Written evidence submitted by NAHT (CYP0024)

NAHT welcomes the opportunity to submit evidence in response to the Health and Social Care Committee’s inquiry into children and young people’s mental health. NAHT is the UK’s largest professional association for school leaders. We represent more than 33,000 head teachers, executive heads, CEOs, deputy and assistant heads, vice principals and school business leaders. Our members work across: the early years; in primary, special and secondary schools; independent schools; sixth form and FE colleges; outdoor education centres; pupil referral units; social services establishments and other educational settings, across England, Wales and Northern Ireland. In addition to the representation, advice and training that we provide for existing senior leaders, we also support, develop and represent the senior leaders of the future, through NAHT Edge, the middle leadership section of our association.

Executive summary

NAHT welcomed the Government’s green paper and its commitment to improve the mental health and wellbeing of children and young people across the country.

However, even at that time NAHT was very concerned by the scale and pace proposed by the green paper which failed to recognise and provide the scale of urgent improvements and resourcing required for mental health services across the country.

The coronavirus pandemic will have impacted on those timescales, pushing back the vital improvements needed to support children and young people’s mental health.

NAHT is very clear that the role of schools in supporting children and young people’s mental health is to:

Contribute to promoting good mental health and emotional wellbeing amongst pupils of all ages.
Play a key part in identifying emerging mental health needs of pupils.
Refer those pupils on to health professionals for appropriate specialist support and treatment.
Support and manage pupils with mental health needs in the school environment and in their learning.

There is no role for education staff in the diagnosis of mental health needs, nor in the delivery of treatment or therapeutic support.

NAHT supported the proposal that there should be a member of staff in every school with relevant knowledge, training and expertise to act as the school strategic lead for mental health focussed on the clear role identified above. It is disappointing that government training for these members of staff has not yet come to fruition.

NAHT is concerned that the pandemic will have affected not only the planned rollout but also the training and work of Mental Health Support Teams.

Schools need specialist services to be available and accessible to offer the support and treatment from mental health professionals that children and young people need.

Even pre-pandemic, many of our members were reporting a system in crisis, where unsupported children and young people were at best struggling to learn and at worst at serious risk. The pandemic has exacerbated not only the issues with accessing specialist mental health support, but also the numbers of children and young people who need this help.

As a result of the pandemic and resulting lockdown periods, many school settings have undertaken expansive support roles, stepping in to fill gaps left by the reduction in other services to ensure that pupils and their families were supported.

This approach is unsustainable and there is a need to reset the roles and responsibilities of the different services which support children and young people. In order for schools to successfully reconfigure their substantive role as educators, other sectors such as social care, CAMHS and other health care support, need to fully step back into their own roles.

There was little reference to the mental wellbeing of school staff in the Government’s green paper and this is an omission which must be addressed. Further investment from government is needed to support the mental health and wellbeing of teachers and school leaders and to mitigate the negative effects of the COVID-19 pandemic on their wellbeing.

The ambitions laid out in the 2017 Green Paper

NAHT welcomed the Government’s green paper and its commitment to improve the mental health and wellbeing of children and young people across the country.

However, even at that time NAHT was very concerned by the scale and pace proposed by the green paper which failed to recognise and provide the scale of urgent improvements and resourcing required for mental health services across the country.

The coronavirus pandemic will have impacted on those timescales, pushing back the vital improvements needed to support children and young people’s mental health.

NAHT seeks a commitment from the government to invest further in health and social care services that support the mental health needs of children and young people, including CAMHS, to increase the capacity to meet the growing demand from schools and pupils and to reduce waiting times for this support.

NAHT supported the proposal that there should be a member of staff in every school with relevant knowledge, training and expertise to act as the school strategic lead for mental health. Many schools already have an identified member of staff who takes on this strategic responsibility.

