Written Evidence from The Communication Trust
Health Committee
Children and young people’s mental health – role of education
About us
The Communication Trust is a coalition of over 50 not-for-profit organisations which supports everyone who works with children and young people in England to improve their speech, language and communication. Our work focuses on supporting children and young people who struggle to communicate because they have speech, language and communication needs (SLCN) as well as supporting all children and young people to communicate to the best of their ability.
We very much welcome the Health Committee’s decision to explore the role of education in promoting emotional wellbeing in children and young people and preventing the development of mental health problems. It is critical to understand the root causes of mental ill health.
Providing appropriate support for children and young people with mental health conditions is essential, all possible steps must also be taken to prevent mental ill health occurring in the first place. The TCT submission explores both of these aspects and their relationship to speech, language and communication (SLC).
The relationship between speech, language and communication needs (SLCN) and mental health
In a recent Public Health England Report[1], good communication skills were identified as supporting resilience when it comes to mental health, with communication difficulties and poor social relationships identified as risk factors for mental ill health.
Speech, language and communication skills can act in a preventative capacity and are essential for developing and maintaining friendships, engaging in learning and supporting wellbeing. These skills have a profound impact on our lives, affecting our interactions, social and emotional development, mental health, behaviour, learning and attainment and later life opportunities for employment. Speech, language and communication skills are central to so much of who we are, what we do and the opportunities we have but when these vital skills do not develop as expected the impact can be serious and long lasting.
Speech, language and communication skills are optimised when they are actively nurtured, encouraged and supported to develop throughout a child’s life, and adults have a key role to play in this. The wellbeing of all children is served by adults talking and interacting with them, playing with them and supporting their communication development and there is a direct link between language development and attachment.
Here, the mental health of key adults in a child’s life also has a part to play - post natal depression and poor parental mental health can contribute to a child’s poor development[2] and there is evidence to show that the mother’s capacity to provide a communicative environment and develop a secure attachment with her child is influenced by her mental well being[3]. Supporting parents’ mental health is therefore an important aspect of supporting a child’s development and later opportunities in life.
For those children with SLCN, children with poor vocabulary at 5 are one and a half times more likely to have mental health problems at age 34[4] and children with a history of SLCN are 2.7 times more likely to have a social phobia by age 19.
SLCN is common, yet often invisible. In some areas of the country, 50% of children are starting school with delayed language. One in ten children have a persistent language difficulty and 7.56% have a clinically significant language disorder; that’s two or three in every key stage one classroom. SLCN and mental health issues frequently co-occur.
Children with SLCN find it difficult to reach the same academic achievements as their peers. In 2014/15 only 16% of pupils with SLCN achieved the expected standard of five or more GCSEs at grades A* to C. This is compared to 64% of pupils with no identified SLCN or additional need (academic success is also identified as a resilience factor[5], with academic failure being a risk factor for mental health problems).
Delayed language skills can lead to a range of difficulties such as anxiety, depression and behavioural problems. These have the potential to affect a child’s overall functioning, educational attainment, lifelong development and opportunities.
Children who stammer may begin to show impaired behavioural, emotional and social development as early as age three and these difficulties are well established in older children who stammer[6]. Parents and practitioners need to be aware of the possibility of these difficulties and intervention needs to be provided in a timely fashion during childhood to prevent the potential development of serious mental ill health later in life.
There is a range of evidence which highlights the impact of SLCN on mental health and wellbeing:
· Law et al (2009) reported that the presence of early language learning difficulties were linked to mental health, literacy and subsequent employment outcomes. Law et al identified that a receptive language difficulty at five years was associated with a higher risk of mental health problems in adult life
· Clegg et al (2005) also identified an increased risk of psychiatric disorders in adult life related to long term receptive developmental language disorders, e.g. theory of mind, verbal short-term memory and phonological processing difficulties, in association with significant difficulties in social adaptation
· 88% of unemployed young men display speech and language difficulties (Elliot, 2009); and unemployment can have a negative impact on long-term health and wellbeing
· 45% of young people referred for mental health services have communication difficulties – three times more than typically [7]
Many interventions and approaches to support mental wellbeing depend on children and young people having good speech, language and communication abilities.
