SCHOOLS NorthEast response on 'Transforming children and young people’s mental health provision: a green paper'

19th March 2018

Transforming children and young people’s mental health provision: a green paper

SCHOOLS NorthEast response

Question 1: The core proposals in the green paper are:

• All schools and colleges will be incentivised and supported to identify and train a Designated Senior Lead for Mental Health who will oversee the approach to mental health and wellbeing.

• Mental Health Support Teams will be set up to locally address the needs of children and young people with mild to moderate mental health issues, they will work with schools and colleges link with more specialist NHS services.

• Piloting reduced waiting times for NHS services for those children and young people who need specialist help

Do you think these core proposals have the right balance of emphasis across a) schools and colleges and b) NHS specialist children and young people’s mental health services?

• We are concerned that the Government has not sufficiently recognised the ever-expanding burden on school staff. In addition to the new Designated Senior Lead for Mental Health role, schools must appoint a Data Protection Officer to comply with GDPR requirements, a Designated Careers Lead to ensure compliance with the Careers Benchmarks and a Designated Safeguarding Lead, amongst other recent additions. The Impact Assessment states of the Mental Health Leads: “the role is voluntary, the time is to be determined by individual schools and we currently have no evidence of the benefits of other tasks that would not be completed.” It would have been extremely helpful to have conducted such an assessment. There is a sense among school leaders that we are reaching a certain limit on the new responsibilities individual members of staff and schools as a whole can take on in the absence of additional funding.

• The Government’s timetable for implementation is distinctly unambitious- 75-80% of the country will see no change in provision over the next five years. There is a need for schools need to see support and funding far sooner. For example, the November 2015 CAMHS Benchmarking Report showed a 64 per cent increase in CAMHS referrals from 2014-15. If we are to begin reversing the worrying trends in children and young people’s mental health in the North East and elsewhere the Government should update its timetable or at least review it when the National Study of Health and Wellbeing publishes its new prevalence estimates later this year.

Question 2:

To support every school and college to train a Designated Senior Lead for Mental Health, we will provide a training fund.
What do you think is the best way to distribute the training fund to schools and colleges?

Please rank the following in order of preference:
1. Funding allocated to local authorities and multi-academy trusts to administer to schools.
2. Set amount of funding made available to each school, for them to buy relevant training with.
3. Funded training places made available locally for schools to book onto.
4. Funding distributed through teaching school alliances.
If you wish, please provide any further information on why you have ranked in this order of preference (max 250 words)
• Our preference would be for a strategic approach which takes into account health inequalities and levels of need across local authority areas in the distribution of funding.

Question 3:

Do you have any other ideas for how the training fund could be distributed to schools and colleges? (max 250 words)
• Training for the Mental Health Leads needs to be quality-assured, evidence based, in-depth and ongoing. It must also be flexible enough to enable the Leads to develop a way of working that works in their own particular school context.

• Funding must cover the full cost of the training. Schools will incur a significant cost for staff to be out of school for training and this needs to be taken into consideration alongside the cost of the training itself.

• We are concerned that funding is to be made available only for the training of Designated Senior Mental Health Leads. Government should ensure that Mental health awareness is part of Initial Teacher Training, committing additional funding for this if necessary. The Green Paper makes some comments around this but remains vague and non-committal. SCHOOLS NorthEast sees this as essential to a whole-school approach to promoting wellbeing.

Mental Health Support Teams

Question 4:

Trailblazer phase: A trailblazer phase is when we try out different approaches
Do you know of any examples of areas we can learn from, where they already work in a similar way to the proposal for Mental Health Support Teams?


Please give your answer below (max 250 words)
Question 5:
Different organisations could take the lead and receive funding to set up the Mental Health Support Teams. We would like to test different approaches.
Which organisations do you think we should test as leads on this? Please rank the following organisations in order of preference:
1. Local authorities
2. Groups of schools
3. Charity or non-government organisation
4. Clinical Commissioning Groups (CCGs)

• Our preference is that organisations with well-established links to schools take the lead in setting up the MHST.

