Written evidence submitted by the Carnegie Centre of Excellence for Mental Health in Schools (CYP0031)

The Carnegie Centre of Excellence for Mental Health in Schools was established in 2017. The centre is a partnership between the Carnegie School of Education, based at Leeds Beckett University, and Minds Ahead CIC.

The Carnegie Centre exists to strengthen the mental health of the next generation by supporting schools to make a positive change at all levels of the UK's education system, thereby improving outcomes and life chances.

Our approach in supporting education settings is focused on evidence-based solutions which address schools', pupils’ and parents’/carers’ needs.

We place emphasis on developing the leadership capacities of the school / college, so that they have sustained capacity to improve in the longer term and can go on to strengthen mental health in their wider community. We achieve this by adopting a range of professional development models such as self-evaluation, coaching, facilitation, peer-learning and supported professional enquiry. As a result, we have seen school leaders from our development opportunities go on to lead local, regional and national events on mental health, serve on various mental health strategic panels and commit to PhD programmes on mental health in education. 

Our research-informed provision is based around supporting a whole school approach to mental health. Our work is mainly with Senior Leaders in Schools / Colleges where Mental Health / Pastoral Lead is a part of their role. 

Our work has enabled schools / colleges to:

●        Ensure that mental health and wellbeing for all members of the school community is a strategic priority.

●        Improve staff wellbeing by creating positive workplace cultures and prioritising staff workload management. These developments have led to improvements in staff wellbeing and retention.

●        Improve the wellbeing of pupils through creating school environments which embrace diversity and engender a sense of belonging. This has led to an increase in pupil attendance.

●        Increase professional development in mental health and wellbeing which has resulted in reducing the prevalence of mental ill health in children and young people.

●        Strengthened links with external services.

The impact of the Centre’s work has been wide-reaching. We have worked with over 2,000 schools on our portfolio of provision including: individual schools, multi academy trusts, groups of schools within teaching school alliances, schools belonging to membership organisations and whole local authorities.

Our provision includes:

●        School Mental Health Award

●        Leadership Development Programme for School Mental Health Lead

●        Developing a Whole School Approach to Mental Health Workshop

●        Leading Mental Health from the Middle Programme

●        Carnegie Governance Lead for Mental Health and Wellbeing

●        MSc in Leadership of School Mental Health and Wellbeing

●        Suite of Masterclasses

94% of schools who worked towards the School Mental Health Award: a development framework for schools agreed that the award improved the mental health leadership in their schools.

88% of schools agreed that staff wellbeing improved

94% of schools agreed that the award created a more positive culture in their school

This paper is compiled following consultation with school leaders as well as colleagues within the Carnegie Centre. We sought the views of school leaders of mental health from across all phases of education. Each participant completed an online survey of 13 questions. 12 responses were received. These are highly engaged school leaders of mental health having successfully completed, or currently undertaking our Mental Health in Schools Award or programmes. The breakdown of responses included:

●        4 Secondary schools

●        3 Primary schools

●        1 MAT

●        1 Sixth Form

●        2 All through schools

●        1 Prep school

Findings:

The government has failed notto lived up to its promise to incentivise and support all schools to identify and train a Designated Senior Lead for Mental Health.

The offer of training to help leads and staff to deliver whole school approaches to promoting better mental health has not been met, as set out in the 2017 Green Paper. 

There have been missed opportunities to provide quality assured, proven and effective training and support for school mental health leads, as this already exists and is ready to go to scale:

‘There are one day 'commercial' courses, for example to become a mental health lead which is in no way enough. The government should be funding courses like the MA School Leadership of Mental Health and Wellbeing…I work with all of the schools in our large multi-academy trust and only a handful have identified a DSLforMH...or they have not prioritised it against other needs and therefore it has not be achieved...the understanding of how important this role is to longer term success is not demonstrated effectively enough for certain schools to prioritise this against other perhaps more immediate needs in the school. (Dawn Aytoun, Head of Wellbeing, Independent All Through School, Surrey)

The school leaders commented on how they ‘have not yet been offered the bespoke training for the Mental Health Lead but we would be keen to make use of it’ and have ‘have sought external expertise from training companies/organisations’.

