Green Paper on mental health provision in schools and academies

31 Dec

I        Proposals

On 4 December 2017, the government published a Green Paper and an open consultation around “transforming children and young people’s mental health provision”.[1] Jointly issued by the Secretary of State for Education Justine Greening and Secretary of State for Health Jeremy Hunt, the Green Paper sets out plans which could have implications for how schools deal with mental ill-health amongst children and young people. The Paper proposes that every school/academy appoint an individual as a “designated lead in mental health”, with a national training programme fully in place by 2025. This individual will take the lead to help young people with mental health issues, provide support and advice to them and staff, and teach students about the warning signs associated with poor mental health.

The mental health lead will also have the power to make referrals to “specialist services” for the victims of mental ill-health.

The proposals recommend that each school mental health lead be linked to wider support teams, forming a bridge between the school/academy/college and the NHS which will mean that every school/academic and college will find it much easier to contact and work with mental health services.

As part of the initiative, the government wants to carry out further research around

  • the impact of the internet, particularly social media, on mental health;
  • how families can provide support to those suffering with mental health issues; and
  • how mental health problems can be avoided in the future.

Further work will also be carried out to see how mental health for 16-25 year olds can be improved.

In the Executive Summary, the government trumpeted what it had already achieved.  It mentioned the following.

“We have:

(i)         legislated for parity of esteem between physical and mental health;

(ii)        promised to ensure that an additional 70,000 children and young people per year will obtain support from mental health services by 2020/21;

(iii)       improved services for eating disorders, with an additional £30 million of investment, established 70 new or enhanced Community Eating Disorder Teams, and set the first-ever waiting times for eating disorders and psychosis;

(iv)       funded eight areas to test different crisis approaches for children and young people’s mental health and tested New Care Models for Mental Health; and

(v)        published cross-agency Local Transformation Plans for children and young people’s mental health for every area of the country.”

In the second chapter of the Green Paper added: “We have made our commitment clear through significant investment in services for children and young people, including:

  1. legislating for parity of esteem between physical and mental health in 2012;
  2. investing record levels in mental health services, totalling £11.6 billion in 2016/17;
  3. making an additional £1.4 billion available for children’s and young people’s mental health between 2015/16 – 2019/20 to enable an additional 70,000 children per year to be seen by children’s and young people’s mental health services by 2020/21; and
  4. committing to recruit 1,700 more therapists and supervisors, and train 3,400 existing staff to deliver evidence based treatments.”

II       What precisely constitutes good mental health?

Good mental health and wellbeing do not simply involve the absence of mental health problems. Rather, they include young people and staff in a school/academy

(i)         feeling confident in themselves; and

(ii)        young people:

  • being able to express a range of emotions appropriately,
  • being able to make and maintain positive relationships with others,
  • developing the ability to cope with the stresses of everyday life,
  • developing skills in managing during times of stress,
  • being able to deal with change; and
  • being able to learn and achieve

Good mental health presupposes that members of the school community are resilient, happy in themselves, successful and able to prevent problems before they arise.

A school/academy that has a robust mental health approach:

  1. creates an ethos and has policies and behaviours that support mental health and resilience with everyone;
  2. helps pupils to develop social relationships, support one another and seek help when they need to;
  3. helps pupils to be resilient learners;
  4. teaches social and emotional skills and an awareness of mental health;
  5. identifies as soon as possible pupils who have mental health needs and plans support to meet those needs, including working with specialist services;
  6. effectively works with parents and carers; and
  7. supports and trains staff to develop their skills and resilience.

III     Sources of poor mental health

The Mental Health and Behaviour in Schools guidance from the Department for Education identifies risks militating against children’s good mental health from a number of sources, which are set out below.

(a)       Within the Child

  • Genetic influences
  • Low IQ and learning disabilities
  • Specific development delay or neuro-diversity
  • Communication difficulties
  • Difficult temperament
  • Physical illness
  • Academic failure
  • Low self-esteem

(b)       In the Family

  • Overt parental conflict including domestic violence
  • Family breakdown (including where children are taken into care or adopted)
  • Inconsistent or unclear discipline
  • Hostile and rejecting relationships
  • Failure to adapt to a child’s changing needs
  • Physical, sexual, neglect or emotional abuse
  • Parental psychiatric illness
  • Parental criminality, alcoholism or personality disorder
  • Death and loss – including loss of friendship

(c)       In the School/Academy

  • Bullying
  • Discrimination
  • Breakdown in or lack of positive friendships
  • Deviant peer influences
  • Peer pressure
  • Poor pupil-to-teacher relationships

(d)       In the Community

  • Socio-economic disadvantage
  • Homelessness
  • Disaster, accidents, war or other overwhelming events
  • Discrimination
  • Other significant life events

Schools/academies use several strategies to promote pupils’ good mental health.  Some examples are set out below.

