From RCPsych Insight: Class acts

Each month we will highlight a story from RCPsych Insight magazine which reflects the work being done in mental health services around the UK.

This article looks at innovative work happening in Oxford and Greater Manchester which has shown the vital role schools can play in improving young people’s mental health.

Full article

The mental health of children and young people has long been a major concern.

The scale of the problem was laid bare in a government survey of children in England published in 2018. It found that 12.5% of five- to 19-year-olds and 5.5% of two- to four-year-olds had at least one mental disorder when assessed.

The study also reported an overall increase in the prevalence of mental illness among five- to 15-year-olds in the past 20 years.

The response to these figures has been a widespread call for better access to Child and Adolescent Mental Health Services (CAMHS) and, in particular, for schools to have a role in providing such access.

Schools are seen as well placed not just to promote good mental health, but also to prevent problems later in life.

A central recommendation of the 2016 report by the Values-Based Child and Adolescent Mental Health System Commission, of which RCPsych is a member, was that schools should teach their pupils about mental health “in the same way they teach them about literacy or numeracy”.

Trailblazers

So, what does this look like in practice? One area of the UK that has blazed a trail in working with schools to improve mental health provision for children is Oxfordshire.

Consultant child and adolescent psychiatrist Dr Mina Fazel explains how it began 15 years ago through working with refugee children. “It came about by chance,” she says, “because a third-sector organisation approached us, interested in developing ways to improve access to mental health services.

They asked us to provide a mental health service within schools.” Dr Fazel and her colleagues set about trying to find the best ways of supporting the refugee children and their families, holding regular meetings in schools with staff, initially without the formal involvement of mental health services, but making referrals to CAMHS where necessary.

“We had a complete shift in our understanding of working in schools,” says Dr Fazel. “At the end of our meetings, the staff would say: ‘Thank you very much; that was really helpful. But now can I talk to you about the 20 other children in school that I’m worried about?’

So, we approached our mental health services and then the commissioners and said: ‘Actually, we need to provide a service for all kids, not just refugee kids.’

All secondary schools in the county get CAMHS time

“Now, through our School In-Reach programme, all secondary schools in Oxfordshire get specific CAMHS time.

From a really small project with a select group of vulnerable children and families, we’ve been able to think a lot more about the needs of all vulnerable kids, no matter where they’re from, and about the role that schools could potentially play in enabling us to better help these young people.”

This way of thinking is fast spreading throughout the rest of the country.

In 2018, RCPsych joined forces with NAHT Cymru, the school leaders’ union in Wales, to explore collaborative ways of working, understand each other’s challenges and share best practice. Their first joint conference was held in December last year in Cardiff.

Mental health packs for schools

RCPsych has also developed a mental health pack for schools, a collection of 14 factsheets that cover a wide range of Class acts disorders, explaining how to recognise them and what can be done to help.

They are much in demand, with Hertfordshire Council, for example, supplying them to every school in the county.

Extra funding

The government is also pressing ahead with its plans to fund new Mental Health Support Teams in schools.

Led by NHS children and young people’s mental health staff, these are designed to provide extra capacity for earlier intervention and ongoing help. From this year, the support teams will start work in 25 areas across England, the largest of which is Greater Manchester.

Leading on the project for the Greater Manchester Health and Social Care Partnership is consultant child and adolescent psychiatrist Professor Sandeep Ranote.

The work of her mental health support teams, already in training, is being informed by a four-month pilot undertaken in 2018.

‘Mentally Healthy Schools’ involved 31 primary and secondary schools across the conurbation. In collaboration with the NHS, it saw four local third-sector organisations deliver on-site training of staff and pupils. That was the best use of resources, says Professor Ranote.

“We don’t have sufficient staff in CAMHS to send to the schools; we need to be here, providing our service. If you had a child that had self-harmed or you were worried that they had an eating disorder, you’d want to get access to specialist CAMHS teams, including a child psychiatrist, really quickly.

Partner working

So, we need to work better as a system in partnership to support our schools and use our workforce more wisely.” The pilot clearly worked well. A total of 690 pupils took part in ‘active workshops’ led by athlete mentors – good physical health being a key component of good mental health – and over 150 were trained as young mental health champions.

In addition, 113 members of staff received mental health first aid training and, crucially, more than 60 senior leaders were taught how to respond to the mental health needs within their school. RCPsych’s lead on schools, professor Tamsin Ford welcomes the new support teams.

“We know that only one in four of the children with clinically impairing difficulties are seen by the current mental health provision,” she says, “and for each of these children there are probably several others who are struggling, if not so severely affected.

This makes the provision of additional staff to work closely with schools to support these children, as well as the teaching staff who are working with them, unquestionably essential.”

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