Radical change at heart

The British Psychological Society and its Behaviour Change Advisory Group has added to its behaviour change briefings on important areas including alcohol consumption and persistent absence from school.

Professor Chris Armitage's (University of Manchester) briefing on responsible alcohol consumption opens with stark statistics. Despite many public health campaigns and legal restrictions aimed at reducing alcohol consumption, alcohol-related admissions to English hospitals increased from 510,800 in 2002/3, to 1,057,000 in 2009/10. A report from 2003 estimated the misuse of alcohol cost the UK economy up to £20 billion.

Armitage told us he was keen to be involved with writing the briefing due to a frustration that much policy seems to be based on common sense rather than high-quality evidence, and psychology has much to offer in terms of offering solutions beyond common sense. However, many psychologists are left torn between giving definitive evidence, which can take years, and providing informed advice, which could contain flaws.

In his briefing Armitage outlined the evidence we have on alcohol consumption, introducing a minimum price-per-unit of alcohol has been estimated to reduce alcohol consumption, crime, alcohol-related hospital admissions and mortality. However, in England, Wales and Northern Ireland this idea was abandoned, and despite legislation passing in Scotland in 2012 for a minimum price per unit this still has not been implemented due to legal challenges.

Advertising for alcohol is regulated by the Advertising Standards Authority which has 16 rules for alcohol advertisements, however studies have shown that consumers see many breaches of these rules. As Armitage pointed out, such policy interventions ignore individual behaviours and differences: people don't react uniformly to them.

Armitage has made recommendations to the government that include working with a broader range of interest groups to ensure the best possible evidence is used in guiding policy. He also suggested developing clinical definitions of concepts such as binge drinking, and hazardous and problematic drinking, to ensure those who fit those definitions are aware that certain health messages may apply to them. He added that an investment should be made in developing a programme of behavioural sciences research dedicated to improving policy-level and individual-level psychological interventions to bring about sustained reductions in alcohol consumption.

A long-time advocate for policy involvement, Armitage told us that while a cautious approach to informing policy is laudable, nature abhors a vacuum and there are many people who are not psychologists but who will provide psychological-type advice based on simple, definitive answers that are not rooted in high-quality evidence. He said: 'It boils down to answering the question "Would you rather have the informed opinion of a psychologist or someone else's opinion?", but the answer is never easy – most of us prefer simple, definitive answers. I would like the government to recognise that behaviour change is complex and that scientific research in this area has at least as much to offer as more purely biological research in terms of improving the health of the nation.'

Educational psychologist Dr Brian Apter, Chair of the BPS Division of Educational and Child Psychology, wrote a briefing on school attendance, exclusion and persistent absences, an issue that has hit the headlines in recent weeks as a new study revealed school exclusion is linked to long-term mental health problems.

Absences from school are a contentious issue, with parents now being fined for even occasional pupil  absence, although this approach is not evidence-based. Apter wrote: 'The conclusion that a student cannot afford to miss even a few days at school without a significantly detrimental effect appears to be based on the unsubstantiated beliefs of teachers, parents and politicians rather than on quantitative longitudinal studies that isolate effects measurably caused by school absence.'

Indeed, the evidence points to persistent absence as more troubling, being correlated with crime and mental health difficulties, and it seems these mental health difficulties lead to school absence rather than vice versa. These persistent absentees account for more than half of unauthorised absence, and there are an estimated 12,000 children and young people in England who are absent from any kind of formal education.

The Department for Education, in 2012, made recommendations that led to the widespread use of fines on parents whose children were absent from school. However, this approach, Apter wrote, is unlikely to have an effect on those children who frequently miss school, and according to psychological first principles we know punishment is rarely useful in modifying behaviour.

Apter listed several categories of psychological factors that can help to explain persistent absence; these problems can be emotionally based, related to physical health, due to attitudinal or systemic issues or related to behaviour in school. Any child who is persistently absent, Apter wrote, may be experiencing problems in a number of those categories, and psychology has much to offer in terms of interventions for issues in all of them.

In his recommendations to schools Apter suggested creating an environment that is inclusive and that excites curiosity and a joy of learning in students. He also recommended that schools should have psychological competence at the core of their improvement agendas, encouraging the development of nurturing, valuing and understanding their most complex students.

We spoke to Apter about his briefing. 'Two things we've discussed in the Behaviour Change Advisory Group is the way we quibble with each other,' he said. 'In fact, somebody who's now retired actually describes a collection of psychologists as a quibble of psychologists. We're so keen to shoot each other down because the evidence isn't quite correct, but that means that documents go out quite slowly, but it also means we word ourselves almost too carefully.'

Apter said the document had radical educational reform at its heart: 'People have started talking about the joy of learning – the idea is that kids naturally enjoy learning, and there's much evidence to back that up, but we make learning an unenjoyable, horrible thing they have to do. Michael Gove was the absolute anathema of true joy in learning and we're hoping to fight back. The idea of radical education is built into this document.' 

- Read the briefings described here as well as past briefings on issues such as voter apathy, physical inactivity and personal debt.