“For many children we are the first point of contact”: supporting children’s mental health in schools

A 2018 evidence review from Public Health England reported that one in 10 young people have some form of diagnosable mental health condition. This, the report suggests, equates to as many as 850,000 children and young people with a diagnosable mental health disorder in the UK. It also reported that half of all mental health problems emerge before the age of 14, and children with persistent mental health problems face unequal chances in life.

Research has also highlighted the impact of “key factors” like poverty and adverse childhood experiences (ACEs), including emotional trauma, abuse or neglect (which people living in higher areas of deprivation are more likely to experience) on an individual’s chance of developing a mental illness. However, an additional factor often cited in surveys around child mental health and wellbeing is the impact of school, including exam stress, and bullying. Mental ill health has also been found to have an impact on attainment, behaviour and a child’s ability to learn. As a result, teachers are often part of the front line of supporting adults for children who are suffering from mental ill health, with increasing pressure being placed on teachers and schools to identify and signpost children to other services.

Schools, as well as teachers,  are increasingly becoming a focus for the delivery of Child and Adolescent Mental Health Services (CAMHS) in their community. Often schools are at the centre of their local community, so it is logistically convenient to coordinate services there; it can for some be a less intimidating or stigmatising environment than attending a clinic at a GP surgery, for example. School is the primary developmental space that children encounter after their family, and children’s learning and development and their mental health are often interrelated, so it makes sense for teachers to take an interest in terms of attainment and progress in learning. In December 2017, the Department of Health and Department for Education (DfE) published the Green Paper Transforming children and young people’s mental health provision which highlighted the role of schools as key in promoting a positive message about mental health and wellbeing among school age children and young people.

Good work is already being done, but how can we do more?

Research has shown that there is already a lot of good and effective practice being done in schools around children’s mental health. Many schools already work in partnership with local health teams to provide in house CAMHS support in the form of mental health nurses and social workers who are posted on site for children to access. One of the major recommendations in a 2018 Audit Scotland report on child mental health in Scotland was to encourage more of this type of partnership working. The report stressed the importance of joint working between public services if child mental health is to be improved, and where possible to include as wide a spectrum of public services in the delivery of CAMHS support, including criminal justice and housing practitioners, as well as health and social care and education staff.

In some schools senior pupils and designated members of staff are being offered mental health first aid training, and wear lanyards to help students identify them should they ever need to talk to someone. While it is important – particularly for students who participate in mental health first aid programmes – to be made aware of the challenges the role may entail, it can be a rewarding experience for young people to participate in and can also be a vital in-road to support for some students who would otherwise feel uncomfortable talking to a member of staff.

Other programmes like those developed by the Anna Freud National Centre for Children and Families, Centre for Mental Health and the ICE PACK and Kitbag tools (which have been used widely in UK schools) look at resilience building  and promoting coping mechanisms among young people, as well as encouraging the creation of trusting relationships which focus on nurturing and normalising mental illness to encourage children and young people to feel comfortable discussing their feelings and thoughts. These programmes also integrate early intervention and prevention approaches, hoping to identify children and young people who are suffering from mental illness as early as possible and signpost them to appropriate support.

The specific role of teachers

Teachers need to remember that they are not health or social care professionals and that – as much as they would like to completely solve all of the problems of their students – they can only do what they can, and that is enough.

It is also very important for teachers to practise what they preach in as much as teacher self-care is as important as signposting children and young people who are struggling with mental health issues. A 2016 survey by the National Union of Teachers (NUT) found almost half of teachers had sought help from their doctor for stress-related condition. Teacher stress and burnout and those leaving the profession due to conditions like stress do not help to create an environment that is supportive of good mental health in the classroom. Teacher wellbeing is so important and building their own resilience is one way that teachers can start to embed good mental health in their practice. If you are doing it yourself it will be easier to help and show children how to do it if they come to you for advice!

Teachers simply being there and offering a safe space and first point of contact for many children is important. Listening and signposting can be so valuable for those pupils taking the first step and teachers should not be put off by any personal perception of a lack of expertise in mental health – a small amount of knowledge or understanding of what to do next is more than enough. In some respects, teachers should feel almost privileged that a student has chosen to come to them, someone they feel they can trust and talk to.

