I am a one in 10
Half of all mental illness in adults manifests before the age of 15 and with three children in every class likely to be affected schools are having to be more proactive in their approach to this aspect of healthcare.
By Caroline Roberts
Mental health and emotional wellbeing are matters of increasing concern for anyone working with children and young people. The most comprehensive study from recent years, the 2004 British child and adolescent mental health survey from the Office for National Statistics, found that almost 10 per cent of those aged five to 16 have a clinically diagnosable mental disorder. In rough terms, it equates to three children in every class. Conduct disorders accounted for around half of cases, with other common problems including anxiety, depression, ADHD and autism spectrum disorders. It's estimated that a further 15 per cent have emotional wellbeing issues that put them at risk of a clinical diagnosis in the future.
It seems likely that the situation has deteriorated over the past 10 years as pressures on young people mount. Increasing online access means more exposure to damaging content, often of a sexual nature, and the growth in social media use has resulted in more cases of cyberbullying. Figures for 2012/13 from the Childline report, Can I tell you something?, showed an 87 per cent rise in calls about online bullying compared with the previous year. The Childline figures also show an increase of 41 per cent in calls about self-harm, while hospital data reveals that admissions due to self-harm have risen by 68 per cent over the past decade.
There is also the effect on family life of the difficult economic climate ± research shows that children growing up in disadvantaged circumstances are three times more likely to develop a mental health problem than those from affluent backgrounds. Alongside this, cuts to social care budgets in many areas mean that demand for children's mental health services often exceeds availability. In June, children's welfare charity, Kids Company, launched the `See the Child, Change the System' campaign, which calls for more support for vulnerable children, a move supported by the NAHT.
The same month, the DfE published Mental health and behaviour in schools: departmental advice, which provides guidance on how to identify and support pupils whose behaviour suggests they may have mental health needs. Half of all mental illness suffered by adults starts before the age of 15, and 75 per cent before the age of 18. This means schools have an important role to play in early intervention and promoting mental wellbeing.
The document outlines the factors that can predispose children to poor mental health. These include educational difficulties, physical illness, low self-esteem, family breakdown, and social and environmental factors such as bullying, discrimination and socio-economic deprivation. It also sets out how schools can help their students to become more resilient, as well as giving advice on referrals to child and adolescent mental health services (CAMHS) and how to access community support.
Tackling the issue will mean a big culture change, says NAHT policy adviser Siôn Humphreys. “Given the decline of external support and the emergence of more complex needs, schools will need to be more proactive.”
Whole-school ethos
One school that is ahead of the game is Framwellgate School in Durham, an 11-18 academy, where promoting mental wellbeing has long been part of the whole-school ethos.
“We started by asking: what is the totality of the student's experience from when they first come into contact with the school, and what kind of person are we trying to develop?” explains deputy head, Peter Connor. “We then identified the key things, which include mental wellbeing and emotional literacy.
“It's a mindset issue. One of the things we've pushed with staff is looking at the needs side of things. This child is being naughty and disruptive, so is there an unaddressed need in their life that is leading to this?” Of course, sometimes poor behaviour is just that, he adds, but getting that judgement wrong can have serious consequences for a child's future.
The school's `achievement centre' was set up in response to the increasing number of pupils with poor emotional health. Two rooms were converted to a space where support could be provided to address any issues creating a barrier to learning – anything from anxieties or behavioural problems to a broken leg preventing a student moving around the school. It is also a base from which to coordinate interventions. The school has invested in the training of staff working in the centre and also buys in the services of two counsellors. Other measures have included training students as peer mentors and anti-bullying ambassadors, inclusion of materials in personal and social education, and key stage three drama dealing explicitly with mental wellbeing and empathy, as well as inviting mental health organisations to talk about the issues.
Pyramid of need
To ensure that students at risk don't fall through the net, Hove Park School, a large secondary in Brighton and one of the most improved schools in the South East, has developed a system it calls the `pyramid of need'. The first step was to identify a range of factors that might have an impact on a student's mental wellbeing. These include progress, attendance, behaviour, special needs, receipt of free school meals and known safeguarding issues. The school then developed a points system based on these and worked out an accumulated score for each student, allotting them to one of four levels. A visual representation was then created for each year group with photos of all students arranged according to their points score, those with the most points appearing at the top of the `pyramid'. Pyramids of need are displayed in the staffroom, as well as in the offices of senior staff and year team leaders.
“It's very powerful, and a real eye-opener for all staff,” says deputy head Jim Roberts. “The first time we put them up in the staffroom you could see everyone being drawn to them. You tend to know the young people who already have a number of interventions in place, but what was really interesting for us was that it highlighted a group of individuals who were never the worst behaved, the poorest attenders, or the lowest achievers but who still had a high level of complexity in their lives. Suddenly, it made those young people visible.
