Mental health, safeguarding & child protection: Three key considerations

Written by: Elizabeth Rose | Published:
Image: Adobe Stock

The links between safeguarding, child protection and mental health are extensive, multi-layered, and complex – what should we be doing to keep children safe? Elizabeth Rose advises

When visiting schools, I am often told that the mental health and wellbeing of children is their primary safeguarding concern, with spiraling numbers of children experiencing mental health problems and a lack of support due to overstretched external agencies exacerbating the issue.

And this feedback is not just anecdotal. The Royal College of Psychiatrists recently analysed NHS digital data (RCP, 2021) and found that:

  • A total of 190,271 0 to 18-year-olds were referred to children and young people’s mental health services between April and June this year – up 134 per cent on the same period last year (81,170) and 96 per cent on 2019 (97,342).
  • A total of 8,552 children and young people were referred for urgent or emergency crisis care between April and June this year, up 80 per cent on the same period last year (4,741) and 64 per cent on 2019 (5,219).
  • A total of 340,694 children were in contact with children and young people’s mental health services at the end of June, up 25 per cent on the same month last year (272,529) and 51 per cent on June 2019 (225,480).

Schools are the frontline in supporting children with their mental health and safeguarding leads are often the people who pick up these issues and make decisions around support. But how does mental health interact with child protection, our statutory obligations and children’s vulnerability across the board – and most importantly, what should we do about it?

The three strands

When thinking about mental health and safeguarding in schools, it may be useful to separate approaches and understanding out into three main strands.

First, we need to consider mental health as a sign or symptom of abuse and neglect when responding to issues.

Second, we need to view mental health and wellbeing as a child protection issue in itself. If children are struggling with mental health problems, it can impact their development and they may physically harm themselves as a result, so this may require multi-agency or even statutory intervention.

Third, we must consider the additional vulnerabilities that children may be experiencing that might trigger mental health problems and those vulnerabilities that might arise as a result of poor mental health.

Separating these issues out makes it more straightforward to develop a strategy and establish who is responsible for what. Of course, behind this direct intervention, we also need a holistic approach to promoting children’s wellbeing – a “universal offer”.

1, Mental health as a possible sign of abuse

The statutory guidance Keeping Children Safe in Education (DfE, 2021) makes it very clear that all staff should be made aware that mental health problems may indicate abuse, neglect, or exploitation. It also states that staff should make the designated safeguarding lead (DSL) aware immediately if they have a mental health concern that is also a safeguarding concern.

Things to think about include:

  • Have you made it clear to staff that mental health issues may be an indicator of abuse? Think about the way you talk about signs of abuse in training and whether you have mentioned this directly.
  • Do staff understand what the signs of mental health problems may be? I would imagine that most schools make it clear that “changes in behaviour” are a cause for concern, but have you shared with staff some of the specifics around indicators of mental health issues?
  • Are reporting mechanisms for children clear and easy to understand? Children are often the first ones to notice that something is wrong with a friend or class-mate – would they know how to report mental health concerns?
  • Ensure that there are clear lines of communication between the DSL, the SENCO, and the mental health lead so that all relevant professionals have all of the pieces of the jigsaw.

2, Mental health as a child protection issue

Mental health is included on most local threshold documents, so it is helpful to consult these when responding to children who are presenting with concerns. As a generalisation (and you should always refer to your own local document), the thresholds tend to be:

  • Universal support: Able to manage emotions, relationships, and everyday difficulties.
  • Single agency early help: Low-level mental health issues, with no suicidal ideation or signs of self-harm.
  • Multi-agency early help or specialist (non-statutory) support: Difficulty coping and/or displaying signs, distress or impact on behaviour that may be consistent with a diagnosis of a mental health disorder.
  • Statutory intervention: Complex mental health issues that are so significant that they are affecting a child’s development, acute mental health needs, risk of suicide, risk of hospitalisation.

Things to think about include:

  • Each local safeguarding children partnership (LSCP) in each area will have different wording around these thresholds. Revisit yours as part of your mental health approach to ensure that you are working in line with local guidance.
  • Look more widely at the thresholds document and ensure that you are including mental health in any referrals for other issues, if necessary. This includes the mental health of the child involved, but also the parents, as this may make it harder to keep children safe.
  • Make sure you are aware of local early help support available. Consider ways that children can be supported with mental wellbeing that isn’t necessarily a specific mental health provision – things to improve self-esteem and peer relationships, for example – so that you can intervene early.

3, Mental health and vulnerabilities

Last year, the DfE published the report Complexity and challenge: A triennial analysis of Serious Case Reviews 2014-2017 (Brandon et al, 2020), which found that mental health problems were the most prevalent parental characteristic (55 per cent) in the 368 cases reviewed where children had been seriously harmed or had died.

Nearly half of the serious case reviews involving children aged over six reported mental health problems for the child themselves.

There is much greater emphasis in recent versions of Keeping Children Safe in Education on understanding the barriers faced by children who have experienced abuse and neglect. It states that: “Where children have suffered abuse and neglect, or other potentially traumatic adverse childhood experiences, this can have a lasting impact throughout childhood, adolescence and into adulthood. It is key that staff are aware of how these children’s experiences can impact on their mental health, behaviour, and education.”

We must recognise that children who have experienced abuse or neglect may experience mental health problems at the time or later and we need to respond to these sensitively. These adverse experiences may also manifest as poor behaviour, leading to exclusions and further heightening a child’s risk of contextual exploitation or abuse.

Things to think about include:

  • What is your universal offer to support all children with their mental health? Does your school promote mental wellbeing through the curriculum and through the behaviour policy?
  • What opportunities exist for children to be engaged in meaningful activity and play that promote wellbeing – such as extra-curricular groups, sports activities, or leadership roles?
  • Have you considered linking your work around aspiration to mental health and wellbeing? Hearing from children about their hopes and dreams and providing meaningful opportunities can be very powerful.
  • Think about how you communicate with any alternative provision around mental health support and information relating to individual children and their needs.
  • Consider implementing support for children early – through the use of a school counsellor, for example – to stop problems from becoming more severe.

Drawing this together

This is a short article discussing a broad topic, at a time when mental health and mental health leads in schools are very much in the spotlight. However, it is important when designing a mental health and wellbeing approach for your school – as you may well be doing in light of new training and funding becoming available (DfE, 2021b) – that you consider these complex and challenging areas that link so closely to abuse, neglect, exploitation, and harm.

It is essential that a wellbeing approach considers the most vulnerable children and thinking through the three strands above could help in designing an approach that improves or extends your safeguarding, child protection and wellbeing work in relation to mental health.

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