What does mental health provision in schools look like in practice? Zoe Dale provides a framework for planning your approach
As the green paper (Transforming Children and Young People’s Mental Health Provision) outlines, schools are expected to ensure their mental health provision is both proactive and focused on individual need. However, with long waiting lists for CAHMS and restricted school budgets, provision can often be reactive.
The current challenge is how to ‘situate’ mental health needs and mental health provision in schools within the statutory frames of SEND, safeguarding and pastoral care. This is a significant challenge: how do schools provide nuanced and proactive support, which ensures individual needs are met effectively?
Current statutory government guidance continues to highlight the pivotal role of schools in addressing key areas of need: SENs, safeguarding and mental health. (Keeping Children Safe in Education, Working Together to Safeguard Children, Children and Families Act 2014).
Utilise the 'three-pillar' strategy in the green paper
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Identify a designated mental health lead in your school or college. Consider combining this with the DSL role, if this can be a protected SLT role.
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Consult with your local CAMHS commissioner and CAMH service – is your area a ‘trailblazer’ for the green paper initiatives?
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Check if your school or college will have access to the new mental health support teams.
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Clarify if your local CAMHS is trialing a four-week waiting time for access to their services.
Provide for the individual
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All approaches to pastoral care should encompass continual reflection on how best to meet the pupil’s needs and achieve good outcomes.
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Evidence, record and review all the pastoral support you provide for your pupils. Detailed timelines can be key in accessing additional resources.
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The SEND cycle of assessment (2014 Children and Families Act) expects individualised assessment and the importance of a graduated approach (assess, plan do, review) as prerequisites for success in tailoring interventions.
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Provide guidance for external professionals on how to effectively contribute to EHC plans. Remember, EHC plans have a responsibility to identify all needs that impact on a pupil's educational, health and social needs. They then set out the additional support needed to meet those needs.
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Maintain a person-centred perspective with the EHC plan, with the child/young person’s views, wishes and feelings clearly evidenced throughout the plan.
Encompass mental health needs
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Audit and review how your school currently supports pupils’ emotional and mental health.
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Ensure that you manage and oversee mental health provision with the same due care given to safeguarding and SEND. (Remember the responsibilities of the DSL and designated mental health lead roles)
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Establish a structure of regular pastoral review and assessment forums which include both teaching and pastoral staff, encompassing mental health, SEN and safeguarding needs.
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At the very least, make sure that all staff have or will receive mental health awareness training specifically focused on children and young people.
Safeguarding
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Schools are expected to maintain an attitude of ‘it could happen here’ where safeguarding is concerned. When concerned about the welfare of a child, the best interests of the child remain paramount.
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The DSL or their deputy is expected to ‘always be available to discuss safeguarding concerns’ and to ensure clear deputising systems are in place. (DfE, 2018)
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The current guidance stresses the importance of early help. ‘Early help means providing support as soon as a problem emerges, at any point in a child’s life.’ (Working Together to Safeguard Children)
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Schools are expected to play a key role in identifying those in need of early help.
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Key staff in schools will be increasingly expected to take on a lead practitioner role, undertake assessments, provide help and coordinate the delivery of support services, alongside advocating on behalf of families.
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Early help can only be effective if local authorities have a clear ‘threshold document’ defining the roles and responsibilities of local services. In particular, what needs trigger a Child in Need and Section 47 assessment.
Invest in relationships
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Do you help parents to recognise the emotional and mental health needs of their child? Do they understand the difference they can make by supporting their child and how they can do this confidently?
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Use the support of a range of external specialists (CAMHS, LA safeguarding advisors, voluntary sector skill and knowledge) to build strong local links. How can these organisations come into, and work alongside your school?
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Invest in maintaining positive relationships with local health and children’s services. Try to avoid being bound by history and current pressures on local services and resources.
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Remember the impact of positive relationships: they have the power to transform relationships with colleagues, as well as children and young people in our care.
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How can we provide opportunities for consulting parents/carers at least once a term?
Case study: providing for the individual
Chelsea is 14 and has complex needs. A rare genetic mutation has left her with complex learning and emotional needs, but this condition does not have a formal diagnosis.
Learning presents many challenges and a worrying pattern is developing of Chelsea stating that she will ‘commit suicide’ or, when triggered by difficulties with completing school work or peer relationships, hitting her head against a wall. School is currently struggling to make a case for an EHC plan.
Action points: ‘minding the gap’ between services
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Re-assessment and review by CAMHS established that whilst Chelsea is not actively suicidal, she has significant difficulties with understanding and processing her distress.
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CAMHS provides individual therapeutic work in school to support greater social understanding and self-regulation. Parents are also offered psychological advice and support.
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In partnership with the SENCO and CAMHS, key school staff are supported to ‘de-escalate’ Chelsea’s distress, minimising the risk of further self harm. Support includes a time out card and structure around peer interactions at break times.
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CAMHS support parents to reflect on approaches to ‘de-escalation’ at home.
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Making a case for an Educational Psychologist review and EHC plan – SEN and CAMHS review and construct timeline of longstanding difficulties, outlining minimal impact of previous CAMHS and psychological interventions.
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If EHC plan is agreed, this would in turn support Chelsea’s needs being considered by the children’s disability team, rather than the generic support from early help.
Mental health at the centre of school provision
Mental health impacts on the functioning of all pupils and hugely contributes to safeguarding and pastoral care.
These remain challenging times for schools and how to maintain the focus on providing for the individual needs of pupils within our wider educational and pastoral practice is key. The current escalating incidence of children’s mental health needs reminds us that childhood distress is one of the key issues of our time.
By placing mental health and emotional resilience at the centre of a school’s provision for SEND, safeguarding and pastoral issues, we take a proactive stance in integrating pastoral approaches, enabling important gains for both individual children and the wider school community.
