Written evidence from Cumbria’s multi-agency CYP Emotional Wellbeing and Mental Health Partnership (CMH0160)

1.     Executive Summary

This submission summarises how partners and schools in Cumbria are addressing the rising demand for emotional and mental wellbeing support for pupils.  It includes:

• A description of our approaches, the underlying rationale, comments on what’s working well and where the challenges lie. 
• Nine separate examples of initiatives and projects that we particularly wanted to include in this submission, representing only part of the overall support that schools provide to pupils in Cumbria.  We’ve chosen them as they best fit with the scope of this inquiry and we believe we are good at innovation in this area and that collaborative working across school clusters, Local Alliances of System Leaders and with wider partners is a strength.
• The report ends with some conclusions of what has worked well and where we see the challenges followed by three recommendations. 

2.     Background

2.1. Our multi-agency Emotional Wellbeing and Mental Health Partnership has oversight of Cumbria’s ‘Whole System’ approach to supporting the emotional and mental wellbeing of children and young people, and the implementation of the Cumbria Transformation Plan.  http://www.cumbriaccg.nhs.uk/about-us/key-policies/strategy-documents.aspx  It is chaired by an Executive Head teacher who is also the chair of the Cumbria Alliance of System Leaders in Schools. Membership includes the County Council, NHS Commissioners and Providers, Schools, the Third Sector and the Police.  Cumbria has a long history of good practice and innovation in supporting emotional wellbeing in schools. The incidence of pupils experiencing emotional and mental health difficulties has risen to such a level that those working in schools and other educational settings regularly express serious concerns about the impact upon both attainment and wellbeing.   The partnership prioritises supporting schools to adopt a ‘whole-school’ approach to pupils’ emotional and mental wellbeing.  All schools have a named Educational Psychologist who works with them at an early help level as well as a statutory one, in an ongoing way via solution-focussed consultation about pupils’ needs, as well as detailed individual assessments where appropriate.

The Partnership shares a ‘whole system’ vision: ‘All our children and young people can access the support they need to achieve emotional wellbeing and mental health’. We face similar challenges to other areas and share their recognition of the crucial role that all schools play in supporting emotional and mental health. Cumbria has a number of unique characteristics; its physical size and landscape, its dispersed population and the relative remoteness of parts of the county on the west coast. It is the most north-westerly county in England and the second largest, based on its geographical size (6,800 square km). The mid-2015 population estimates report that 498,000 people live in Cumbria, making the county the most sparsely populated county in England (74 persons per square km). 103,500 Cumbrian residents (20.8%) are aged 0-19 years. Nationally 0-19 year olds make up a higher percentage of the population (England & Wales 23.7%).

Of the 322 communities in Cumbria, (lower super output areas) 29 are among the most deprived 10% of communities in England.  There are 13,585 children aged 0-19 years living in poverty.  The numbers in Barrow in Furness are highest where 20.4% of 0-19 years live in poverty. (HMRC 2014)

2.2   A programme of work carried out over the last three years has included;

• improving the information about resources available.   Appendix 1.
• a detailed emotional resilience building programme in schools utilising Big Lottery HeadStart funding in two targeted areas of Cumbria, partnering with third sector providers to develop local community services and school based initiatives
• the support of a multi-agency network to grow a Mindfulness in Schools programme
• a jointly commissioned targeted Primary Mental Health Service called ‘My Time’ providing both direct and indirect support to schools
• a growing emphasis on utilising digital media to deliver services or co-produce digital resources that support mental wellbeing

3.     Numbers of Schools in Cumbria

There are also 5 Further Education Colleges in Cumbria with over 4.000 students aged 16 to 19

4.     Selected examples of initiatives and projects – We have selected nine examples of how schools and partners are supporting the mental wellbeing of pupils and their families.  We’ve picked these as a representative range of both recent and current developments that reflect the scope of the inquiry.