Interest in our leadership programmes for mental health has grown as over 1,000 schools have started the award and 60 school leaders have started the Masters.  It is clear that there is demand for this training and it needs to be provided as soon as possible. 

The majority of the school leaders had not had any experience of the Mental Health Support Teams. Only 3 out of 12 had any experience of working with them. Several had spoken with local CAMHS, school nurses and other professionals who likewise did not know about MHSTs. This is poor communication for a flagship scheme.

‘We definitely have a 'gap' in supporting needs & we need to improve multi-agency working through better communication and co-ordination of support’ (Antonia Clark, Deputy Head)

Many school leaders have decided to fund and source the support themselves as ‘there has not been any joint working in mental health’:

‘My own school has a graduated approach to mental health, funding a school counsellor & more recently engaging the services of a paediatric mental health nurse to support children struggling…’ (Kerry Hill, Head teacher, Eyres Monsell Primary School).

There were three positive instances of working successfully with MHSTs. These schools reported a good communication and referral process and some good support for pupils. However, there was the need to improve the training,  received by MHSTs so that MHSTs it had d a greater education focus and to improve the diversity of the staff greater diversity of staff, who are often not representative of the local community:  ‘there can be a lack of diversity offered to our BAME community which doesn’t always enable cultural understanding and the role this plays is seeking support.’

Alongside the MHST a School Mental Health Specialist is also needed.  An individual based within the school, who understands the school context.  Having undertaken extensive research it is clear that headteachers want this school-employed role to be a key part of the school community. Many existing school staff are doing this important work but have not had a proper qualification or training to support their work and deepen their practice. The School Mental Health Specialist will have an educational and mental health focus and better reflect the diversity of the school community. This is why we are launching a SMHS PGDip in September. 2021. We currently have over 200 school professionals interested in undertaking this 2-year programme. This would support many issues mentioned, such as the mental health training provided being ‘basic...As society and the pressures change, the need for this to be built on will be necessary. Plus staff forget if they don’t enact what they know everyday - so it needs to be built into the culture of the school better.’ A School Mental Health Specialist would be part of the school culture and that would be more than a ‘stop gap’. 

Settings were are not receiving the mental health awareness training. Which was promised for a member of staff in each school. For Aall of the settings we spoke to bar X it had been driven by the initiative themselvesof individuals, there was no government help or coordination.  Some school leaders had delivered it themselves if they had been on training from us or they had invested their own budget.  Some voluntarily signed up to online courses such as the ones we provided in June 2020 in partnership with Bupa Foundation where over 1,200 school leaders accessed our resources. ‘The onus is very much on the voluntary sector. The government should standardise training for staff with different levels of training akin to safeguarding' (Antonia Clark, Deputy Head).  This comment came through a number of times, stating there is a need for the government to ‘formalise the training and training expectation to provide a consistent approach nationally’ (Senior Leadership Mental Health Leads, Outwood Academy Hemsworth)

Further recommendations for this training would also to be to include a preventative approach as we know how important this is to protect young people's mental health and to ensure a trauma informed approach.

All the settings reported insufficient supply of quality mental health support capacity to meet their growing demand. Many settings had deployed their own resources such as counsellors and they are ‘mindful of post-COVID increasing demand for supportive intervention even further’.  Some felt ‘due to lack of central government funding and guidance it's inconsistent and variable… essentially a postcode lottery ’. There were also widely held views that the approach at the moment was not systematic nor consistent, leading to confusion and duplication. Independent schools and FE settings were feeling left out and ignored.

