Mental health in secondary schools

[Bigfatlie]

I have NC for this.

I am part of the pastoral team of a large secondary school, and I have noticed not just a massive decline in the mental health of young people (and their parents for that matter) but also, from my own perspective, the provision has progressively dwindled. This scares me so much.

I used to love my job and felt that it mattered as I performed a pivotal role in a child's wellbeing, road to recovery, etc. I have done this for almost 9 years with the school having provided zero training for me. Nothing at all. I have made it my business to educate myself, and this has been at my own cost and in my own time. In those 9 years I have dealt with more and more complex cases, including attempted suicides, and I still have not received any training, or support for myself for that matter.

I am not sure how much parents are aware that many of the pastoral members that look after your child's mental health are not trained at all. They're just people like you and me who probably got a lowly paid job at a school in order to work term time only.

What I am hearing now pretty much on a daily bases is parents asking school to provide interventions because their GP has said 'school will put something in place'. I don't know about other schools, but where I work, this means that very complex cases (neurodiversity, suicidal ideation, eating disorders, self harm, potential mental health disorders, etc), get shoved towards a member of the pastoral team who's meant to make a difference to that child's wellbeing, having had zero training, and having to balance the demands placed upon them from other aspects of school that get prioritised over mental health EVERY TIME: attendance, uniform, detentions, and general compliance.

I am not sure how much parents realise that schools are not always honest about the fact that they do not have qualified staff to deal with most emerging mental health difficulties. Quite often we have children joining in Year 7 with a history of mental health difficulties, and parents expect school to deploy a whole host of interventions. Whilst I believe that schools are ideally placed to deal with the mental health difficulties of our young people, this is simply not the reality because there's no funding and no training is allocated to non-teaching staff . The result is that our young people deteriorate, and the adults being paid nearly minimum wage for addressing these difficulties are on constant burnout mode, often developing mental health issues themselves.

The difficulty for parents of course is the fact that when they take their child to the GP, they learn that CAMHS' waiting list is 2 to 3 years, and then get reassured by the GP that 'school will put something in place'. Parents out there, you want to question schools as to what qualifications the person looking after your child's mental health has. What the interventions that schools put in place really mean. Their frequency, consistency, are they evidence based... Don't be fobbed off. Make sure they're not just paying lip service, because from where I am standing, that's all that's on offer right now.

Dealing with. A lot do cope and some cope until they snap. I get fed up with resilience being shoved in on every one of these threads.

I think there are two problems here.
One is - as we've already said - that schools are woefully underequipped for this.
The second is the pathologising of normal emotions. We have countless students in my school presenting with anxiety. In many cases, this is simply the normal worry you might feel about a test or whatever... but it's become a huge "thing". And because we're so worried about getting it wrong or missing something vital, we have to put support in place.

I'm not trying to dismiss the fact that mental health issues seem to be on the rise: they are. But actually, being worried or unhappy or whatever are normal emotions for most people at some point, and I think we have to be able to say "yes of course you're nervous about the test but if you mess up, there's nothing bad going to happen".

I had a student burst into tears this week in class because she thought she'd submitted an essay but hadn't.

So to insinuate that if schools could just 'prioritise' mental health funding then all would be fine is insulting. What would you have those schools cut from their budgets to fund a counsellor? Teachers? Pastoral support?

I thought schools prioritized education?
Now they are expected to be councilors as well?

Staff aren’t doctors or nurses or councilors- they are trained to education your children in maths English and science and society is expecting far too much.

I'm not trying to dismiss the fact that mental health issues seem to be on the rise: they are. But actually, being worried or unhappy or whatever are normal emotions for most people at some point, and I think we have to be able to say "yes of course you're nervous about the test but if you mess up, there's nothing bad going to happen".

I agree with this. I think this was a compassionate and sensible post.

@Roseau18

Well that’s the point really. No one working in a school can diagnose a mental health condition. That’s what psychiatrists are for. Problem is we now have people who think they’re trained in mental health because they’ve completed a two day mental health first aid course 🤦‍♀️.

Having been recently involved with trying to get students to the right place at the right time for in school counselling, I can tell you that this is probably not a regular of schools undervaluing counselling. The people who are supposed to be answering your emails or telling the child where to go or checking they are in fact present have 101 other things to do - sometimes including urgent safeguarding issues - which unfortunately means counselling arrangements might be given less priority. I know it needs short term pain for long term gain, but schools are not set up to support longer term individual MH strategies. Plus, it can be surprisingly hard to establish where a student, particularly one with issues, is at any given time. (Although those with known self harming tendencies are watched v closely, rest assured).

