Written evidence submitted by the British Association for Counselling and Psychotherapy (CYP0081)
The British Association for Counselling and Psychotherapy (BACP) is the UK’s leading body for counselling and psychotherapy, with approximately 55,000 practitioner members working with people across a range of settings throughout the UK, many of whom will be children and young people (CYP). BACP registered and accredited CYP counsellors are highly trained practitioners working within a CYP competence framework, based on the latest research evidence linked to safe and effective practice.
The role of CYP counsellors supporting children and young people in schools, colleges, third sector and health settings is now more crucial than ever, though sustainable funding for counselling services is patchy across the nation.
The following evidence focuses on the role of school based counselling provision, where it currently sits within Mental Health Support Teams (MSHTs) and how it is delivered in areas not served by trailblazing sites.
School and college-based counselling is a form of psychological therapy providing children and young people with an empathic, non-judgemental and supportive relationship to find their own answers to their own problems. School counselling is a professional service delivered by qualified and experienced CYP practitioners working to a children, young people and families competence framework, linked to evidence-based professional standards.
Speaking to a school counsellor can be a transformative experience for children and young people. It can help them cope with the difficult circumstances they face in their lives - and to go on and flourish in the future.
England is lagging behind in its provision of counselling in schools. Scotland, Wales and Northern Ireland all have government funded school counselling services. England does not. In Wales, school counselling provision is statutory.
As children face increased change and uncertainty in their lives because of the Covid-19 pandemic, it’s more important than ever before that they have access to this vital support.
BACP welcomes the introduction of the designated senior mental health leads for school and colleges and recognises the value of there being a single point of contact, particularly when buying in or accessing counselling support.
However, we have two concerns. Firstly, the similarity of the role title itself to designated safe-guarding leads, risks unnecessary confusion. Secondly, this role should be mandatory as opposed to ‘encouraging’ schools to ‘designate’ a senior lead.
Regarding the wider ambitions set out within the green paper, this inquiry provides an opportunity to review, reflect and achieve the ‘building back better’ objectives.
BACP has concerns that the Mental Health Support Team programme runs the risk of not being fit for purpose as we move through the Covid-19 pandemic. This is linked to its limited geographical reach and its reliance upon referral pathways to other community mental health providers (including school/college based counsellors) that are not consistently available in all areas.
A variety of delivery models are being piloted within the trailblazer areas, raising concerns that some support services (including counselling) are only available dependant on what additional services are commissioned locally alongside where a child or young person lives.
Mental Health Support Teams (MHSTs) are actively encouraged to work with established services (and not replace existing provision), including school counselling and voluntary community provision (where counselling is also provided). It is important to differentiate between the work school counsellors provide and that of EWP’s (Educational Well-being Practitioners), with counsellors able to work with more complex cases. There are early indications from schools in Hertfordshire where in-house school counsellors were not re-employed, due to ever decreasing school budgets and the hope that MHSTs would backfill these roles. A further concern is linked to third sector counselling providers where NHS funding may be time-limited and restricted to only six sessions.
Access to counselling is currently piloted in a number of ‘trailblazer’ sites across England. The anticipated demand from young people due to the pandemic means we should not wait for these pilots to be completed, before additional measures are put in place. Research suggests that community-based counselling services for CYP may be more accessible to marginalised groups, particularly those from ethnic minority groups and those with complex additional needs (e.g. being a looked after child, experiencing problems at schools, home or in the community, etc), as well as being associated with significant reductions in psychological distress (Duncan, Rayment, Kenrick & Cooper, 2020)[i]. This highlights the need for counselling services to be available in a variety of settings, including schools and the community.
BACP is deeply concerned that MHSTs will only work with a fifth to a quarter of schools and colleges in England by 2023, in line with the commitments of the green paper . BACP is calling for a nationally funded school and college counselling programme to ensure equality of access for all children and young people. The availability of a universal, non-stigmatising counselling intervention, meeting the needs of the ‘missing middle’ of support between CAMHS and MHSTs (i.e., those young people whose complex needs fall between the two services), plus the needs of children in the 75-80% of schools not
supported under this new MHST model, will provide sustainable additional mental health support for all
BACP has consistently called for a national commitment to fund counselling for all children in England’s secondary schools and colleges, bringing England in line with the other nations of the UK. The Department for Education (2017)[ii] published results of research into mental health provision in schools and colleges in England. The survey of over 2700 institutions found that 84% of secondary schools and 56% of primary schools offered counselling services. Individual counselling was by far the most recommended mental health provision across all school types. 93% of the schools and other institutions providing counselling services used their own budget to fund this provision, making them effectively the commissioners of the service.