Inquiry scope references –

• Promoting emotional wellbeing, building resilience, establishing and protecting good mental health
• Support for young people with mental health problems
• Building skills for professionals
• Social media and the internet

4.1. The Early Years Wellbeing and Involvement Initiative - Good knowledge with regard to supporting young children’s emotional well-being is crucial to working successfully with those two year olds accessing funded early education many of whom have delayed personal, social and emotional development.  In 2010-2011 the Cumbria Early Years Team organised a Well-being and Involvement Project, based on the internationally recognised work of Ferre Laevers. https://www.scribd.com/doc/54235287/Leuven-Scale-of-Children-s-Well-Being-and-Involvement All Early Years settings across Cumbria were invited. The project enabled practitioners to understand the importance of developing high levels of well-being and involvement in young children, the use of scales to measure children’s levels of well-being and involvement and the factors that can affect this.  In 2013/14 we built on the work undertaken in 2010-2011 and focused in particular on meeting the emotional needs of children accessing the Early Education Funding for 2 year olds. Practitioners received training, ideas and resources to provide interventions to support children’s emotional well-being and a pack containing selected case studies and a guidance booklet of ideas to further support the development of practice and professional development of staff in this area. The ‘Supporting Young Children’s Emotional Well-being’ pack of materials is available to all providers of Early Education in Cumbria. Early Years outcomes have improved significantly since 2013.

4.2. Upskilling a whole community: Millom’s Good Enough Start initiative.  The importance of a good understanding of how attachment relationships impact upon mental wellbeing and emotional resilience is being led by schools in the Millom locality to work with local services to develop and integrate attachment friendly service delivery.  Building on the principles of an ‘integrated care community’ 10 schools (2 Secondary) have partnered with public health nurses, health visitor, midwives, the local Action for Children led children’s centre, the Council and community groups.  The aim is to upskill everyone in terms of attachment informed practice and promote resilience to impact long term on the health of the community and prevent mental health problems from becoming serious.   

4.3. Forest School – The Longtown Primary School which has c200 pupils and a morning nursery, has not yet achieved a ‘good’ judgement from Ofsted.  Senior school staff, identified the significant levels of poor emotional resilience, poor attitudes to learning and a lack of social confidence and skills and decided to prioritise meeting emotional needs and raising the profile of emotional and mental health. This included the adoption of the Forest School approach; i.e. a long-term process of frequent and regular sessions in a woodland or natural environment to support the development of a relationship between the learner and the natural world and the individual’s holistic development.  Reception to Year 6 groups were covered and other local Primary Schools soon became involved.  A key outcome was that some children with very challenging behaviour have remained engaged with school, had positive academic and behavioural outcomes and in one instance managed to attend a residential before leaving primary school following the Forest School programme.  There are frequent examples of pupils demonstrating key universal skills including speaking and listening, independent learning, perseverance and resilience in the face of failure and challenging social situations.   Longtown School now has three trained staff members and will continue to support other Primary Schools to develop a Forest School approach.

4.4. Family Learning Family Resilience (‘Bouncebackability’) – As part of our Phase II HeadStart project (2014 – 2016) and as a result of feedback from parents our County Council Community Learning and Skills Service developed a course on Emotional Resilience for parents and carers aimed at those families with pupils in Year 6 about to move up to Secondary School.  Consultation groups were established with parent and carer volunteers in two Primary Schools.  They developed the key areas to include, a ten hour timeframe (to be delivered in two-hour sessions) and a ‘toolkit’ for parents, carers and children to jointly produce.  All aspects of the course are underpinned by the “Boing Boing” Resilience Framework (Hart and Blincow with Thomas 2007) www.boingboing.org.uk  The courses were then piloted by five Primary Schools; Westfield Nursery and Primary, Workington; Hayton C of E Primary School, Brampton; Brook Street Primary School, Carlisle; Ewanrigg Junior School, Maryport; Caldew Lea Primary School, Carlisle.

4.4.1. Feedback from parents highlighted how much they had learned about how to communicate about emotions and resilience with their children and the number of tools and ideas they now had to hand to help them support their emotional wellbeing and resilience as they start their journey through secondary school and adolescence.  It’s proved successful and popular and parents were keen to engage as the course was offered on a universal basis in the school setting.   Some very vulnerable parents got involved and grew in confidence.  https://vimeo.com/185298069/68ec9aa498  Work on rolling out the course in schools and in other settings to other key groups continues.

