PA0216

Written evidence submitted by Mind

Introduction

We're Mind, the mental health charity for England and Wales. We provide advice and support to empower anyone experiencing a mental health problem. We campaign to improve services, raise awareness and promote understanding.  

We welcome the opportunity to submit evidence to this Inquiry. Our most recent education inquiry into mental health in secondary schools, conducted in 2021, provides a basis for this response link here). It involved consultation with almost 3,000 young people, parents/caregivers, mental health professionals and school staff across England.  

This response sets out key recommendations which will help to reduce persistent and severe absence in school and create better school settings for young people experiencing mental health problems.

Key Issues

• Young people who experience mental health problems or who are from disadvantaged socio-economic backgrounds are disproportionately likely to face issues related to persistent and severe absence in school. [1]
• There is an overrepresentation in persistent and severe absence specifically for young people who are on SEN support, in Alternative Provision or Special Schools, in receipt of free school meals (FSMs), have a social, emotional, mental health need (SEMH) and Education Health Care Plan (EHCP).[2]
• The current system in place to manage and authorise attendance does not properly take into account the mental health experiences of young people, nor does it appropriately address the barriers which prevent young people with mental issues from being in school.
• The school system is currently not providing adequate early support for pupils and must foster positive school environments for young people with mental health problems to be able to thrive educationally and mentally.

Summary of Recommendations

• Strengthen onsite mental health provision and support channels for young people at school to ensure that those who are at risk of experiencing severe and persistent absence are identified, targeted and met according to their specific needs.
• Review the current national system for managing , authorising and recording school attendance so it does not disadvantage young people experiencing mental health problems or put unreasonable emphasis on medical evidence.
• Work to create better access to mental health services and reduce NHS waiting times and thresholds for referrals to ensure that young people are able to get early support, diagnoses and treatment for their mental health problems and therefore take less time off school.
• Work closely with school leads to ensure that schools make it a priority to promote positive settings for young people and their wellbeing.
• Take a less punitive and criminalising approach to school attendance by removing duty for parents to pay fixed penalty notices.

Q1) The factors causing persistent and severe absence among different groups of pupils e.g. disadvantaged pupils, pupils from minority ethnic backgrounds, pupils with SEND, pupils who are clinically vulnerable to covid -19, pupils in AP.

Mental Health

There is a strong evidence base to suggest that mental health is clearly linked to ill-attendance. [3] Indeed, absence can be seen as an indicator for underlying mental health problems of young people in school. [4] Our own research supports this: Seven in ten (68%) of 1271 young people reported that they had been absent from school due to their mental health: [5]  

“Due to my anorexia taking a toll on my physical health I was taken out of school which meant I lost a lot of lesson time. I’m also now attending day patient treatment which has meant I am missing one day a week of school.” Young Person

Not only do the findings from our Inquiry demonstrate that mental health is a common cause of severe and persistent absence, but also that parents have been experiencing difficulties in trying to get their child’s non-attendance authorised. Of the nine in ten parents (88%) who disclosed that their child had been absent from school because of their mental health, only one in four (28%) were successful in receiving authorisation from school. In circumstances where a young person might not have proof of their mental illness due to struggling to access mental health services and receive a diagnosis, this could decrease the likelihood of their absences being deemed as legitimate by their school and subsequently result in penalties or prosecution. Some young people described how their mental health deteriorated after they were disciplined for being unable to attend school, while not being provided with effective mental health support.

“Despite being hospitalised for much of my time out of school (17 months out of 2.5 years), my headteacher and other staff members often refused to authorise my absences. They claimed that by doing this, they would be motivating me to attend. When I could not do this, they threatened to expel me, because I was bringing their attendance statistics down (they admitted this).” Young person

The Department for Education’s State of Nation report further draws attention to the deterioration of mental health amongst young people and how rates of probable mental disorders and eating problems among young people in England remain ‘at elevated  levels’ compared to before the pandemic. [6]  Due to this, statutory guidance must go further to ensure that schools respond to unmet mental health and SEND needs, by promoting early identification, intervention, and specialist support within the education system.