●        ‘there are still far too many young people who are unable to access mental health support in a timely fashion - it is often the case that things need to reach a 'crisis' stage before referrals are accepted due to stretched capacity and therefore there is often significant avoidable damage that is done to young people’ (Carl Duffett, Inclusion Manager)

●        The waiting lists for CAMHS are full and the level and complexity of mental health seems to be increasing. Some young people are escalating self harm and suicide attempts to get noticed as they are turned away as not meeting the criteria. Being signposted to group talking therapy, which also has a waiting list, isn't meeting the needs of a lot of young people’ (Karen Murray-Gow, Mental Health and Wellbeing Lead, 6th Form)

●        We have parents who have been waiting over 12 months for NHS counselling, which the school responded to, offering its own parents counselling opportunities. As such, the school is now having to fund its own services for mental health, as those in need are in a system which is already strained. (Kerry Hill, Head teacher, Eyres Monsell Primary School)

In terms of recommendations moving forward suggestions included setting up ‘local hubs could be set up … in health care settings or community centres which children, who are not accessing mainstream education, can access.  These hubs should provide training and support for those who are supporting them, workshops for young people…as well as providing them with access to targeted mental health support, if required especially if they do not meet the threshold for CAMHS’ (Anonymous, Primary Deputy Headteacher).  Additionally, this could support children who are excluded or electively home educated which was highlighted as a need to ensure these children are not missed.  One school leader also highlighted how ‘cultural, ethnic and religious groups and LGBT pupils  are under represented, because many services do not offer culturally competent support’ (Antonia Clark, Deputy Head, Independent School)

In reference to the changes that are needed in the system as a whole, school leaders commented on the need to remove focus from ‘outcomes and league tables’ to enable focus on mental health and spend money in this area.  Additionally, it was highlighted that there is a need for the issue of child poverty to be properly addressed, so the work schools will be doing to support children will not be continuously undermined.  ‘Schools can put in a range of protective factors and develop children's resilience.  However, if a child is living in poverty, in poor over-cramped housing and suffering from hunger and lack of resources, then their resilience is going to be permanently challenged by the stress of living in such conditions’ (Kerry Hill, Head teacher, Eyres Monsell Primary School)

In regards to a focus on early intervention in children and young people’s mental health, there was consistent agreement that this is essential, yet not only does there need to be training provided to early years settings but it needs to be placed ‘within family’ solutions and must include parental involvement, education and engagement.  This could occur in ‘Children's Centres as these are also a key resource for parents to access support and their services should be extended rather than cut back as they have been over the past decade’ (Anonymous, Primary Deputy Headteacher)

There is a lot to learn from international best practice. The Carnegie Centre works with international partners to develop and disseminate international best practice, including running courses exploring global perspectives in school mental health. However this needs to be done carefully, to ensure that the school leader is adequately equipped to use such information appropriately, as highlighted by one leader ‘we need to tackle the challenges faced in our context which, unfortunately, is implicitly tied in with governmental policy and cultural identity. Other countries can certainly offer ideas for tackling specific areas of need, but the whole picture needs to be taken into account and the various factors leading to the poor mental health in our country need to be looked at in relation to each other’(Dawn Aytoun, Head of Wellbeing, Independent All Through School, Surrey).

School leaders wanted to highlight the need for funding and resources for ‘schools to access supervision for school leaders and members of staff delivering interventions to pupils’. we think this It is incredibly important as supervision occurs in other settings where practitioners are supporting young people in difficult situations and with complex needs. School leaders are doing the same but without the support. To this end, Leeds Beckett University have also launched a supervision in education hub.. 

One school head also highlighted again the need to bring parents into training within schools and for the government to consider providing schools with funding for this: ‘it is important that parents are educated on the impact of adverse childhood experiences and trauma, particularly on the development of a child's brain architecture, so they have a greater understanding of the importance of establishing caring and nurturing attachments with their children.  It would also be beneficial if there was training for parents on how best they can support their children with their mental health and well-being at key transition points, particularly transition to secondary school so they can understand how the teenage brain develops and how this affects their behaviour’. (Kerry Hill, Head teacher, Eyres Monsell Primary School)

The DfE 2017 ‘Creating a Culture’ document is inappropriateneeds updating. It is wrong towould be better to have a document about ‘mental health and behaviour in schools’ which causes an implied overlap in these two distinct subjects.  There should be a separate ‘mental health in schools’ document. The existing document has a general deficit, within child approach or as clearly put by one school leader ‘it may be inferred that all MH issues result in challenging behaviour negatively viewed as naughty children’ (Antonia Clarke, Deputy Head).

