Written evidence from National Children's Bureau (NCB) (CMH0193)

1. Executive summary:

• The Inquiry should consider two distinct but overlapping themes:
• 1) how schools can better promote all children’s emotional health and wellbeing (universal); and
• 2) how schools can better address the needs of children with specific mental health problems (targeted).
• A ‘whole school’ approach essential in improving wellbeing; prevention and early intervention; and improving support for individual children with mental health needs. In the case of early intervention and support for individuals, there are significant parallels to be drawn, and lessons to be learned, from the special education needs and disabilities (SEND) framework, in terms of law, policy and practice and a lot to be learned by looking at effective anti-bullying programmes which involve a whole school approach.
• There should be a clear recognition in (law, policy and practice) that promoting wellbeing and good mental health is a key objective for all schools. Improving wellbeing and mental health should be seen as an end in itself. However, there are also clear links with academic attainment and successful transition into adult life, including further and higher education and employment.

Note on the involvement of children and Young People

NCB recognises the value of enabling children and young people to participate in the policy making process.  We urge the committee to hold an oral evidence session(s) in which children and young people can share their experiences directly and offer our advice and assistance in making this happen.  See Annex.

2. About NCB

NCB is a leading children’s charity working to build a better childhood for every child. We listen to children and young people and work with those supporting them to develop evidence on what needs to be done to enable children to enjoy their right to be safe, secure and supported so they can flourish and fulfil their potential.

NCB hosts the Partnership for Well-being and Mental Health in Schools. The Partnership is a national network of more than 50 leading organisations from the education, health and children's sectors that supports schools and services to improve the well-being and mental health of all children in education. Our vision is an education system where good well-being and mental health are at the heart of the culture and ethos of all schools, so that children and young people – supported by their teachers – can build confidence and flourish.

NCB also hosts a number of specialist membership groups that have fed into this submission:

Anti-Bullying Alliance
The Anti-Bullying Alliance (ABA) is a unique coalition of organisations and individuals, who work together to reduce bullying and create safer environments in which children and young people can live, grow, play and learn. They coordinate Anti-Bullying Week each year in schools across England, visit www.anti-bullyingalliance.org.uk.

Childhood Bereavement Network

The Childhood Bereavement Network is the coordinating hub for services across the UK that offer direct support to children and young people who have been bereaved of a parent or sibling. Our members find creative and therapeutic ways for children and their families to begin to understand what has happened and to live with and beyond their loss. For more information and a directory of ‘open access’ services, visit www.childhoodbereavementnetwork.org.uk

Council for Disabled Children (CDC) is the umbrella body for the disabled children's sector. We want disabled children and children with special educational needs (SEN) to have full and happy childhoods; fulfil their potential; and be active within the community. We do this by influencing Government policy, working with local agencies to translate policy into practice and producing guidance on issues affecting the lives of disabled children. For more information visit www.councilfordisabledchildren.org.uk

Sex Education Forum
The Sex Education Forum is the national authority on sex and relationships education (SRE). We believe that good quality SRE is an entitlement for all children and young people and we are working with our core members, who all support statutory SRE and include local authorities, children’s, religious, health and family organisations, to achieve this.

3. Introduction

The National Children’s Bureau (NCB) welcomes this joint inquiry into children and young people’s mental health and the role of education, as well as the Prime Minister’s announcement this month that the power of government will be used to transform the way mental health problems are addressed. Over more than 50 years we have developed expertise on a wide range of issues affecting children, including vulnerable groups such as children with SEND, children in care, and children living in poverty.

In recent years, national Government has been strongly focused on academic attainment and exam results, which has filtered down to education authorities, teachers and students. However, the time has come to rebalance the school purpose and accountability through a clear shift towards wellbeing and good mental health.

(i)                  Schools must play a clear role in promoting ‘social and emotional wellbeing’ (hereafter ‘wellbeing’).[1] There is growing evidence that children in England are more likely to be ‘unhappy’ in comparison with other countries.[2] Meanwhile, factors such as exam pressure, economic uncertainty and cyber-bullying mean children are facing new and increasing challenges. There is a clear need for schools to play an active role in neutralising threats to wellbeing and promoting good mental health.

