Mental Health and Behaviour November 2018

This is non-statutory guidance to go alongside the existing guidance on Behaviour and Discipline in Schools (2016) and updates the 2016 version of this guidance.

It is a rather disjointed document which spends much of its space telling schools things that they already know. It is not fully able to encompass the concept of behaviour as communication. There are mixed messages about the need to individualise approaches understanding the link between mental health problems, SEN and additional vulnerabilities and behaviour, while ensuring a consistent approach to behaviour. Also, that simply by identifying a problem a school should be able to manage it. There is recognition that schools are not experts in mental health, but they are expected to manage complex needs. Chapter 4 talks about multi-agency working, but not what to do when these services are not available or won’t pick up the referral.

Much of the advice on behaviour; ‘create a calm and safe environment’, be proactive to seek early help, does not seem to match with the descriptions of significant mental health issues, or the impact they can have on children’s and others’ learning. Schools are told to consider underlying issues before exclusion, but offered no support to deal with them.
The document states the obvious, for example it is more effective to act early than to wait until problems escalate and to include all relevant information and understand the criteria for referral to CAMHS. Schools know this, what they need is support (and funding) to do it.

The guidance considers 4 areas

Schools’ roles and responsibilities

Under Keeping Children Safe in Education schools have a responsibility ‘to prevent impairment of children’s health or development, and to take action to enable all children to have the best outcomes’. In this way mental health and behaviour are linked to safeguarding.

The school role is summarised as
• Prevention- creating a calm and safe environment, promoting resilience and appropriate teaching through the curriculum.
• Identification
• Early support
• Access to specialist support

The guidance highlights the need for behaviour policies to be consistent with the ‘legal requirement that treating all pupils the same may be unlawful where a disability affects behaviour. It may be unlawful to apply a behaviour policy that treats all pupils the same if a pupil’s disability makes it harder for them to comply with the policy than other pupils who are not disabled.’ (page7) This reflects the legal cases over the summer.

Also, the guidance identifies the increased vulnerability of children with SEN and that mental health problems may be an indicator that a child is suffering or has suffered significant harm.

Creating a whole School Culture

There is a recognition of the school’s ‘profound influence on both pupil and staff mental wellbeing’ and their role in helping ‘prevent mental health problems by promoting resilience as part of an integrated, whole school approach that is tailored to the needs of their pupils.’ (page 8).

This should be done through
• Culture, ethos and environment including the hidden or informal curriculum
• Using the curriculum to promote pupil’s knowledge about health and wellbeing
• Partnerships and active engagement with families, the community and outside agencies.

School leadership have a key role creating a culture where ‘calm, dignity and structure encompass every space and activity.’(page 8) This will involve clear behaviour expectations ‘underpinned by a clear system of rewards and sanctions and an accountability system that sets expectations for all staff, parents and pupils to play their part as much as they are able.’ (page 8). Also, a behaviour policy that prevents and tackles bullying.

This should be supported by CDP to help staff be ‘aware of some common symptoms of mental health problems: what is and isn’t a cause for concern; and what to do if they think they have spotted a developing problem’ (page 9). There is some recognition that some pupils will be more vulnerable and that they should be identified.

Understanding the link between mental health and behaviour

There is a discussion of what are mental health problems. They are classified as:

• emotional disorders, for example phobias, anxiety states and depression;
• conduct disorders, for example stealing, defiance, fire-setting, aggression and anti-social behaviour;
• hyperkinetic disorders, for example disturbance of activity and attention;
• developmental disorders, for example delay in acquiring certain skills such as speech, social ability or bladder control, primarily affecting children with autism and those with pervasive developmental disorders;
• attachment disorders, for example children who are markedly distressed or socially impaired as a result of an extremely abnormal pattern of attachment to parents or major care givers;
• Trauma disorders, such as post-traumatic stress disorder, as a result of traumatic experiences or persistent periods of abuse and neglect; and
• other mental health problems including eating disorders, habit disorders, somatic disorders; and psychotic disorders such as schizophrenia and manic depressive disorder.

Pages 11-12

There is a recognition school staff are not mental health experts and should not attempt to make diagnosis.

There is a recognition of the increased vulnerability of those

• with SEN including: ‘Children with autism or learning difficulties, for example, are significantly more likely to have conditions such as anxiety’ (page 11).
• Child in need, LAC and previous looked after saying: ‘For example, they may struggle with executive functioning skills, forming trusting relationships, social skills, managing strong feelings (e.g. shame, sadness, anxiety and anger), sensory processing difficulties, foetal alcohol syndrome and coping with transitions and change. Children in Need may be living in very chaotic circumstances and be suffering or at risk of suffering abuse, neglect and exploitation. They may also have less support outside of school. The impact of these circumstances can have wide-ranging impacts on children’s own behaviour, their interpersonal behaviour and emotional state’ (page 11).

There is a useful (but not new) table considering risks and protective factors for mental health issues (pages 14-15). This does not fully embed the Contextual Safeguarding Approach and does not consider the impact of the child’s peer group or neighbourhood as providing either risk or protective influences or give consideration to the impact of children’s life online. The document goes on to talk about the importance of school as a ‘safe and affirming place’ (page 13).

Unfortunately, it will take more than that to overcome the mental health issues described at the beginning of this chapter.

The guidance then adds that negative experiences and distressing life events can impact mental health which can show in changes in emotional state and/ or behaviour and that concerns about these should lead to an assessment.

To identify children at risk of mental health problems school should
• Make effective use of data including patterns of attainment, attendance and behaviour
• Have an effective pastoral system.

The process should include the assess-plan-do- review approach.

When considering exclusion, schools should consider the mental health implications and try to address the underlying causes before exclusion.

There is a summary about Adverse Childhood Experiences (ACEs), including both the need to consider those not presenting any obvious issues and the importance of early help. (Page 18). Page 19 focuses on Children in Need, LAC and previously looked after children and their needs. Staff should be aware of their experiences and this should be reflected in the design and application of behaviour policies. The guidance identifies the need for multi-agency working to support these children including work with the Virtual School. Chapter 3 finishes by focusing on special educational needs and identifying the links with mental health.

Providing support and collaborative working with other agencies

The document identifies that there are a range of support options and the importance of early intervention. Early intervention is more effective than reacting later. This could include
• Support the teacher to manage behaviour
• Additional educational one to one support for the pupil
• An individual health plan
• One to one therapeutic work
• Family support and therapy

The document does not suggest where funding for these would come from. It continues to talk about direct commissioning of services and the need to ensure that schools commission effective services. Further it suggests MATs might want to commission joint services. Serious cases should be referred to CYPMHS and it is important to include all the relevant information with such referrals! It also recommends schools should work with parents to support their children.

The document talks about Alternative Provisions and what they should aim to achieve (page 25).

Where to find out more

This section talks about the Green paper and the new Mental Health Support Teams being established from 2023. Then provides a useful reference section of agencies and links.

Possible School Actions

• There is no requirement to have a mental health policy, but schools do need clear systems and procedures to identify and escalate mental health concerns.
• Ensure that any published behaviour policies are consistent with the legal requirement that treating all pupils the same may be unlawful where a disability affects behaviour.
• Get involved in your local CYPMHS and the Mental Health Provision Green Paper and share your views.

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