“Children’s mental health services swamped” – what can we do?
What part do school’s play in strengthening children and young people’s mental health?
From “Swamped – NHS mental health services turning away children say doctors”
“The shocking state of CAMHS care is laid bare in a survey for the youth mental health charity stem4 of 1,001 GPs across the UK who have sought urgent help for under-18s who are struggling mentally. CAMHS teams, already unable to cope with the rising need for treatment before Covid struck, have become even more overloaded because of the pandemic’s impact on youth mental health…… in some areas it takes children and young people two years after being referred by their GP to start receiving help.
Mental health experts say young people’s widespread inability to access CAMHS care is leading to their already fragile mental health deteriorating even further and then self-harming, dropping out of school, feeling uncared for and having to seek help at A&E. Delayed treatment increases risk and you can expect problems in application to study or work, relationship issues, other emerging co-morbid mental health issues, for example depression, with increased vulnerability to self-harm, anxiety with panic attacks and so on.”(Guardian: Dennis Campbell April 3 2022)
Case note; secondary school, March 2022
School staff were worried about fifteen year old A’s low level of wellbeing and self-care, refusing food in school, frequently missing lessons and failing to engage in class. Routine behaviour management using graded punishments had not led to improved outcomes. A’s parents reported problems at home too and were asking the school for help. The family were waiting for a CAMHS appointment. I was asked to meet A for Solutions Focused Coaching as part of the move towards early help and prevention in school.
I met A early in the school day, a small, slight figure, features obscured by a thick hair, a face mask and glasses. In the corridor outside our meeting room I said hello, A didn’t reply.
“We’re going to work in here.”
Our Solutions Focused Coaching session was held in a small, well-lit studio, with sofas and a table. I’d offset two identical upright chairs to one side of the room, so we wouldn’t face one another directly.
Once settled I told A how the meeting had come about, my name, the school’s feeling that some extra support might be useful. I asked A what the work might be about from their perspective, what might be useful to them.
“Suppose something changed a bit that meant things would be better in school for you – something that we could work on, that would be useful to you – what might that be about?”
A long wait, a reply I couldn’t hear.
“I’m sorry I can’t hear you too well – could you say that again?”
Just barely audible “I don’t know” with a look towards me.
“Thanks, that’s a useful answer because it tells me I need to ask you a different question.”.
“I’m going to ask you about something different ….. what’s your best thing…. What do you like doing?”
A long wait, a whisper.
Time to reflect. A core belief in SF Coaching is that the young person is doing their best, even when it might not look like it. Communication comes in many forms and it’s my job to make sense of what’s happening, focusing on what’s working, on strengths.
As at the start of an SFC conversation I offer a school exercise book to the student to record their story of change. I’d asked A to write their name on the front of the book at the start of our session. They did that and showed it to me. It was a clue. We could do more of what worked.
“I’m struggling a bit to hear you and I know you’re doing your best to answer all these questions …. I wonder …. When I ask a question could you write your answer in the book?” A nod, and a direct glance towards me from under the fringe of hair.
From then onwards things went well. I asked a question, A wrote their reply and turned the book towards me to read it, with a glance towards me …. clear handwriting, accurate spelling. We agreed the project, we talked about hopes, strengths and change.
We brought the SF conversation to a close with compliments for A; a self-compliment and one from me on the session.
A’s task; notice what’s going well.
And finally “Would you like to meet me again?” Quietly and clearly, “Yes”.
Next time we’ll talk about what’s going well.
I’m working with the staff in A’s school to build capability in Solutions Focused Coaching for young people needing something different to rewards and punishments for meeting and overcoming psychological and educational challenges in their lives. In the early phase of this development, as school staff build their own skills, I can offer early help and support for those students with a high level of need and we can already see positive outcomes of for young people, their parents and carers and for the school.
This school has chosen to build Solution Focused principles and practice into their routines, but all schools could provide SF systematic personalised support to protect children’s mental health and wellbeing given effective training and support. The need is demonstrated by children through their behaviour and is clearly there, with the SF approach able to provide effective support before clinical diagnosis comes into action.
Given that all schools cater for children with experiences of trauma, who demonstrate their distress and anxiety, it would be more accurate to say that school staff do offer therapeutic experiences as best they can, usually through their own innate resources of kindness and compassion with little relevant Continuous Professional Development support available. There are well over a million adults in all working in UK schools in total, including over 600,000 teachers. This is a huge resource which could be better enabled to focus effectively on improving children and young people’s mental health, their ability to manage their anxiety and to improve attendance and engagement in school, all critical factors in mental health and learning.
Do schools in have an official remit to offer a prompt strengths-based service such as Solutions Focused Coaching? It has been asserted that “teachers aren’t therapists”, they’re there to deliver the knowledge-rich curriculum currently promoted by the DfE. But this focus on academic content sidelines the other areas of learning for which schools are responsible, which create the environment for children’s healthy growth towards adulthood.
Schools as mental health providers? Really?
The Child and Adolescent Mental Health Service has four tiers of provision. Tier 1 early intervention and prevention services are provided through schools and children’s centres, health visitors, school nurses, GPs, Youth workers, helplines and websites. Tier 2 provides support through targeted professional services. Tier 3 and 4 are specialist and hospital based clinical services.
“1.2 National/local context and evidence base
There has been universal acknowledgment in policy over the past ten years of the challenges faced by children and young people in developing resilience and psychological wellbeing. For those children and young people with diagnosable mental health problems and their parents/carers and the agencies that support them, the challenges are greater. A number of disorders are persistent and will continue into adult life unless properly treated. It is known that 50% of lifetime mental illness (except dementia) begins by the age of 14 and 75% by age 18. Young people who are not in education, employment or training report particularly low levels of happiness and self-esteem. The Macquarie Youth Index 2014 reported that 40% of jobless young people have faced symptoms of mental illness as a result of being out of work, and one-third of long-term unemployed young people have contemplated suicide. At the same time, effective treatments have been identified to improve the life chances of children and young people, and to minimise the impact on the long-term health of the population and economic cost to the public purse.
Comprehensive support for children and young people with emotional and psychological problems or disorders is provided through a network of services, which include: Universal services such as early years services and primary care (Tier 1 CAMHS)”
Schools are mental health providers, for early intervention and prevention as specified in the CAMHS framework. This provision is framed by relationships based on kindness and empathy and reliable attachment between adults and children, the building blocks of mental health, resilience and psychological wellbeing. These are not interventions in a medical sense, requiring a diagnosis and clinical response. Tier 1 provision is part and parcel of the day to day interactions between adults and children in school, taking the relational, strengths-based Solution Focused approach, drawing on the evidence from Positive Psychology that optimism is both a learned and protective resource.
Effective, structured support at Tier 1 meets the needs of the majority of children who are learning to develop productive optimism which in turn reduces the demands on specialist diagnostic and intervention services. There will always be a minority of children who need clinical support at the higher CAMHS Tiers, in a manageable flow.
Making the system work as intended.