(ii)                Alongside this, schools must also play a crucial role in providing targeted support (including identification and early intervention) for children with ‘mental health problems.[3] Growing numbers of children have mental health needs, and some proportion of those will require specialist support. Schools need to provide a range of universal and targeted support, in some cases alongside other specialist services (usually Children and Adolescent Mental Health Services, ‘CAHMs’) in order to help meet their needs. 

In achieving the desired objectives in both these areas, a ‘whole school’ approach is essential. ‘Whole school’ approaches are characterised by a concern for the entirety of school life, and the health and wellbeing of students, staff, parents, and the community. They encompass and mobilise the ‘totality of the school experience to promote wellbeing and address mental health issues’.[4] 

4. Response to the four areas identified by the Inquiry

(i)                 Promoting emotional wellbeing, building resilience, and establishing and protecting good mental health

Schools are under significant and growing pressure to deliver academic results. This has been the clear focus of national government policy in recent years, often to the exclusion of other areas. However, there has also been increasing interest in concepts such as resilience, ‘character education’ and life ‘life skills’ – in recognition of the fact that school needs to prepare children for adult life.  

The role of schools is not simply to measure and improve children’s attainment but also to prioritise and promote their wellbeing. In recent work on behalf of NCB, Professor Weare has highlighted increases in attachment disorder, anti-social behavior, anxiety, and attempted and actual suicide among young people, as a serious cause for concern.  These often inter-related problems frequently remain undetected and untreated for an extended period unless schools or other agencies take an active role to address them at an early stage.[5]

Based on this evidence, NCB has developed a self-assessment and improvement tool for school leaders to support them in implementing a whole school approach to wellbeing and mental health.[6]

The Inquiry should explore how schools can be encouraged and supported, through policy and best practice, to place the promotion of wellbeing at the heart of everything they do. Crucially, this needs to be ‘everyone’s business’ – not the reserve of specific staff or services. Schools should also aim to foster an environment of ‘connectivity’, where pupils create a bond with their school and view it as a safe place where they will be respected and accepted for who they are. There is evidence that this has a positive impact on pupil attainment, reductions in bullying and incidences of stress, anxiety, and risky behaviour (violence, impulsiveness, early sexual experiences etc) among students.[7] 

NCB recognises the significant challenges in implementing such an approach, especially in large secondary school environments.  To avoid failure and collapse, we recommend that any new approach should be developed incrementally over an extended period of time with the full support and commitment of the senior leadership team. 

Many schools are already taking important steps to improve students’ wellbeing. Ofsted has found that primary schools are using the pupil premium to improve pupils’ attendance, behaviour, confidence and resilience, as well as support for maths and literacy. A survey of primary schools by the National Association of Head Teachers and Place2B found that nearly all primary schools are engaging in activities to support mental health, including working with parents. Two in five primary schools have staff trained in mental health issues and over a third have access to a school-based counsellor.[8]  A survey by NCB and the Association of School and College Leaders (ASCL) found that all schools reported providing PSHE lessons dedicated to mental health and wellbeing (83%); topic-specific assemblies (60%) and peer mentoring (55%).[9] The Government’s proposals in this area should include a system for recognising schools where they demonstrate progress and achievement in promoting wellbeing and good mental health.

However, evidence also shows significant gaps that need to be filled. The NCB/ASCL survey found that just half of secondary schools provide training or support to teachers on mental health issues and just a third currently use whole school approaches, or integrate emotional wellbeing into lessons.

Curriculum

In order to promote high levels of wellbeing and, where possible, to prevent the development of more serious long term mental health problems, schools should incorporate emotional skills, values and attitudes learning into the mainstream curriculum.[10] 

There is a correlation between the quality of PSHE in a school and improved student wellbeing, and in turn their overall effectiveness academically.[11]  In particular, there is a role for schools and teachers in developing young people’s resilience and preparing them for potential challenges such as bereavement. Simple, low cost interventions in this and similar areas can often be extremely effective. For example, local members of the Childhood Bereavement Network can provide input to PSHE lessons and curriculum development.[12]

NCB is currently undertaking research for the Department for Education (DfE) on how schools and colleges are currently providing character education and supporting the mental health of their students. Due for publication in summer 2017 this research will provide case studies of good practice for other schools and colleges to consider.  NCB recommends that these case studies should be widely disseminated by DfE in order to encourage other schools to re-think their approaches to achieving good mental health and wellbeing for all students.