The December 2016 Public Health England report cited Cognitive Behavioural Therapy and early work focusing on problem solving as successful measures to support and alleviate a range of mental health conditions. These approaches rely heavily on good communication skills, both in conversation, but also in supporting the thinking, verbal reasoning and problem solving that these approaches rely on.
For those children and young people with co-occurring mental health and communication difficulties, identification of their SLCN is vital, and subsequent consideration is needed by the workforce to facilitate access, enable alternative approaches, or to build appropriate communication skills in order to access the required support.
What needs to change?
Under-identification of SLCN continues to be an issue in Education. Research suggests around ten percent of children have long term, persistent SLCN and that in some areas, up to 50% of children have delayed speech, language and communication skills. Nationally however, the most recent SEN data from the Department for Education indicates that only two percent of children are identified as having SLCN as their primary need. The later children are identified as having SLCN, the harder it is for them to catch up. Children with unexplained language disorders have higher social, emotional and behavioural problems, with 88% failing to achieve early curriculum targets (Norbury, 2016).
For those children and young people with mental health difficulties who also have SLCN, identification it is even more important as without it they are likely to be provided with approaches that they cannot easily access, including ‘talking therapy’ which may not be suitable. It is therefore imperative that we successfully identify SLCN in this group of children and young people.
Initial teacher education (ITE) and CPD opportunities do not currently equip teachers with the skills they need to identify and support pupils’ resilience through speech, language and communication development, or pupils with SLCN. A recent national survey by The Communication Trust revealed that approximately half of the children and young people’s workforce received little or no initial training in typical SLC development or supporting and identifying SLCN, and nearly half of the workforce is still yet to receive training in this area in their current role.
The 2015 Carter Review found that ITE programmes do not cover support for children with SEND sufficiently, resulting in an inconsistent quality of education for these children and young people. The same is true for SLCN specifically - a lack of training and CPD to support teachers and other school staff to gain a stronger understanding of typical language development means that many children’s SLCN is missed, or misunderstood.
All children who have significant SLCN should be screened to determine their mental health needs. Equally, children and young people with mental health needs should have their language competence assessed before receiving interventions such as Cognitive Behaviour Therapy to ensure they are able to engage meaningfully with them.
Up-skilling the workforce to provide support at a universal and targeted level and improving access to specialist services for children with long term persistent SLCN would make a significant contribution to improving their mental health and wellbeing.
Summary
Mental health issues and communication skills or needs are intertwined. Difficulties co-occur and appropriate support of mental health often relies on strong communication skills.
The impact of speech, language and communication difficulties on children’s lives can be devastating; adversely affecting wellbeing, resulting in mental ill health and making the usual support mechanisms unsuitable or even more challenging to access. These consequences are not inevitable, many children with SLCN, given the right support at the right time, will catch up but it is essential that meaningful steps are taken to improve early identification of SLCN as well as providing sufficient support and intervention to improve educational outcomes and wellbeing.
Organisations allied to the TCT acknowledge the important cyclical link between parental mental health, disadvantage and SLCN and are committed to supporting parents and children who are impacted by these issues.
Those working in education have a vital role in supporting good mental health and good speech, language and communication skills.
[1] Public Health England (2016) The mental health of children and young people in England
[2] Pilyoung Kim and Hannah Bianco (2014) How Motherhood and Poverty Change the Brain Zero to Three Journal
[3] Roulstone, S., Law, J., Rush, R., Clegg, J. and Peters, T (2011) Investigating the role of language in children’s early educational outcomes University of the West of England, Bristol
[4] Law, J. et al (2010) Modelling developmental language difficulties from school entry into adulthood. Journal of speech, language and hearing research, 52, 1401-1416
[5] Public Health England ibid
[6] McAllister, Jan (2016) Behavioural, emotional and social development of children who stutter. Journal of Fluency Disorders 50 (2016) 23–32
[7] Cohen, N. Farnia, F. And Im-Bolter, N (2013) Higher order language competence and adolescent mental health. Journal of Child Psychology and Psychiatry