Mental Health Services in Schools and Colleges

Baroness Tyler of Enfield Excerpts

Thursday 9th July 2015 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I am very pleased that children and young people’s mental health is garnering so much attention in your Lordships’ House, and I congratulate my noble friend Lord Storey on focusing our attention this afternoon on mental health provision in schools and colleges. I declare an interest as vice-president of the charity Relate, which provides counselling to children and young people in various schools, children’s centres and GP surgeries.

As we have already heard, schools have a critical role to play in supporting pupils by promoting positive mental health and emotional well-being as part of their overall school ethos, as well as spotting and addressing minor problems before they escalate, and helping to connect pupils who have more serious problems with the more specialist help they need. We know that 75% of adult mental health problems emerge before the age of 18, and in recent debates in this House we heard about the difficulties that children and young people face in school such as bullying, relationship and family problems, the impact of domestic violence in the home, academic stress and other things that often trigger or exacerbate mental health problems, including self-harm. Why is this issue so pressing? My noble friend Lord Storey set out the key statistics, so I will not repeat them. However, I will just mention, picking up on what the noble Earl, Lord Listowel, said, that 72% of children in care have behavioural or emotional problems.

I want to acknowledge that in recent years we have seen progress in embedding a commitment to positive mental health within schools. It is encouraging that over 90% of schools now address mental health and well-being in the personal, social and health education curriculum, and that a similar proportion also do so in other lessons—a point I will return to in a minute. This past spring, the Department for Education has published new guidance for the PSHE curriculum and an evidence-based counselling strategy that encourages the use of counselling in schools. Moreover, the new draft Ofsted framework Better Inspection for All includes a new judgment on personal development that will help ensure that schools will be held accountable for providing good mental health services.

However, despite all these good things, much more work still needs to be done to ensure that all students are able to access good mental health services in schools. Research from the think tank CentreForum published late last year shows that 86% of secondary schools provide access to a qualified counsellor—which in some ways sounds quite good—but provision is patchy. For example, special educational needs schools are much less likely to provide counselling than mainstream, maintained schools, even though children with SEN are more likely to have mental health problems.

In addition, as the British Association for Counselling and Psychotherapy has pointed out repeatedly, England lags behind Northern Ireland and Wales in providing access to counselling for all secondary students. The simple reason for that is primarily because there is a statutory requirement in Wales and Northern Ireland for local authorities to provide school-based counselling in all secondary schools. In short, it is not seen as an optional extra. What plans do the Government have to ensure universal access to school counselling across England?

Work must also be done to make these services more widely known and welcoming to students. Only about half of schools advertise or promote their services, and perhaps as a consequence, according to the charity YoungMinds, which does such excellent work in this area, one-third of children report that they do not know where to turn for mental health support. This must be a matter of real concern for us all. Equally worrying, there is evidence to suggest that children who belong to various minority groups are less likely to take up school-based counselling. Schools could learn a lot from successful examples from the voluntary sector about how to encourage take-up of school counselling among children who need it, particularly in a non-stigmatising way.

Moving on, these measures are most effective as part of a whole-school approach to good mental health and well-being. Part of this means that school staff must be equipped with the skills and feel confident to identify students who are having difficulties and to provide some level of support. Yet, according to CentreForum—a point already raised by my noble friend Lord Storey—there is no mental health and well-being training in 17% of mainstream maintained schools. Can the Minister say, either now or perhaps by letter, what plan the Government have to act on the recommendations of the CentreForum report and the recent Carter review of initial teacher training, and improve training for teachers on mental health?

Of course, in some cases the services within schools will not be enough to tackle the challenges that children with mental health problems can present. So it is critical that children who need them are quickly and effectively referred to CAMHS services, and it is equally critical that CAMHS services are resourced to respond promptly—something which has been spoken about many times in your Lordships’ House but which patently is not happening.

While the vast majority of schools have a referral pathway in place, only half of these were referred to in the CentreForum report as being effective. More concerningly, schools typically do not have the resources to properly determine when students need to be referred to a specialist service. Indeed, CentreForum found that only about a third of schools used screening tools to gauge the severity of need of their pupils. For that reason, I very much welcome the Department for Education’s proposal for a pilot programme that will place a CAMHS contact in 15 schools across the country to help develop good communications and links between CAMHS, school staff and students. If implemented effectively, this programme has the potential to provide more direct entry points into specialist mental health services and, equally importantly, to allow school staff to gain real insight into how to cultivate a healthy learning environment. Such joined-up thinking is key in giving children the support that they need.

At the same time, as others have already said, we need to focus on prevention and early intervention—in short, how we should promote positive mental health for children and young people. We really do need a joined-up approach across government here. At present, the Department for Education promotes mental health support as a form of early intervention and as part of the broader goal of emotional and academic development—something that I support—while the Department of Health uses a more medical, diagnosis-driven approach that requires children to be diagnosed to a certain level in order to receive support. While having increased contact between CAMHS and schools, as I have just referred to, may help identify children who already have pressing mental health issues, we should be wary of applying this very medicalised approach to every student.

I also ask the Minister what conversations are taking place between the Department of Health and the Department for Education about the best ways of marrying together these rather different approaches to children’s mental health and well-being. Given the expertise that resides in this House on the issue—as we have heard this afternoon—would it be possible to convene a meeting with both departments and a few of the noble Lords who have spoken in this debate to discuss further how these rather different approaches can best be reconciled?

Of course, the 16 to 18 year-olds with mental health issues include a large number of young people studying in FE colleges, and it is really important that they are part of the equation. I shall not repeat what my noble friend Lord Storey has already said about this area but FE must be central to a mental health strategy moving forward. I join my noble friend in calling for FE students to be included in the prevalence study that the noble Lord, Lord Prior of Brampton, outlined to this House on 23 June.

It is clear from today’s debate that schools and colleges have an indispensable part to play in promoting good mental health. This means providing accessible services such as counselling in all schools and colleges, and ensuring that the PSHE curriculum is taught effectively in all schools, irrespective of their status. For my money, that must include academies and free schools. I would like to ensure that high-quality sex and relationship education—which has just been referred to by the noble Earl, Lord Listowel, and which is so important for positive mental health and emotional well-being—is integrated within the provision of counselling in schools and statutory PSHE. That is something that we have called for from these Benches on many occasions.

In conclusion, despite the progress that we have heard about and which I very much welcome, there is still much to do. The life chances of many pupils and students depend on these services and we must not let them down.