At last, mental health proposals that recognise the importance of schools.
Teachers are often among the first to notice when a pupil’s psychological state deteriorates: the school absences, the trouble concentrating in class, difficulty making friends, depression, low moods, even self-harm. But the trouble is that schools, under increasing financial pressure, have not been able to prioritise the pastoral support that can make a difference.
That could change under proposals outlined in the government Green Paper – Transforming Children and Young People’s Mental Health Provision – which sets out a clear role for schools with a strong emphasis on prevention and early access to support.
The plans are long overdue. Recent research suggests that at age 14, one in four girls and one in 10 boys suffer from symptoms of depression. Headteachers have confirmed that as they experience a dramatic increase in the number of students suffering from mental health and wellbeing issues, specialist support from services beyond the school gates is increasingly difficult to access.
It was no exaggeration that the prime minster described this as one of the “burning injustices” of our time, pledging to “transform” the way the country deals with mental health problems “across society and at every stage of life”.
For school-aged children this transformation will be spearheaded by a member of staff designated to lead on mental health work within their school. Schools will be offered incentives and support to introduce these designated leads, who it is hoped will engender a whole-school approach to mental health.
The National Children’s Bureau hosts the Partnership for Well-being and Mental Health in Schools, and has advocated for a whole-school approach for many years. We want to see schools supported to create an ethos across the whole school community, from governors to playground supervisors, where emotional welfare is a top priority and where this is threaded through the school’s policies, curriculum and pastoral support.
One of the areas the designated lead must focus on is bullying. We know that being bullied at school affects young people’s mental health and emotional wellbeing. We also know that the relationship between bullying and metal health is complicated: some children are bullied as a result of their mental health issues, and some young people develop mental health issues because they are bullied.
While the government Green Paper sets out evidence that school-wide anti-bullying programmes have the potential to stop bullying, the proposals stop short of requiring the designated lead to have responsibility for tackling bullying as part of their whole-school approach to mental health.
Similarly, in relation to PSHE and relationships and sex education (RSE), we hope the government will state explicitly how the designated leads in schools should use these subjects to their full potential. PSHE could teach children how to describe emotions, talk about anxiety and worries, and develop coping strategies.
Older children can learn in more detail about how to respond to eating disorders, self-harm, depression and anxiety. Similarly, RSE, when it is properly inclusive for all pupils, can help children understand the importance of healthy relationships in supporting mental health.
And what about pupils who are particularly prone to suffering poor mental health? Children in care have often suffered from disruptions, trauma, abuse, or neglect prior to entering the care system so may have particular mental health needs. These vulnerable young people, who often don’t meet a clinical threshold for specialist NHS care, could benefit greatly from support at school.
The government is currently piloting mental health assessments for children in care, at present it is unclear how these will dovetail with the work of the designated lead in schools. This must be addressed.
There are also outstanding questions about how the new designated leads will work with the SENCO to ensure that the mental health and wellbeing needs of children with SEND are appropriately reflected in their Education and Health Care Plans.
Schools should also benefit by the creation of Mental Health Support Teams, designed to act as a link between schools, specialist mental health services and other community support groups. By providing support such as cognitive behavioural therapy to children showing the early signs of distress, the new Mental Health Support Teams could provide a lifeline for the thousands of children caught in the middle ground, whose needs are beyond the means of schools but don’t reach the threshold for specialist mental health services. They could also reduce the strain on specialist services so they have greater capacity to work with children in acute need.
For these children, the ones with levels of psychological distress that require interventions by properly trained, clinical mental health teams, accessing support should become easier. The introduction of four-week waiting times will help restore faith in the system, and ensure that children’s mental health issues are treated promptly rather than being left to deteriorate.
The pilots of the new waiting times must look in detail at how to prevent perverse incentives, such as unintentionally raising thresholds for care, and their widespread introduction must be backed by adequate resources to meet the increased demand on the system.
All-in-all the proposals could mark an important milestone in how children access mental health support, but the trouble with the government’s plans is not the proposals themselves but the lack of urgency. Children in urgent need today will not benefit from the new way of working as none of the Green Paper’s initiatives will be funded until 2019 at the earliest and the majority of areas won’t see them implemented until after 2023.
So while we should be applauding the Departments of Education and Health for working together and coming up with a promising plan for young people’s mental health, and for recognising the key part that schools must play, it is also obvious that children and young people can’t wait five years or more to receive the benefits.
- Anna Feuchtwang is chief executive of the National Children’s Bureau.
Further information
- Transforming Children and Young People’s Mental Health Provision: A Green Paper, Department for Education, Department of Health, December 2017: http://bit.ly/2nOHFel
- A consultation on the proposals within the Green Paper has been opened and will close at noon on March 2. Visit https://engage.dh.gov.uk/youngmentalhealth/
- To find out about the Partnership for Well-being and Mental Health in schools visit http://bit.ly/2l0XXjh