4.5. Third Sector Partnership with Schools: Mates in Mind and With You in Mind – Young people told us that they often worry about their friends and wanted to know how they could help them more if they seemed to be struggling emotionally or feeling down.  In partnership with Carlisle/Eden MIND a Year 9 training programme was developed and delivered through the PSHE curriculum as part of a whole school approach in 4 Secondary Schools. The 2 hour session focussed on the central theme of mental health and resilience being everyone’s business and not the preserve of professionals. One of the outcomes was that pupils learned that as an individual we can make a difference to our own and to our peers mental health and resilience. The training aims to empower children and young people to recognise and understand common mental health issues and forms of distress, to reach out, to listen, to be naturally inquisitive (helpfully nosey) and to ask questions, to listen respectfully and try and understand their friends and peers. The sessions also provided information on who else could help and when to seek support from trusted adults, schools staff, the GP.  Mates in Mind supplemented a Year 9 Peer Mentoring Programme undertaken by a small number of pupils in each of the four schools.  There was a high level of engagement by pupils and schools who requested something similar to be developed for 6th form pupils. ‘With You in Mind’ is the 1 hour general mental health awareness for young people who commonly experience high levels of anxiety due to exam stress and the pressure resulting from negotiating peer and sexual relationships in a digital world at a crucial phase of psychological and emotional development.  Carlisle/Eden Mind also work in schools in the Carlisle and Eden area to provide free independent mental health advocacy for young people aged 11 to 18 years (funded through Children in Need).  Young people are encouraged to speak up and are assisted to be heard in resolving any issue that may be impacting on their emotional wellbeing or mental health, including bullying, housing, relationships with friends and family, health, college training, employment and safety. 

4.6. Supporting a ‘Whole School’ approach – In Cumbria an increasing number of schools are developing a whole school approach to supporting the emotional and mental wellbeing of pupils.  This is supported in different ways.  Good practice is shared through termly conferences throughout the county (3 x Local Alliances of System Leaders in Schools); locally developed materials and national toolkits are shared via the cumbria.gov website.  For example in 2014 the Cumbria South Lakes Federation of Schools produced a resource pack for schools on Emotional Resilience.  Their report and the included resources arose out of a research project which aimed to embed good practice in enhancing the emotional wellbeing of all students. There are three main themes; research, communication and the trialling of interventions with young people aged 11-18yrs attending South Lakes Federation Schools. The many detailed resources for schools staff to use with individuals and groups are readily available to all schools whether they are thinking about their own emotional resilience policy or wanting to deliver some practical approaches to supporting emotional wellbeing and health.

4.6.1. Utilising external funding to embed an integrated and sustainable ‘Whole School’ – Dowdales Secondary School in Dalton in Furness used a combination of their own resources and staff and HeadStart Big Lottery funding to implement a core aim of their school improvement plan, “Outstanding personal development and welfare, including emotional wellbeing.”  One hundred pupils (10% of the total school roll) across Year 7 to Year 11 groups were targeted to receive direct additional emotional interventions and support.  A range of interventions were available from an in-school Mindfulness programme to individual 1 to 1 outreach support and on-line emotional support and counselling. (Provided externally by ‘Kooth’)   Other pupils trained as Peer Mentors with the specific role of aiding transition from Year 6 to Year 7.  A theatre group and a film and digital media company were also used to raise pupil’s awareness and create an avenue for the expression of emotional and mental wellbeing issues.

4.7. Mindfulness in Schools in Cumbria - In January 2015 we started introducing Mindfulness into our schools in Cumbria as part of the Head Start project. We knew we had to introduce Mindfulness in a way that involved the teachers, captured their imagination and use a model that would be sustainable over the coming years. A GP - led Steering Group including Head Teachers, a Public Health consultant, Head Start Manager, Educational Psychologist, young people, a PhD student and Mindfulness trainers. Learning was captured throughout the implementation and future sustainability incorporated.  Teachers at 5 secondary schools and 25 primary schools completed a Mindfulness Based Stress Reduction (MBSR) course and learnt to deal with their own stress and experienced how Mindfulness could help them personally. Teachers had to develop their own regular Mindfulness practice over 6 months and then went on to train in how to teach Mindfulness to young people. The .b Mindfulness course for young people year 8 and above and the Paws b course for year 7 and below have a robust evidence base. 

