Mental Health in Schools: Key policy developments

This showed that in 2022, 18 per cent of 2,866 pupils aged seven to 16 reported having a probable mental health disorder, equating to around one in every 5.5 children. This compares with 12 per cent in 2017 (one in nine) and 16.7 per cent in 2020 (one in six) suggesting there has been a significant rise since the start of the pandemic (see infographic).

Other studies have also reported rising prevalence in recent years. Research by University College London and the Sutton Trust last year found that 44 per cent of 16- and 17-year-olds that took part had “probable mental ill health”. This had risen from 35 per cent in 2017 and 23 per cent in 2007. The study, which looked at the mental health and wellbeing of 13,000 year 11 students, concluded that the decline in students' mental health had “likely been accelerated by the pandemic”. Mental ill health was more common among girls than boys, and those with problems were twice as likely to self-harm or attempt suicide.

A report published in February by the Office of the Children's Commissioner for England cites prevalence data from the 2021 Census that shows 1.4 million children aged seven to 17 as having a probable mental health disorder. NHS dashboard data shows that 668,000 children received at least one contact with children and young people's mental health services (CYPMHS) in 2021/22, which indicates that just 48 per cent accessed provision. The average waiting time from referral to CYPMHS and starting treatment was 32 days.

Several studies have shown the negative impact of the pandemic on children and young people's mental health, and the education select committee recently highlighted how it had led to a rise in children struggling at school. The government has put significant funding into a post-Covid education catch up programme, but the British Association of Counselling and Psychotherapy said this isn't enough and called for it to fund a counsellor in every secondary school.

Impact on schools

Rising numbers of pupils with mental health problems is adding to the pressure on schools, say teaching unions. A poll of school leaders and teachers by charity Place2Be and teaching union the NAHT last year found that increased levels of anxiety and other mental health disorders among pupils had affected their ability to engage in learning, behaviour in the classroom and their academic progress. Evidence gathered by the children's commissioner also found thousands of children were still missing from education post the pandemic.

The response from policymakers has focused on identifying children missing from education and encouraging schools to implement stringent behaviour policies, an approach criticised by teaching unions and campaigners for failing to address the underlying causes. A recent survey by the Children and Young People's Mental Health Coalition found that two-thirds of young people said that school behaviour policies are not always responsive to their mental health needs. The use by schools of exclusions, removal rooms, suspensions and non-attendance fines were criticised by education professionals and parents as harmful approaches. Young people from low-income households, with special educational needs and disabilities and from ethnic minority communities were disproportionately affected by school behaviour policies, while many young people interviewed for the coalition report said being subject to school behaviour management techniques had harmed their mental health.

The coalition says there needs to be greater recognition of the links between pupil mental health and behaviour in the classroom and calls for policymakers to develop system-wide approaches rather than making it the responsibility of just schools.

Secondary-school age pupils with a mental health disorder were less likely to feel safe at school than those without a disorder, according to the National Education Union survey. Meanwhile, teachers at secondary schools not rated “outstanding” by Ofsted were less likely to have received mental health training, research by the Early Intervention Foundation found last year.

Policy response

The green paper consultation, Transforming Children and Young People's Mental Health Provision, was published by the Department for Education and the Department of Health in December 2017. The green paper included several proposals to improve support for mental health in schools, including for every school and college to identify and train a designated senior lead for mental health, with relevant training rolled out to all areas by 2025, and to create new mental health support teams (MHSTs) to work with groups of schools and colleges, in addressing the problems of children with mild to moderate mental health problems and provide a link to services for children with severe problems.

MHSTs aim to strengthen partnerships between education providers and mental health services through linking schools with single points of contact in child and adolescent mental health services (CAMHS). A government pilot initially reached 255 schools.

As of 2022/23, 28 per cent of schools and colleges (about 6,800) were covered by an MHST and 35 per cent of pupils (see practice example). This is projected to rise to 35 per cent of schools and colleges and 44 per cent of learners by April 2024. There are around 400 MHSTs in operation currently, each covering an average of 8,500 learners. However, the children's commissioner and others want MHST's roll out to be sped up (see ADCS view).

