The uphill battle for mental health in schools

To say young people’s mental health services are facing difficulties would be an understatement. The services were already overstretched pre-pandemic but covid – with its accompanying isolation and uncertainty – has aggravated the situation.

What if there was another way? What if early intervention could be brought into a setting where children spend several hours each day with people attuned to their development and who are able to head off problems, potentially averting a crisis or at least a desperate referral to child and adolescent mental health services?

The government proposed funding mental health support teams for educational settings – along with encouraging schools and colleges to train a designated senior lead for mental health – in its 2017 Transforming Children and Young People’s Mental Health Provision green paper, published jointly by the (then) Department of Health and the Department for Education. The proposals got the official thumbs up in the 2018 government response.

“Some element of distress is a normal part of children’s development and it’s wrong to think all young people in distress must receive some sort of treatment,” explains Mina Fazel, professor of adolescent psychiatry at Oxford University and member of the Royal College of Psychiatrists. “It needs to be more nuanced, as it may be that CAMHS is not the right place to refer these children to.

“Mental health support teams can offer this middle way with early intervention.”

So far, the numbers seem fairly encouraging. By spring 2022, 287 teams were up and running, covering more than 4,700 schools and colleges and around 26 per cent of pupils in England.

The government announced a further £79m in March 2021 to support the rollout of the teams, adding that it now aimed to increase the number of teams by 400 by 2023. NHS England believes the current trajectory means there will be more than 500 teams by 2024.

Meanwhile, the government has said more than 8,000 schools and colleges claimed a £1,200 grant to train a senior mental health lead in the six months to March 2022, with a further £7m announced this May to fund more institutions in training for the role.

An uphill battle

But the services face an uphill battle. According to NHS Digital statistics, 17 per cent – approximately one in six – of children aged six to 16 had a probable mental disorder in 2021, up from 12 per cent – the equivalent of one in nine – in 2017. Among 17-to-19-year-olds, the 2021 rate was also 17 per cent, up from 10 per cent in 2017.

Meanwhile, Royal College of Psychiatrists analysis of NHS Digital data for the BBC, published in February, found a 77 per cent rise in the number of children needing specialist treatment for severe mental illness between 2019 and 2021.

“It isn’t fair to assume every child has struggled during the pandemic, but we know from our Oxwell student survey that there is a subgroup of children who were already struggling before the pandemic that had a much, much worse experience,” says Professor Fazel.

There’s also the issue of workforce. At the time they were proposed, it was estimated the mental health support teams workforce could consist of 8,000 new staff, compared to the then 7,000 children and young people’s mental health staff working in the NHS.

Ambitious and worthy, yes, but there is the argument it overlooks those already working within health and education.

“There is the risk the teaching profession gets left out of this discussion, when a valued teaching staff is well placed to help out in this area – teachers are privy to so much of the complexities children are dealing with,” says Professor Fazel. “We’ve been missing a trick by not bringing education staff more into mental health…

“We hear children who have been able to turn a corner often say they have done it in their education setting.”

Whitney Crenna-Jennings, associate director for mental health, wellbeing and inclusion at the Education Policy Institute, adds: “Despite the large numbers of professionals being trained to staff the support teams, longstanding issues like retention, burnout and pay in the existing mental health workforce remain. We are going to have to wait and see whether this new part of the workforce will be plagued by the same issues.”

Working together

Not to mention the fact that, for the schemes to take effect, they actually have to be used. Ms Crenna-Jennings points out: “The designated leads are not mandatory for schools – they are incentivised but not mandatory – while the mental health support teams are not going to be rolled out to the majority of the country for some time.

“Accountability is lacking and how well this is implemented depends on the level of school leadership as well as existing resourcing. Schools in less affluent areas would benefit from some more targeted support.”

Although there’s clearly still more to work through, what is agreed on is what young people need is a more holistic and integrated approach to their mental wellbeing. Ms Crenna-Jennings says: “The mental health support teams are primarily an early intervention measure, helping children who are already struggling with their mental health.

“We should look at wider policy issues and address what we can to prevent mental health issues from developing. We also need schools, CAMHS and other local services to be working better together.”

Professor Fazel adds: “We see health and social care coming together more, but now we need to see health and social care and education come together.”

A government spokesperson said: “We provided £79m last year to help 22,000 more children and young people access community mental health services, and by 2023 mental health support teams in schools will reach 3 million pupils.

“We’re investing at least £2.3bn to give an additional 345,000 children access to NHS mental health support each year by 2024.”