This document fails todoes not properly recognise the promotion of mental health (it gets straight onto prevention of ill-health) and neglectsfails to reference issues such as racism, LGBTQ discrimination, Homophobia, suicide, self-harm,  and social media harm which are key issues that schools are working to address.

‘It is generic in places and I would not necessarily feel like it offered us clear guidance on what we need to do (Assistant Headteacher -Secondary School, South Yorkshire)’

This document is doing a lot more harm than good. A rewrite is needed.  Some suggestions to update this document from the school leaders:

●        ‘more detail in how to achieve the ambitions set out in the document would improve it e.g. which measurement tools can be used, when, who with and how…needs to be updated though to reflect the effect of trauma, adverse childhood experiences and post-traumatic stress experience on individual children.  It should, however, also make reference to the fact that social deprivation also has a considerable impact on children's mental health and well-being.’ (Anonymous, Primary School Deputy Head)

●        ‘The inclusion of MH in KCSIE needs to be linked and MH acknowledged as a potential Safeguarding/Child Protection issue in and of itself and not just as an indicator of abuse/past trauma (Antonia Clarke - Deputy Head)’.

Regarding the updated RSHE curriculum, responses from the school leaders are that it has been utilised and appropriate changes were made and this guidance from the government was needed and appreciated as it had been ‘a long time coming’. Additionally, ‘The emphasis placed on mental health having equal importance as physical health is an important message in order to reduce the stigma surrounding mental health and the profile of both mental and physical health will be raised within schools as a consequence of these changes’ (Senior Leadership Mental Health Leads, Outwood Academy Hemsworth). However, there are recommendations for improvements as it could be more challenging for schools that are doing well.  For example, ‘more emphasis on MH, especially in Primary, it's a bit 'wishy washy' whereas we have found that introducing the term mental health in Reception and giving the children the vocabulary and understanding to talk about MH works really well and that the children are anecdotally good observers of their own MH. I also think there needs to be a stronger focus on diversity and inclusion (Antonia Clarke - Deputy Head)’

Some noted that the resources were ‘a little clinical’, could have ‘contained more guidance and depth’ and that it is missing the ‘ideas for schools as to how they both explicitly and implicitly teach strategies such as these within their curriculum’ (Dawn Aytoun, Head of Wellbeing, Independent All Through School, Surrey)’ and at a secondary level there needs to be emphasis on this being a lesson on every child's timetable as this is still ‘a battle’ (Assistant Headteacher -Secondary School, South Yorkshire)

School leaders felt that Ofsted had a role to play. ‘it supports embedding and heightening awareness of the correlation between mental wellbeing, academic outcome and positive progression, whilst holding senior leadership accountable for ensuring that mental well being policies are robust and meet the needs of students and staff’ (KMG , Mental Health and Wellbeing Lead, Gosport, FE College). This sentiment was repeated by many of the school leaders we consulted with. 

Schools cannot be expected to implement something overnight, and with minimal support and zero budget. The current circumstances make mental health even more important for schools to consider but also make it so much more difficult to achieve this so, before we hold anyone to account, we need to ensure everyone has the skills and resources to achieve this to the best effect (Dawn Aytoun, Head of Wellbeing, Independent All Through School, Surrey)

It is wrong to link teacherIt would be better if Ofsted looked beyond wellbeing to workload as the only risk to staff wellbeing. Excessive scrutiny and high stakes testing systems are shown to cause teacher stress and result in many leaving the profession. Ofsted push increase theis responsibilityies of the onto the headteacher, without reference to also caring for their wellbeing. It would be helpful if OOfsted should auditevaluated the mental health impact of their current own approach to inspection.

February 2021