Place2Be – Written evidence (FFF0013)
Place2Be is a children’s mental health charity with over 27 years’ experience working with pupils, families and staff in UK schools. We support school communities and facilitate a ‘whole school approach’ to mental health. We provide professional mental health support through one-to-one and group therapeutic work using evidence-based methods backed by research in our work with children, young people, parents and school staff. We offer expert training for education staff, and accredited and validated professional counselling qualifications and training placements.
Place2Be is submitting evidence and recommendations about the importance of both education professionals and mental health professionals in supporting the mental health and wellbeing of children and young people. The children’s mental health workforce is crucial for providing effective early intervention and prevention services which help to stop issues developing into adulthood. When we refer to ‘workforce’ in this submission we mean both education staff and mental health professionals. The following evidence is based on our experience in this field over the past 27 years.
1.1. Current capacity in the children’s mental health workforce will not meet the increasing need we see in the demand for our services. Training mental health professionals at the current pace and using existing formats cannot be scaled sufficiently. We need more creative approaches to attracting, training and retaining a more diverse workforce. This includes subsidised training beyond NHS routes.
1.2. Teachers and education staff need to be skilled at, and trained in, what is going to better prepare young people for work in the 21st century. Education needs to give the same value to the linked life skills of relationship building, understanding others and resilience (Social Quotient, Emotional Quotient, Adversity Quotient) as it does to academic attainment (Intelligence Quotient) otherwise there is a lag between the end of education and being ready to take on the demands of working in public services. Not being ready for those demands leads to early exit and burnout. While we need to solve an immediate problem, we also need to be thinking about how we avoid always being in a position of catching up.
1.3. It is vital for school based mental health services to be able to ‘triage’ cases to specialist NHS child and adolescent mental health services (CAMHS) when needed. Therefore, the CAMHS system needs to be well resourced and financed. Issues with long CAMHS waiting lists are well documented and we would welcome significant investment in the end-to-end CAMHS system to address the issues with demand and ensure that no child or young person is left unsupported. When children and young people are referred to CAMHS, this system needs to have capacity to meet this demand in a timely way. This is an immediate problem that needs to be addressed, however in the longer term, if attention and investment was shifted to prevention and early intervention, we would see less pressure on the NHS CAMHS system.
2.1. The voluntary sector is well placed to reach ‘hard to reach’ communities. It is important to recognise and utilize capacity in the voluntary sector. We need to see more local commissioning and support for the voluntary sector.
2.2. Place2Be has seen over the last two years how online learning can reach greater numbers than we have ever projected previously, our online Mental Health Champions – Foundation programme has so far reached nearly 58,000 education professionals. We deliver this learning in big cohorts and estimate the unit cost as approximately £15 per head. This is an example of how training can be scaled to maximise reach.
2.3. Over the next two years we’ll be building on that learning and applying what we now know about combining online and face-face learning both in person and via conferencing technologies to training the children’s mental health workforce as well as increasing understanding of mental health in the education workforce.
2.4. Currently adult mental health training dominates the field, accreditation bodies need to adapt the value they place on training hours with children so that they count towards qualification.
2.5. Self-funded training as a mental health professional outside NHS routes is not realistic for many workforce groups. As a charity providing training to meet national need, we need to be able to offer NHS / Education / Social Care bursaries to attract a more diverse range of trainees.
3.1. Education staff need to learn about child development and mental health and wellbeing – at different stages of training (ITT/NQT/Middle Leader, Senior Leader, CEO of Academy Trust) – all relevant to the role they play in leading and implementing a ‘whole school approach’ to mental health and wellbeing.
3.2. Mental health staff need to understand the school system and work more effectively with schools – state as well as academies and free schools. The different structures in Local Authorities/Education alongside Health/Integrated Care Systems are incredibly complex and everchanging. This all needs to be included in training for mental health staff (MHSTs and CAMHS)- you could introduce a module about the education system; and vice-versa include mental health in education training.
3.3. Increase opportunities in leadership development programmes to join up around local systems – especially middle leaders across Health, Education, Social Care, and the Police force.
4.1. Progression routes within professions often have bottlenecks, limiting opportunities to grow. More flexibility to move between different public services with Recognition of Prior Learning routes into training programmes could fulfil the need for remaining engaged in new learning and motivated to stay in public service. For example, multiagency work means greater transferable skills between teaching, social work, nursing into the mental health profession.
4.2. Subsidised training to move between public service roles.
4.3. Creating opportunities for developing portfolio careers through job shares, part-time working, shift and online work to fit around other commitments might make staying in public services more manageable. (e.g. being a part-time teacher/nurse/social worker and a part-time counsellor). Encourage more secondments across sectors - these could be supported by the private sector as part of their social value commitments.
4.4. A focus on the importance of social values and promoting the benefits of this.
5.1. A lack of diversity and breadth in the child counselling workforce because it is only accessible to those who can afford the training. This can be a barrier to accessing those communities in the greatest need of support. The wider workforce is majority white, middle class, females who are in the later stages of their career (often a second career). We know that we need to recruit more men, people from different socio-economic backgrounds, and culturally diverse communities in order to have greater impact for the children and families we support. For example, our experience has shown that where we have a male counsellor in the school, boys are more likely to seek and accept help for their mental health.
