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What Mental Health Provision Alternatives Should your School Look Into?

March 28, 2019, 11:54 GMT+1
Read in 10 minutes
  • With access to local SEMH services becoming increasingly scarce, what alternatives should schools be looking into? Jules Daulby weighs up the options...
What Mental Health Provision Alternatives Should your School Look Into?

There’s no doubt that many children aren’t thriving in schools. Access to external social, emotional and mental health (SEMH) services is in decline, just as headteachers are having to deal with more complex situations than ever before.

School leaders have already got plenty to concern themselves with, of course – league tables, Ofsted, ever-changing DfE goalposts, an ongoing funding crisis and persistent issues with staff retention and recruitment. A child with complex mental health concerns or social and emotional difficulties will likely need specialist support, yet there will be few resources available until things reach the point of crisis.

Teachers aren’t trained to deal with a suicidal child, for example – but could the system at least be streamlined, so that those most in need get the support they require, whilst others with less severe needs are looked after by school staff? The continuing lack of local support services in some areas is a scandal, but there are some strategic questions leaders can start asking themselves in order to provide pupils, staff and families with better support and early interventions.

Identify your needs

The SEND category of SEMH was officially recognised for the first time in September 2014, when it replaced the old acronym, EBD (‘Emotional and Behavioural Difficulties’). Areas that fall under SEMH include social and emotional functioning, wellbeing, self-regulation and mental health difficulties. The driving force behind the change was a desire to see behaviour as the physical symptom of deeper, underlying needs, such as mental health and adverse childhood experiences (ACE).

Has the ‘SEMH label’ ever been thought through at the highest levels in your school? As a leader, how confident are you that staff even know what it means? Does your school build a holistic picture of the children? Have they been assessed to ensure there are no other unidentified, SEN-triggering behaviours?

One of the things that surprises me most when visiting an alternative provision setting is how often the children there come with a very patchy history of circumstances and need. The first priority for leaders must therefore be to ensure that these pupils’ behaviours have been scrutinised, and that staff know them well.

Given the money spent on reactive measures for some children with SEMH, it’s worth considering a shift in resources and prioritising preventative measures. This could involve taking on counsellors who can dispense specialist provision, rather than maintaining supervised isolation rooms.

Could your TAs be trained to provide targeted support for early intervention strategies? Emotional literacy support assistants (ELSAs) can make a real difference, especially when they’re able to receive supervision from education psychologists. If properly trained and appointed where needed, ELSAs can help make the system more rigorous and better rooted in evidence and expert knowledge – see elsanetwork.org for more details.

Dig deeper

While mental health generally shouldn’t be considered as a form of SEN, introducing a proactive and preventative mental health strategy in school may, in the long term, reduce the number of children labelled as having SEMH. This would allow targeted and specialist resources to reach those children most in need. What are the underlying reasons for their behaviours? A child that’s quiet and compliant but with low attendance should be just as concerning as a pupil who’s regularly disruptive with 100% attendance.

Leaders should set themselves the task of devising system in which learning difficulties never go unidentified. Start with high quality teaching using the graduated approach (assess, plan, do, review). Then move on to targeted work, adopting an explorative approach and digging deeper to see if there are any traits and triggers that are repeating themselves.

If serious issues persist, specialist support, such as that available from CAMHS, will be required. Some schools have successfully set up drop-in sessions by partnering with their local CAMHS’ service, which can be an excellent way of putting preventative measures in place.

Maintain an analytical approach when addressing the needs of children with mental health difficulties, and treat them as you would an important new arrival with no spoken English, or a child with a different category of SEND. Developing attachment- and trauma-aware schools will be a useful first step in carrying out preventative work.

Examine your system

How would you characterise your school’s behaviour system? Is it broadly restorative, solution-focused, warm, strict? Whatever type of system it is, it should always be consistent and broadly understood. Stepped approaches which rely on joined up working between leaders, teachers, pastoral staff and SENCos must be clearly communicated to staff across the school.

Early interventions and partnerships with parents/carers should be straightforward and quick to set up so that problematic behaviours can be nipped in the bud early on, thus saving resources later down the line.

Who is a teacher’s first point of contact in the event of a behavioural issue? Will that person be able to react immediately, or will the teacher be left struggling in the classroom with their lesson disrupted? When will the family be contacted?

Will the student with SEMH understand how your system works?

Wherever possible, try to keep the child in the classroom. If removal is required, this should be addressed instantly and the student returned to class as quickly as possible. The process should be managed in such a way that the student and class teacher both feel supported throughout. Deescalation should form part of the response, though putting a child back in class before they’re ready can have the effect of making the situation worse.

In my opinion, using isolation as consequence to make up for organisational difficulties is unhelpful. Students miss lessons, teachers have to find a way for them to catch up, and you run the risk of embedding a negative cycle. Unless required for safety reasons, use a different sanction – perhaps a centralised detention at lunchtime or after school?

We should also be wary of stereotyping. An educational psychologist I heard speak on this discussed how girls tended to receive ‘nurturing’ interventions while boys received anger management support. Could it be that some students are over-represented in SEMH and underrepresented in other areas, such as dyslexia? Could it be worth auditing your detentions and behaviour points to identify common patterns?

Cast your net wide

The process of building staff awareness starts in the classroom, but its success will depend on the school’s culture. Fostering a culture of inclusion and diversity will encourage tolerance. Organising speakers who can share experiences of adoption and living in care and talk about their subsequent successes can be a great way of showing children what’s possible.

Charities such as ICAN and the National Autistic Society can help train staff in language and communication difficulties and provide teachers with excellent CPD on inclusive pedagogy and recognising behaviours that might indicate other difficulties. Equipping staff with this level of awareness will likely ensure that children’s opportunities are maximised within the classroom first, before external support is sought.

It’s also worth being savvy about what these types of organisations can offer your school for free, since many are funded externally.

Outreach from PRUs and special schools can be another valuable source of support. One highly experienced primary school teacher recently told me of how she had a class of 30 with high levels of need and support from one TA in the mornings only.

Having struggled under this arrangement, she took the step of asking for help and was able to receive support from an outreach service specialising in autism for a child with SEMH and ASD. This provided her with a series of ‘quick win’ tips and resources that enabled her to pursue more effective inclusive strategies for the child in question, while continuing to teach the rest of children in the class.

PRUs will often be willing to work with teachers so that young people with acute SEMH difficulties can transfer back into mainstream. Remember that from their perspective, prevention is better than reaction – if they can get ‘in’ with your school early on and embed helpful practice, that’s helpful to them.

Hold on

But, I hear some of you say, We do all these things and don’t have access to CAMHS. ‘Our’ educational psychologists spend their time writing up EHCPs and attending annual reviews for complex children – we can’t do it on our own. Believe me, I hear you.

The paucity of external provision available to schools is currently the worst I’ve seen since 1997, when I first began teaching. The years when schools could call on Children Centres, Sure Start, parent support advisors, teenage pregnancy services, wider CAMHS provision and a larger social services department seem very long ago.

I’m not saying it’s easy, but I hope some of the points above have either reassured you that you’re doing all you can, or brought to light some practical ideas that may save you resources and frustration later on.

Jules Daulby is an education consultant specialising in inclusion and literacy.

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