However, later research carried out by the IPPR (2020)[iii] found that only 48% of schools offered onsite counselling with fewer state schools providing the service than when previously surveyed. These statistics are alarming and demonstrate that services in schools are not financially sustainable, with schools in more affluent areas likely to employ in-house provision.
School and college counselling in England is patchy. Some employ in-house provision, including peripatetic sessional workers whilst other schools rely on access to commissioned third sector services. Whilst some schools use the Pupil Premium budget to pay for in-house counselling this is not ring-fenced funding for mental health support and is not available to all.
It is vital that timely and accessible school and college based counselling is available to all. School based counselling dramatically reduces the average waiting time for essential mental health support. Waiting times for CAMHS have potentially devastating impact on the lives of children and young people. BACP welcomes the drive within the green paper to reduce these times. In 2018, The Education Policy Institute[iv] reported the average median waiting time for CAMHS was 188 days. Due to increased demand we know that waiting times are even longer now for those who meet the CAMHS threshold. As a result of Covid-19, there is whole system pressure manifesting itself on already stretched CAMHS services. Universal provision of school and college based counselling has a critical role to play in alleviating this pressure, with waiting times for in-house school counselling often under four weeks.
School based counselling is known to improve young people’s experience of mental health support. It reduces the stigma commonly associated with mental health and having one point of contact within a school removes having to repeat and retell their stories. Children and young people can also self-refer, removing the barriers as the support is onsite.
The provision of school and college based counselling in England prior to Covid-19 was inadequate to meet all need and as noted earlier, was patchy and inconsistent. The additional demand as a result of the pandemic means that urgent action is required. We are still unclear of the long-term impact on children, young people and families.
Access to free, timely, non-stigmatising counselling interventions for children and young people plays a vital role in responding to both pre-existing mental health needs and those
brought about by the pandemic. Counsellors and psychotherapists continue to offer critical services supporting vulnerable young people though the current challenges with commissioned and funded services offering free (at the point of access) support to children and young people where they can.
There is robust research evidence that school-based counselling has a significant positive impact on young people’s levels of psychological distress, self-esteem and achievement of personal goals (Cooper et al., 2021)[v], over and above the positive effects that a school’s existing pastoral care provision can provide.
BACP believes that all children and young people should have access to counselling as part of a step-care approach to mental health. As has happened in Wales, it is vital to recognise the ‘missing middle’, referred to earlier, those children whose complex needs cannot be met via lower level interventions offered by EWP’s, yet do not meet the threshold for specialist CAMHS provision.
BACP is committed to a step-care approach in response to children and young people’s mental health needs with a clear and accessible pathway to early-help counselling provision as part of that offer. Referral routes to counselling are embedded in a number of Mental Health Support Teams areas, an example of good practice is provided below.
In Croydon, South London, two Voluntary Sector services, Croydon Drop In and Off The Record, are currently delivering one of the ‘Waves’ to 12 local Primary and Secondary Schools with a total of 8000 children on the roll.
Their MHST consists of four Education Well-Being Practitioners (EWP’s), four counsellors, two senior counsellors/team leaders and one clinical lead/clinical supervisor. Whilst promoting the Whole School Approach by building solid relationships with schools, this model allows school staff, parent/carers and other professionals to refer children and young people into an on-site, open access service that can firstly offer ‘low level’ guided self-help interventions from the EWP’s for issues of anxiety and low mood. When a more serious, complex issue is identified these children can be swiftly picked up by the counsellors who also have access to the senior counsellors for advice/support or potential onward referral. The delivery team is supervised by the clinical lead so the skill set is broad and is also able to deliver group work, psycho-educational webinars/workshops and emotional well-being support for the whole school community.
One of the advantages of this model is that children are offered a service on-site in familiar and easy to access surroundings meaning referrals to local specialist CAMHS are almost non-existent.
This is an example where Voluntary Sector counselling services, trusted and funded by South West London CCG, are working effectively alongside statutory colleagues which also illustrates that positive outcomes for children and young people are the common and shared goal for all services.
Due to the training and qualifications, CYP counsellors adopting integrative approaches to their practice work with a wide range of presenting issues, including childhood trauma and abuse, loss and bereavement, loneliness, family breakdown, relationships, eating disorders….the list is endless. These are issues that can affect any child, from any background, in any school in the country and it is vital they have access to a trained and qualified counsellor to minimise their distress.
