How the Best programme can help improve mental health services in schools

There is little flesh yet on the bones of the government’s recent announcement to spend £60m over the next three years to support schools working with mental health practitioners. But there will be no shortage of advice from experts and practitioners who believe that it provides a golden opportunity to extend existing successful preventive work, particularly into secondary schools.

Statistics abound about the scale of the problem. For example, an Office of National Statistics survey in 2004 showed that 10% of children suffer from mental health problems. Recently, the National Institute for Clinical Excellence said that only 25% of children with depression were detected.

While many schools work closely with mental health practitioners, there is a recognition in the teaching profession that more awareness is needed about how to identify and treat mental health conditions. A survey of teachers last year conducted by the Barnet, Enfield and Haringey Mental Health Trust on behalf of the NASUWT teachers’ union concluded that information about pupils’ problems was “not being shared between schools or even within schools”.

There is also concern among practitioners assigned to work with schools. Mental health practitioners often feel frustrated by the way some schools want to set the agenda and use them “in ways in which they have not been trained and which do not meet their original brief”, says Alison Towndrow, administrator of the child and adolescent mental health and educational psychology services in the London Borough of Enfield.

As a former secondary school head teacher, Young Minds chief executive Barbara Herts welcomes the government’s money but insists that it must be allied to a pledge that the Department of Health will work with the Department of Children, Schools and Families. In particular, the £60m should not be used “to bail out the NHS” by helping to make up the shortfall of child psychiatrists, therapists and counsellors – a cost, she says, the DH should help to meet.

It is equally important, she adds, that the government builds on existing good practice of multi-agency working exemplified by Behaviour and Education Support Team (Best) initiatives, which were started in 34 pilot areas in 2002 as part of the Behaviour Improvement Programme.

Best was designed to “promote emotional well-being, positive mental health, positive behaviour and school attendance among children and young people, and help in the identification and support of those with, or at risk of, emotional and behavioural problems, through the provision of multi-agency support in schools and to families”.

Kim Wade played a pivotal role in developing Manchester’s Best and was seconded to work part-time for the then Department for Education and Skills to help broaden this work into 50 other areas. She says that while mental health practitioners went into school in the past, it was usually in response to a specific identified need. “It was like putting a soothing plaster on the problem and not getting to the core,” she adds.

She says the strength of the Best approach, which she believes should be developed, is that it works closely with parents and carers as well as children. “If you work with children on mental health issues in schools, often those youngsters come from families where there have been instances of mental health problems so it is important to work with adults too.”

For the past five years, Elspeth Bromiley, Camhs lead in education at Liverpool Council, has been at the heart of a preventive strategy involving multi-agency teams comprising Camhs workers, youth and social workers, nurses, the police, educational psychologists and welfare officers. The aim has been to pick up early signs of mental health problems and signpost children to groups in schools, including those using cognitive behaviour therapy for anger and anxiety and ones that build self-esteem and resilience.

A key policy objective has been “to stem the flow of kids being referred early to Camhs”. She believes teachers need “to think differently about these young people”.

She adds: “At the end of the three years [when the £60m is to be spent] you would want teachers skilled up to manage quite a lot of this stuff without having to refer on.”

She says teachers often view a child’s behaviour as something that requires immediate referral, rather than as a way of communicating how they are feeling. “We come into the school and talk to the teacher about what this behaviour is about and work out the best way forward. It may involve some form of containment, a clear behaviour plan or it may mean referral. It’s a question of working jointly to see what needs to be done instead of referring the child elsewhere.”

Denny Grant, Camhs assistant director and principal educational psychologist in Enfield, believes some of the £60m could be used to extend the type of therapeutic work done by the charity, Place 2 Be, which supports many children in primary schools.

He says depression and self-harming occur among secondary school pupils and in Enfield there are plans to develop counselling support, which would mirror what is already happening in primary schools.

How the government intends to use the £60m remains unclear, but ministers and officials would do well to listen hard to the advice on offer.

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