looking at schools and the provision of a

health promoting ethos, one has to examine the context of

promotion and the notion of the school as an educator both of

which coincide directly with a ‘settings’ approach to health

promotion and development due to the inherent character

building characteristics within an educational setting.

Positive mental health can either be promoted, deterred,

detected or enhanced due to the organisational structure or

setting of a school. Policy has grown and developed around

this and recent years;

“....have witnessed an expanding role for schools andteachers in promoting good health practices, realising

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the ‘interdependence of learning and psychosocialdevelopment.” 3.

The Green paper ‘Every Child Matters’ (ECM 2005) outlined

a clear link between school settings, emotional health and the

notion of equity in school settings when indicating that

children’s mental health should be the business of all the

people, agencies and services in contact with children and

young people. Much of a child’s and young adult’s time is

spent at school and therefore school should be seen as

significant contributory health promoter for personal

development and wellbeing. The WHO Health Promotion Glossary

suggests that a situational ethos for health is the place or

social context in which people ‘engage in daily activities in

which environmental, organisational and personal factors

interact to affect health and well being’ (Nutbeam, 1998 P.

362). The school body in respect to this statement has a

definite role to play as an organisation of a positive mental

health promotion and research shows that children’s mental

health is now the business of all those in contact with

children and young people and is an essential aspect within

any service working with children (Finney, D. 2006 P. 23).

Research also shows how a setting of positive mental

health promotion within schools can enhance skills of self

efficacy, empowerment and self actualization especially

focusing on research conducted on vulnerable populations and

the notion of self efficacy where;

“..vulnerable populations such as disadvantaged inner-city pre-schoolers...and women who were raised in

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care...suggests that, when other aspects of theirlives do not provide fulfilling experiences, thenature of their schooling may be relevant todeveloping feelings of self efficacy and self esteemthat are important....outcomes....related to changesin motivation, self concept and beliefs about success”5.

This research especially highlights how social obstacles can

be overcome where a positive setting for health promotion

exists within schools. A settings approach to health promotion

has its roots within the World Health Organisation, namely in

the ‘Health for All Strategy’ and specifically the Ottawa

Charter for Health promotion which stipulates that ‘Health is

created and lived by people within the setting of their

everyday life; where they learn, work, play and love’ (WHO,

1981 p.111). The health ethos of most schools represents an

equitable service where achieving social wellbeing represents

a certain cross over between different socio-economic fields

within the context of health promotion. It represents the

marrying of equal rights for all and equal health care for all

despite environmental determinants or background. Health

promotion and education are in general implemented through

preventative and equitable services for all. Services such as:

“... rubella immunization and dental measures withinthe school ... the provision of a positively healthfuland safe environment ... to ensure that facilities areseen as available to all pupils rather than only thesporting elite: this would be expected to enhanceesteem as well as physical fitness.” 6.

This indicates a health promoting ethos within schools

that is theoretically grounded in the notion of equity,

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empowerment and a free, equal, education for all. Central to

equity is the notion of empowerment and the importance of

empowerment as a key aim within health promotion. Highlighting

the need to cite the work of Tones and Tilford (2001) who

state that the key objectives within health promotion should

be: ‘educational’, ‘preventative’, ‘empowerment’ and ‘radical’

approaches to promoting health and in conclusion they viewed

empowerment as the central focus of health education and

health promotion.(Wills and Earle, 2007 p. 152)

This ultimately views health as a resource for living an

empowered life where reaching ‘a state of complete mental and

social well being an individual or group must be able to

identify aspirations to satisfy needs, and to change or cope

with the environment. Health is therefore seen as a resource

for everyday life, not the objective of living’ (WHO) Such

definitions of health indicate that health is powerfully

influenced by the cultural setting that surrounds what is

being promoted and that a culture of positive intervention

promotes well being and empowerment. The development of a

healthful organisation is therefore seen as a cultural marker

for health as the above definition on the World Health

Organisation’s website would indicate.

