This is a personal reflection on the Green Paper which sets out government planning to address the rising concerns for the mental health of children and young people, especially in education.

Please respond to the consultation process as this will determine the lives of so many; children and young people, teachers and professionals –  and in my view the proposals are deeply flawed.

The deadline for responses is March 2nd.
gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper

Words in italics indicate a direct quote from the document.

Positives:

  • Acknowledgement that MH is a major and growing concern.
  • Funds of £1.4 billion earmarked for YP & C Mental Health
  • Acknowledgement that schools and colleges play a vital role (in identifying MH needs at an early stage)
  • Whole-school approach acknowledged
  • Designated senior lead in each school for mental health and wellbeing
  • Mental health support teams supervised by NHS CYP mental health staff – work to be managed jointly by schools, colleges and the NHS
  • Recommendation to reduce waiting times for access to specialist NHS services
  • Children to learn about ‘mental wellbeing’ – reference to PSHE and RSE (consultation on this ended on 12th February)

Issues:

The overriding framework is a medical ‘within child’ model that sees difficulties existing within CYP who need ‘treatment’. The language of ‘disorders’ is threaded throughout the document. This is very different from an interactionist model that positions difficulties as the outcome of child and environmental issues.

There is virtually no reference to the causes of MH issues, ie one reference to poverty but not in relation to children’s MH, no mention of the impact of loss (including family breakdown,) or the impact of high-stakes testing on anxiety – although it does refer to the school environment as a site for ‘social anxiety’.

Although the report says that schools are a non-stigmatising environment the use of ‘mental health’ rather than ‘wellbeing’ is potentially problematic.

There seems to be no clear understanding of the difference between wellbeing and welfare.
Welfare is what happens when young people come to the attention of staff and indicate a need for intervention, wellbeing is what happens universally to promote all the protective factors in resilience. Without wellbeing as core school business there will be more children in need of specialist help – this does not make sense on any level, including financial.

Resilience is mentioned three times only – and there is no research reference to resilience or the factors that support it. These basic factors include:

  • the critical nature of teacher-student relationships (showing belief in the best of CYP)
  • the importance of belonging and connectedness
  • high expectations (not giving up on anyone)

Whole school approaches are mentioned several times but there is no real clarity of what this means, including the relevance of teacher wellbeing:

A whole school approach, with commitment from senior leadership and supported by external expertise, is essential to the success of schools in tackling mental health.

The report states:

… there is limited evidence for the efficacy of universal approaches for addressing a range of serious MH issues related to suicide and self-harm, depression and anxiety and alcohol and drug misuse at 12 months.However, the review found that some general mental health promotion approaches such as mentoring showed promise.

The ‘evidence’ is clearly cherry-picked and ignores a vast body of research on the protective factors in resilience including the wide-reaching impact of social and emotional learning (eg Durlak et al, 2011) and the value of positive relationships (Roffey, 2017).

Educational psychologists are mentioned once only – they are in all schools as the lynchpin between health and education, but their skills are entirely sidelined – even though there is a stated need for ‘external expertise’. School nurses are, however mentioned several times.

There is a proposal to pay for a significant increase in counsellors, but this may inhibit the role of the school in developing the positive emotional climate for learning that underpins protective factors.

The report says, however, it will ensure that every member of staff in every primary and secondary school receives mental health awareness training. There is no indication of who is going to provide this training, what it will include, and the theoretical underpinnings it will be based on.

School staff play an essential role in early identification, particularly for eating disorders, self-harm and attention deficit hyperactivity disorder (ADHD), and are able to encourage coordination between children and young people’s mental health services and school staff, which is important for specific diagnoses, such as of ADHD.

The report goes backwards in its conceptualisations. It puts the individual child as the ‘problem’, not the multi-factorial circumstances that lead to mental health difficulties. The BPS itself Is taking a position against labelling and medical diagnoses.

Sue Roffey 21.2.18.

References:

Durlak, J.A., Weissberg, R.P., Dymnicki, A.B., Taylor, R.D., & Schellinger, K.B. (2011). The impact of enhancing students’ social and emotional learning: a meta-analysis of school-based universal interventions. Child Development, 82(1), 405-432.

Roffey.S. (2017)  ‘Ordinary magic’ needs ordinary magicians: The power and practice of positive relationships for building youth resilience and wellbeing, in Kognition & Pædagogik 103 (Spring 2017). This is a Danish journal – Danish version can be found here: http://dpf.dk/produkt/tidsskrift/kognition-paedagogik-nr-103. Has extensive references to other research.