In May 2021, up to 7,800 schools and colleges in England were offered initial funding worth £9.5m to train a senior mental health lead – an extra £7m was provided in 2022 to offer the training to a further 8,000 settings. DfE data shows that 13,800 schools and colleges (58 per cent) have claimed the £1,200 grant for the training, and there is a government commitment to offer this training to all state schools and colleges by 2025 (see training, below). In addition, a £7m Wellbeing for Education Recovery programme provided training, support and resources for staff dealing with children and young people experiencing additional pressures from the pandemic, including trauma, anxiety, or grief.

Alongside changes to relationships and sex education, the government announced the introduction of statutory health education in July 2018. The statutory guidance came into force in September 2020, with schools able to implement the changes from September 2019 if they wished. The requirements cover physical health and mental wellbeing and make clear that the two are interlinked.

MHSTs make progress

The Trailblazer programme, jointly led by the Department of Health and Social Care, NHS England and the Department for Education, funds the creation of MHSTs for schools and colleges. The first MHSTs began delivering services in England in January 2020. They work in schools and colleges, helping staff promote emotional wellbeing for pupils. They also support young people with mild to moderate mental health problems. This may be through tailored one-to-one and group activities.

Analysis of the Trailblazer's first three years undertaken by academics from several institutes including the University of Birmingham, identified positive outcomes from around 300 schools and colleges where MHSTs had been established. These included staff feeling more confident talking to young people about mental health, quicker access to support, stronger relationships between staff from different organisations and a speeding up of referrals.

Children and young people highlighted how they felt their concerns were listened to and staff would be able to help them. They mentioned how learning techniques helped them cope with stressful situations. They also highlighted how this helped them manage difficult experiences and feelings.

In the 25 areas studied, challenges emerged around staff retention and the ability to support children with specialist needs. Concerns were also raised about the suitability of cognitive behaviour therapy approaches for some problems, and how to achieve a good balance between supporting children with mental health conditions and promoting good emotional health.

Commenting on the Trailblazer analysis, lead researcher Dr Jo Ellins, from the University of Birmingham, said: “Overall, children and young people who had contact with an MHST reported an overwhelmingly positive experience. Mental health services in schools and colleges are facing increased pressure, particularly following the pandemic, and the programme has significant potential. But teams may find it difficult to sustain activities focusing on promoting wellbeing, given the increasing demand for mental health support.”

The bigger picture

While there are some encouraging signs that MHSTs can help young people with emerging problems access services there are concerns about pupils who fall outside of their remit – particularly, those whose problems may be of sufficient severity to be beyond the skills of a school-based team but may not meet the high thresholds for referral to CAMHS.

This situation was articulated by one education setting involved in the Trailblazer pilot report: “We have quite complex mental health issues in school. These cannot be handled by the MHST and yet I know that the CAMHS is also over-run with referrals. Unless these children receive timely, prolonged support, their mental health will continue to decline.”

The children's commissioner for England's recent report highlights lengthening delays in accessing CAMHS as a key factor in children missing education and their mental wellbeing deteriorating - waiting times of more than a year from referral to treatment in some parts of the country are commonplace. Despite the evidence that some children are falling through the gaps between MHSTs and CAMHS, the commissioner calls for every school to have a team by 2025 to help address rising demand for help.

To that end, the Trailblazer evaluation cites examples of some MHSTs that have adapted their approach to use clinicians' therapeutic skills to support pupils' unmet needs. As one MHST manager said: “Those young people who fall through the gap…are the cases we're now starting to work with…supervisors now are able to step into their role as clinicians a bit more which they weren't able to do in the first year.”

The role of MHSTs and how they dovetail with CAMHS will be crucial to ensuring children don't fall through the cracks in services. It will also make schools a key agency in referring children for specialist support. Some settings however are going further by working with specialist organisations to embed a mentally healthy school culture. For example, Thrive, The Place2Be and the Anna Freud Centre's Mentally Healthy Schools initiative are working with schools to implement evidence-based approaches to supporting pupils' mental health and wellbeing (see practice example).

At the front end of this process, schools are already delivering a mental wellbeing curriculum through statutory PSHE education. However, some experts think the building blocks for good mental health need to be developed earlier and built into the everyday experience of children. One such expert, Nadim Saad, an author and parenting coach, has launched a campaign calling for schools, families and policymakers to “invest 10 minutes a day to children's mental wellbeing” (see interview).

