Must do better

Reports last month that fellow school pupils of the murdered
Soham children Jessica Chapman and Holly Wells have been offered or
are receiving counselling to cope with the recent tragedy suggest
that schools are better able to respond to mental health issues now
than when many of us were at school.

But there are still concerns that, when not faced with a high
profile and obvious trauma, schools are not doing enough to cope
with the small but increasing number of young people with
psychological problems. Many disorders rise or peak during the
teenage years, including suicide and suicidal or self-harming
behaviour, depression, eating disorders and alcohol and drug abuse.
Thus early intervention in primary and secondary schools, sometimes
earlier, is key to promoting good mental health in children.

The Office for National Statistics (ONS) estimates that one in 10
children aged between five and 15 experience clinically defined
mental health problems, while the Mental Health Foundation says one
in seven pre-school children have some kind of mental health

But YoungMinds director Peter Wilson advocates unpacking the ONS
figures carefully. “Schools are enormously important places where
[children] spend a large proportion of their time developing
personally and emotionally and “building” their mental

He estimates that about 1 per cent of children “really do suffer
what we could call illness” – some type of easily identifiable
mental disorder. Of the remainder, most are children with emotional
and behavioural difficulties that are caused largely by distressing

Too often these children end up in a special school or pupil
referral unit. According to a report published in August by the
Mental Health Foundation, 20,000-25,000 pupils attend special
schools and PRUs in England. “Commonly their difficulties are
‘socially constructed’, often exacerbated by experience beyond the
special school or PRU,” says the report, The Mental Health
Needs of Young People with Emotional and Behavioural

Although the report recognises the need for special schools and
PRUs, it calls for a focus on developing mainstream schools that
better understand children’s emotional needs, thus reducing future
dependence on alternative school settings. There also needs to be a
stronger emphasis on the promotion of mental health and pastoral
care in mainstream and special schools.

The government’s approach to these issues in mainstream schools is
set out in guidance published last year1 by the
Department for Education and Skills. In her foreword, early years
and school standards minister Catherine Ashton says: “The school
may be better placed to support and maintain progress achieved by
children with mental health problems than may contact with a health
professional, seen solely for specific problems and for the
duration of that problem.”

While that may be so, this core piece of guidance is only given the
status of “strongly recommended” – as if it were a particularly
good brand of washing powder – so doubts must remain over its use
and efficacy.

The document talks of “whole school approaches” to promoting
children’s mental health, involving dedicated senior management and
generating a school culture that values all those engaged in the
care of children, clear policies on behaviour and bullying, low
staff turnover, good training in child development and skilful
teaching which arouses the interest of the pupils and motivates

Early interventions in mental health problems could range from
positive classroom management techniques to playground schemes such
as circles of friends and other forms of peer support, or play
assistants. In more complex situations, one-to-one educational and
therapeutic work may be needed or even medication.

Teachers and other education professionals all need to know what
they are dealing with, says the guidance.

Yet, although teachers can play a major role in the early detection
of mental health problems, they receive little or no training in
child development, mental health needs or pastoral care.

According to a training needs analysis carried out by YoungMinds in
one English region in 2000, 80 per cent of front-line staff,
including teachers, had received no relevant training on child
mental health.

“Pre-qualification training is a major issue,” says the Mental
Health Foundation’s director of Scotland and UK development Maddy
Halliday, emphasising the need to give teachers more room within
the crowded national curriculum to promote mental health issues.
But she also highlights a more fundamental issue in the way
education is viewed in Britain.

“The focus is on education for vocation, rather than education for
life,” she says. “There is a conceptual and policy division between
human development and a narrowly defined concept of education.”
This division is widened by a “deeply embedded bias to physical
health” within school life, she adds.

This bias is seen in the DfES’s National Healthy Schools Standard
and Programme, an initiative to create “enjoyable, safe, productive
learning environments”, with “minimal health risks”. Mental health
is covered, largely in the form of the existing guidance, but more
space is devoted to alcohol, smoking, drugs, disability issues,
bullying, child protection and sex and relationships.

Which is not to dismiss the Healthy Schools Standard, but it does
highlight a policy blind spot. Mental health is bizarrely neglected
in the pursuit of better academic performances from pupils, says
Halliday. “The capacity to learn is predicated on mental
well-being.” But she goes further, claiming that, currently, a lot
of policy is not properly informed.

In short, a culture change is needed. Although there are examples
of good initiatives, there needs to be a proper look at the whole
school approach advocated by the DfES, says Wilson.

He argues for a high-level intervention in schools at the head and
governor level, with an extended but defined timetable of
discussions about mental health within the whole school. There has
to be an understanding of each school as a large corporate
organisation, each with its own concept of what matters.

But few people have the expertise to help schools through such a
culture change. They need to understand group or people dynamics,
as well as having mental health expertise. Some voluntary agencies
and other organisations can offer this sort of training and
consultancy, but it is scarce. One possible solution has been the
government’s hurried launch of behaviour and emotional support
teams (Bests).

Although not solely directed at dealing with mental health
problems, the initiative includes the development of behaviour
improvement programmes involving Bests made up of four or five
people from education, social services and health

DfES director of pupil support and inclusion Tom Jeffrey says: “The
aim is to offer intensive support on a key worker basis for
children aged five to 13 who are showing signs of emotional and
behavioural problems.”

Wilson supports the idea, but is worried there are not enough
“right people to take it on”. One only has to look at the array of
people already working in or with schools on children’s issues (see
panel, left) to realise there cannot be many left with the

In many cases it will still be the teachers who will be best placed
to make early interventions. But, with their workload and other
pressures, how realistic is it for them to take on this added

As Wilson says: “A teacher is a fine and beautiful instrument.” It
is a question of enabling teachers to be better resourced. You have
to appreciate what they know and how to excite their interest to
develop the necessary mental health expertise,” he adds. Therein
lies the challenge.

Promoting Children’s Mental Health within
Early Years and School Settings
, DfEE 2001, and a summarised
version, DfES 0619/2001, 2001

Support for Schools

  • Internal and external staff that can help schools meet pupils’
    mental health needs:
  • Special educational needs co-ordinator.
  • Learning support assistants. 
  • Peer support networks.
  • Home-school link workers.
  • Pastoral staff.
  • Learning mentors.
  • Personal Connexions advisers.
  • Education social workers.
  • Behavioural support staff.
  • Educational psychologists.
  • School nurses.
  • Primary mental health workers.
  • Social services staff.
  • Health staff operating outside school, including health
    visitors, practice nurses, GPs, speech therapists and community
  • Specialist mental health professionals, including clinical
    psychologists, psychiatrists and community psychiatric nurses (all
    often located within child and adolescent mental health

More from Community Care

Comments are closed.