“We've been really clear with staff ± this is not about making excuses, or giving certain students an easy ride, but to give a context that will help us support that young person to make progress and achieve just like everybody else.”
DfE guidance highlights the importance of helping young people develop resilience, an inner strength that allows them to cope with adversity. Hove Park has been working with Professor Angie Hart of Brighton University's faculty of health and social science in developing a toolkit on `academic resilience' for use by schools. She says: “Promoting resilience involves strategic planning and detailed practice involving the whole school community to help vulnerable young people do better than their circumstances might have predicted. It's not about sticking plaster solutions.” The resource will be made available to schools throughout the country (see resources).
As well as whole class activities, the toolkit suggests a range of simple interventions for tutors to use. For example, if a student has been identified as needing to develop a sense of belonging, the tutor ensures that they individually acknowledge that young person every morning to help them feel part of the school community. “Little things make a massive difference to that young person ± just the fact that someone is interested in what's going on in their life and is ready to listen,” says Jim. “Then, if things go wrong, they feel they can tell that person. It's about building that relationship.”
That sense of community is an important part of the whole school ethos and `we care about you' is a message that students need to hear from all quarters, he adds. “How fantastic is it when one of the canteen staff asks a young person how they're doing or how they got on at football at the weekend?”
Elements of the pyramid are now being rolled out across the local authority and Jim has presented the work to groups within the educational psychology team, the police, and social services. “We need to develop a commonality of knowledge and language among all agencies that support young people.”
Of course, mental health problems also affect many children of primary age. King's Hedges Primary School in Cambridge is in an area with high levels of social deprivation and many of the children are from families facing challenging circumstances. “We're finding that problems previously associated with older children are starting to creep into the primary age group,” says deputy head Barbara Stoneman. “These include self-harm, eating disorders and quite serious anxiety problems.”
The school has a meticulous system for logging concerns. “If a child forgets their book bag, that could mean nothing, but if it happens three times, then it could mean that no-one's keeping an eye on them so we would very quickly speak to a parent to check that everything is alright.”
Thresholds for support from social care agencies are high, making it difficult to cater for all the children needing help, she adds. The school's own interventions include securing lottery funding to buy in support from small local charities such as the Red Hen Project, which provides home-school workers, and Blue Smile, a counselling, therapy and mentoring service. Over the past academic year, Blue Smile has supported 26 children with individual sessions of play and art therapy. “The idea is to give them the chance to explore their emotions and be able to put words to them. Lots of our children have delayed language development so it helps them to express how they are feeling and develop their resilience so they can cope better,” says Barbara.
Whole staff awareness and training is also key, she adds. The 450-pupil school has four designated members of staff with a responsibility for child protection, who receive annual training. This term, a speaker from Blue Smile will visit the school to talk about attachment issues that can arise when parents are depressed or abuse drugs, and Barbara will attend training on self-harm.
Peter agrees that staff training is a priority. “Schools tend to be better at addressing medical issues than mental health. People think it's beyond their level of expertise, so there's an element of it being left
for other staff to deal with rather than being viewed as a mainstream issue.”
A new website, developed with investment of £3m from the Department of Health, aims to address this by educating adults about children and young people's mental health. The MindEd site, launched in March 2014, was set up by a partnership of interest groups led by the Royal College of Paediatrics and Child Health. It contains more than 170 short e-learning packages to help professionals, including teachers, identify behaviours that might indicate a mental health condition, provide support and tackle stigma.
“Improving academic standards is hugely important,” says Jim. “If a young person leaves with good qualifications they are going to have better opportunities further down the line. But there is a balance to be struck and it's got to be about the whole person too.”
Professor Angie Hart’s tips
Developing a whole-school approach to building resilience
Conduct a resilience audit. You can find a step-by-step guide to how to do this on the Young Minds website (see resources panel).
Use an inset day to ensure that all staff, including support staff and volunteers, understand the concept of resilience and their role in promoting it.
Make sure all students have at least one trusted adult in the school community to whom they can turn, preferably a consistent person over time.
Support vulnerable pupils by providing easier access to clubs and activities. Developing hobbies and interests can be immensely therapeutic.
Research has shown that problem-solving skills are important in developing resilience, so ensure students have frequent opportunities to develop these skills.
Resources
Government guidance, Mental health
and behaviour in schools
and-behaviour-in-schools
MindEd
The DfE has also issued guidance (as a PDF)
on supporting pupils at school with medical needs, which comes into effect from September bit.ly/DfE_Supporting
The charity YoungMinds is scheduled to host the Academic Resilience Toolkit developed
in Brighton and Hove from the autumn term
Place2Be is a charity providing mental
health support in schools to children aged four to 14 in England, Scotland and Wales
The Royal College of Psychiatrists (RCPSYCH) provides mental health information
for young people, parents, and teachers:
Information on resilience from Professor Angie Hart and others