New government advice highlights the route to CAMHS – but schools portray CAMHS as a service in crisis. What can we do to help pupils struggling with their mental health? Suzanne O’Connell reports.

"In order to help their pupils succeed, schools have a role to play in supporting them to be resilient and mentally healthy. There are a variety of things that schools can do, for all their pupils and for those with particular problems, to offer that support in an effective way.”

The above is taken from Mental Health and Behaviour in Schools (key point 1, page 5), a guidance document released in June by the Department for Education (DfE). It outlines how schools can identify, intervene, refer and commission. It provides case studies and good practice examples for schools trying to address pupils’ unmet mental health needs.

The guidance reflects the emphasis in the new SEND Code of Practice – behaviour is no longer a need in itself but the consequence of other learning needs or social problems. Identify these and address them and the behaviour should disappear.

But what if it doesn’t and the mental health needs persist? Then, it is CAMHS (Child and Adolescent Mental Health Services) that schools are advised to turn to. Yet, anyone with any experience of schools knows that a referral to CAMHS can be an uphill struggle. The service has always been a resource under stress. Now, it appears to be in crisis. 

CAMHS in crisis

The charity YoungMinds reports that 59 out of 98 (60 per cent) of local authorities in England have cut or frozen their CAMHS budgets since 2010/11. YoungMinds are campaigning to stop the cuts to CAMHS and through its “Fight the Pressure” campaign is also highlighting the difficulties young people are facing as a result of school stress, bullying, sexual pressure and lack of work opportunities. 

Enough is Enough: A report on child protection and mental health services for children and young people, by Adele Eastman at the Centre for Social Justice (June 2014), also raises serious concerns about statutory mental health provision. It states: “Our report has revealed a stark picture of some social care and statutory mental health services heaving under the current pressures and failing to take a child or young person-centred approach.”

The report paints a picture of a system that is overwhelmed and unable to cope with the complexity and depth of the traumatic family lives that children are experiencing. They refer to the inability of CAMHS to respond and the rising thresholds that are frustrating those making referrals (see also page 51, CAMHS under pressure).

School experiences 

This situation is not new or unexpected for schools. Briony Henshall is child welfare co-ordinator at Bodriggy Academy in Cornwall. Working at the school for the past two-and-a-half years, she expects to wait if a referral is made.

She explained: “CAMHS has a very high threshold. We can be waiting for months. We have built relationships with them and have a very good link person, but they are just overloaded and can’t react in the time we need them to.”

Having a close working relationship with local specialist CAMHS is one of the seven recommendations that the DfE makes for schools when referring serious cases. Another is encouraging the pupil and their parents to speak to their GP. 

David May, headteacher at Bodriggy, is not convinced of this as a solution either: “We have a case where a referral was made by a GP and we are still waiting for help in spite of expressing severe concerns about this child’s behaviour.”

Andy Fisher is assistant headteacher with responsibility for inclusion at Ocklynge Junior School in East Sussex. For him, the situation with CAMHS is no different than before: “It has always been difficult to make a referral to CAMHS, that hasn’t changed.” 

What has changed for Mr Fisher is the number of children presenting problems: “We are definitely seeing more children finding it difficult to settle in class and an increase in the complexity of need they are presenting, and it’s often very difficult to pinpoint the underlying causes of these behaviours. Many have troubled early lives.”

In the meantime, children continue to demonstrate a range of needs and schools are left to dig into their own reserves to support them. At both Bodriggy Academy and Ocklynge Junior School staff have been employed and resources established to meet the needs of pupils as quickly as possible.

The ‘Oasis’ facility at Ocklynge

Ocklynge Junior runs an “Oasis” facility for children who have additional emotional needs. This resource features in Mental Health and Behaviour in Schools as a case study example.

Mr Fisher explained: “It’s a purpose-built room that is equipped differently from a classroom,with comfy chairs, cushions and decorations, all meant to help children relax. Teachers fill in a referral form and include all kinds of issues such as low-level disruptive behaviour, friendship difficulties, anger, social and emotional needs and playground disputes.”

The room is similar to nurture provision and staff can be immediately responsive as problems emerge: “There are four members of staff,” Mr Fisher continued. “They are very skilled at adapting provision to the needs of the children. We want to be proactive and support these children as quickly as possible.”

It forms one of the different ways in which children are supported in groups or individually. Its flexibility is a key attribute: “It’s usually for six afternoons but often the difficulties are complex and children might return at different times.”

If the need is not met in this context then they do make referrals to outside agencies, including behaviour support services and CAMHS. Ocklynge also commissions the services of a parent support advisor employed by the county. Family support and involvement is a key factor in securing emotional health and wellbeing.

Commissioning your own services is becoming increasingly popular in the light of the difficulties schools are having in accessing services through their local authorities.

Adult support at Bodriggy

Mr May employs specialist staff at Bodriggy Academy. This includes a child welfare co-ordinator, an autism champion, a speech therapy assistant and SENCO.

“I feel that having adult support workers available is making a big difference,” he explained. “We need to have people right there when the need emerges.”

This, and the style of management and ethos of the school are what he considers to be the reasons for such effective provision and for Ofsted’s recent comments. In June, inspectors said of the school’s provision: “The school provides very high-quality care for its pupils whose circumstances make them vulnerable, demonstrating very effective links with parents and carers. This is strengthened by the school’s appointment of a child welfare co-ordinator who operates exceptionally well with the families. The school has also forged very close effective links with many outside support agencies.”

The school does not have an easy catchment area. With a larger than average number of pupils supported by the Pupil Premium and serving a deprived estate, Mr May is concerned about the increasing range of needs he sees among both pupils and families.

“I have been a headteacher for 25 years,” he explained, “I can see a growth in the complexity of need of some of our families. We have selective mutes, and autistic children, children whose needs are so complex it is very difficult to get to the real issues. I still occasionally meet a child, after all my years of headship, who I don’t really understand.”

For Mr May and his team, it isn’t just a matter of short-term fixes: “The approach of going in for six weeks to support a family and then withdrawing doesn’t work. They need more than that. After a while, the same needs arise. It all has to be joined up and not just a sticking plaster approach.”

Mr May is concerned that many schools are developing a culture that will hinder rather than support the mental wellbeing of its pupils. He said: “Putting too much pressure on staff creates illness and unhappiness, this has a knock-on effect to everyone in the school. Some schools I know are achieving outstanding results but at such a cost to pupils and staff.” For Mr May, leading a happy school is paramount. 

Ms Henshall is a key person when it comes to maintaining this overall ethos. Her work begins when individual staff refer a child to her and she opens up a conversation with them. “I start by talking,” she explained. “There might be some kind of creative activity that remains the focus for the discussion. In some cases that’s enough. Where it isn’t, I talk to the child about contacting their parents and will ask them too about our worries. 

“Sometimes it’s the parent who comes to us. It will often emerge that there is something happening at home that’s causing the change of behaviour. Then it’s a matter of alerting staff to this too.”

Ms Henshall is involved in helping equip other staff with the skills they need. For example, at the moment she is disseminating information about sensory processing disorder and recommends the Thrive Approach. This approach aims to help adults understand children’s behaviour and respond appropriately. 

“It’s being there everyday, available and accessible. Sometimes the children just need to off-load and share their worries, then they can rejoin their classes and continue with their work. It’s being there for them, when they need you.”

A luxury that CAMHS is simply not able to provide.  

  • Suzanne O’Connell is an education writer and former headteacher.

Further information and links