(i)         In Oakington Manor Academy in Wembley – which is part of the Excellence in Education Multi-Academy Trust – boxes are placed in strategic positions around the academy.  Pupils can post anonymously their concerns about alleged bullying, for instance.  Teachers pick these up for discussions during circle time.   Also, the information could well be passed on to the counselling service, A Place2Be, if it is which operates at Oakington Manor.

(ii)        At the St Marylebone CE School in Westminster, pupils are taught about mental health and self-esteem.  Independence and personal responsibility form themes within the Personal, Social and Health Education lessons.  Pupils are instructed about the importance of sleep and practical relaxation techniques like Yoga and Mindfulness.

IV     When are children mentally healthy?

Where children are mentally healthy they

  • develop psychologically, emotionally, intellectually and spiritually;
  • initiate, develop and sustain mutually satisfying personal relationships;
  • use and enjoy solitude;
  • become aware of others and empathise with them;
  • play and learn effectively;
  • develop a sense of right and wrong; and
  • face and resolve problems and setbacks robustly and learn from them.

V     What are the mental health problems from which children may suffer?

The types of mental ill-health can be placed in the following categories:

  • emotional disorder such as phobias, anxiety and depression
  • conduct disorders such as stealing, defiance, fire-setting, aggression and anti-social behaviour;
  • hyperkinetic disorders, such as disturbance of activity and attention;
  • developmental disorders such as delay in acquiring certain skills such as speech, social ability or bladder control, primarily affecting children with autism and those with pervasive development disorders;
  • attachment disorders – e.g. when children are markedly distressed or socially impaired because of an extremely abnormal pattern of attachment to parents or major care-givers; and
  • habit disorders, post-traumatic stress syndromes, somatic disorders and psychotic disorders such as schizophrenia and manic-depressive disorder.

VI       Organisations that help

The following organisations can be approached to help a school/academy:

(i)         ChildLine is a confidential service provided by the NSPCC.  It offers free support for children and young people up to the age of 19.

(ii)        Counselling MindEd is an online resource within MindEd. It provides free evidence-based e-learning to support the school of school/academy and youth counsellors and supervisors working in a wide variety of settings.

(iii)       MindEd provides free e-learning to help adults identify and understand children and young people with mental health issues.  MindEd’s guidance on mental health to adults who work with children and young people is simple and clear.

(iv)       The National Institute for Health and Care Excellence (NICE) is an organisation that aims to improve outcomes for people using the NHS and other public health and social care services.   It produces guidance and advice in non-specialist language for the public to understand social, emotional and mental ill-health conditions and recommends treatment.

(v)        A Place2Be is a charity working in schools providing early intervention and mental health support to children from 4 to 14 years old in England, Scotland and Wales.

(vi)       Play Therapy UK is a not-for-profit professional organisation operating in the country with registrants working in primary schools to alleviate social, emotional, behavioural and mental health problems.  Accredited post-graduate training for school staff is available either in-house or at 10 venues in the UK. The Register managed by PTUK is accredited by the Professional Standards Authority, providing an assurance of the quality of the Registrant’s work.

(vii)      Young Minds is a charity committed to improving the emotional well-being and mental health of children and young people.   The organisation campaigns and undertakes research, makes resources available to professional and runs a helpline for adults worried about the emotional problems, behaviour and mental health of anyone up to the age of 25.

VII     National Initiative for all citizens

Meanwhile, Paul Farmer, chief executive of Mind, the mental health charity, and Lord Stevenson of Coddenham issued a report, Thriving at Work, at the end of October 2017, which had been commissioned by Prime Minister Theresa May. It reveals that Britain faces a bigger challenge on mental health at work than experts thought.  May (in my opinion rightly) believes that tackling the scourge of mental illness effectively will secure improvements for human welfare and the economy.   About 15% of working people have symptoms of a mental health condition. Annually, 300,000 (circa) with long-term mental health conditions lose their jobs, a much higher rate than those with physical illness. The economic cost of poor mental health, through output forgone, is estimated at between £74 and £99 billion a year. The human cost in misery is incalculable.