Schools are a central location for positive health

promotion and enhancement as they lend themselves to the

philosophy that ‘prevention is better than cure’. Inevitably,

due to their context, schools are themselves an environment

for the detection and monitoring of mental health issues. The

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importance in identifying such issues for Health Promotion in

schools has been outlined by Atkinson and Hornby where schools

need to be able to identify problems so that more serious

mental health problems can be averted. (Atkinson & Hornby,

2002, p. 57) This highlights the important functioning of

schools as an arena for this form of mental health detection.

Especially in contexts where research shows that most young

children with problems do not come to the attention of mental

health professionals immediately. Research suggests that they

are known to social services or community child health clinics

as well as being known to their teachers and to their peers in

school indicting why of school experiences and peer

relationships are as important as family. (Barnes J., 1998,

p.58)

Although the context for enhancing mental health and the

detection of mental health in educational locales (schools)

and clinical primary care locales are different, their

underlying ethos are similar in objectives; on which enhances

children’s mental and physical health and will improve their

ability to learn and to achieve academically as well as their

capacity to become responsible citizens and productive

workers. The aim of schools and clinical settings as set out

by Dave Finney (2006) is that schools ‘educate for

citizenship; the mental health agenda is to prevent by

promoting emotional well being or to treat or cure mental

illness’ (Finney, D.,2006 p.23)

This highlights the mutual aim within both clinical and

educational settings and underlines the need for emotional

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well being as a working pre requisite for functioning within

society. This also suggests a greater role for health

promotion to play in larger society, one that extends beyond

the limits of the bio medical model of health promotion with

preventative measures on disease prevention as it places

greater emphasis on the role of persons, groups and

organisations as active agents in shaping health practices and

policies.

This would indicate a need for collaborative work between

communities, schools and health communities in general.

However, the issues of health promotion and wellbeing are not

mutually exclusive when targeting the health of needs of

children compared to those of adults. The setting for health

promotion is precedent for children. This illustrates the

importance of a school as a health promoting body typified by

a schools’ capacity for community building and their social

representation in larger society .The importance of

collaboration for the success of health promotion

interventions is widely acknowledged and research shows that

many health interventions for adults are targeted at the

individual but that in childhood they are best targeted at the

child’s environment. Evidence supports the view that

competence-enhancing programmes carried out in collaboration

with families, schools and wider communities have multiple

benefits (Prof. Barry, Margaret. M.; Canavan, R.; Clarke, A.;

Dempsey, C.; and O’Sullivan, M., 2009 P. 13)

This highlights the importance of schools as environments

for the detection and monitoring of mental health issues among

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young people and the need for well executed programs that

enhance personal development, self efficacy and empowerment

within the school ethos and curriculum. Learning, working,

playing and loving are all found in the school environmental

mix. In Ireland the social, personal and health education

(SPHE programme) incorporating relationships and sexuality

education has been a mandatory part of the curriculum in all

primary and junior cycle post-primary schools since 2003. The

importance of schools as a setting for mental health promotion

and the importance of the skill set needed to execute such a

curriculum was highlighted in a recent forum at Áras An

Uachtaráin on Working Together to Promote Positive Mental

Health. The forum focused on the centrality of the RSE

programme as a positive force for promoting positive mental

health in young people and how the successful operation of

such a programme in all schools is crucial to the development

of active, fully rounded and responsible citizens for Irish

society:

“Both the SPHE and RSE programmes have been mandatoryin all primary and junior cycle post primary schoolssince 2003. In addition, all schools are required tohave an agreed policy on SPHE. The SPHE curriculum atprimary level is designed to foster, in an ageappropriate way, the personal development, health andwell-being of the individual child. The junior cycleSPHE curriculum builds on this at second level. Forsenior cycle students, all schools are obliged to havean agreed school policy and a suitable RSE programmein place. It should include in-depth coverage ofissues such as relationships, accepting sexualorientation, pregnancy, family planning,contraception, responsible parenthood, implications of

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sexual activity, sexually transmitted diseases, aswell as sexual harassment and assault.’6.

The model for healthy schools within Europe, and in

England in particular, has outlined the important role schools

play in positive mental health promotion and detection due to

the very social nature of their primary setting and;

“...the DFES (2001 a)... advocated that schoolsbecome mental health promoting organisations. Schoolsprovide an ideal setting for the promotion of mentalwell being ... because they are the primary settingfor the development of relationships with peers andadults”7.