The key aspects of the school’s role which should be overseen by a senior lead are:

Contributing to promoting good mental health and emotional wellbeing amongst pupils of all ages.
Playing a key part in identifying emerging mental health needs of pupils.
Referring those pupils on to health professionals for appropriate specialist support and treatment.
Supporting and managing pupils with mental health needs in the school environment and in their learning.

Government committed to offering training to these mental health leads to develop their skills in leading this mental health work. It is disappointing that this funded training has not yet come to fruition.

NAHT understands that despite initially looking to procure a specific training programme, government is now considering alternative methods of delivery. In a competitive environment it is likely that a wide range of courses will be developed by different providers and the Government must enable schools to navigate those options. This could be achieved either through Government funded places on particular courses or, if schools are provided with funding, with a clear list of approved and quality assured providers.

NAHT members believe that access to therapeutic support for children and young people with mental health needs must be improved and so welcomed the proposals in the green paper to increase the capacity of specialist services through the development of Mental Health Support Teams (MHSTs) working directly with schools.

NAHT is concerned that the pandemic will have affected not only the planned rollout but also the training and work of MHSTs. As part of the solution to addressing the key issues around access, availability and need, there must be a more concerted effort to roll out Mental Health Support teams across the country. Unfortunately, there is little data available on the effect of existing MHSTs on access to treatment, something that is highlighted in the Children’s Commissioner’s annual report [1]. Data must be transparently published in order to effectively assess the success of the development of MHSTs as this programme continues.

Schools need specialist services to be available and accessible to offer the support and treatment from trained health professionals that children and young people need. Even pre-pandemic, many of our members were reporting a system in crisis, where unsupported children and young people were at best struggling to learn and at worst at serious risk.

An area of significant concern for our members is the thresholds set by specialist mental health services. With a lack of capacity and funding, raising thresholds for intervention is one way to try to manage the increasing demand for children and young people’s mental health services. Our members report that thresholds are problematic and seem to change, with increasingly higher levels of need required to meet them.

The pandemic has exacerbated not only the issues with accessing specialist mental health support, but also the numbers of children and young people who need this help. Predictions have been made by field experts that approximately 1.5 million children under 18 will need new or additional mental health support as a result of the pandemic, with one third of these being new cases.[2]

NHS data [3] reports that the rate of probable mental disorders has increased since 2017 with 1 in 6 children aged 5 to 16 years being identified as having a probable mental disorder (1 in 9 in 2017). In this same study, children and young people with a probable mental disorder were more likely to say that lockdown had made their life worse than those unlikely to have had a mental disorder. This suggests that children and young people with a probable mental disorder are likely to have had their mental health more negatively impacted by COVID-19 than those without.

Systematic reviews of existing evidence on the impact of COVID-19 on mental health have found that the pandemic has impacted youth mental health with a particular association to depression and anxiety in young people [4] whilst others have identified that the most common diagnoses are acute stress disorder, adjustment disorder, grief, and PTSD [5]. These reviews are backed by studies showing that some likely reasons for these common diagnoses are increased feelings of loneliness among young people as well as worries about school and the future [6].

With COVID-19 exacerbating financial difficulties for many families across the UK, data suggests further mental health implications for children and young people as a direct result of the pandemic. Trends in children and young people that have a mental disorder appear to be affected by the financial circumstances of their household. Research from the Mental Health Foundation [7] suggests that teenagers with unemployed parents appear twice as likely to exhibit certain symptoms of anxiety and depression than those with parents in full-time employment. NHS data [8] also shows similar trends, highlighting that children aged 5 to 16 years with a probable mental disorder were more than twice as likely to live in a household that had fallen behind with payments than children unlikely to have a mental disorder.

With more children and young people experiencing mental health issues, already strained services will be under higher demand. In the Children’s Commissioner’s most recent report on the state of children’s mental health services [9] it is stated that, given that clinically significant mental health conditions amongst children had risen by 50% compared to three years earlier, the already considerable gap between children’s needs and the services available is likely to have grown much greater.