Wider school policies

As a part of the whole school approach to improving mental health and wellbeing, schools should develop robust policies around behavior for all students and staff.  Anti-bullying, equality, behaviour and online safety policies should be used to challenge prejudice around disability, sexual orientation, race, gender and ability.[13]

With bullying in particular, evidence indicates that early intervention is key to preventing long term harm.  Indeed, research from University of Warwick and Duke Medical Centre suggests that the long term impact of bullying may even be worse than that of child abuse.[14] Further research has shown the substantial long-term effect of being bullied (especially if a child falls into a ‘frequently bullied’ category) indicates people were more likely to[15]:

• experience a range of mental health issues as an adult including suicide ideation
• earn less money
• be not in employment, education or training into adulthood
• be obese (particularly in women) 
• not gain qualifications
• not be in stable relationships
• commit or be a victim of domestic violence[16]
• be homeless[17]

We know that children who are bullied are more likely to develop mental health problems, and children with mental health problems are more likely to bully others.  This vicious cycle is problematic and worrying, and as such, the root causes of bullying need to be addressed by schools as part of wider measures to improve long term wellbeing.

(ii)               Support for young people with mental health problems

Across the UK approximately 850,000 five to 16 year olds have a mental health condition, accounting for approximately one in 10 children and young people.  Notably, half of lifelong mental illness starts by age 14, meaning prevention and support for children throughout their schooling is critical to identifying problems early and protecting young people’s long term wellbeing and resilience as they grow into adulthood.[18] 

Early intervention for young people with mental health difficulties is critical to prevent escalation. The earlier children receive support, the better their chances of achieving positive outcomes later on.

School, as the universal service available to all children, has a key role in early intervention. NCB is currently conducting research looking at a specific aspect of this, relating to children missing education. We know that in many cases this is caused by mental health difficulties in the child and/or his or her parents. Alongside taking responsibility for supporting the child to return to school, schools should seek to understand and record the underlying causes, including poor mental health. They should also consider whether this is linked to experiences at school, such as bullying, or to non-school factors.  Additionally, schools should have strategies in place to support children at risk of developing mental health problems. For children with SEND, this should be covered by their SEN support at school or the package of support identified in their Education Health and Care Plan. There is growing concern, debated at length in the Children and Social Work Bill, (currently being considered by the House of Commons), that children in care are missing out on support. Nine out of ten children who have been abused or neglected at a young age will develop a mental health condition by the age of 18, yet there is no automatic offer of a specialist assessment, and no clear route to support.[19] We welcome the Government commitment to conducting a trial of mental health assessments for children in care. To be successful, this must consider the role that schools should play in prevention, early identification, referral and ongoing support, alongside specialist services.   

Some schools undoubtedly support children with mental health needs to receive appropriate support early. However, as the Government has acknowledged, there is significant variation in the system, and a need to identify and promote best practice. Professor Weare has advocated a three step approach.  First, schools should focus on social and emotional skills development for children with particular difficulties via both one-to-one activities and wider group work with peers; second, specialist staff should initiate new approaches to provide continued long term support for children who need it; and third, schools should develop clear internal policies with clear pathways for making decisions about provision of support for students within the school environment.  They should also provide guidance for staff as to when to make referrals to outside agencies such as CAMHS. The focus should be on early intervention, accountability and transparency at all levels of the assessment and referral process.[20] 

In addition to this, schools must be sensitive and responsive to the individual needs and circumstances of each child. Policies and procedures should respect children’s rights and give due weight to their views.

NCB warmly welcomes the Government’s stated intention to introduce a ‘comprehensive package of measures to transform mental health support in our schools…’. This will require change at every level – in law, policy and practice. There is an important role for central Government in setting the direction and establishing clear duties. Currently, there is no single piece of guidance covering duties towards all children with mental health difficulties in schools.[21] NCB recommends the Government review the existing guidance, and consider how this can be streamlined and clarified in respect of this group. This complex landscape creates variation and uncertainty for professionals, leading to children falling through the gaps. Children, parents, schools and professionals need clarity about their duties and entitlements.

In developing a new framework for supporting children with mental health needs, we recommend the Government draws heavily on the exiting SEND framework, which establishes the role of schools in early intervention, referral and ongoing support, as well as detailing how this fits with specialist services. It also provides a useful blueprint for commissioners. However, as outlined above, alongside changes in the system for supporting individual children with mental health needs, schools must also be supported and incentivised to prioritise wellbeing for all students.