However to become such a health promoting environment a huge

dynamic of interpersonal and therapeutic skills come into play

where the need for counselling skills, mediation skills and

communication skills are paramount. On one hand schools

traditionally fall short in this department as schools are by

and large associated with the management of large groups of

people and not necessarily individuals. In his article on the

subject of Mental Health Promotion in schools Dave Finney

states that the emphasis within schools has been on discipline

and control using behaviour strategies compared to mental

health interventions within clinical settings which focus much

more on the individual and the development of personal

measures rather than external regulations as in schools.

(Finney, D. 2006, p.24)

This highlights a certain contradiction that is latent

within the provision of a positive mental health promoting

ethos in schools and its direct implementation and management

within the schooling context. Often the skill set of teachers

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do not match the health promoting objectives or criteria of

health promotion due to lack of training or time. Hornby and

Atkinson have cited limited training time and resources as one

of the main obstacles when dealing with pupils with mental

health difficulties and that in many instances the only

options is referral to a more clinical setting. (Hornby, G.

And Atkinson, M., 2003 P. 7)

This is a fundamental flaw within the system itself as the

health promoting ethos is largely dependant on a school

principals’ penchant towards the development and training of

skills necessary for the proper implementation of a mental

health promoting ethos within school.

“The degree of principal and administrative support fora school-based programme can have a critical influenceon its success or failure...A supportive schoolprincipal can be an encouraging force in building andkeeping teachers’ motivation and interest, as well asfacilitating their attendance at training sessions.” 8.

In today’s curriculum driven society results and academic

achievements are seen as more important than the mental health

promoting aspects of the curriculum which are often curtailed

according to the curriculum’s other academic needs. A recent

Senad debate on the importance of SPHE programme in Ireland on

Wednesday 20th July 2011., highlighted on the fact that figures

given in the 2009 Dáil na nÓg survey show that of the

respondents in schools only three quarters of senior cycle

pupils have RSE classes in that year and that in 85% of these

schools RSE was not timetabled as a class.

However, positive mental health promotion in general has a

dual relationship with schools in this respect. The importance

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of the implementation and management of positive mental health

promotion and its development in programs within schools is

shown to have positive educational spinoffs for schools on the

whole and needs to be addressed as such. In the Work of Hornby

and Atkinson on the promotion of mental health in schools they

have highlighted the importance of schools meeting the

emotional needs of children which they view as essential and a

significant contributor toward academic achievement. (Hornby &

Atkinson, 2003 P. 3)

The role of the educator as one of enhancing personal

development needs to be highlighted when looking at the notion

of educational payoff and general well being and research

indicates that mental well being is promoted and learning more

effective in an environment where pupils are encouraged to

think autonomously (Hornby & Atkinson, 2006, p.5). Promoting,

detecting and enhancing a positive mental health promoting

ethos and the development of a skill set to enhance its

promotion in schools would appear to be a viable option;

however, reality does not always reflect policy in this

regard:

“The most common barriers to implementing mentalhealth education in schools were thought to be lack ofteacher training (87.5%) and an overcrowded curriculum(81.3%).” 9.

Only recently, in a Senad debate on the implementation of

the efficient running of the SPHE (Social, Personal and Health

Education) program in Irish schools, does Senator Mary Moran

highlight the importance of choosing the correct teachers for

the SPHE program in schools and how certain individual

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attributes and characteristics are better suited toward its

correct implementation and management. She stated that:

“....Not every teacher would be suitable forproviding instruction in SPHE. It is a very personalsubject.....those who teach it should be in a positionto form close bonds with their pupils. In addition,the timetable should be organised in such a way that ateacher will not have a class for an examinationsubject in the period before he or she is due to takethe same class for SPHE.” 10.