5.2. Failure to meet the increasing need for embedding expert mental health support within the school community. There simply aren’t enough child counsellors. Only 10% of counselling qualifications in the UK are aimed at working with children.
6.1. Utilise the capability of quality/accredited training organisations within the voluntary sector to attract and train professionals who bring a breadth of cultural diversity and ability to engage with local communities. The voluntary sector plays a significant role in terms of workforce. Place2Be is the largest voluntary sector employer of children's mental health professionals. Place2Be also offers high quality training and professional qualifications in child counselling. Traditionally, it can be expensive to train to be a child counsellor and this can, and has, resulted in a lack of diversity in the workforce. Firstly, we need to utilise the capability of quality training organisations in the voluntary sector to help with broadening the workforce – Place2Be has 1,000+ Counsellors on Placement annually all accessing training, along with over 500 people annually on accredited training. We would recommend the Government look at funded bursaries or subsidies for training places beyond the NHS training routes. Secondaly, an option is a new apprenticeship standard, to boost and diversify the children’s mental health workforce. An apprenticeship for school counsellors has recently been recommended by the Coalition for Youth Mental Health in Schools.[1]
6.3. As part of Place2Be’s commitment to broaden the workforce, we recently awarded 28 bursaries to students on low incomes to support their professional training with Place2Be, with funding from the Wolfson Foundation.
7.1. The exploration of delivering counselling and other mental health support via digital platforms is also seeing the possibilities for support to users being more flexible – once safeguarding issues have been mitigated.
7.2. Bursaries or scholarships that include specific allowances for technology resources (hardware and Wi-Fi access) for trainees.
7.3. Digital technologies cannot entirely replace in-person delivery of counselling and mental health support; there is a need for increased investment in both forms of support. Our research with young people[2] has found that different people like to access support in different ways. Choice is important, as is having a hybrid/blended model with in-person as well as online.
7.4. The value of data to evaluate and refine services – should have access to much more via digital tools (with appropriate privacy agreements) and this can help with much greater refinement of services and target where most needed.
8.1. Digital tools open the possibility for undertaking a greater proportion of our training at a distance. There will always be a need for some in-person training as developing skills in counselling is a relational exercise, but improvements in quality and wider access to digital tools mean more content is available without travel.
8.2. Digital tools are very effective to upskill staff, especially in the preventative and early intervention space. Importance of learning in bite-size chunks, at your own pace/time. Understanding of mental health and wellbeing being more easily embedded across public services roles (e.g. in education, social care, youth work) Some aspects of training really require ‘experiential’ element- there is value of in-person delivery for this.
9.1. Meeting the need where it is, rather than isolating users in a medical model of mental health. Greater investment in early intervention and an integrated clinical approach, 1-1 counselling, and training in a safe environment where the users are (e.g. schools). Taking children and young people out of school for treatment has a knock-on effect on their learning, their relationships with peers and school staff, generating greater isolation and impacting their sense of self-worth.
9.3. Spreading the investment towards early intervention and prevention of mental ill health. The lack of this investment, with a focus on reactive treatment rather than proactive intervention, is resulting in the need for more expensive investment at the higher end of need.
9.4. The role of teachers and other education staff - Teachers, and other education professionals, can play a crucial role in supporting the mental health and emotional wellbeing of children and young people. They can help with: role modelling positive attitudes and behaviours, creating ‘psychologically safe’ learning environments, identifying potential mental health needs, and signposting or triaging on to other public services. Teachers can do this best if they have: received adequate training around mental health and wellbeing, have opportunities for continuous professional development (CPD), and have access to support and consultation with an expert. Place2Be can provide the following innovative ‘best practice’ examples.
9.5. Training programme for teachers and education staff – Funded through charitable donations, in the past academic year, we have delivered Place2Be’s online Mental Health Champions - Foundation programme, reaching a staff member in 42% of schools in the UK across every county in England, Wales, Scotland and Northern Ireland. The course enhances professionals’ understanding of children’s mental health and introduces approaches that foster positive wellbeing in schools and communities. 54,786 teachers and school staff took part in the programme. 97% of those who completed the course would recommend it and 74% learned something that resulted in a change in their action, behaviour or attitude in the workplace.
9.6. Reflective supervision, support and consultation with an expert – As part of our whole school approach model in schools, Place2Think is available for teachers and school staff. This is small group supervision sessions for education professionals supporting positive mental health in school communities. It is facilitated by Place2Be clinicians experienced in school and community settings and the model borrows from therapeutic and social care practices.[3]
9.7. The role of senior mental health leads in education - The Department for Education is rolling out a programme of training for every school to have an appointed Senior Mental Health Lead. This is usually a member of the senior leadership team in a school. Place2Be is an approved, quality assured, provider of this training. We think this role is pivotal in ensuring that whole school approaches to mental health are successfully developed. We would urge the Government to commit to funding this for every school and to plan for the long-term future of this programme. An ongoing reflective supervision model such as Place2Think, mentioned above, should ideally be available for the Senior Mental Health Lead to be able to access ongoing support and consultation.