4.7.1. We then worked with schools to introduce the courses across an entire year group within the national curriculum. The entire year 9 in a secondary school did a .b Mindfulness course and the whole of year 6 did a Paws b Mindfulness course. Within every year group there are some young people who are struggling and some who are fine but none of us know what the future holds. By the end of the course young people have a greater understanding of the neuroscience behind stress, anxiety and low mood and also have 'Tool kit' of practices they can use to prevent mental health problems developing. In total in 1 year, 900 pupils completed a Mindfulness course.  For 2017 we are concentrating on embedding Mindfulness in the participating schools and working closely with a PhD student from Leeds University looking at Implementation. Our experience is the educational setting is the perfect place to introduce Mindfulness to young people and we continue to learn how to implement in a sustainable way. With encouragement 900 pupils will experience a Mindfulness course this year. We will then involve other schools.  (Dr Andrea Baqai)

4.8 – Digital tools - Unlike older people (often digital immigrants over 40) children and young people do not distinguish between a digital and virtual world.  In Cumbria we have used digital counselling support services such as ‘Kooth’ in selected areas of the County as part of HeadStart and also an NHS waiting times initiative.  https://kooth.com  This service has a good take up rate by males and the feedback from young people in monitoring reports demonstrate how supported young people feel through this online service and how valuable it has been to be able to access the service in the evenings.  Partners in Cumbria are currently seeking funding to roll out a service like ‘Kooth’ across the whole County. We have also worked with young people to create resources to help them raise awareness of some of the detrimental effects that digital media can have on mental wellbeing.  A couple of examples can be found at: 

https://vimeo.com/185334278/42bcb87e39

https://vimeo.com/190743738/7a6fbc0d98

4.9 – Good Together – is an example of very effective mental wellbeing support developed by a Cumbria Educational Psychologist (Dr Debra Brewer) It involves a CBT based support approach, comprising school-based group sessions and home visits to work with parents on implementing strategies.  It has evaluation embedded within it and has been very successful in increasing pupil’s wellbeing and their ability to meet social and behavioural expectations at school and at home.

5.0 Conclusion

5.1. We very much welcome the announcement of a Green Paper to look at the crucial role played by schools and other educational settings in supporting the emotional and mental wellbeing of pupils.  The examples that have been included in this submission reflect the willingness of partners to work together and to innovate.  The majority are in addition to the statutory work undertaken in schools by both targeted and specialist mental health and educational support services provided by NHS Cumbria and Cumbria County Council. In conclusion of our submission to this inquiry we wanted to highlight what has worked well and where we see the challenges to successful outcomes and sustainability.

5.2 What works well?

• Reported impact has been greatest, where we have been able to combine an evidenced based approach with innovation and co-production  involving families and parents e.g. The Family Resilience Family Learning course
• Having a single point of contact strategically has resulted in schools reporting that it is easier to link with the rest of their local community as well as understand the need for a county wide approach.
• Upskilling third sector organisations and then building partnerships between schools and third sector providers as well as other statutory services has been particularly successful and mutually beneficial.  Third sector providers need to feel confident about the quality of their services before going to work in educational settings.  
• A varied rather than a one-size fits all approach works well in our large and diverse county
• Active school clusters, where skills and learning can be shared across several schools and schools can encourage and support each other and provide opportunities for pooled funding of resources have enhanced what any single school can achieve

5.3. Challenges

• Whilst innovation and local developments are effective at supporting pupils mental wellbeing we face a challenge in delivering consistent levels of support and service delivery across all areas of the county.  This is often down to a lack of a sustainable funding stream or investment in addition to other factors.  We have utilised small amounts of funding for schools to develop, innovate and implement initiatives and then found challenges to rolling them out into other districts. We’ve effectively used funding from the Targeted Mental Health in Schools initiative, the Health Gains funding and HeadStart monies since 2011 to upskill both schools staff and other agencies, but its’ difficult to sustain that development without a funding mandate explicitly linked to the regulatory framework, when schools have difficult choices to make.   
• Whilst there is no shortage of information and resources, many schools need guidance and support about how to develop their own ‘whole school’ approach and find the toolkit that best suits them.  This is not always available however we are developing this support to schools through the ‘My Time’ Primary Mental Health Service as part of their ‘indirect’ service offer. 
• We are currently setting up a Mental Wellbeing in Cumbria Colleges, network.  It has been a challenge to include colleges in many of our initiatives and they are often simply not referenced in terms of the policy or mentioned in the information about Future in Mind and the 5 year plans now being implemented.