(iii)              Building skills for professionals

As part of a whole school approach to promoting wellbeing and supporting young people with specific mental health needs, teachers must have access to training and resources. School staff must be equipped to understand the risk factors relating to whole school wellbeing, to understand what is ‘normal’, to identify early warning signs, and to help students to develop resilience, so they can overcome adverse circumstances.[22]  They should also understand when and how to refer for specialist support. There is some evidence that teachers can delay the decision to refer for fear of creating stigma, or in the belief that a child will ‘grow out’ of the problem, which can lead to unchecked deterioration in the child’s mental health.[23]  We welcome the Government’s announcement that every secondary school will be offered ‘mental health first aid training’ but to be effective, this must be part of a wider package of changes.

As above, aspects of the SEND framework can be usefully applied. For example, every member of school staff must have a defined and proportionate level of responsibility for each child’s wellbeing and mental health.  Similarly, teachers, school leaders and school governors must all have a defined and proportionate degree of accountability. Responsibility and accountability for wellbeing and mental health should be brought in line with that in place for academic attainment.

However, although teachers must have clear responsibilities in this area, they must receive appropriate support from specialist professionals both in the school and externally, and funding must be available to schools for this purpose. There is significant concern that cuts to local authority budgets and other funding streams are resulting in reductions in the numbers of school nurses and councillors, with a serious implication for pastoral care. Evidence suggests this carries particular risks for vulnerable children, such as those in care.[24] 

Beyond this, schools must have a good working relationship with local CAHMS. Cross-agency working is essential to ensure young people don’t fall through the gaps and that referrals are effective. Importantly, schools must play an ongoing role in supporting children with mental health problems, including after they have been referred for specialist support.

When considering the role of schools in addressing mental health problems, the Government must consider the wider context in terms of increasing pressure on specialist services. Specifically, evidence has shown that local areas are not necessarily allocating additional funds from Future in Mind as intended.[25]  Importantly, the forthcoming Green Paper and related policy must treat schools as one vital piece in the puzzle, rather than providing a replacement for specialist health services.

(iv)             Social media and the internet

One of the key drivers for action to address wellbeing and mental health issues is that as ‘digital natives’, children now face significant new pressures in a world of 24/7 connectivity.  As yet, little is known about the long term impact of the internet and social media on human relationships. However, the immediate impact on wellbeing and mental health is very clear.  One young person told the Anti-Bullying Alliance (based at NCB):

“Your social life is everywhere.  Not even your bedroom is yours.”

Cyberbullying is an increasing issue for children. The nature of smart phones, tablets, social media and constant connectivity means that children can communicate 24/7 which in turn makes bullying something that can happen in any location and children can struggle to get a break from bullying.  One young person told the Anti-Bullying Alliance (based at NCB):

“Bullying is far more wide spread now it is online - it’s not just your time in school. It affects your social life. Your social life is online.  How many people like your status or your picture. Social pressures are just made worse.” 

This kind of sentiment is reflected in research that found social media and related cyberbullying are increasingly a cause of emotional disorders with young people.[26] Linked to this, ‘sexting’ can have significant long-term consequences, especially where pictures are passed to third parties or made public without consent. NCB welcomes moves to prevent automatic criminalisation of children in these circumstances through police[27] and schools guidance[28]. However, school staff also have a key role to play in helping children understand the risks and their rights and responsibilities. Specifically, they need to learn about the potential long term consequences, including the creation of a ‘digital footprint’ which one young person told the Anti-Bullying Alliance is more like a ‘digital tattoo’ where your digital activity can be hard to delete.

Although social media poses a great many challenges for young people’s mental health and wellbeing, it can also act as an important forum for support for young people to share their experiences with others who share similar experiences, such as the Hope Again website www.hopeagain.org.uk for young people who have been bereaved. In a consultation with disabled young people the Anti-Bullying Alliance found that one young person said:

“If you can’t get out a lot, it can keep you in touch with people.”

And another:

“Even if you don’t communicate directly with that person, you can feel a connection.” [said regarding watching YouTube video’s of people with similar experiences]

NCB encourages the committee to explore how these support groups could be expanded and utilised more widely.  However, we also encourage the committee to be wary of treating these types of online support groups as an alternative to counselling and other specialist support.

