Statutory guidance

Physical health and mental wellbeing (Primary and secondary)

Updated 13 September 2021

Applies to England

The aim of teaching pupils about physical health and mental wellbeing is to give them the information that they need to make good decisions about their own health and wellbeing. It should enable them to recognise what is normal and what is an issue in themselves and others and, when issues arise, know how to seek support as early as possible from appropriate sources.

Physical health and mental wellbeing are interlinked, and it is important that pupils understand that good physical health contributes to good mental wellbeing, and vice versa.

It is important for schools to promote pupils’ self-control and ability to self-regulate, and strategies for doing so. This will enable them to become confident in their ability to achieve well and persevere even when they encounter setbacks or when their goals are distant, and to respond calmly and rationally to setbacks and challenges. This integrated, whole-school approach to the teaching and promotion of health and wellbeing has a potential positive impact on behaviour and attainment.

Effective teaching should aim to reduce stigma attached to health issues, in particular those to do with mental wellbeing. Schools should engender an atmosphere that encourages openness. This will mean that pupils feel they can check their understanding and seek any necessary help and advice as they gain knowledge about how to promote good health and wellbeing.

Schools have flexibility to design and plan age-appropriate subject content, but this guidance sets out core areas for health and wellbeing that are appropriate for primary and secondary aged pupils.

Puberty including menstruation should be covered in Health Education and should, as far as possible, be addressed before onset. This should ensure male and female pupils are prepared for changes they and their peers will experience.

Menstruation

The onset of menstruation can be confusing or even alarming for girls if they are not prepared. Pupils should be taught key facts about the menstrual cycle including what is an average period, range of menstrual products and the implications for emotional and physical health. In addition to curriculum content, schools should also make adequate and sensitive arrangements to help girls prepare for and manage menstruation including with requests for menstrual products. Schools will need to consider the needs of their cohort of pupils in designing this content.

Physical health and mental wellbeing: Primary

The focus in primary school should be on teaching the characteristics of good physical health and mental wellbeing. Teachers should be clear that mental wellbeing is a normal part of daily life, in the same way as physical health.

This starts with pupils being taught about the benefits and importance of daily exercise, good nutrition and sufficient sleep, and giving pupils the language and knowledge to understand the normal range of emotions that everyone experiences. This should enable pupils to articulate how they are feeling, develop the language to talk about their bodies, health and emotions and judge whether what they are feeling and how they are behaving is appropriate and proportionate for the situations that they experience.

Teachers should go on to talk about the steps pupils can take to protect and support their own and others’ health and wellbeing, including simple self-care techniques, personal hygiene, prevention of health and wellbeing problems and basic first aid.

Emphasis should be given to the positive two-way relationship between good physical health and good mental wellbeing, and the benefits to mental wellbeing of physical exercise and time spent outdoors.

Pupils should also be taught the benefits of hobbies, interests and participation in their own communities. This teaching should make clear that people are social beings and that spending time with others, taking opportunities to consider the needs of others and practising service to others, including in organised and structured activities and groups (for example the scouts or girl guide movements), are beneficial for health and wellbeing.

Pupils should be taught about the benefits of rationing time spent online and the risks of excessive use of electronic devices. In later primary school, pupils should be taught why social media, computer games and online gaming have age restrictions and should be equipped to manage common difficulties encountered online.

A firm foundation in the benefits and characteristics of good health and wellbeing will enable teachers to talk about isolation, loneliness, unhappiness, bullying and the negative impact of poor health and wellbeing.

By the end of primary school:

Mental wellbeing

Pupils should know:

• that mental wellbeing is a normal part of daily life, in the same way as physical health
• that there is a normal range of emotions (e.g. happiness, sadness, anger, fear, surprise, nervousness) and scale of emotions that all humans experience in relation to different experiences and situations
• how to recognise and talk about their emotions, including having a varied vocabulary of words to use when talking about their own and others’ feelings
• how to judge whether what they are feeling and how they are behaving is appropriate and proportionate
• the benefits of physical exercise, time outdoors, community participation, voluntary and service-based activity on mental wellbeing and happiness
• simple self-care techniques, including the importance of rest, time spent with friends and family and the benefits of hobbies and interests
• isolation and loneliness can affect children and that it is very important for children to discuss their feelings with an adult and seek support
• that bullying (including cyberbullying) has a negative and often lasting impact on mental wellbeing
• where and how to seek support (including recognising the triggers for seeking support), including whom in school they should speak to if they are worried about their own or someone else’s mental wellbeing or ability to control their emotions (including issues arising online)
• it is common for people to experience mental ill health. For many people who do, the problems can be resolved if the right support is made available, especially if accessed early enough