Other Interrelated social factors:

Young people with Special Educational Need or Disability and Social, Emotional and Mental Health needs

The Centre for Social Justice (CSJ) found that while only 3% of the school population has a diagnosed SEMH need in England, they represented 10% of all the pupils who were severely absent. Their rate of severe absence was nearly eight times that of pupils with no identified SEND. Similarly, children with an EHCP make up only 4% of all pupils in England but they represent 12% of all severely absent pupils. [7] These statistics highlight the fact that young people with complex mental health and educational needs are more prone to being off school due to experiencing greater hardship from underlying mental health issues and disabilities, lack of support in school, waiting for a suitable school place, waiting for a first or updated EHCP, as well as being subject to higher rates of exclusion. [8] These groups are also more likely to drop out of mainstream schools and make up a high proportion of young people in Alternative Provision (80%) and special schools for these reasons, which both have higher severe and persistent absence rates than normal secondary schools. [9]

Poverty

There is a strong connection between poverty and non-attendance in schools, with over 28% of primary and 40% of secondary school pupils who qualified for free school meals being persistently absent during the 2021/22 autumn term.[10]  As a consequence of  the pandemic, absence can be explained by pupils experiencing crippling anxiety, a loss of social and academic confidence, difficulties in paying for bus travel and parents deeming it unnecessary for their children to attend post pandemic. [11]

“If you’ve got a child who’s living at home with high levels of deprivation and high levels of need within the family home, they’re not going to be prepared to come into school and sit down and sit there at a desk and learn. This is because they’re too busy thinking about ‘Is mum safe? Is dad safe? Is mum having a good day? Is mum having a bad day? Is there going to be any tea when I get home? I wonder how my little brother’s doing at school? Has he gone to school today?’ Social, Emotional and Mental Health (SEMH) Lead, local authority special school ” [12]

Our Inquiry demonstrated that:

• Young people receiving free school meals were more likely to say that mental health had affected their ability to do their schoolwork most of the time (69% compared to 54% for young people who did not receive free school meals).
• Those who received free school meals were far more likely to tell us they were not able to get support from school (34% compared to 24% of those who did not receive free school meals).[13]

Ethnicity

In our Inquiry, Young people from Black, Asian and Minority Ethnic backgrounds described how they faced racism at secondary school which damaged their mental health. As a result, some were unable to learn or take part at school. Having difficulties attending school was a very common experience for young people from Gypsy, Roma and Traveller communities. Over half (6) of these interviewees often missed school. Respondents identified anxiety, bullying, and struggling to manage anger as reasons why they were unable to attend school.[14]

Black young people are more likely to experience mental health problems yet experience more barriers when it comes to accessing mental health support, due to services not being culturally appropriate, mistrust in the healthcare system and trauma from historical racist treatment.[15] Minority groups are also more susceptible to racism and bullying, stereotyping of behaviour, as well as increased health risks associated with Covid -19 and therefore the traumatic loss of loved ones.[16]

It is worth highlighting that Black young people are also likely to come from a household and area with a high deprivation index (with more than half of the UK’s black children living in poverty [17]) and therefore experience an increased risk of mental health related factors which may contribute to issues with performance and attendance at school.[18]

Q2)  How schools/ families can be better supported to improve attendance and how this affects pupils and families who are clinically vulnerable to covid -19

As pupil non-attendance can be a symptom of underlying mental health problems, it is important to identify potential mental health needs early on and provide adequate support in schools. Mind recommends:

Schools strengthen onsite mental health provision and support channels for young people at school to ensure that those who are at risk of experiencing severe and persistent absence are identified, targeted and met according to their specific needs. This should include:

• Increasing the coverage of Mental Health Support Teams (MHST) across schools to deliver wellbeing development plans, support senior mental health leads, promote early intervention and ensure that pupils can access the right external specialist services where necessary. Despite UK government efforts to reach a total of 500 MHSTs in operation by the end of 2023, this will still only cover 36% of pupils across the country which means that the majority of pupils will miss out on getting the extra support which they need. [19]
• Introduce mandatory teacher training initiatives around mental health and cultural awareness in schools to minimise stigma and make sure that staff are better equipped to support disadvantaged young people with mental health issues.
• Offer additional support to families from deprived and disadvantaged backgrounds, where a need might present itself. This could include providing extra financial and emotional assistance and food supplies to young people receiving FSMs whose families are struggling with the increased cost of living or offering therapy and counselling to those enduring difficult living circumstances at home or who have negative relationships with family members, in order to address trauma and bridge the gaps in experience and overall life quality.
• Consider reasonable adjustments or concessions for those young people struggling with attendance or attainment and are more clinically vulnerable to Covid-19. This can include providing more opportunities for remote or flexi learning so that attendance records are not jeopardised, providing extra breaks in-between lessons and offering more assistance with school workload, especially to help with reintegration.

The DfE reviews the current national system for managing, authorising and recording school attendance so it does not disadvantage young people experiencing mental health problems and sets clear standards for families.

• Statutory guidance should recognise the barriers that young people face in providing medical evidence, including difficulties in identifying and receiving support for mental health problems, and use this as a premise for absence authorisation.

• Approaches to attendance should be centred around improving the mental health of young people in schools (which should drive up attendance as a by-product) and less around encouraging schools to meet attendance targets or statistics. [20]

School leads to ensure that schools make it a priority to promote positive settings for young people and their wellbeing.