6. Recommendations 

i. The Cumbria Children and Young People’s Partnership for Emotional and Mental Wellbeing, would like to see a sustainable framework for funding clearly linked to the regulatory requirements. This would support schools to develop a ‘whole-school’ approach and remove the need to skip from one short term emotional and mental wellbeing in schools funding initiative to the next.  

ii. We welcome the announcement that MHFA training will be available to schools. We recommend that once school staffs are upskilled to identify mental health problems and signpost to further support that the resources to undertake evidence-based interventions to alleviate emotional and mental distress in school settings can also be put in place.  We believe that this can be achieved by building capacity and capability in the existing workforce and also enabling providers to grow in a safe development environment which means access to specialist support and advice. 

iii. Colleges and other FE settings should be included in any plans going forward.  They have large numbers of less academically able and emotionally vulnerable students.

Steve Wilkinson, Executive Head Teacher, Queen Katherine Schools Kendal

Chair of Cumbria’s Multi-agency CYP Emotional Wellbeing and Mental Health Partnership 

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Appendix 1 – Young People’s report 

The Mental Wellbeing of Children & Young People in Schools Conference

On Wednesday, 20th April 2016 the Mental Wellbeing of Children & Young People in Schools Conference took place at the Shap Wells Hotel in Cumbria. The Conference was organised by partners and members of the Multi-Agency Emotional Wellbeing and Mental Health Partnership and was aimed at teachers, pastoral leads and other schools staff working with children and young people.

The event focussed on the following objectives:

• To help schools to see where they fit in our wider whole system approach to the emotional and mental wellbeing of Children and Young People
• To raise awareness and understanding of the crucial role schools play in supporting emotional and mental wellbeing
• To give schools more confidence about where they can get support to help them with their role
• To celebrate good practice in schools from across Cumbria

Staff and Young People registering at the Shap Wells Hotel and John Macilwraith launching the Children and Young people’s Plan 2016-2019

The Conference was opened by Jess Ford-Powel and Justin Mahone (Both Members of the Copeland Youth Council and UK Youth Parliament Candidates).

Jess opening the Conference and with Justin and Lucia on the Young People’s Panel

The event attracted over 180 professionals working with Children and Young People within Cumbria in addition to Youth Council Members from Copeland, Barrow and South Lakeland.

The Event was hosted by the Multi-Agency Emotional Wellbeing and Mental Health Partnership and its Chair - Steve Wilkinson; with the event organised by Anne Sheppard – Strategic Manager Emotional Wellbeing and Mental Health Services for Cumbria County Council

A number of valuable presentations were delivered in the morning session, notably from Damian Hart – Consultant and Trainer – Young Minds and Lucia Harrington – Youth Councillor for South Lakeland and UK Youth Parliament Candidate.

In the afternoon, a number of very informative and engaging Workshops were available, including Psychodrama in Schools, Mindfulness and a Case Study on the Headstart Programme from Dowdales School. 

The event was, we believe, an overwhelming success. The presentations were extremely well delivered and received, providing an invaluable insight in to the work currently going on to support the Mental Wellbeing of Children and Young People within Cumbria. Additionally, the various workshops on offer were insightful, engaging and well attended.  It was also acknowledge that the Conference benefitted greatly by the contributions made by the assembled young people. The presentation by Lucia Harrington on Recommendations for Improving Mental Health Support Systems in Schools was particularly well received; as were the comments made by Jess Ford-Powell on the need for all organisations to support each other and work together in what are challenging times due largely to the austerity measures we are all experiencing in the current financial climate. The Conference was closed by Councillor Anne Burns – Portfolio Holder for Children and Young People and Bethany Thornton – Chair of Furness Youth Council.

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