ATL

Early intervention

Mental health problems can arise in very young children. Benita Refson OBE, chief executive of mental health charity The Place2Be, advises on what schools can do

Children's mental health is the business of all of us, not least parents and school staff. Education professionals play a particularly crucial role as children spend a third of their day at school (during term time). School is therefore a key place to notice child mental health issues and address or refer them in an appropriate and non-stigmatising way.

First of all, it is important to be as clear as possible about the terms that are used. 'Mental health' is what it says it is: well-being and strength of the mind. That's different from 'mental illness' or 'mental disorder'. For the most part, children who are mentally healthy enjoy their friendships, are happy and able to learn, and overcome the difficulties that come their way. Children who are ill or have a disorder all too often become overwhelmed by the demands made on them and are unable to cope with their disturbing thoughts and feelings.

It is estimated that more than a million children in the United Kingdom - about 1 in 10 children aged 5 to 16 - have a diagnosable mental health problem (Office for National Statistics 2004). Research by charity YoungMinds calculates that in any secondary school of a thousand pupils, there are likely to be 50 pupils (ie 1 in 20) who are seriously depressed. These mental disorders are more common in boys than girls and become most pronounced in adolescence, although their origin can be identified much earlier in childhood and in primary school. Unless treated, many of these problems will continue well into adult life. Social deprivation and factors associated with poverty will increase the risk of mental health problems in children and young people.

Spotting the signs

All children have their ups and downs. Some children, however, faced with difficulties and worries at school and at home, may withdraw into themselves and become isolated from their friends. Others may become restive, unable to settle and increasingly disruptive. Making judgements about the mental health or emotional well-being of children is rarely straightforward and staff need the chance to check out their thoughts and feelings with teacher and support staff colleagues. By and large, what matters is whether a child's behaviour and attitudes are extreme, persistent (over two months) and significantly interfering with his/her enjoyment of everyday life at school in his/her friendships and in their work.

Sometimes it is noticeable how some children suddenly change, for example, from being naturally outgoing and easy-going to becoming morose, silent and withdrawn. Very often, education professionals may notice that certain children seem unable to help themselves and pull themselves out of it, despite help from friends and adults. It is then that staff need to share their observations with these children and find time to talk to them. Alternatively, they should arrange for some other appropriate member of staff, such as the pastoral head, the year tutor, support staff such as special educational needs coordinators (SENCOs), or any counsellors who may be in the school, to do so.

What schools can do

• Ensure that a sufficient number of staff have the skills, knowledge and support required to offer personal, health and social education to pupils with group work, role play, circle time and active listening, and attention to pupils' feelings and emotional development.

• Integrate programmes such as peer mentoring, pastoral support, anti-bullying initiatives and nurture groups within the school.Engage with parents - this can be challenging and time-consuming, but will usually create an important source of support for children and young people suffering mental distress.

• Pay attention to pupils in Year 6 and Year 7 since transition to secondary school can involve significant distress that will exacerbate any underlying mental health problem.

• Refer to specialist child and adolescent mental health services or voluntary sector counselling services those children who show persistent difficulties despite interventions carried out in the school.

• Familiarise yourself with Targeted Mental Health in Schools, a three-year £60 million government-funded pathfinder project aimed at introducing and supporting models of therapeutic and emotional support for children and young people aged 5 to 13 at risk of, and experiencing, mental health problems.

• Bring in an external school-based support service, such as a school counsellor or a professional mental health service, which supports children, teachers and parents, such as The Place2Be.Make arrangements for education staff to have the opportunity to reflect on their own feelings and thoughts in reaction to children's distress. 

The Place2Be works with and in schools to improve the emotional well-being of children, their families and the whole school community. Find out more on their website at www.theplace2be.org.uk.