A quasi-experimental evaluation of one-to-one counselling to improve mental health and education outcomes amongst school pupils in England, Scotland and Wales
Abstract
Background: Mental health problems in Great Britain have increased amongst school pupils in the last decade. Ongoing poor mental health jeopardises children’s health and education outcomes. The devolved governments of England, Scotland and Wales have policies to deliver school-based mental health support at scale, including one-to-one counselling. However, the evidence-base for counselling to improve outcomes is sparse and mixed, with most studies employing non-controlled designs. Methods: We used propensity score matching to identify matched controls to our dataset of 15,000 children in Great Britain receiving school-based one-to-one counselling between 2016 and 2019. Controls were identified from three population-based datasets (Growing Up in Scotland, Millennium Cohort Study, Understanding Society). We estimated intervention effects on Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) and Prosocial scores, percentage school attendance and persistent absence, and their socio-demographic moderators using mixed regression models. Results: There were significantly greater reductions in intervention mean SDQ-TD scores compared to controls in all three analyses, ranging from -0.99 (95%CI -1.76, -0.23) to -1.91 (95%CI -2.08, -1.75). Prosocial scores marginally improved for intervention participants relative to controls, but school attendance outcomes did not. Consistent moderators of SDQ outcomes were ethnicity, special educational needs, and English as an additional language, and for school attendance outcomes were ethnicity, age, family structure, region, and deprivation (England only). Conclusions: School-based one-to-one counselling, delivered at scale, is effective in reducing mental health difficulties, with magnitudes of effect aligned with meaningful lasting change, as reported in other research. There was no evidence of positive impact on overall school attendance measures. Further research could explore the effect of counselling on emotionally-based school avoidance. Implementing organisations should consider the intersection of characteristics (such as ethnicity, deprivation, and special educational needs) in intervention design and delivery, and assess outcome data for differential effectiveness.
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BibTeX
@misc{saxton2026quasiexperimental,
title = {{A quasi-experimental evaluation of one-to-one counselling to improve mental health and education outcomes amongst school pupils in England, Scotland and Wales}},
author = {Jennifer Saxton and Catherine L saunders and Simon White and Katalin Toth and Jemma White and Sarah Golden and Hannah Wilkinson and Tamsin Ford},
howpublished = {PsyArXiv},
year = {2026},
month = oct,
doi = {10.31234/osf.io/4xsm7_v1},
url = {https://osf.io/preprints/psyarxiv/4xsm7_v1/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - A quasi-experimental evaluation of one-to-one counselling to improve mental health and education outcomes amongst school pupils in England, Scotland and Wales
AU - Jennifer Saxton
AU - Catherine L saunders
AU - Simon White
AU - Katalin Toth
AU - Jemma White
AU - Sarah Golden
AU - Hannah Wilkinson
AU - Tamsin Ford
PY - 2026
DA - 2026/10/20
PB - PsyArXiv
DO - 10.31234/osf.io/4xsm7_v1
UR - https://osf.io/preprints/psyarxiv/4xsm7_v1/
AB - Background: Mental health problems in Great Britain have increased amongst school pupils in the last decade. Ongoing poor mental health jeopardises children’s health and education outcomes. The devolved governments of England, Scotland and Wales have policies to deliver school-based mental health support at scale, including one-to-one counselling. However, the evidence-base for counselling to improve outcomes is sparse and mixed, with most studies employing non-controlled designs. Methods: We used propensity score matching to identify matched controls to our dataset of 15,000 children in Great Britain receiving school-based one-to-one counselling between 2016 and 2019. Controls were identified from three population-based datasets (Growing Up in Scotland, Millennium Cohort Study, Understanding Society). We estimated intervention effects on Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) and Prosocial scores, percentage school attendance and persistent absence, and their socio-demographic moderators using mixed regression models. Results: There were significantly greater reductions in intervention mean SDQ-TD scores compared to controls in all three analyses, ranging from -0.99 (95%CI -1.76, -0.23) to -1.91 (95%CI -2.08, -1.75). Prosocial scores marginally improved for intervention participants relative to controls, but school attendance outcomes did not. Consistent moderators of SDQ outcomes were ethnicity, special educational needs, and English as an additional language, and for school attendance outcomes were ethnicity, age, family structure, region, and deprivation (England only). Conclusions: School-based one-to-one counselling, delivered at scale, is effective in reducing mental health difficulties, with magnitudes of effect aligned with meaningful lasting change, as reported in other research. There was no evidence of positive impact on overall school attendance measures. Further research could explore the effect of counselling on emotionally-based school avoidance. Implementing organisations should consider the intersection of characteristics (such as ethnicity, deprivation, and special educational needs) in intervention design and delivery, and assess outcome data for differential effectiveness.
ER -