Written Submission to the Parliamentary Inquiry
into the role of Education in Child and Adolescent Mental Health, from
The Bridge in Schools
The Bridge in Schools is part of the Bridge
Foundation, a Bristol-based mental health charity which has pioneered
mental health services for children and families in
for over 30 years. Last year our Schools programme worked with 174
families across 17 local schools.
Children’s Mental Wellbeing – the role of Education
We welcome the Parliamentary Inquiry
into Child Mental Health and the role of schools. As mental health
professionals working with children and families, we are acutely aware of
the growing numbers of children and young people with emotional and mental
health issues in our local communities. Their difficulties are
increasingly serious and complex – high-risk cases in our self-referral
clinic have more than doubled during the past five years. Despite good
work in CAMHS, there are major gaps in provision, especially for children
aged 5 to 11, whose parents cannot pay for professional help. Moreover,
of information requests have found that 57%
of CCGs plan to reduce their
spending on child mental health in 2017.
We would like to share some learning
points from our Bridge in Schools programme, set up nearly 8 years ago in Bristol, to address these concerns through a
working partnership with local schools.
There is a major gap in
service provision for children aged 5 – 11. Vulnerability is higher in
areas of high deprivation.
Schools are uniquely
placed to host and co-deliver mental health support for this age range
Mental health support in
schools is best based on a partnership approach, which is
multi-layered (ie combines input for children, families, and school
staff), and includes co-working between health and education
Mental health training
for school staff needs to be standardised across schools
School staff with mental
health responsibility require supervision from mental health
professionals to ensure safe practice
School staff are not
equipped, and should not be expected, to substitute for trained mental
health professionals in the case of more complex, enduring
An effective school-based
mental health service will require leadership and dedicated funding
agreed at a strategic planning level, on top of current provision,
between relevant government stake-holders.
As a core provider,
better integration of the third sector in service planning and
provision is needed at national and local levels.
1. Mind the gap
Our focus has been especially on children of
primary or early secondary school age, in areas of high deprivation.
Deprivation doubles mental health risk. And this is the age when research
shows many later mental health problems are germinating. There is also
more possibility of working alongside parents and addressing broader
family issues, with children in this age group. However, the 5-11 year old
population is very under-represented in current service provision. For
instance, in Bristol where we work, the
emphasis has been on services for the under 5s, eating disorders, and on a
range of services for teenagers, by which time problems have often become
acute. Intervention at a younger age is urgent to avoid further growth in
the numbers of teenagers in crisis.
Schools are places where children live a large part
of their lives. At primary school age, children are often better known by
their teachers than by any other adults outside the family. Teachers have
ongoing contact with parents and families as well. This makes schools very
important in two respects:
school staff are in a position
to notice early on when things start going wrong, discuss it with parents,
and remain consistently involved over time.
Where children’s home
situations are chaotic, schools are the most accessible and regular points
of contact for connecting children/families up with professional help.
This is especially crucial in complex cases where these younger children
often miss out on help because of the level of family support that is
needed to get to professional appointments in the first place, and to keep
attending over time.
School-based mental health services
We have nearly 8 years experience of
working with local schools to fine-tune a model of specialists mental
health support in schools. We find that what works best is a partnership
approach, bringing education and mental health professionals into a close
working alliance in the local school setting. This ensures that work is
joined up and responsive to local priorities. A financial aspect to the
partnership has been crucial, ensuring that work is owned and valued by
Components of the service are as follows (quotes
are from Heads and senior staff in partner schools):
3.1 A School observation and assessment service
In our experience, teachers and support staff can
be highly skilled at building relationships with children, and supporting
their emotional development as well as their academic progress.
However, the behaviour and issues
of some children require more specialist assessment. On the Bridge model,
when a child’s problems persist , the teacher can flag the concern to the
mental health professional, who observes the child in school and may meet
also with the parent. There is then a three-way discussion between family,
school and therapist to build a shared understanding and approach to the
“Our therapist has
been invaluable in providing advice to the teaching staff and SLT…Many of
the strategies she has suggested have been useful for other children.”
3.2 A School therapy service
When facing trauma, abuse or
sustained emotional deprivation, children will need extra help which
school staff do not have the time or training to provide. A mental health
professional in school, using a mix of family and play-based therapy,
offers a highly effective form of early intervention in these cases. The
DNA rate is very low, and there is a good support network in situ to start
the conversation with parents, and help them and the child keep going
through setbacks and disappointments. There are also skilled school staff
available to stay in touch at the end of therapy, who can step in if
things look like slipping.