10.1. Our experience with schools is that the pandemic has placed enormous pressure on the adult workforce. School leaders and teachers report increased anxiety through holding responsibility for keeping schools open, keeping children and adults safe while at school, managing the uncertainty of what would come next and at the same time ensuring learning is as uninterrupted as possible. These higher levels of anxiety have proved contagious and are now being replicated in children and young people. The opportunity for reform is to place a greater emphasis on emotional wellbeing and mental health within the school curriculum.
10.2. There has also been a rise in interest in supporting mental health and minimising the impact of poor mental health within schools. The opportunity for reform here is to encourage those who are planning to leave education to consider a move into roles that support mental health in schools. Easier routes and subsidised training could facilitate that direction.
10.3. The impact of Brexit on the mental health workforce has been a reduction in availability of workers from the European Union who previously trained and worked with us in schools. Mainland Europe has a long tradition of psychotherapy and counselling, we are now less attractive as an employment opportunity than we were, particularly for long-term career planning.
11.1. Due to the pressure on both, there has historically been an invisible wall between schools and CAMHS. Firstly, with schools not understanding local CAMHS thresholds and referring unsuitable cases to be supported medically. Conversely, no feedback loop to schools from CAMHS has led to children and young people getting ‘lost’ in the system, without the adequate support in the ‘step-down’ back to in-school provision. The Schools Link programme (delivered by the Anna Freud National Centre for Children and Families) has started the work of bringing together education and health services, but there is still much work to be done to ensure a positive and smooth user-experience.
12.1. When embedded as part of the school team, our mental health professionals can provide a link between NHS Mental Health Support Teams and local CAMHS teams, picking up cases which don’t meet local thresholds, but which are beyond the training qualifications of Mental Health Support Teams. The current ambition is for Mental Health Support Teams to cover 35% of country by the end of 2023/24. Therefore, there is still a gap in provision for the remaining 65% of England. There is a role here for the voluntary sector, either in delivering for this 65%, and/or filling the gaps in provision in between Mental Health Support Teams and more specialist CAMHS.
12.2. Place2Be school-based staff also support education professionals with understanding universal mental health needs, they provide group work interventions and can support the adults in school with the impact carrying out their role has on them, in addition, they can give guidance on referrals to more specialist provision where required.
12.3. Place2Be offers high quality training and professional qualifications in child counselling, filling a gap that falls outside public service training routes.
12.4. There is an important role of the voluntary sector often in reaching ‘hard to reach’ communities, there is often a greater sense of trust; may be especially relevant in ‘levelling up’ and addressing inequalities.
13.1. Place2Be brought organisations together to form a Diversity and Inclusion Coalition, to encourage change at grass roots level across the sector. Place2Be chairs and hosts the coalition, which is trying to influence the curriculum of learning institutions to bring about cultural change and remove barriers to make the sector more inclusive.
13.2. Online learning offers some great opportunities for connectivity and shared programmes across sectors. Joint training of future leaders across sectors. Embedding this thinking early on in careers. Joining datasets to look at services / practice / needs across sectors, makes joined up work more meaningful.
14.1. Use of outcomes data – qualitative and quantitative, to look at the impact from the user point of view, we’re all motivated by users’ needs and making a positive impact on their lives.
16. Our previous inquiries have shown that public services are failing to deliver joined-up support that is centred on the user. What workforce barriers need to be overcome to bring about a more user-focused approach to public services delivery?
16.1. While the 1-1 counselling in schools provided by Place2Be is child-led and informed by a person-centred approach, the systems around referral and assessment before arriving at the Place2Be team may not be. Equally, services that take the child or young person out of school create possibilities for lack of cohesion (as in answer 11), providing more support in-school, at a higher level than is offered by Mental Health Support Teams, reduces the potential for children suffering from the adults’ failure to join up services.
16.2. More previous (or current) users of counselling and mental health support services training to deliver.
17. Users’ expectations of public services are changing rapidly. How, in your experience, have their expectations changed? What are the best ways to involve users in the design of public services, and what skills will public services workforces need in order to respond? For example, what skills will employees need to support users who expect more choice in the public services that they use
17.1. Hybrid delivery of services and/or choice (digital and face to face) - digital helps greatly in user engagement in shaping services through an iterative approach. Commissioning development of new services need to take this different approach to service design and development into account.
Further information
For further information please contact Sally Etchells Wragg, Place2Be, on sally.etchells@place2be.org.uk
February 2022
[1] https://www.publicfirst.co.uk/wp-content/uploads/2021/10/MHC-Report.pdf
[2] https://www.place2be.org.uk/about-us/news-and-blogs/2019/june/research-young-people-want-a-mix-of-face-to-face-and-digital-mental-health-support/
[3] https://www.place2be.org.uk/our-services/services-for-schools/school-mental-health-consultations-place2think/