Finally, principals are ultimately responsible for

fostering a school climate that nourishes positive mental

health. The importance of a trained teacher workforce imbued

with the correct skills set needed for the implementation of

such a program needs to be highlighted as an essential pre

requisite when looking at the positive mental health promoting

ability of any school. Therefore training teachers before they

teach a programme would seem an essential part of programme

integrity and a number of studies have found that the degree

of training received is associated with both better programme

fidelity (WHO, 1997) and better outcomes (Byrne, M.; Barry, M.

and Sheridan, M., 2004 P. 19). Schools are naturally

communicating environments; in general they are ‘head spaces’

with most time dedicated to either learning or the development

of peer relationships. Therefore counselling needs are

enhanced where these different dynamics of life intertwine and

where personal counselling is a fundamental part of effective

pastoral care and can help prevent more serious mental health

problems from developing. Therefore the ability of staff to be

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able to use counselling skills to help pupils with day to day

problems is an essential aspect of school life.

Good communication skills would therefore be essential and

have been identified as a core component of good health

promotion. Levy (1997) identifies ‘ten ‘top’ suggestions for

good communication in public health. He identifies the ability

to ‘listen’ as ‘...an essential part of communication’.

(Wills & Earle, 2007 P. 143) Schools are intrinsically

listening environments where communications skills and active

listening skills are important educational tools and ‘A key

aspect of counselling for classroom teachers is the use of

active listening’. (Hornby & Atkinson, 2003 P. 7) However good

communication skills cannot be taken at face value and active

listening is not a skill set that everyone is endowed with and

this can often lead to a lack of clarity when detecting

certain mental health issues in a classroom setting.

“...inadequate teacher training and in servicesupport is pinpointed as a crucial factor in theescalation of exclusions (OFSTED, 1996). Teachers, intheir initial training and in service support, aresaid not to be given a sufficient background in mentalhealth issues or in ways to manage behaviour. TheOFSTED report states that ‘teachers ... were unsure ofthe distinction between poor behaviour and behaviourspringing from deep-seated emotional disturbancerequiring treatment.”11.

This highlights the fact that teachers often have limited

training, skill sets and resources when dealing with pupils

presenting with mental health difficulties and issues and that

the provision of effective counselling in such instances may

be hard to achieve.

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Highlighting that teachers may not have the exact skill set

necessary to avert psychological issues in the classroom.

However, this is not to say that teachers cannot aid and

promote mental health issues by serving as a detector for

behavioural issues and with such a high occurrence of

behavioural problems manifesting in the school setting. This

is all the more necessary when looking at research regarding

the statistics of conduct and behaviour disorders:

“Epidemiological studies suggest that 12 per cent ofchildren are likely to have behaviour problems ofwhich roughly half of that group are likely to displaysymptoms of Conduct Disorder (Mental HealthFoundation, 1999)”

Popple (1995) outlines a pluralist theory for community

work and suggests “....that change in communities takes place

as a result of the constant bargaining of competing

interests.”(Wills & Earle, 2007 P. 141)

It is only when the community of the school at large takes

action or feels the direct need for change that change will

actually occur. An example of how competing interests can

promote positive mental health and how the skill of mediation

can be maximised and moved from a clinical setting to an

educational setting is illustrated by ‘Interpersonal

Negotiation in Paris’.

This was developed initially with children in clinical settings

with severe behavioural problems and from there dispersed into

the general everyday school environment. Teachers are asked to

identify children at risk those displaying either aggressive

behaviour or social withdrawal. The children with opposite

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interpersonal styles are then paired and using both

hypothetical and real life examples, the two children, with a

counsellor, generate alternative solutions for managing

interpersonal relationships. (Barnes. J, 1998 P. 60-61)

This illustrates how the use of mediation, communication

and counselling between student, teacher and counsellor can

enhance a positive healthy environment that is safe and

fulfilling. This type of intervention is not mainstream;

however, it serves as an example of how schools can serve as

an environment for mental health promotion and ‘the utility of

‘pairing for prevention’ has been demonstrated in one inner-

city primary school in Boston, USA and is being implemented in

several additional schools (Barnes. J, 1998 P. 60-61). This

shows how even a change in attitudes and beliefs at an

adoption level can change an ethos around behaviour management

and can work towards positive change in the context of

positive health promotion within schools, the aim being to

develop an ethos where: ‘children with emotional problems are

seen as ‘needy’ rather than ‘difficult’. (Hornby & Atkinson,

2003 P. 4)

We can see how open communication can enhance a positive

mental health promoting ethos in schools that involve other

strategies for the development of life skills and efficacy in

the classroom and intervention that facilitate open

communication. A strategy outlined in the Healthy School

Standard which emphasises the importance of pupils expressing

and understanding feelings via approaches such as Circle Time,

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Nurture groups, Peer support and Personal development

programmes (Atkinson and Hornby, 2006, p. 8)

In conclusion the pace at which health promotion policy is

assimilated and established within schools is slow and change

requires a proactive movement towards change wherein schools

become promoting environments across the board. This is often

limited due to teacher training and student support resources.