A poll conducted as part of a webinar held for educational practitioners found that rather than requiring more information about mental illness, what teachers actually wanted was more practical examples of how to apply support in the classroom and how to embed mental health into their teaching and the learning of their students.

A unique opportunity

Schools and teachers are on the front line of public services and have a unique opportunity through regular contact with children to help to build and promote resilience among pupils, and embedding this within the whole school can be an effective way of ensuring pupils feel the benefit without being singled out. Taking nurturing approaches to learning and teaching, and promoting the creation of trusting relationships is key to some of the already effective practice going on in schools. Sharing the learning and best practice that is already happening will be vital to ensuring that support for children suffering from mental ill health improves and adapts to changing needs in the future.


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Writing and recovery: creative writing as a response to mental ill health

Addressing social mobility through education – is it enough?

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

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Parental capacity to change: a new approach to child protection assessments

“Current assessments focus more on harm to the child and its causation than on capacity to change”

The assessments undertaken by social workers on children who are on the edge of care are significant. Very few, if any, assessments are straight forward; many cases are complex, with children and their families facing multiple social barriers, poverty, crime, addiction or mental health issues.

paper family on hand

Very little standardisation of practice exists and the pressure and scrutiny on social workers and their professional judgement can sometimes be unbearable. Increasingly there has been a development in the literature around child protection which suggests that social workers’ assessments should reflect the complexities of family life and should acknowledge efforts of parents to positively adapt their lifestyle in order to allow them to care for their child.

The parental capacity to change, as well as the capacity to parent effectively should be considered in these assessments.

Assessing a combination of motivation and ability, professionals it has been suggested, should work with parents to assess their readiness to accept or deny the need for change when completing their assessments. Provided that change can occur in an appropriate time frame for the child in question, professionals can work with the parents to achieve the best outcome for the child remaining with parents where possible, and returning to parents when possible, if additional action to change is necessary.

bambole di stoffa

C-Change Approach.
There has been a push of late to encourage social services to look at the needs of the parent as much as the needs of the child, and to offer support to families throughout the period the child is with them, particularly when the child has been returned to them after a period in social care.

This approach is about developing relationships between social workers and families and creating realistic, clear and accessible targets for parents, to show their change process, and progress,  and to build an understanding of what is expected of them, with the social worker acting as an assessor but also as a motivator and a facilitator to change. Plans should be long term to create stability and a solid goal, but should also be short term enough to show regular results to keep morale high and to regularly show positive progression.

This new long term approach seeks to change behaviour in parents, but evidencing behaviour change can be difficult. Previously, research suggested that parents changed in part, so as to re-gain custody of their children, but that after time they often relapse which led to the child being taken back into care. This inconsistent approach is something which government and the third sector are trying to address through relationship building and long term consistent and implemented strategies, although it is becoming increasingly difficult given the increased demands on budgets and calls for greater efficiency within the sector.

As a result, guidance on the C-Change model emphasises that there must also be tangible consequences for those who fail to comply or who relapse – it is about altering a mindset and a behaviour – and rewards should be agreed for milestones and achievements in the same way as consequences should be in place for non-compliance.

Image by Jerry Wong, via Creative Commons License

Image by xcode via Creative Commons

Shaking the negativity
The literature which considers parental capacity to change as a way to approach social work assessment highlights a common trend – the apparent failure of social services to provide sufficient support to parents and children once the child has been returned. This in turn, the research suggests, leads to more children being taken back into care.

This is often viewed negatively by the media, who are on the one hand critical of social services for being too quick to intervene and break up family units by removing children from their parents’ care, but on the other are highly critical of their practices and their reluctance or delay in removing children from abusive or distressing situations. This negativity translates into how they are viewed by the public.

Perhaps adopting this model of partnership and change promotion can be a way forward for children and their parents and a way for social workers to reform their practices to create a more standardised transparent way of working where they can share ideas and practice, work in partnership, and be recognised for the good they do and the safeguarding role they play for vulnerable people, rather than the criticism of their inconsistent working or un-compassionate approach, as some make out.


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