Mental health and schools – a missed opportunity?

This week the former Care Minister, Paul Burstow MP, told Society Central that young people were being badly let down by mental health services. Today, Holly Taggart from the think tank, CentreForum, follows up with new evidence of missed opportunities in schools to prevent and support pupils with mental health problems.

Photo credit: World Bank Photo Collection

Children and young people are being left without the mental health support they need, leaving schools struggling to cope, according to our England wide survey of head teachers.

In England, one in ten children experience a mental health problem at any one time, equating to three children in every classroom. A further 20 per cent of children also display behavioural problems. However, too many children do not receive any form of support: several conduct disorders and eating disorders are undiagnosed and untreated and approximately 35 per cent of those with depression and 51 per cent of those with anxiety disorders are not in contact with any services.

The Care Minister, Norman Lamb MP recently described Child and Adolescent Mental Health Services (CAMHS) to be in crisis. That certainly appears to be the case considering the national shortage of beds which means children either having to travel hundreds of miles to their nearest unit or take a place on an adult mental health ward.

This follows a £50 million funding cut to CAMHS since 2010, with much of the services delivered in schools and local authorities being reduced, if not abolished. So what is the role of schools in promoting and protecting the mental health and well-being of pupils?

Variations in strategy

Our survey of head teachers aimed to ascertain the extent to which secondary schools in England are delivering a comprehensive mental health and well-being strategy.

This included the promotion of positive mental health, the identification of mental health problems, the delivery of interventions that promote positive mental health and interventions for complex problems; together with the referral of serious cases to CAMHS and the commissioning of services, in accordance with DfE guidance.

Our findings indicate that there is regional variation in the delivery of a mental health strategy and this also varies a great deal by the type of school, e.g. Academy, Independent, SEN school, PRU.

Three of the main themes that emerged were: early identification, promotion of positive mental health and accessing specialist services.

We know that early identification of mental health problems is essential, yet we found that:

  • Almost half (47 per cent) of respondents from mainstream, maintained schools and SEN schools say that increase in their general workload is impacting on their ability to identify mental health problems at the earliest possible point.
  • Less than half of schools (47 per cent) use screening tools, such as the Strengths and Difficulties Questionnaire to identify problems, but where these tools are used, 86 per cent say they are effective.
  • 65 per cent of teachers do not use screening tools to differentiate between severity of need (mild, moderate or severe) when a mental health problems is suspected; yet in schools where these tools are used, 85 per cent of head teachers reported they were effective.

Despite this, the majority of schools surveyed report that they implement programmes to promote positive mental health universally across the student population: 93 per cent do this within the course of Personal, Social, Health and Economic (PSHE) education; 94 per cent do this in other lessons such as drama; and 75 per cent promote positive mental health in school assemblies.

Support mechanisms not understood

A whole system approach, that involves the young person, their family, NHS services and schools is, therefore, crucial for effective partnership working and accessing specialist services. However, we found that:

  • More than half (54 per cent) of head teachers said they find their local mental health services ineffective in supporting pupils.
  • 87 per cent of head teacher also reported that pupils have identified the attitude of their parents/ guardian/ family as a barrier to accessing support.
  • Three quarters of schools (77 per cent) commission mental health services directly.

We concluded that whilst support mechanisms do exist in many schools, they don’t seem to be fully understood or utilised. This is particularly insightful, as children with severe behaviour problems or conduct disorder are twice as likely to leave school without any qualifications, while children with emotional problems are twice as likely as other children to have marked difficulties in reading, spelling and mathematics.

It is clear that missed opportunities in schools to prevent and support pupils with mental health problems has a much wider and damaging effect on life chances.

In moving towards a comprehensive child and adolescent mental health services system, we must ensure that the role of schools in promoting, protecting and providing early intervention for pupil mental health issues is fully utilised. This will not only improve mental and physical health outcomes but also improve attainment, attendance and productivity in later life.

We recommend the following:

  1. The national curriculum should include the requirement to teach children and young people how to look after their mental health and build emotional resilience.
  2. Teachers should receive training in child development, mental health and psychological resilience to enable them to identify children and young people who are vulnerable.
  3. All children and young people should be screened by teachers and other practitioners using tools such as the Strengths and Difficulties Questionnaire to identify those falling outside the normal range of healthy development.
  4. For young people experiencing mild to moderate mental health problems, there should be increased access to psychological as well as other therapies in schools or in the community.
  5. All agencies who work with children and young people need to work together to plan, commission and deliver a full range of  child and adolescent mental health services.