Proactive interventions may reduce stress but mechanisms in

most schools are reactive and designed to respond to

incidents.

In Ireland, research shows that the mechanisms of support

services do not always match the needs of both teachers and

students. A national study cites Two-thirds of Irish schools

with inadequate support services and mental health services to

meet students’ mental and social needs and the same number of

schools reports that teachers and parents are not provided

with information about local services and their accessibility

for counselling and referral. (Byrne, M.; Barry, M. And

Sheridan, M., 2004 P. 19). This would indicate a need of

active participants and engagement in personal health issues

and health promotion.

The value of engaging young people “as ‘active partners in

research’ rather than treating them as ‘passive objects’ is

multifaceted....” and cannot be undervalued. The focus of

empowerment would seem to enhance the skill of mediation for

all parties involved. To illustrate an example of this type of

positive mental health promotion in a school setting for

positive mental health promotion in a school setting, I use

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the example of ‘Schoolwatch’ a pupil organised initiative

developed by South Wales Police.

“The initiative ... allows pupils to improve theirenvironment by taking responsibility for their behaviourand their actions through the implementation ofactivities such as a bully box ... playground patrols ...and community projects.”13.

Therefore, the school body in this regard inadvertently

becomes a direct promotional setting for wellbeing and

positive health, where an ethos for positive health and well

being are seen as comprising of true well being (with its

roots in empowerment, and of considerable value to the

individual and society) together with the notion of fitness,

and as having physical, mental and social ingredients. This

example illustrates the potential for schools as mental health

promoting environments. Rooted in an ethos of equity, one that

mediates between all parties involved and is therefore

interrelated to the concept of holistic health as it is

influenced by cultural, social and philosophical factors which

link meaning and purpose to our lives and our interpersonal

relationships. Illustrating how health promotion in schools is

or can be linked to a health promoting ethos and an associated

skill set therein that mediates between all parties involved

and which is mutually beneficial to all. Reiterating again

that a holistic ethos is required in all schools and the

recognition that:

“. . . all staff working with children and youngpeople in any service are able to recognise thecontribution they can make to children’s emotional

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well being and social development, and use theirown professional skills in supporting them, whenthere is a concern about their well being.”

Bibliography and Footnotes

Books:

Downie, R.s; Tannahill & C; Tannahill, A; ‘Health Promotion

Models and Values, 2nd Edition Oxford University Press

(1996)

Gilligan, R; ‘Promoting Positive Outcomes for children in

need – The importance of protective capacity in the child

and their social network’ in Horwath, J. (ed.) ‘The Child’s

World The Comprehensive Guide to Assessing Children in

Need’ Jessica Kingsley Publishers London and Philadelphia

(2010)

Wills, Jane & Earle, Sarah; ‘Theoretical perspectives on

promoting public health’ in Earle, S; Lloyd, Cathy E;

Sidell, M; & Spurr, S (eds.) ‘Theory and research in

promoting public health’ SAGE (2007) P 129 – 161

Wills, Jane & Earle, Sarah; ‘Focusing on the health of

children and young people’ in Earle, S; Lloyd, Cathy E;

Sidell, M; & Spurr, S (eds.) ‘Theory and research in

promoting public health’ SAGE (2007) P 163 – 193

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Journals:

Finney, Dave (2006) 'Stretching the Boundaries: Schools as

Therapeutic Agents in Mental Health. Is it a Realistic

Proposition?’ Pastoral Care in Education, 24: 3, 22 — 27,

Routledge publishing

Power, Mike; Cleary, Deirdre & Fitzpatrick, Carol (2008)

