My regular meetings with the Principals of schools in the RSA Family of Academies include a slot for colleagues to share things they are particularly proud of, as well as what is currently keeping them awake at night. Over the last eighteen months concerns about the mental health of children in their schools has rocketed to the top of that latter list. Indeed, if we presented these worries as a league table it would rate somewhere between anxiety about staff recruitment and retention and school funding as a top concern.
I was therefore cheered to hear of today’s announcement that, in the words of the Prime Minister, the government is going to, “employ the power of government as a force for good to transform the way we deal with mental health problems right across society”, with “an emphasis on early intervention for children and young people”.
The government is right to focus on children’s mental health. Statistics in this area drawn from the Health Committee enquiry into Children and Adolescent Mental Health Services (CAMHS) in 2014 indicate that:
- One in ten children aged between 5 and 16 years has a mental disorder.
- About half of these (5.8%) have a conduct disorder, 3.7% an emotional disorder (anxiety, depression), 1-2% have severe Attention Deficit Hyperactivity Disorder (ADHD) and 1% have neurodevelopmental disorders.
- The rates of disorder rise steeply in middle to late adolescence and the profile of disorder changes with increasing presentation of the types of mental illness seen in adults.
The Health Committee also received evidence suggesting that around 30% of English adolescents reported a level of emotional wellbeing considered as (sub-clinical) "low grade" poor mental health, that is they regularly (at least once a week) feel low, sad or down. The levels were higher among girls than boys. There is a strong correlation between mental health problems and social disadvantage, with children and young people in the poorest households three times more likely to have mental health problems than those growing up in better-off homes. And the statistical information appears to back up the experience of staff working in our RSA Family of Academies that the numbers of children with mental health difficulties, and their levels of need, are increasing.
The government’s acknowledgement that more needs to be done to support good mental health amongst children and young people is therefore welcome, as is the confirmation that schools have an important part to play. Ensuring that all schools have access to free training is an excellent place to start, as is the aim to strengthening links between schools and local NHS services.
In my view, however, the proposals do not go nearly far enough. It appears that the commitment is to train just one person in recognising and responding to mental health issues in children and young people, and the scheme is limited to secondary schools. We know from the Health Committee enquiry referenced above that the peak onset of mental ill health as being between the ages of 8 and 14, which means that this sort of training and support needs to be available for staff working in primary schools too. And surely all staff working in schools need to have some level of awareness of children’s mental health issues and how to recognise, talk appropriately about, and provide at least initial support to children in their classes with these difficulties? The RSA Academies Teaching School Alliance has developed proposals for a programme to do just this across our network of schools in the West Midlands, and is currently looking for partners to work with us on this project.
It is also important to recognise that, whilst schools can and should be doing preventative and early intervention work, families must be able to draw on more specialised services when they need them. It is no secret that Child and Adolescent Mental Health Services (CAMHS) have been cut dramatically over recent years, meaning that the ‘thresholds’ for accepting a referral have become very high, with long delays between referral and treatment, all of which can leave parents and the teachers and other professionals working with children on a day to day basis struggling to support the young person. A report by the Education Policy Institute last month found that specialist mental health services were turning away 23% of young people referred to them by a GP or teacher, that only 18% of areas were meeting four week target for routine referrals, and only 14% were meeting the one week target for urgent referrals.
And these are not the only services to have been cut. Over the last few years local authorities have had to significantly reduce their non-statutory services, including youth and play services and grants to voluntary organisations working with the most vulnerable young people and their families. Whilst these services were not, in the main, working overtly or explicitly to support children’s mental health, youth workers and others in similar roles would often have provided the stable, interested adult outside the family that can be so important for developing a young person’s resilience.
If the government is committed to improving young people’s mental health it needs to ensure that priority is given to these wider specialist and support services – schools have a role to play but cannot and should not be a replacement for expert help where needed.