In addition, there is likely to be a surge in more severe mental health issues caused by delaying treatment. Figures suggest access to mental health services has been affected by the COVID-19 pandemic and that access will continue to be an ever-increasing issue should services not be significantly strengthened. A study of child mental health in England before and during the COVID-19 lockdown [10] held that almost 45% of those aged 17-22 with probable mental health problems reported not seeking help because of the pandemic.

Over the course of the pandemic, referrals to CAMHS have varied widely. The Children’s Commissioner’s fourth annual report (2020) notes that referral number fell early on into lockdown with referrals in April 2020 being 34% lower than in the same month in 2019. By September 2020, however, they had soared to 72% higher than in September 2019. Importantly, the same report highlights that whilst referral numbers have soared, the number of children in contact with CAMHS has only risen very gradually. Research by the Nuffield Trust corroborates this, highlighting a drop in both referrals to the IAPT programme as well as reduced numbers of people accessing secondary mental health services (Nuffield Trust, 2020). They warn that these drops mean that services will need to prepare for a surge in demand in the future when things return to a level of normality.

Provision of mental health support in schools

NAHT welcomed the recognition in the Government’s green paper that the key role for schools is to contribute to promoting good mental health and emotional wellbeing amongst pupils of all ages. Government also clearly recognised that education staff are not mental health specialists and should not be expected to deliver any kind of therapeutic support or treatment to pupils. Schools must refer pupils on to health professionals and other relevant services.

NAHT is very clear that the role of schools in supporting children and young people’s mental health is to:

Contribute to promoting good mental health and emotional wellbeing amongst pupils of all ages.
Play a key part in identifying emerging mental health needs of pupils.
Refer those pupils on to health professionals for appropriate specialist support and treatment.
Support and manage pupils with mental health needs in the school environment and in their learning.

However, as a result of the pandemic and resulting lockdown periods, and even when restrictions have been moderately eased, many school settings have undertaken more expansive support roles, including providing elements of provision for pupils that would ordinarily have been the role of sectors such as social care and health support services. In the circumstances, schools and their staff stepped in to fill gaps left by the reduction in other services to ensure that pupils and their families were supported.

The incredible work of schools to support their pupils and families is illustrated through eight individual stories from NAHT members [11]. These provide just a snapshot of the immense difficulties our members faced in the run-up to and during the first lockdown.

This approach is unsustainable and there is a need to reset the roles and responsibilities of the different services which support children and young people. In order for schools to successfully reconfigure their substantive role as educators, other sectors such as social care, CAMHS and other health care support, need to fully step back into their own roles.

There was little reference to the mental wellbeing of school staff in the Government’s green paper and this is an omission which must be addressed. Further investment from government is needed to support the mental health and wellbeing of teachers and school leaders. The success of a whole school approach to promoting and supporting good mental wellbeing relies on teachers and school leaders being supported to maintain their own mental health.

Survey research from Education Support [12] reported that 50% of all education professionals (52% of teachers and 60% of headteachers/principals) felt that their mental health and wellbeing had declined either considerably or a little during the coronavirus pandemic. Common issues underlying this were reported as the challenges of home working (58%) and ensuring social distancing when working in education settings (32%) which suggests that further support is needed for education professionals both during periods in which schools are operating remotely and when they are providing on-site education. The study reports that most professionals turned to family/friends (58%), their partners (52%) and peers/colleagues (27%) for support, further suggesting that there may be benefit in providing designated, clear support for education professionals to turn to when they need support with their wellbeing or mental health.

That external support is lacking for education professionals is robustly clear when taking into consideration the fact that a common theme amongst respondents was a lack of perceived support or appreciation from the public, media, or government (only 25%, 12% and 15% of education professionals felt ‘greatly or somewhat appreciated’ by each respective group). This further suggests that the education profession would benefit from readily accessible, robust support in their work in order to mitigate the negative effects of the COVID-19 pandemic on their wellbeing.