‘Mental Health Promotion in Irish Schools – A Selective

Review’ Advances in School Mental Health Promotion 1:1, 5 -

15 The Clifford Beers Foundation & University of Maryland

Barnes, J. (1998) ‘Mental health promotion: a developmental

perspective. Psychology, Health & Medicine, 3:1, 55-69,

Carafax Publishing

Hornby, Garry & Atkinson, Mary (2003) ‘A Framework for

Promoting Mental Health in Schools’ Pastoral Care in

Education, 21:2, 3-9. Routledge Publishing

Byrne, Mary; Barry, Margaret & Sheridan, Margaret (2004)

‘Implementation of a school-based mental health promotion

in Ireland’ International Journal of Health Promotion, 6:2,

17-25, The Clifford Beers Foundation

Nutbeam, D. (1998) ‘Health promotion glossary’, Health

Promotion International, 1, 349–364.

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Reports:

Prof. Barry, Margaret; Clarke, M; Canavan, R; Clarke, A;

Dempsey, C; & Sullivan, M (2009), ‘Review of Evidence-based

Mental Health Promotion and Primary/Secondary Prevention’,

compiled by Health Promotion Research Centre, National

University of Ireland, Galway for the Department of Health,

London. P. 1-257

Seanad Debates:

Motion - SPHE Curriculum, Wednesday, 20 July 2011, Seanad

Éireann Debate Vol. 209 No.11

Webiography:

WHO (World Health Organisation)

http://www.who.int/healthpromotion/conferences/previous/

ottawa/en/

Footnotes

1. Finney, Dave (2006) ‘Stretching the Boundaries:

Schools as therapeutic agents in Mental Health. Is it

a realistic proposition? ‘Pastoral Care in Education

(22 – 27) P. 24.

2. Gilligan, R; ‘Promoting Positive Outcomes for children

in need – The importance of protective capacity in the

20

child and their social network’ in Horwath, J. (ed.)

‘The Child’s World The Comprehensive Guide to

Assessing Children in Need’ Jessica Kingsley

Publishers London and Philadelphia (2010), P. 181

3. Power, Mike; Cleary, Deirdre; Fitzpatrick, Carol;

(2008), ‘Mental Health Promotion in Irish Schools – A

Selective Review’, Advances in School Mental Health

Promotion 1:1, P. 6

4. Barnes, J. (1998), ‘Mental health promotion: a

developmental perspective’, Psychology, Health &

Medicine, 3:1, P. 61.

5. Downie, R.S; Tannahill, Carol & Tannahill, Andrew;

‘Health Promotion Models and Values’ 2nd edition,

Oxford University Press (1996), P. 112

6. Seanad Eireann Debate Vol. 209, No. 11, SPHE

Curriculum: Motion, Wednesday, 20th July, 2011.

7. Hornby, Garry & Atkinson, Mary; (2003), ‘A Framework

for Promoting Mental Health in School’, Pastoral Care

in Education, 21: 2, P. 3

8. Byrne, Mary; Barry, Margaret; & Sheridan, Margaret;

(2004), ‘Implementation of a school-based mental

health promotion programme in Ireland’, International

Journal of Health Promotion, 6:2, P. 19

9. Byrne, Mary; Barry, Margaret; & Sheridan, Margaret;

(2004), ‘Implementation of a school-based mental

health promotion programme in Ireland’, International

Journal of Health Promotion, 6:2, P. 19

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10. Byrne, Mary; Barry, Margaret; & Sheridan,

Margaret; (2004), ‘Implementation of a school-based

mental health promotion programme in Ireland’,

International Journal of Health Promotion, 6:2, P. 19

11. Barnes, J. (1998), ‘Mental health promotion: a

developmental perspective’, Psychology, Health &

Medicine, 3:1, P. 64.

12. Hornby, Garry & Atkinson, Mary; (2003), ‘A

Framework for Promoting Mental Health in School’,

Pastoral Care in Education, 21: 2, P. 4

13. Earle, Sarah; (2007), ‘Focusing on the health of

children and young people’ in Earle, Sarah; Lloyd,

Cathy, E; Sidell, Moyra; & Spurr, Sue; (eds.), ‘Theory

and research in promoting public health’, SAGE (2007)

P. 180 – 181

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