The goals, in themselves, are not spectacular.  However, if adopted nationally, they will help many who are struggling at work and will signal the nation’s desire to help a growing number of vulnerable people whose illnesses are not easily visible.  Broken limbs are discernible and attract sympathy. Mental illness isn’t.  And when victims of mental illness declare their frailties, they are stigmatised, ignored or ridiculed.

People who suffer from mental ill-health find their performance compromised and their productivity declines.   Cognitive-behavioural and compassion-focused therapies – among other measures – work very well and are highly cost-effective.

The Stevenson-Farmer report set out the cost of mental illness to the country:

  • 300,000people with a mental health condition lose their job each year
  • 15%of people at work have symptoms of a mental health condition
  • £74-99bncost of poor mental health to the economy
  • £33-43bndirect cost to employers, mostly from “presenteeism”
  • £4.20 average return on each pound invested in improving mental health at work

VIII    Commentary

Professor Paul Stallard of the University of Bath is one of the leading lights in the country on children’s mental health. A consultant clinical psychologist with nearly four decades of experience of working with Children and Adolescent Mental Health Services (CAMHS), Professor Stallard has been a major contributor to the Improving Access to Psychological Therapies programme of young people and helped train childcare professionals across many countries.  However, Professor Stallard, talking to The Times Educational Supplement, said that he could not tell whether young people were experiencing a deterioration of their mental health because we have not done a “good, up-to-date” survey of mental health problems.

The last one was carried out nearly 14 years ago and is out of date.  Since then, we have seen the growth of the internet, cyberbullying, concerns about body-image and an increase of terrorism and natural disasters.   However, he does acknowledge that more children were seeking help on- and off-line.

From the experiences of the experts we do know that there is an upward trend in the severity and complexity of mental health problems, he states.  There are many contributory factors to mental ill-health, smart phones and social media being two. Cyber-bullying is on the ascendancy. There are the academic pressures placed on young people by schools/academies – because of the league-table and inspection pressures – the culprits being government and Ofsted.  Add to that the social expectations set out for young people by the media – especially around body image, socialisation and the need to engage in particular activities.

So what can schools/academies and parents do to help our young people?  Professor Stallard said it was vital to recognise their strength and value them.  It will assist in reducing the level of self-harm.  School/academy “staff need to engage in conversations with children in a caring, empathetic, open way rather than being judgemental, critical or wanting to jump in too quickly with a ‘let’s sort this out’ attitude.  Just giving young people an opportunity to express how they are feeling can be a very positive experience, without having to go into any wonderful, whizzy interventions,” he told the TES.

He, like Natasha Devon, the former mental health Czar, questions the level of funding being made available by government.   Both consider that despite the noble intentions of government, the resources just don’t match.  The £300 million for children’s mental health over five years, according to Natasha Devon, “is a drop in the ocean”.

“We currently spend 14 times more on adult mental health services than we do for young people, despite the commonest onset age for mental illness being adolescence,” Devon wrote in an article in the TES.

She would also like the government to ringfence mental health funding. The former shadow minister for mental health, Luciana Berger, revealed that despite £76 million having already reportedly been “invested” by 2016, only half of local authorities had increased their spending on mental health in real-terms.

The government wants to increase the number of health-care providers.  However, with Brexit looming, Devon has concerns about where such professionals are going to be recruited.   With one in five doctors planning to quit after we leave the EU and a decline in the number of people training to become nurses, the problem will be exacerbated.

Last, but by far the least, Devon wants more emphasis placed on prevention.  Is there a way to make the lives of our young people that much better so that they don’t suffer from the pressures they are currently under caused by a raft of factors?


[1] A Green Paper is “a preliminary report of government proposals published to stimulate discussion”.  It is a government publication that details specific issues, and then sets out choices in terms of policy and legislation.  The government commissions it from the relevant department where new legislation is required, or existing legislation needs to be re-vamped. Crucially, a Green Paper contains no commitment to action.  It is more a tool for stimulating discussion, but is often the first step towards changing the law.


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