Question 6:

Mental Health Support Teams will work and link with a range of other professionals and we would like to test different approaches. From the list below

Please identify the three most important 'links' to test in the way they would work with Mental Health Support Teams:
Educational psychologists
Local authority troubled families teams
Local authority children and young people’s services
Local authority special educational and disability (SEND) teams
School nurses
School-based counsellors
Charity or non-government organisation
Youth offending teams
Other: __________________________________________
• Variations in local conditions and commissioning structures may require different models of linkages, so we would be reluctant to place greater importance on any particular group.

• We are concerned, however, by the significant shortages in the CAMHS workforce highlighted by the Centre for Mental Health and the decline in the number of mental health nurses and rising vacancy rates in CAMHS consultancy posts reported by the Royal College of Psychiatrists. This may make establishing strong linkages more difficult.

Question 7:

Mental Health Support Teams and Designated Senior Leads for Mental Health in schools and colleges will work closely together, and we will test this working through the trailblazer phase.
Out of the following options how do you think we should measure the success of the trailblazer phase? Please pick your top three:
1. Impact on children and young people’s mental health
2. Quality of mental health support delivered in schools and colleges
3. Amount of mental health support delivered in schools and colleges

4. Impact on quality of referrals to NHS Children and Young People Mental Health Services

5. Impact on number of referrals to NHS Children and Young People Mental Health Services
6. Effectiveness of interventions delivered by Mental Health Support Teams
7. Children and young people’s educational outcomes
8. Mental health knowledge and understanding among staff in school and colleges
9. Young people’s knowledge and understanding of mental health issues, support and self-care
10. Numbers of children and young people getting the support they need
11. Other: __________________________________________

• The impact on CYP is by far the most important measure. The other options listed seem to be limited to processes rather than outcomes.
Question 8:

Trailblazer phase: A trailblazer phase is when we try out different approaches. When we select areas to be trailblazers for the Mental Health Support Teams, we want to make sure we cover a range of different local factors. What factors should we take into account when choosing trailblazer areas?

Deprived areas
Levels of health inequality
Urban areas
Rural areas
Areas where children and young people in the same school/college come under different Clinical Commissioning Groups (CCGs)
Other: __________________________________________

• All of the above factors are relevant in the context of the North East and should be considered alongside each other.

• The objective for the pilot should be to learn what works best for reaching different groups of CYP. Ideally there should be a selection of sites between areas that are already well-geared to support CYPMH and areas that struggle.

• The Government should not concentrate the trailblazer areas solely in the “Opportunity Areas”. SCHOOLS NorthEast has repeatedly raised concerns that a two-tier system for accessing Government funding seems to be emerging, with the Opportunity Areas at the front of the queue. While the methodology behind Opportunity Areas is more than defensible, the omission of the North East with its list of negative employment and destination indicators exposes a flaw in the implementation.

• We would welcome greater clarity as to how the piloting process would enable a national roll-out, especially in schools and areas with the least capacity where pilots would likely fail.

Question 9:

How can we include the views of children and young people in the development of Mental Health Support Teams?
Please provide your answer below (max 250 words)
• Current school questionnaires on pupils’ views may not provide information on mental health as they are designed more in line with inspection outcomes. This notion should go further and in some cases should include families. A child with difficulties will invariably struggle in many aspects of life to work in isolation will not have the impact expected. Young people may not wish families to become involved but younger children receiving prompt interventions and a 'wrap around' support programme may benefit.

Question 10:

Waiting time standards are currently in place for early intervention for psychosis and for eating disorder services. Outside of this, are you aware of any examples of local areas that are reducing the amount of time to receive specialist NHS help for children and young people's mental health services? Can we learn from these to inform the waiting times pilots?
Please give your example(s) below (max 250 words)
• Unaware of any at present.

Question 11:

Schools publish policies on behaviour, safeguarding and special educational needs and disability.
To what extent do you think this gives parents enough information on the mental health support that schools offer to children and young people?
1. Most of the information they need
2. All of the information they need
3. Some of the information they need
4. None of the information they need
5. Don’t know
Please tell us more about why you think this (max 250 words)

• School policies on EYFS and PHSCE should also include how schools support mental health and early detection of any concerns.

• We would question whether school policies on behaviour, safeguarding and special educational needs and disability are being widely read by parents. Many schools do produce good websites with the right information, but the sense among Heads is that a significant number of parents are not accessing and interpreting this information. More support could be provided to schools in this regard.