Internet safety and harms

Pupils should know:

• that for most people the internet is an integral part of life and has many benefits
• about the benefits of rationing time spent online, the risks of excessive time spent on electronic devices and the impact of positive and negative content online on their own and others’ mental and physical wellbeing
• how to consider the effect of their online actions on others and know how to recognise and display respectful behaviour online and the importance of keeping personal information private
• why social media, some computer games and online gaming, for example, are age restricted
• that the internet can also be a negative place where online abuse, trolling, bullying and harassment can take place, which can have a negative impact on mental health
• how to be a discerning consumer of information online including understanding that information, including that from search engines, is ranked, selected and targeted
• where and how to report concerns and get support with issues online

Physical health and fitness

Pupils should know:

• the characteristics and mental and physical benefits of an active lifestyle
• the importance of building regular exercise into daily and weekly routines and how to achieve this; for example walking or cycling to school, a daily active mile or other forms of regular, vigorous exercise
• the risks associated with an inactive lifestyle (including obesity)
• how and when to seek support including which adults to speak to in school if they are worried about their health

Healthy eating

Pupils should know:

• what constitutes a healthy diet (including understanding calories and other nutritional content)
• the principles of planning and preparing a range of healthy meals
• the characteristics of a poor diet and risks associated with unhealthy eating (including, for example, obesity and tooth decay) and other behaviours (e.g. the impact of alcohol on diet or health)

Drugs, alcohol and tobacco

Pupils should know:

• the facts about legal and illegal harmful substances and associated risks, including smoking, alcohol use and drug-taking

Health and prevention

Pupils should know:

• how to recognise early signs of physical illness, such as weight loss, or unexplained changes to the body
• about safe and unsafe exposure to the sun, and how to reduce the risk of sun damage, including skin cancer
• the importance of sufficient good quality sleep for good health and that a lack of sleep can affect weight, mood and ability to learn
• about dental health and the benefits of good oral hygiene and dental flossing, including regular check-ups at the dentist
• about personal hygiene and germs including bacteria, viruses, how they are spread and treated, and the importance of handwashing
• the facts and science relating to allergies, immunisation and vaccination

Basic first aid

Pupils should know:

• how to make a clear and efficient call to emergency services if necessary
• concepts of basic first-aid, for example dealing with common injuries, including head injuries

Changing adolescent body

Pupils should know:

• key facts about puberty and the changing adolescent body, particularly from age 9 through to age 11, including physical and emotional changes
• about menstrual wellbeing including the key facts about the menstrual cycle

Physical health and mental wellbeing: Secondary

It is important that the starting point for health and wellbeing education should be a focus on enabling pupils to make well-informed, positive choices for themselves. In secondary school, teaching should build on primary content and should introduce new content to older pupils at appropriate points. This should enable pupils to understand how their bodies are changing, how they are feeling and why, to further develop the language that they use to talk about their bodies, health and emotions and to understand why terms associated with mental and physical health difficulties should not be used pejoratively. This knowledge should enable pupils to understand where normal variations in emotions and physical complaints end and health and wellbeing issues begin.

Teaching about the impact of puberty, which will have started in primary school, should continue in secondary school, so that pupils are able to understand the physical and emotional changes, which take place at this time and their impact on their wider health and wellbeing.

Emphasis should continue to be given to steps pupils can take to protect and support their own health and wellbeing. They should know that there is a relationship between good physical health and good mental wellbeing and that this can also influence their ability to learn. Teachers should cover self-care, the benefits of physical activity and time spent outdoors. This should be linked to information on the benefits of sufficient sleep, good nutrition and strategies for building resilience.

Pupils should know the contribution that hobbies, interests and participation in their own communities can make to overall wellbeing. They should understand that humans are social beings and that outward-facing activity, especially that with a service focus (for example, work, volunteering and participation in organisations such as the scouts or the girl guiding movements, the National Citizen Service or the Duke of Edinburgh Award) are beneficial for wellbeing. This can also contribute to the development of the attributes for a happy and successful adult life. Pupils should be supported to recognise what makes them feel lonely. Self-focused or isolating lifestyle choices can lead to unhappiness and being disconnected from society for those who have greater need for companionship and relationships.

