1.1 It is recommended that a holistic approach is taken to mental health provision in primary schools. There should be embedded mental health counselling services in each school, working with all stakeholders including the children and their families. This provision should be extended out of school hours.
1.2 The uplift in recruitment of teachers should also include a recruitment for mental health leads in schools so that all schools have ring fenced funds for service provision with the aim of all schools having a mental health counsellor by 2022.
1.3 The standards and the provision of training should be overseen by a working party that draws together the key stakeholder. This working party must include teachers, as well representation from families and children.
2.1 This submission is led by Dr Gary Winship with support from the University of Nottingham’s Institute for Policy and Engagement. It aims to share research, experience and findings with the Health and Social Care Committee in order to inform work being done on the mental health of children and young people.
2.2 Dr Gary Winship is course leader MA Trauma Studies University of Nottingham, School of Education. He is a registered Mental Health Nurse and psychotherapist and internationally renowned in the field of young people and mental health, he has developed and worked in Therapeutic Communities for young offenders, and has supervised more than 100 practitioners working with children and young people across a range of professions including psychology, psychiatry, nursing, social work, teaching, counselling and psychotherapy. Winship’s teaching and research has a close focus on schools and he works closely with teachers and school counsellors. His funded research has looked closely at the lived experiences of troubled young people, especially substance misuse, young offenders and young persistent fire setters. Winship is the ditor of the International Journal of Therapeutic Communities, and editorial board member for Adolescent Psychiatry (edited by Lois Flaherty, Harvard, USA).
2.3 The case study is from the charity, Mulberry Bush, who have worked tirelessly to meet the needs of emotionally troubled and traumatised children, their families and communities. They have since extended their charitable objectives to enable them to support adults who may have experienced childhood trauma via their specialist services, which now include training and research.
2.4 The research this submission is based on emerges from working with front-line practitioners (eg Child and Adolescent Mental Health Services (CAMHS) staff, and counsellors working in schools), special educational needs and trauma informed practitioners and driven specifically by a gap in our knowledge about the potential for a more considered focus on Primary School Mental health. One of the striking features of that original round of policy feed for the Government’s 2017 report was the absence of any schoolteacher or counsellor giving evidence to the commons select committee. So, the research we have produced looks to bring practitioner voice to the fore, and therein the voice of advocacy for younger children. Finally, the research seeks to address the anxiety among schoolteachers about engaging with mental health. Teachers need a much more substantial core of preparation.
3.1 Between 2011-2014 Winship led a research group, funded by the Institute for Mental Health (IMH) which brought together key stakeholders in Nottingham in response to a significant spike in suicide among children and young people across Nottinghamshire. The leadership team was Dr Nigel Chapman (Notts Coroner), Dr Dilip Nathan (lead consultant for the Child Death Overview Panel) and Marie Armstrong (Nurse Consultant). We hosted a number of seminars and conferences between 2011-2014 including a presentation from Professor Louis Appleby (lead for the National Inquiry Suicide and Homicide), and the events brought together a wide range of stakeholder service providers like Place2Be, Harmless, as well as professionals, parents and young people. In 2014 the School of Education hosted an international conference on ‘Schools and Suicide’ which Winship led. The conference attracted over 350 delegates and offered an essential networking opportunity for numerous stakeholders. The conference received national radio coverage and was an item on BBC East Midlands News link here. The welcome outcome from this sustained activity was a downturn in children and young people suicides in Nottingham. Winship was part of the Consortium for Well Being in Schools (CEWBS) and contributed to the Round Table discussion convened by Francis Earl Listowel in the House of Lords on October 28th 2013, and was part of the launch for the CEWBS report which was hosted by Graham Allen in November 13th 2014. He is a member of the Centre for Social Futures in the Institute of Mental Health which was launched by Graham Allen with the aims tallied to the concerted effort to position Nottingham City at the vanguard of early intervention.
3.2 The research is drawn together in The Essentials of Counselling and Psychotherapy in Primary Schools – On Being a Speciality Mental Health Lead in Schools (Winship and MacDonald, 2018). The book speaks directly to the challenge set out by the Governments Green Paper (2017) ‘Transforming Children and Young People’s Mental Health Provision’ which has proposed changes to the way children and young people’s mental health is managed in schools. The research looks specifically at the challenge of delivering mental health provision in primary schools, making a specific case for adjustment to the developmental needs of primary school age children. The epistemological focus is orthopedagocical (Broekaert, et al, 2004; Broekaert et al, 2011) and the knowledge advanced here informs a range of intellectual fields, from pastoral counselling to mental health to education and developmental psychology. The case studies not only focus on work with children, but also with parents and teachers.
3.3 The research sets out a model for the development of mental health leadership in schools the way in which a designated mental health lead might support schools, parents and children in schools, including lessons on mental wellbeing in schools as part of the PSHE syllabus. Essentially the formula for mental health leadership in schools in built on the idea of a system approach whereby all stakeholders as seen as crucial to a school as a therapeutic community (MacDonald and Winship, 2016).