Question 12:

How can schools and colleges measure the impact of what they do to support children and young people’s mental wellbeing?
Please give your answer below (max 250 words)
• If schools have strong, nurturing relationships with pupils where referrals systems are based on child centred support, conversations with known adults could provide useful qualitative information. Where this does not exist collecting data will prove more problematic.

• There are some schemes to 'measure' self-esteem and other aspects of mental health. However, measuring how someone feels quantifiably and presenting it in a way that is reliably comparable is extremely difficult and fraught with risks.

Question 13:

In the development of the Mental Health Support Teams, we will be considering how teams could work with children and young people who experience different vulnerabilities.
How could the Support Teams provide better support to vulnerable groups of children and young people?
Please give your answer below (max 250 words)
• Including parents and the wider family in the Support Teams’ interventions would increase their effectiveness. Many of the problems vulnerable children experience originate in the quality and consistency of their parenting. We know that, for example, parenting groups for the parents of children with behavioural difficulties as early as possible do a great deal of good. The lack of reference to parenting is a major omission from the Green Paper.

• Education and Health Care Plans should emphasise emotional wellbeing more prominently. Schools require resources in terms of staff capacity and signposting to multi-agencies with clear defined routes for referrals based on level of need.

• We know that children living in poverty are at greater risk of developing a mental illness but there is little recognition of this in the Green Paper. According to DWP figures, half a million more children fell into absolute poverty from 2010 to 2015, which has driven by stagnant real incomes and exacerbated by welfare policy. Moreover, the IFS paper ‘Living standards, poverty and inequality in the UK: 2017’, projects a rise in child poverty of 37% by 2022. The issue of vulnerability cannot be looked at in isolation; there has to be a recognition of the wider context and a political will to address the cause as well as the symptoms of vulnerability.

Question 14:

As we are rolling out the proposals, how can we test whether looked after children and previously looked after children can easily access the right support?
Please give your answer below (max 250 words)
• Looking at outcomes
• Better resourcing of and engagement with Virtual School Heads
• Paying particular attention to children and young people looked after at home, who typically have difficulty accessing services
Support for children in need

Question 15:

As we are rolling the proposals out, how can we test whether children in need who are not in the care system can access support?
Please give your answer below (max 250 words)

Question 16: 

As we are rolling the proposals out, how can we test whether children and young people with special educational needs or disability are able to access support?
Please give your answer below (max 250 words)

Providing evidence for an Impact Assessment
A consultation stage Impact Assessment was published alongside the Green Paper. The following questions seek to gather further evidence to inform future versions of the Impact Assessment. We welcome references to any evidence, published or in development, or expert opinion on the topics set out above to help refine our final Impact Assessment.
If you have not read the Impact Assessment or do not wish to respond to these questions then please skip to the next section.
 

Question 17:
Please provide any evidence you have on the proportion of children with diagnosable mental health disorders, who would benefit from support from the Mental Health Support Teams.
Please give your answer below
 

Question 18:
Please provide any evidence you have on the proportion of children with pre-diagnosable mild to low-level mental health problems who would benefit from support from the Mental Health Support Teams
Please give your answer below
 

Question 19:
Please provide any evidence you have of the impact of interventions for children with mild to moderate mental health needs, as could be delivered by the Mental Health Support Teams. We are interested both in evidence of impact on mental health and also on wider outcomes such as education, employment, physical health etc.
Please give your answer below
 

Question 20:
Please provide any evidence you have on the impact of Children and Young People Mental Health Services therapeutic treatments
Please give your answer below
 

Question 21:

Is there any other evidence that we should consider for future versions of the Impact Assessment?
Please give your answer below

• The context of real terms cuts to school funding must be taken into account. Many schools have already been forced to cut back on mental health services and given that the Mental Health Lead role will be “incentivised” rather than required, provision will rely on schools’ having an individual commitment to the mental health of their pupils. The Impact Assessment mentions that 49% of schools already have a mental health lead, so it is likely that many of those able to introduce such a position have already done so.

• We believe the political direction of travel exacerbates pressures on pupils. First, the current trend is towards a high-stakes education system, increasing stresses, particularly around the time of KS4 assessments. There has also been a narrowing of the curriculum which forces children into subjects they may dislike and have no aptitude for. These pressures will persist regardless of what schools themselves do. There is therefore a limit to what can be done at a school level to address these low level issues and this needs to be taken into consideration.

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