One of the government’s many current targets for schools is mental health. This week the BBC’s ‘In the Mind’ week, following on from Children’s Mental Health Week earlier in the month, have focused national attention on mental health, placing an important spotlight on the issue. It promotes the national conversation and is part of the movement to remove the stigma of mental illness. This is a long and slow battle. Not surprisingly, people don’t really understand mental illness, so it is scary. Our fear of cancer is decreasing as we understand more and are more able to treat it. It has become more normalised and less of a death sentence. Mental illness is not there yet. We have moved from the brutality and isolation of the nineteenth and twentieth century asylums, but not out of their shadow. Mental health is unseen. It can affect anyone. How it affects people is unpredictable. Much of the language used to describe those with mental illness is the language of abuse. This all adds to the negative perceptions of mental health.
In the media
The BBC’s week included a second documentary featuring Stephen Fry. His public admission of his mental health difficulties has done much to open up public discussion about mental health and remove stigma. But his brave step is not enough and does not have any real reach beyond certain sectors of society. Few children watch QI or the BAFTAs. Also Stephen Fry’s work does not support the idea we need to get across to children and adults alike that mental health difficulties are not a single illness, any more than cholera, rubella and tonsillitis are a single illness. The presentation of characters in soap operas and other TV dramas with mental illness who are not ‘mad, bad and dangerous to know’ is a step towards reducing stigma and changing public opinion. But more and more people need to speak up. Schools have a key role here; tackling abusive language, opening discussions of feelings and enabling admissions of mental health difficulties without stigma.
However, the implications for schools and teachers is enormous. Young Minds tell us that 1 in 10 children and young people aged 5 – 16 suffer from a diagnosable mental health disorder – that is around three children in every class. However, for many children and their parents this is still a taboo subject. If we were looking at a group of physical illnesses that affected one in ten children, there would be a huge outcry and demand for resources to be put into schools. In reality, many parents feel unable to admit their children need help and schools’ ability to provide that support is limited. Only 36% of primary schools have access to a school based counsellor and 59% of these are on site for a day or less. Two thirds of local authorities reduced their CAMHS budget between 2010 and 2013 and as any teacher who has tried to refer to CAMHS knows, there are not enough CAMHS resources to meet need. Russell Hobby, general secretary of the NAHT stated in January three-quarters of school leaders had reported they lacked the resources needed to provide the kind of mental health care required to meet children’s needs. The major constraints are funding or the lack of services and those with appropriate qualifications. There is a growth in the work of ELSA (Emotional Literacy Support Assistants) in school, but they are not equipped and should not be expected to work with children with serious mental illness. They work on emotional support, not mental health difficulties. They are amazing people doing amazing work, but cannot perform magic, any more than home school link workers or nurture groups can. Children with mental illness need appropriate support from those specifically trained to work with them.
The issue is complicated by the re-writing of SEND definitions in the 2014 SEND Code of Practice. The category of Behaviour, emotional and social difficulties was replaced with Social, emotional and mental health difficulties. This, rightly, identifies that behaviour is communication about other issues. However, the demands of the classroom and their training means that teachers’ focus is on children’s behaviour, not the causes of those behaviours.
Government policy has made some progress in linking behaviour and mental health with the March 2015 update of the Mental Health and Behaviour in Schools guidance. However, as with so many of the myriad areas that teachers are now supposed to be responsible for, there is little by the way of training and no practical ideas about how this is to be incorporated into an ever more tightly packed curriculum.
It is behaviour that interferes with teaching. OFSTED’s September 2014 Below the Radar report increased the focus on behaviour, particularly low level behaviour and teachers’ ability to manage it. Responsibility for the cause of low level disruptive behaviour is placed with the teacher and their classroom management. What the child might be trying to communicate through their behaviour is disregarded. How teachers deal with low level behaviour is a key element in OFSTED’s judgments of quality of teaching. This means, even though teachers are often aware of the root of children’s difficulties and the reasons for their behaviour, they don’t have the time (or energy) to consider it. Their focus is on classroom management and the ever increasing demands of data. As Russell Hobby states:
“Schools play a vital role in supporting children’s mental health and building their resilience – but rising demand, growing complexity and tight budgets can get in the way of helping the children who need it most.”
Teachers are not psychologists or psychiatrists. We might be experts in managing children’s behaviour and supporting their learning, but we are not experts in their mental health, nor can we be expected to be. There are only so many hours in the day and we cannot be expected to impact everything that might affect a child’s life and development in that time. These are roles for others with appropriate training and expertise. Teachers work well with other professionals, but are not able to do everyone’s job.
The pressures being put on teachers are, in turn, impacting on their own mental health. More and more teachers are suffering both major and minor mental health problems. They are able to empathise with the growing stresses faced by the children in their care, but they cannot treat them. A teachers’ job is to teach, not to treat either mental or physical health problems. No-one expects teachers to treat physical illness, so why are they expected to bear so much responsibility for children’s mental health.
The role of schools
The conversation about mental health is becoming more open and accepting, but there is still insufficient recognition of the extent of mental health issues among children or the need to provide real resources to treat them. The Department for Education told us at the beginning of the month:
“We’re at a turning point in how we tackle children’s mental health issues and are determined to get it right. That’s why we’re investing £1.4bn over this Parliament to transform mental health support for children and young people.”
We need to ask is this enough? Where will the staff to do this work come from? Will it be added to the demands placed on teachers or will there be medical and counselling support in schools? Only by providing the appropriate treatment, as well as open conversations, can we remove the stigma and fear of mental health difficulties and hope to produce a healthier next generation. This needs to happen across society, not just in schools.
Useful links and references
• Below the Radar (September 2014)
• Mental Health and Behaviour (March 2015)
• Russell Hobby’s blog on children’s mental heath
• BBC report on children’s mental health 8/2/2016
• Place2Be and NAHT report in mental health in primary schools
• Young Minds: Full of good resources for young people, parents and professionals
• In our hands: The website of the amazing Pookey Knightsmith- great resources, particularly for self harming and body image and the voice of a survivor
• Time to Change:Tackling mental health discrimination http://www.time-to-change.org.uk/