Additionally those staff will probably not have been properly trained or resourced.

Thank you for what you do though.

Also, if counselling is the only thing offered, that surely won’t work for everybody. I had counselling and didn’t find it very helpful, and it certainly isn’t going to’cure’ everybody.

That's disgraceful @Roseau18

I once had a student in my pastoral role having severe panic attacks prior to her GCSEs. They were so severe she would fall to the ground, hyperventilate, drip with sweat and become very confused. She was at the higher end of the anxiety spectrum with a whole host of issues so I had a discussion with her after one particularly awful panic attack, whereby I told her that her GCSE results were not the be all and end all of life and she should try and reign her perfectionistic tendencies in etc.

Well she did take my advice on board but then she started to swing in the other direction where she disengaged with work/lessons etc. She stopped having panic attacks but disengaged with her school work and I 💯 percent got it in the neck from teaching staff for her new found level of “I don’t give a fuckness”. The jury is out on any potential good outcomes that I achieved for that young lady. For all I know, I may have hindered her.

@Tiredallofthetime

But what else could they “do”? Counsellors offer talking therapy/CBT etc.

No one is going to start dishing out medication to kids in an educational establishment so I’m just curious to find out what magical MH interventions exist out there? I see it all the time on pastoral job specs “experience in delivering MH interventions”.

Well what are these magical “interventions”? Genuinely curious, because they will not be evidence based and they will not be delivered by trained practitioners.

I have, as a primary teacher, been told that a child was self-harming in my class, in front of me, because I ‘wasn’t good with children with behavioural needs’. End of story. No provision for the child, no support for me, no referral, no advice. My fault, and mine to sort out.

Not your fault either way. If one comment is enough to swing somebody’s life in an entirely new direction then had no hope really.

I don’t think we should just offer counselling as a catch all, to be honest, @DarkKarmaIlama

There aren’t any magical interventions. If there a serious condition with a diagnosis such as a personality disorder, an eating disorder, then even with lengthy and expensive treatment is isn’t easy to manage.

Things like anxiety or depression or poor self image can be managed with counselling but not always. For some people, it just doesn’t work, and for some it is actually harmful.

But what else could they “do”? Counsellors offer talking therapy/CBT etc.

OT, SALT, other types of mental health therapies (such as play therapy, art therapy, animal assisted therapy…), alternative provisions such as care farms. Obviously additional funding would be required. If the mental health difficulties were severe enough to require the above an EHCP could be sought in order to secure the funding.

In cases such as that mentioned by a previous poster where a GP believes online provision is necessary schools could help parents secure such provision from the LA.

Ok, well I am sorry if it is like that in your experience or in your area. In mine, the process is this - any family or professional refers in to a central triage hub. Referrals are triaged within one week max, within the day if they are urgent. Triage can involve calls to the families, school, other services involved so may take some days, for information gathering. Outcomes can be - a) declined if not mental health related and signposted elsewhere eg if family support needed or drug and alcohol services etc; b) accepted for 'low level' support from partner mental health services eg counselling or mental health in schools team c) accepted for CAMHS - routine wait or urgent appt as I described.

Bringing farm animals into schools? Seriously?

Not necessarily, no. But work with horses is surprisingly effective at hard-to-reach young men, in particular.

Please tell me where I said farm animals had to be brought in to schools?

Alternative provisions such as care farms aren’t on the school site, hence being called alternative provisions.

Many schools do have therapy animals such as dogs or rabbits on site, but if they don’t or another type of animal is more suitable for the individual pupil animal assisted therapy doesn’t have to be on site either.

It is hard in schools at the moment. I agree with the poster about how some emotions are normal everyday emotions and it's ok to have a shit day, be nervous about something, not want to do something, hate something etc etc.

Whilst there are some truly awful situations out there, and we deal with self harm, attempted suicides, real anxiety and real complex family situations, we also have a huge amount of not real problems - exacerbated by parents more often than not.

We seem to have a problem looking inwards so much, look at me, look at my pronouns, look at my issues, here's a selfie of me, here's a picture of my updated status....we don't do a lot of looking outwards and this is resulting in a lot of kids having all sorts of issues.

Guaranteed that a kid you have had a run in with who is acting like an absolute shit and you challenge them on their shitty behaviour...very soon the staff email comes out about that exact child and how we need to be mindful of their anxiety and how sometimes they don't always understand their behaviour is bad

But yes, we're on minimum wage pretty much, and dealing with some very dark and difficult things.

