The designated mental health lead: what it means for schools
Go straight to
While education and health professionals may applaud the ambition of the green paper published last year, Transforming children and young people’s mental health provision, fundamental questions about its core proposals – in particular the introduction of a designated mental health lead in every school – remain unanswered.
This article outlines how schools will be able to get the most from this new role in a climate of restricted budgets. It draws on the government’s initial guidance and consultation, along with the advice of leading organisations in education and child and adolescent mental health.
The green paper set out the government's ‘three-pillar’ strategy.
- A designated senior lead for mental health in every school and college.
- New mental health support teams working with groups of schools and colleges.
- Trials of a four-week waiting time for access to child and adolescent mental health services (CAMHS).
In response to the green paper, the education and health select committees published a joint report, Failing a Generation, which amounts to a sobering criticism of the government's proposals. The committees express concern that the scope and focus of the planned interventions are insufficient, over too long a timescale and, in the case of the mental health lead role, lacking necessary detail and protected funding. They impress on the government to recognise that ‘mental health is a significant social justice issue’ for all children and young people.
It seems likely that the burden of delivering on the government’s ambition will fall squarely on schools and colleges. Schools will be incentivised to establish this role from their existing workforce, rather than recruiting new members of staff. However, Failing a Generation consistently highlights that it is likely financial remuneration will be needed to encourage senior teachers to take up the designated lead role.
However, notwithstanding the significant challenge posed to schools by the current lack of additional funding, the introduction of a designated lead role remains a valuable opportunity to put effective mental health awareness and intervention at the heart of school life.
The most immediate concern for schools should be the training for this role. In the green paper, the government pledges to support every school and college in identifying and training their designated mental health lead, rolling out this training to all settings by 2025.
We know from the green paper that the designated mental health leadwill be expected to have oversight on the school’s approach to mental health and wellbeing, with particular emphasis on creating and reviewing the school's behaviour policy, curriculum and pastoral support.
They will also need to consider:
- how to engage pupils and their parents in wider psycho-education, and help them access a range of mental health interventions
- how to promote staff wellbeing.
Organisations such as the British Psychological Society (BPS) and Association of Child and Adolescent Psychotherapists (ACPC) have drawn attention to the level of professional expertise needed to identify and treat emerging mental health needs in children and young people. Echoing their concerns, the Royal College of Psychiatry has suggested that this new role requires training that is 'high-quality, regularly updated and consistent across the country.’
Schools will be incentivised to establish this role from their existing workforce, rather than recruiting new members of staff
If the designated mental health lead is not equipped with the necessary skills to differentiate between the more complex referrals for CAMHS and cases of emerging need for the new mental health support teams, a key pillar of the approach outlined in the green paper will prove ineffective.
Priorities for the government
- Assess the feasibility of schools paying teachers more to take on the role, so that the designated mental health lead role becomes a new career pathway for existing staff.
- Standardise the training content associated with the role, so that every child who needs support can access services that are evidence-based and of a high quality.
Priorities for schools
- As a baseline, make sure that all staff have or will receive mental health awareness training specifically focused on children and young people.
Advocate for high quality training for the designated lead role. Ensure that any training:
- has a clear evidence base, and is accredited to an academic or clinical institution
- is subject to objective review and robust quality assurance processes.
- Build clear working links with children and young people’s mental health services so that the school can refer to the NHS when appropriate.
- Coordinate the school’s provision for young people’s mental health needs, including oversight of interventions where they are being delivered by staff.
- Oversee the mental health interventions that take place in school. In practice, this could mean supervising the delivery of CAMHS interventions within a school or college, while clinical responsibility for treatment and professional supervision is held by the NHS.
- Give applicable members of staff the knowledge and skills they need to support children with emerging mental health issues. One prevalent concern is that schools take a reactionary, not preventative approach when it comes to mental health.
- Assess the outcome of interventions on pupils’ attainment and wellbeing. This remains a fundamental question: what is actually making a difference to pupils’ mental health? CAMHS already use a number of different techniques to evaluate the impact of interventions, such as the strengths and difficulties questionnaire (SDQ) – how might these be applied in schools?
We know that multi-agency working in mental health support takes considerable time, care and multiple face-to-face meetings in order to work. But it can work.
It is vital that schools are seen as equal partners in the process of negotiating mental health care that meets the particularly needs of their pupils and communities. After all, effective relationships are paramount to safe, effective and economically viable professional mental health care.
Priorities for schools
- Build robust links with your local CAMHS commissioner and CAMHS senior clinical lead or service manager. Agree on a partnership-led approach to making referrals and supporting families, rather than ‘passing’ cases from agency to agency.
- Define local thresholds for CAMHS and mental health support team referrals. In partnership with CAMHS, begin differentiating what needs core CAMHS should address and what the new mental health support teams will cover. Schools should know what emotional and mental health needs can be held safely in school, and how to help pupils access more specialist intervention.
Other commentators have noted the similarities between the proposed designated mental health lead role and the already well-established designated safeguarding lead (DSL) role. Given that some DSLs will already be responsible for meeting mental health needs, they will also be expected to step in to the mental health lead role.
This could prove to be problematic: the responsibilities of the mental health lead are significantly broader, encompassing the immediate mental health needs of pupils and staff as well as the development of the school’s curriculum. Large schools and colleges may need to consider making the mental health lead a full-time SLT role.
While acknowledging the links between the two roles, the select committees recognised that ‘there is a clear difference between protecting and promoting wellbeing, and diagnosing and treating mental illness.’ Any training package for the mental health lead role should address the important differences between safeguarding and meeting mental health needs.
- Audit what you already provide for pupils’ mental health and wellbeing. How well do your counsellors, educational psychologists, peer mentors, and other pastoral care workers currently cooperate?
- Assess the extent of staff mental health needs in your school. Consider issuing a confidential staff survey to capture any prevalent sources of stress or anxiety.
- Review your school’s PSHE curriculum. How much time do you already devote to discussing the significance of mental health and emotional resilience?
- Gather input from parents on what advice they would value. Parents are increasingly concerned about the emotional wellbeing of their children, so it’s important to offer high quality advice and support in schools.
- Create a policy that sets out how the school supports pupils’ mental health and wellbeing. This should be written plainly, and easily accessible on the school website.
- Create a policy that sets out how the school promotes wellbeing for its staff. This should draw on the results of your staff survey, and explain what the school’s governors and senior leadership team are responsible for putting in place.
- Transforming children and young people’s mental health provision: a green paper, Department of Health and Social Care and Department for Education, December 2017
- The government’s green paper on mental health: failing a generation, Commons Education and Health and Social Care Select Committees, May 2018