5. Conclusion

NCB is calling for changes in law, policy and practice to create a clear framework to ensure:

-          Schools prioritise the promotion of wellbeing and good mental health alongside academic achievement; and

-          Schools provide high quality, consistent support for children with mental health problems, in close partnerships with specialist services and other agencies. The Ofsted inspection framework should be expanded to focus more on the mental health and emotional wellbeing of young people in schools.

National Children’s Bureau

January 2017

Annex: Young people’s top tips[29]

Female, 17 - “I believe that schools should certainly play a more active role in mental health than I personally have experienced: one suggestion could be to have an SMS based support system where a young person could confidentially request a visit to the school nurse or simply ask for advice without, for example,  antagonising their anxiety. Also, I think that schools could be providing structured, age appropriate and statutory mental health education from the age of seven, where children will be taught symptoms and coping methods as well as suggestions of where to go to get external support. Additionally, something as simple as having a full time school nurse employed in every school who has no other role in the school would help”.

Male, 20 – “I believe schools should support young people's mental health by starting the discussion on the topic a lot sooner; a lot of kids find themselves lost in spots of depression and anxiety and have no idea how to express those feelings, either because they fear being ostracised by their peers or because the support network in their school isn't visible enough to them”.

Male, 23 – “Schools should ensure that there is a qualified full-time counsellor employed by the school or that support is covered by another service (like the local CCG in the area). Some young people don’t have anyone who can provide the emotional help which cannot simply be assumed by an ordinary teacher. Schools could introduce a peer support model that has pupils who might have experienced a mental health problem first hand who can support those who have minor needs, like exam stress or relationship issues - anything that is a crisis or where someone is at higher risk would obviously need adult intervention. Embed the topic as part of PSHE from Primary education and help build personal resilience by identifying at an early age when they are feeling low and becoming more aware of spotting others who might be hiding their problems. For those who are known to have a mental health issue or are more vulnerable, schools could introduce smaller group sessions in school hours, so rather than a lesson every fortnight or month, the group would meet with an experienced counsellor to talk about what's affecting them and finding solutions to the dilemmas they face. I think that all SEN staff should be trained to support students who have a mental health issue - those with autism and learning disabilities are more likely to experience a mental health difficulty. I think that ICT lessons must feature a course on social media security from Year 7 to identify earlier on the measures that they can take to protect themselves and the impact that cyberbullying can have on someone if they are involved. Schools should establish clear communications with services like CAMHS, so a plan of action can be put into place for the services a young person is accessing and to make sure that there is a consistency with various support networks”.

Female, 19 – “Schools should support the mental health of children through a preventative method. In the compulsory PSHE session, discussions about mental health awareness should be incorporated so that if people feel they need help they know where they can get it. Depending on age, it can be taught and presented in various ways even through activities such as everyone sitting in a circle, having a discussion or passing a ball around so that people can contribute ideas, or watching documentaries and then having discussions”.

Male, 20 – “Through most of my school life there were mental health services available for me to use within the school but my experiences with these services have all been outside of the school environment through the CAHMS service, although it was actually one of the teachers at my school who recommended to me the services of a stress nurse who helped me by giving me the right tools to get through my GCSEs.  But most of the mental health support in school has been for people who did not have any extra needs and so not for me and so this is why I think that there needs to be better emphasis on providing mental health in schools starting in primary and moving right the way up through secondary and on to the 6th form. Schools also need to have a better way of signposting young people towards the services”.

Female, 15 – “Ensuring that children/teenagers realise what they can do to get help is what I consider to be the most important thing in school life, ranging from dealing with exam related stress, to incidences in which counselling could be appropriate.  This could be handled by holding discussions or putting up posters around the school (such as ChildLine) or holding interactive workshops to educate children.  It would be helpful for the students to know there is someone they can talk to who wouldn’t necessarily contact their parents – which I’ve noticed is a common theme as to why children do not open up to adults, as some people don’t want to worry them. I believe many symptoms of mental problems are passed off as teenage behaviour or exam stress. I think that the more research that is done towards mental health, the more understanding and support will be given for future generations”.

Male, 15 – “I think that mental health being dealt with in school is a massive problem which will never be understood enough by the everyday English or Maths teacher. I think that school nurses are also struggling to deal with mental health problems as they actually aren't qualified to. Counselling should be offered all day, every day for anyone to visit not just one day a week or even one day a month”.