Finally, we need to consider the impact of wider education policy on children’s mental health. If the government is serious about significantly improving children’s mental health, it would be wise to review current and proposed policies for their likely impact on health and well-being and ask,
“is this policy likely to increase or reduce the number of children suffering from anxiety, depression, or otherwise regularly feeling sad, down or low?”
For example, how would the proposals to increase the number of grammar schools affect the mental health of the overwhelming majority of 11 year olds who fail to gain a place? Do we know how teenagers’ mental health is affected by the move from modular to terminal examinations? And what is the impact of reducing the opportunities for studying sports and arts to GCSE through the priority given to e-bacc subjects, or of requiring 17 year olds to re-sit the maths and English exams they ‘failed’ at 16?
Only when the government is able to take an overview of the range of factors that contribute to children’s mental health, to “fully employ the power of government as a force for good to transform the way we deal with mental health problems right across society”, will we make significant strides in this crucial area.
Alison Critchley is Chief Executive of RSA Academies
Follow Alison on Twitter @Ali_Critchley
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Good to see the issue being raised but always worry about the focus on "disorders" whenever the government or health professionals get involved.
In 2011, when we carried out an audit of schools, colleges, universities & workplaces in 46 countries, we found that one of the biggest issues is the lack of training, teaching, mentoring or coaching around listening skills. 6 years later, there's been some marginal improvements but still very little investment in this essential discipline for learning, educational success, broader success, and positive mental health.
Interesting comment re listening skills Paul and one I identify with, both from work as a trustee in a youth counselling charity and everyday interactions. I'm not sure if listening skills have ever been a priority in education (or business and politics...) but I'm convinced many challenges we face individually and as a society would be reduced if we paid more attention to both what we and others say. Good listening skills are a sign of interest and respect and go a long way to building relationships and defusing conflict, sorely needed in schools and society.
In the UK we have a crisis in the basic physical fitness of our children (Sandercock Essex University). British Heart Foundation, 2015 children aged 2-4 years only 9% of boys and 10% of girls are achieving their physical activity recommendations in England.
Lack of physical fitness at 4 years impacts on the development of all subsequent cognitive motor skills (Ayres 2005).
In the UK we have no defined goals for children's physical fitness and development and we do not do any checks either. So P.E. lessons are literally pointless and lack direction. This is in stark contrast to what would be found in early years settings in many Asian countries and in Eastern Europe.
We have no checks in the UK for sound processing; also no sound processing therapy available. Children are literally sitting in classrooms in the UK struggling to make sense of the speech of others in the classroom; this can make them very frustrated, anxious and agitated - it is not difficult to correct. We understand sound processing so little some of our infant children are doing phonics lessons and spellings tests on sounds that they are not all yet mature enough to process - try matching phonics lists to Dodd et al 2003 analysis of which ages children hear which sounds in the English language.
We have no routine checks to ensure that children have binocular vision. If vision is flickering or double it can be very disturbing for a child and will significantly restrict their ability to learn. It is correctable. Development of sound and motor skills impacts on visual development and may need to be sorted out in order to sort out vision.
Our education system has to stop making demands of children before they are developmentally ready and operate to maximise child development.
In order to be an efficient learner children need to be able to integrate their motor skills and senses. They also need regular sleep and good diet and a secure home - none of which are guaranteed for many of our children in B & B's.
If we understood child development we might stand a chance of designing a world that will maximize children's cognitive skills and minimise their distress. All of our children need to be fit in order to build resilience to operate as independent adults. Everyone can be physically fit in a country as rich as the UK, it is just a matter of social and political will.
Getting the absolute basic aspects of child development right seems to have more point than philosophizing about the emotional impact of grammar schools.
An excellent reminder Charlotte that we need to take a more holistic approach. I think we are far from achieving this for the majority of children, let alone the most deprived. Given almost every child passes through the education system we have a structure in place to help children live healthy lives (both physical and mental) but we are failing to prioritise or enable this essential role. It is an assumption on which all other educational interventions are based but poor physical and mental health limit how successful these can be.