Policymakers and parents increasingly recognise the importance of mental wellbeing in children being happy and healthy and fulfilling their potential. With greater awareness comes increased demand and expectations, and over the coming years schools look set to play a crucial role in ensuring children who need mental health support get it in timely way.

ADCS VIEW
CONNECT SCHOOLS AND COMMUNITIES TO BETTER SUPPORT CHILDREN

By John Pearce, ADCS president 2023/24

Poor mental health and wellbeing can have a lasting impact on children and young people's life chances, but they face multiple pressures in their lives that adversely affect their mental health. The numbers are stark: one in six children have a probable mental health disorder, up from one in nine prior to the pandemic. We must be ambitious if we are to meet the growing, and urgent, need for mental health support both inside and outside of the classroom.

Accessing the right support early can make a huge difference, yet too many children are waiting months for an assessment and over a year for treatment. We need far better access to mental health services for children and young people with waiting times for accessing CAMHS (child and adolescent mental health services) being far too long, however, schools also play a key role.

We know that schools are often the best environment for early identification where teachers, school counsellors and learning support staff see children every day and can spot the signs of distress quickly. Most mental health illnesses begin during childhood but unless problems are diagnosed early, we cannot provide the help and support that many children urgently need.

A target of 35 per cent of schools having a mental health support team does not go far enough, nor does it recognise the crisis in children's mental health that we face. We need a sustainable long-term funding strategy for children and young people's mental health that leaves no child at the mercy of a postcode lottery. Teachers must also be given the time and resource to deliver these important messages effectively.

Children and young people face multiple pressures, both online and in the classroom and these have only been exacerbated by the pandemic. However, many teachers are reporting being unable to access CAMHS or other relevant support. We need to think differently about how we integrate services across places so that children's outcomes are at the heart of every decision made by all partners. This goes beyond structures but focuses on how we can meet all children's needs, with local schools and community services better connected. The role of local authorities as leaders of “place” would be key.

Local authorities, schools and education settings are doing all they can to respond to the situation, including by stepping in when children cannot access the support they need, but this is not sustainable. The current system is not working, yet children and young people tell us it is their biggest concern. We owe it to them to get it right.

TRAINING TO BECOME A SENIOR MENTAL HEALTH LEAD

WHAT IS A MENTAL HEALTH LEAD?

The Department for Education is offering a grant of £1,200 for eligible state-funded schools and colleges in England to train a senior mental health lead to develop and implement a whole school or college approach to mental health and wellbeing. Schools and colleges can decide who is best placed to take on the role of senior mental health lead and undertake the training – it could be a head teacher, deputy head, member of the senior leadership team or an appropriate member of staff who is empowered to develop and oversee a whole school's approach.

WHAT DOES THE TRAINING COVER?

There are a set of learning outcomes that participants achieve, and which are aligned with the DfE and Public Health England's principles to promote children and young people's emotional health and wellbeing. These outcomes cover identifying needs and monitoring the impact of interventions, how to target support and refer children to specialist services, staff development and creating the right culture, and working with children and parents. This is underpinned by research that indicates a co-ordinated and evidence-informed approach to mental health and wellbeing leads to improved emotional health and wellbeing in children and young people, and greater readiness to learn.

HOW TO APPLY

There is a three-stage process to applying for funding. An initial check ascertains eligibility after which a place on a DfE quality-assured training course can be booked. This has to start before 31 March 2024. Proof of the booking is then submitted to process the grant claim. Grants will be provided to cover (or contribute to) the cost of attending a quality-assured course and may also be used to hire supply staff while leads are engaged in learning. Eligible settings are able to claim only one grant, so the DfE advises to take into account succession-planning and career development plans when choosing a senior mental health lead.

Source: Learning outcomes for senior mental health leads in schools and colleges, DfE, June 2021

• Read more in CYP Now's Mental Health in Schools Special Report
  
  

FURTHER READING

• Behaviour and mental health in schools enquiry, Children and Young People's Mental Health Coalition, June 2023

• Children's mental health services 2021/22, children's commissioner for England, March 2023

• Evaluation of the Trailblazer programme, NIHR, January 2023

• COSMO study, UCL and Sutton Trust, November 2022

• Children and young people's mental health survey, NHS Digital, November 2022

• Education Catch-up Programme, education select committee, May 2022

• Transforming Children and Young People's Mental Health Provision, DfE and DoH, December 2017