• Promote a zero-tolerance policy around bullying and racism to ensure that schools are inclusive and safe environments for young people, especially for those from ethnic minority backgrounds.
• Develop recruitment practices which bring diverse staff from different backgrounds into the workforce and reform school curriculums to reflect the experiences of young people from different demographic groups.
• Review disciplinary measures around attendance to ensure that they are centred around understanding the deep-rooted challenges which are preventing young people from participating in school.
• Encourage schools to instil a wellbeing development policy and culture, as well as promote participation in extracurricular and wellbeing activities (e.g. sports, art, music therapy), wellbeing and culture days, in order reduce intensity of school life and create balance.

NHS England to reduce waiting times and thresholds for referrals to ensure that young people are able to get early support, diagnoses and treatment for their mental health problems and therefore take less time off school.

• Roll out early support hubs which young people can access on a self- referral basis and be able to get immediate support and intervention for their mental health needs before critical or crisis condition. [21]
• Implement goals within the NHS Long Term Plan to expand CAMHS services and tackle long delays, widen access to services and deliver specialist mental health care centred around young people’s needs. [22]

Q3) The impact of the department’s proposed reforms to improve attendance.

We recognise the crucial role school plays in a young person’s development and how it can help to eradicate the risk of experiencing a range of other adverse outcomes later in life. [23] However the Department for Education’s proposed reforms to drive up attendance and ensure that pupils are engaging as best as they can with the school system fail to outline the resources and investment needed to adequately support young people’s mental health needs. [24]

The DfE has outlined the following principles in their guidance, which Mind believes should help identify a young person’s mental health needs and tackle some of the inherent causes of absences, if implemented effectively within schools: [25]

• Develop and maintain a whole school culture that promotes the benefits of high attendance.
• Have a clear school attendance policy which all leaders, staff, pupils, and parents understand.
• Accurately complete admission and attendance registers and have effective day to day processes in place to follow-up absence.
• Regularly analyse attendance and absence data to identify pupils or cohorts that require support with their attendance and put effective strategies in place
• Build strong relationships with families, listen to and understand barriers to attendance and work with families to remove them
• Make special provisions for pupils with medical conditions or special educational needs and disabilities
• Share information and work collaboratively with other schools in the area, local authorities and other partners when absence is at risk of becoming persistent or severe

Although these reforms highlight government intent to make provisions for young people with medical conditions or SEND, there are certain aspects which may have an adverse effect on young people who are dealing with mental health problems. In order to reduce the potential negative impact these reforms can have, the DfE should review the following aspects within the attendance guidance:

1. The imposition of fines, and other punitive interventions, in circumstances to do with mental health ‘where voluntary support has not been successful or engaged with’. [26]

Under this guidance, local authorities will have the power to issue education supervision orders, parenting contracts and fixed penalty notices and prosecutions for non-attendance or unauthorised public appearances under the Education Act 1996.[27] Given that school absences are already higher for young people in receipt of free school meals and who are more likely to experience mental health issues, these fines and legal interventions are more likely to disproportionately affect the most disadvantaged young people and families.

Although the guidance advises that fines will only be used as a last resort, there has been an alarming increase in the number of parents being fined for their child’s absence (by June last year, fines amounted to a total of £3.7 million).[28] The widespread use of fines for school absence is also having a disproportionate effect of these on the most disadvantaged young people and does not provide a solution for the mental health problems which cause non-attendance in the first place. These fines might have the opposite effect of making the wellbeing of families worst and causing  additional financial strain.  For these reasons, we urge the DfE to remove these fines.

In our education inquiry, parents have recounted the negative impact which court action threats for low attendance have had on family wellbeing and that they were only able to have their children’s absences authorised after the intervention of mental health services, resulting in some choosing to home-school their children .[29]

“School threatened to send my parents to court if they didn't force me to come into school, even when I was suicidal”  Young Person

2. Requesting medical evidence, ‘where the school has a genuine and reasonable doubt about the authenticity of the illnesses.’  [30]

The DfE’s most recent guidance, ‘Summarising school responsibilities where a mental health issue is affecting attendance’, stipulates that school staff should not routinely ask pupils for evidence when dealing with short mental health related absences and that this should only be required in circumstances where a young person has a long-term mental illness which may prevent them for attending school for extended periods. [31] This is a step in the right direction, but we are concerned about the 15-day threshold at which schools report absence to local authorities who could then fine parents or use legal interventions. There are widespread difficulties around accessing both GP and mental health services, and in turn, securing medical evidence for mental health problems, which need to be considered if the interests of young people with mental health issues are to be preserved.

February 2023