In our school, anxiety means a reduced time table and picking all of your favourite subjects

@Tiredallofthetime

Okay well if schools can’t just offer counselling what else can they do?

There are five main approaches to “treating”mental health conditions and they are….

1. A biomedical approach aka diagnosing a condition and offering medication. Usually delivered by psychiatrists and facilitated by mental health nurses. For obvious reasons this cannot be provided within school.

2. A social needs model, whereby we look at the social factors that are causing the child to be in distress. This is usually difficult family dynamics, the child’s environment, poverty etc etc etc. List is extensive but it’s not something that can be rectified within the school gates. This is the work of social workers.

3. A psychological approach to MH whereby psychologists and counsellors do not seek to diagnose but rather offer support holistically usually in the form of talking therapies which we have already discussed (counselling).

4. An occupational approach to MH usually delivered by occupational therapists and mainly within the adult remit of MH. For the purpose of children their “occupation” is going to school and learning. So we could say that schools are doing this, but it’s obviously not a direct MH “intervention”.

5. An educational approach to MH usually delivered by charities whereby people are educated on the many different approaches to MH/different conditions etc. I think schools achieve this very well during their PSHE lessons.

So other than counselling as an evidence based intervention what else can schools do? Curious.

Indeed. I have been in treatment for mental health issues for decades - so long before it was acceptable to say out loud.

it's not a situation where money will help. It's not a job many people want to do. I don't blame them. I am still alive and reasonably well due to medication but feel ridiculous weight is attached to the value of what another human being can actually do.

the biggest risk of creating more jobs is that anyone can set themselves up and get "trained" and earn a living while not really being able to help.

@RibbonRed

OT/ SALT/play therapists do not currently work in schools though do they? Schools are struggling to afford the basics to provide an education for children so what makes you think they can afford all these registered practitioners to work on site? I agree there needs to be a more integrated approach but that responsibility does not lie within a schools budget.

@DarkKarmaIlama , no one is saying schools should not offer counselling. Rather, that it shouldn’t be assumed that accessing counselling or any other type of talk therapy is what a child needs and will lead to, if not a ‘cure’, at least an ability to manage the symptoms.

There are a couple of interesting interviews with Charlene Lunnon and Lisa Hoodless, who were abducted at the end of last century, taken to the home of a paedophile and repeatedly raped and suffered horrendous psychological trauma. The girls were found by sheer chance - police were following up complaints made by other children who lived locally.

The girls were offered counselling and both found it unhelpful - they wanted to move on and not have to keep reliving the experiences. In one case, the doubtless extremely well meaning parent of one girl made her continue, and this made her angry and resentful.

Of course the girls should have been offered counselling, as ideally anyone suffering with low mood, self esteem issues, anxiety, should be. But what should not happen is it being presented as the only possibility, the only thing that can possibly make you feel better, the only intervention available. Perhaps you don’t realise, but the first line of your post above seems to imply ‘well, there’s nothing else so that’s all we can do.’

My son has a recurrent ear infection which doesn’t respond to antibiotics. It would be utterly pointless to keep giving him antibiotics as there is nothing else. So it is with counselling.

OT, SALT and other forms of mental health therapies can be accessed via education, including in schools. They have been deemed to be educational provision. I did say additional funding would be required, but if a pupil’s mental health difficulties were severe enough to need the above therapies the funding can be secured via an EHCP. As can alternative provision.

I have a DS in a mainstream secondary school who has OT, SALT and clinical psychologist sessions funded via his EHCP.

OTs are often used to support children and young person with mental health difficulties. Among other things they can support emotional regulation, independence, daily living and self help skills, social skills, sensory processing differences.

@Tiredallofthetime

You are missing the point entirely. There is no ONE approach that will help someone’s MH condition. Some people respond well to meds, some people respond well to counselling. MH is complex I’m certainly not disputing that. Hell I’ve wrote 4000 word essays on that subject that I am trying to sum up in a few paragraphs. I have extensive experience in statutory/voluntary MH services and more recently within secondary school pastoral provisions.

This thread is about the assumption from certain parents that schools should provide “mental health treatment”. First and foremost schools are there to provide an education.

Counselling is only ONE tool in the box but it can be provided within school if the school pays for one out of their budget. All of the other approaches are not able to be delivered within schools and all other “interventions” are lip service and not evidence based.