Pupils should also be taught about problems and challenges. This should include factual information about the prevalence and characteristics of more serious mental and physical health conditions, drugs, alcohol and information about effective interventions. Schools may also choose to teach about issues such as eating disorders ^{[footnote 1]}.

Teachers should be aware of common ‘adverse childhood experiences’ (such as family breakdown, bereavement and exposure to domestic violence) and when and how these may be affecting any of their pupils and so may be influencing how they experience these subjects. The impact of time spent online, the positive aspects of online support and negotiating social media, including online forums and gaming, should also be included. Teachers should understand that pupils who have experienced problems at home may depend more on schools for support.

Pupils should be taught how to judge when they, or someone they know, needs support and where they can seek help if they have concerns. This should include details on which adults in school (e.g. school nurses), and externally can help.

Schools should continue to develop knowledge on topics specified for primary as required and in addition cover the following content by the end of secondary:

Mental wellbeing

Pupils should know:

• how to talk about their emotions accurately and sensitively, using appropriate vocabulary
• that happiness is linked to being connected to others
• how to recognise the early signs of mental wellbeing concerns
• common types of mental ill health (e.g. anxiety and depression)
• how to critically evaluate when something they do or are involved in has a positive or negative effect on their own or others’ mental health
• the benefits and importance of physical exercise, time outdoors, community participation and voluntary and service-based activities on mental wellbeing and happiness

Internet safety and harms

Pupils should know:

• the similarities and differences between the online world and the physical world, including: the impact of unhealthy or obsessive comparison with others online (including through setting unrealistic expectations for body image), how people may curate a specific image of their life online, over-reliance on online relationships including social media, the risks related to online gambling including the accumulation of debt, how advertising and information is targeted at them and how to be a discerning consumer of information online
• how to identify harmful behaviours online (including bullying, abuse or harassment) and how to report, or find support, if they have been affected by those behaviours

Physical health and fitness

Pupils should know:

• the positive associations between physical activity and promotion of mental wellbeing, including as an approach to combat stress
• the characteristics and evidence of what constitutes a healthy lifestyle, maintaining a healthy weight, including the links between an inactive lifestyle and ill health, including cancer and cardio-vascular ill-health
• about the science relating to blood, organ and stem cell donation

Healthy eating

Pupils should know:

• how to maintain healthy eating and the links between a poor diet and health risks, including tooth decay and cancer

Drugs, alcohol and tobacco

Pupils should know:

• the facts about legal and illegal drugs and their associated risks, including the link between drug use, and the associated risks, including the link to serious mental health conditions
• the law relating to the supply and possession of illegal substances
• the physical and psychological risks associated with alcohol consumption and what constitutes low risk alcohol consumption in adulthood
• the physical and psychological consequences of addiction, including alcohol dependency
• awareness of the dangers of drugs which are prescribed but still present serious health risks
• the facts about the harms from smoking tobacco (particularly the link to lung cancer), the benefits of quitting and how to access support to do so

Health and prevention

Pupils should know:

• about personal hygiene, germs including bacteria, viruses, how they are spread, treatment and prevention of infection, and about antibiotics
• about dental health and the benefits of good oral hygiene and dental flossing, including healthy eating and regular check-ups at the dentist
• (late secondary) the benefits of regular self-examination and screening
• the facts and science relating to immunisation and vaccination
• the importance of sufficient good quality sleep for good health and how a lack of sleep can affect weight, mood and ability to learn

Basic first aid

Pupils should know:

• basic treatment for common injuries
• life-saving skills, including how to administer CPR ^{[footnote 2]}
• the purpose of defibrillators and when one might be needed

Changing adolescent body

Pupils should know:

• key facts about puberty, the changing adolescent body and menstrual wellbeing
• the main changes which take place in males and females, and the implications for emotional and physical health

1. Eating disorders and extreme weight loss are a specialised area and schools should use qualified support or advice as needed. Schools may consider accessing support from the NHS or local specialist services who may be able to provide advice and CPD for teachers. ↩

2. Cardio Pulmonary Resuscitation is usually best taught after 12 years old. ↩