3.4 RESEARCH RIGOUR: There are three main research frames that are explicitly outlined in the book:
i) A whole system approach, school as case study, the opening chapter consider a model of the primary school as therapeutic community (MacDonald and Winship, 2018);
ii) Individual in-depth qualitative case study where each chapter is built around lived experience foregrounding the experience of teachers, children and parents, with due diligence to the ethical contingencies of case study identity protection and informed consent (Winship, 2007);
iii) Chapter 2 describes in detail the research method of doing observations. The chapter proposes an extension of the internationally renowned Tavistock method, and points to a new frontier for application in schools based research where the child’s social matrix is the locus of investigation. The chapter offers a thorough going genealogy of the research advances in infant observation, (an internationally recognised method of training for midwives, nursery school teachers, social workers, psychotherapists) and threads this conceptual theory build to an illustrative example with new case material.
The book is drawn directly from practice, so it is practice leading research, co-author Shelley MacDonald has been running counselling and psychotherapy services in schools for more than 10 years.
4.1 The Mulberry Bush’s work with children, adults, families and communities is underpinned by three core principles ‘Psychodynamic theory, Reflective Practice and Collaborative working’ which ensures that their work is underpinned by relevant theory that can help them navigate the complexities of working closely with trauma.
4.2 Research has shown that trauma, neglect, and abuse have great impacts on the developing brain. It is also known that Adverse Childhood Experiences (ACEs) and environmental risk factors associated with childhood trauma can lead to a lack of attachment and poor outcomes for children. Environmental risk factors that diminish resilience in the personality include family breakdown, parental drug addiction, major losses such as bereavement, neglect, sexual and physical abuse, and domestic violence. These factors often become co-morbid and compound to decrease the chances of the child’s successful adaptation to his or her home, school, and community environment. Recent advances in neuroscientific research shows that just as traumatic experiences freeze and dysregulate children’s emotions, over time the experience and delivery of empathic caring relationships can work to ameliorate and modify these states. Therefore building strong relationships through empathic and nurturing experiences, resilience is increased and positivity encouraged.
4.3 Working closely with trauma is anxiety-provoking. The effective management of anxiety is therefore a critical and key concept in providing a safe and nurturing environment. In our daily engagement with our client groups, we often work with a background ‘field’ of the projection of early trauma. The impact on staff of working ‘close in’ with levels of deprivation, neglect and abuse is very powerful. Regular ‘reflective spaces’ and other support and training structures equip our staff to develop a ‘conscious use of self’ so they are able to engage thoughtfully. Reflective groups enable staff to reflect on the feelings invoked in them, and help them disentangle which feelings belong to them, and which to the person they are working with. If left unprocessed these intolerable and ‘unwanted’ feelings are ‘passed on’ from child to adult, adult to adult, and team to team. Without an implicit understanding of the management of these processes, they can create a ‘contagion’ of unthinkable feelings, which can immobilise and create splits in the staff teams of the schools, children’s homes and organisations we work with. Our trauma informed practice continues to evolve from the synthesis of a number of theory bases, traditions and legacies. We believe it shows that well-managed, relationship-based work really can contribute to the psychological well-being of our society’s most emotionally troubled children and young people.
The Institute of Recovery from Childhood Trauma’ (IRCT) offer a helpful checklist for those working with children and young people who are traumatised on their website www.irct.org.uk.
4.4 Overall feedback and evaluation of Mulberry Bush showed positive impact on children’s emotional behavioural development, improved capacity to deal with difficult feelings and improved self-esteem and better relationships with others- it also positively impacted their academic attainment in the longer term.
4.5 Research expansion in this area is key to its development. Existing research has been carried out outside of the UK and the Department for Education has noted gaps in UK research. There are significant limitations to this research such as selection bias and a lack of a globally standardised framework, making it difficult to ensure that results are robust.
5.1 One of the striking features of that original round of policy feed for the Government’s 2017 report was the absence of any schoolteacher or counsellor giving evidence to the commons select committee. So, the research we have produced looks to bring practitioner voice to the fore, and therein the voice of advocacy for younger children. Finally, the research seeks to address the anxiety among schoolteachers about engaging with mental health. Teachers need a much more substantial core of preparation.
5.2 Key line of argument in the Cambridge Journal of Education paper (Winship, 2021) is that mental health is best considered in regard to a more holistic approach to schools rather than narrowing it down to responses of children in distress. A more holistic school approach has a much better chance of early identification and prevention of mental health problems. And on this front the paper on the primary school as a therapeutic community is salient. In that paper we point to the concept of therapeutic communities. There are many schools up and down the country who operate as therapeutic communities and are registered with the Royal College of psychiatrists.
Winship, G. (2021) The evolution of mental health in schools – where from, where next?. Cambridge Journal of Education, accepted 12/02/21. : https://doi.org/10.1080/0305764X.2021.1891204
Winship, G. & Macdonald, S. (2018) New Ingredients of Counselling and Psychotherapy in Primary Schools – Mental Health Leadership in Schools. London. Routledge.
MacDonald, S. G. & Winship, G. (2016) Primary School as Therapeutic Community. International Journal of Therapeutic Communities, 37, 2, 14-21
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 ‘Therapeutic Residential Care involves the planful use of purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support and protection to children and youth with identified mental health or behavioural needs in partnership with their families and in collaboration with a full spectrum of community-based formal and informal helping resources.’