“The children have
all made great progress in terms of their emotional well-being. Often this
has also impacted on their academic success as they are less anxious in
class and therefore can concentrate more”
Whole School Training
In our experience, school staff have often been
keen for training on basic child development, mental health, and mental
health First Aid. In Bristol,
Primary Mental Health Specialists run good courses for school
staff. The CASCADE training, developed by the Anna Freud Centre, is also
to be piloted across Bristol.
Currently, trainings are optional and usually
limited to one or two members of a staff team. If
schools are to have a more formal role in child mental health, a
challenge is how to mainstream and consolidate these trainings across
school staff groups.
Mainstreaming mental health and emotional wellbeing training
Basic child mental health awareness and training is
currently ad hoc, often dependent on the interest of individual staff,
rather than seen as a requirement for good school practice. By contrast,
government guidance has ensured that regular Child Protection training is
now standard for all schools. Similar government guidance could have an
important part to play in setting Emotional Wellbeing training standards
for schools and monitoring compliance.
Stand-alone training is an important asset to build
on. However, it can be presented as a quick fix substitute for staff with
professional mental health qualifications. In practice, much of its value
depends on how training is reinforced and developed after the original
input. In our experience, there is particular benefit from a training
model which combines:
Formal training sessions
Ongoing reflective practice
groups led by a mental health professional
For instance, a staff training on
attachment in one Bristol primary school
sparked a programme of termly reflective practice groups, grouped by
Phase, so that staff had the opportunity to put their learning into
practice with the help of a mental health professional. They have used the
model to develop their learning, and build a shared approach to
understanding and managing behaviour across the school.
reflective practice groups are considered to be very important spaces to
reflect on anxieties and support each other. Staff look forward to them.
The level of discussion about individual children and what their behaviour
may be communicating has developed, showing an increased awareness of
children’s needs. It feels like real learning has been able to take place
in the last two years.”
3.3.3 Support for specialist school staff
All our school partners have staff
trained at a more advanced level (SEN, Thrive, etc) to support children
with emotional difficulties and children at risk. These staff work with
high levels of distress and risk, which appear to be increasing as other
services are cut. Burn-out, sickness and stress are occupational hazards.
In our model, regular supervision from qualified mental health
professionals is a crucial safety net for staff in these roles. Experience
shows that to retain strong, effective staff, such supervision should be
built into standard guidelines for professional practice ( as is currently
the case for colleagues in CAMHS and Social Care, across statutory,
private and voluntary sectors).
knowledge about supporting children’s emotional and mental health has much
improved due to being able to have in-depth discussion with our therapist.
Knowing that we have the capacity to support children in this way is
The limitations of training
Training is a tremendous asset to
support staff identify emotional and mental health difficulties, provide
mental health First Aid, and build supportive relationships for children
in school. For most children in school, this level
of support will be enough to help them weather problems and develop
healthy resilience. However, staff trained to this level cannot substitute
for the expertise provided by trained mental health professionals.
A rigorous professional mental health
training is the level of expertise needed by the 10% of children in
schools with a diagnosable mental health disorder. On current figures,
only one quarter of these will access professional mental health help
through a statutory service, and there is a risk that their needs will be
continue to be overlooked by a “quick fix” approach.
The Bridge model demonstrates how basing mental health
professionals in school is highly effective in addressing the gap.
Funding and Human Resources
A common pitfall is the absence of a clearly
defined funding basis for such comprehensive, school-based, mental health
provision. Currently, apart from voluntary sector fund-raising,
therapeutic input is largely financed by hard-pressed schools on an ad hoc
basis and is highly vulnerable, in light of the mounting pressure on
school budgets, and focus on education targets. This past year, five
separate Primary School Heads told us that they were having to decide
between keeping teaching support posts, or funding key pastoral support
This is the harsh reality which new
policy must address, if it is have real impact. Consequently, a
sustainable school-based mental health service will require leadership and
dedicated funding, on top of current provision, agreed at a strategic
planning level between relevant government stakeholders.
Moreover, there is currently a shortage
of mental health expertise available through statutory services. Over
recent years, third sector organisations have become core providers of
mental health support in the education sector. They have extensive
experience and established partnerships with schools, which is a valuable
resource for future planning (as well as bringing in additional financial
resource through charitable grants). An ongoing challenge is how to
integrate this resource at a strategic planning level, to avoid unhelpful
splitting and the inefficient lack of coordination which currently
Dr. Emily Ryan
Manager of the Bridge in Schools
Child and Adolescent Psychotherapist.
Office: 0117 942 4510
07948 530 644