Counsellors work in-depth with children and young people who self-harm, experience suicidal ideation or have suicidal plans. They also work with children and young people when they transition to CAMHS and when CAMHS support comes to an end.
The NHS Long Term Plan includes a commitment that by 2023-24 an additional 345,000 children and young people aged 0-25 will be able to access support via NHS England’s funded mental health services. To meet this objective it is essential to have government funded counselling services.
Funded counselling is already offered via Clinical Commissioning Groups in some areas as part of the mental health support team offer. Other voluntary sector counselling providers offer similar school counselling provision in other areas of the country, including TIC+ in Gloucestershire, 42nd Street in Greater Manchester, and YPAS in Liverpool, all with a history of working closely with local Clinical Commissioning Groups and delivering good outcomes for children and young people.
In one geographical area not served by MHSTs, Northamptonshire has an established referral management centre for children and young people where referrals are assessed and directed to one of three contracted third sector counselling services or referred directly to CAMHS.
Whilst the above examples highlight mental health workforce solutions for some areas in England, it remains geographically inconsistent. We know from our membership that a trained, professional counselling and psychotherapy workforce is available to support schools and colleges through the mental health struggles facing our children and young people.
In partnership with Professor Mick Cooper from Roehampton University, BACP carried out a UK wide survey with counselling practitioners to look at the impact of the pandemic on the delivery of school and college-based counselling during the initial period of school disruption and closure across the UK. 742 practitioners took part in the survey, which closed in July 2020, with a further 200 practitioners taking part in a series of follow up surveys as part of a longitudinal study regarding the impact of Covid-19 on service delivery.
The survey found that 94% of school and college counsellors used the time spent in the initial lockdown of 2020 to retrain to competently deliver counselling via video platforms and by phone. Practitioners invested in their own CPD to help them meet future demand, resulting in a more flexible and competent CYP workforce to deliver counselling sessions both remotely and safely, enabling young people to have more choice as we go forward. However, we know digital poverty and lack of space to have confidential support is a huge barrier and that children and young people are not currently accessing the level of support on offer due
to the restrictions linked to a national lockdown.
It should be noted that the results from the initial lockdown survey in July indicated that counselling provision had halved during this time, though provision was up to nearly the same amount as before the pandemic by December(albeit with social distancing measures in place). Our next survey will take place at the end of March, 2021, if fewer children and young people access online counselling support during this time, due to lack of space, lack of technology or simply linked to choice (preferring face-to-face contact), this will impact continuity of both on-going mental health support and new referrals. Children and young people will once again miss out on vital counselling support at a time when most needed.
Children and young people aged 10-18 in Northern Ireland, Wales and more recently Scotland benefit from universal access to government funded school and community based counselling provision across the devolved nations. Wales are planning to extend their statutory counselling offer to primary aged children as they have recognised the need is so great.
[i] Duncan, C., Rayment, B., Cooper, M., & Kenrick, J. (2020). Counselling for young people and young adults in the voluntary and community sector: an overview of the demographic profile of clients and outcomes. Psychology and Psychotherapy: Theory, Research and Practice, 93(1), 36-53
[ii] DFE (2018) Supporting Mental Health in Schools and Colleges, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/634726/Supporting_Mental-Health_survey_report.pdf
[iii] IPPR (2020) https://www.ippr.org/news-and-media/press-releases/only-half-of-teachers-say-their-school-can-offer-pupils-on-site-mental-health-counselling-in-wake-of-pandemic-finds-ippr
[iv] Education Policy Institute (2018) Access to children and young people’s mental health services https://epi.org.uk/publications-and-research/access-to-camhs-2018/
[v] Cooper, M., Stafford, M. R., Saxon, D., Beecham, J., Bonin, E. M., Barkham, M., Bower, P., Cromarty, K., Duncan, C., Pearce, P., Rameswari, T. & Ryan, G. (2021). Humanistic counselling plus pastoral care as usual versus pastoral care as usual for the treatment of psychological distress in adolescents in UK state schools (ETHOS): a randomised controlled trial. The Lancet Child & Adolescent Health: https://doi.org/10.1016/S2352-4642(20)30363-1
[vi] Welsh Government (2019) Counselling for children and young people https://gov.wales/counselling-children-and-young-people-september-2018-august-2019