Since September 2005, as part of the new framework for inspection for children’s services, schools are expected to demonstrate how they are contributing to the five national outcomes for children stipulated by Every Child Matters and the Children Act 2004

These outcomes are: being healthy; staying safe; enjoying and achieving; making a positive contribution; and economic wellbeing. Although there are inherent challenges in meeting these outcomes, it is not a new insight that mental health concerns must be addressed if schools are to function satisfactorily and if students are to learn and perform effectively.

The Ofsted report
In July 2005, Ofsted published a report entitled Healthy Minds: promoting emotional health and well-being in school. This report examined the vital role played by schools in promoting the emotional wellbeing of their pupils, and analysed practice based on evidence gathered from visits by Her Majesty’s Inspectors to 72 schools.

It also reported on the impact of the guidance provided to schools four years ago by the Department for Education and Skills: Promoting children’s mental health within early years and school settings and the National Healthy Schools Standards (NHSS), agreed in 1999.

The NHSS is jointly funded by the DfES and the Department of Health (DH) and hosted by the Health Development Agency (HDA). The overall aim is to help schools become both healthy and effective, providing an environment that is conducive to learning and that encourages pupils to achieve. Guidance has been provided to education and health partnerships in the form of standards for developing local healthy schools programmes.

The NHSS is at the core of the government’s healthy schools programme. One of its key areas of activity is emotional health and well-being (including bullying). Serious concern is raised in the Ofsted report about the large number of schools in the survey which were not working towards meeting the standard. Only just over half were aware that the NHSS existed and, of these, only a very small minority were working towards or had met the criteria for emotional health and wellbeing in their school.

Characteristics of schools which demonstrated good practice in the promotion of mental health included an ethos which valued and respected individuals, a serious approach to bullying and pupils’ difficulties with relationships combined with a swift resolution of problems, good arrangements for listening carefully to pupils’ views, and the involvement of parents.

Good joint working between health services, social services and schools was at the heart of effective planning and provision for individual pupils. The best arrangements included regular meetings attended by a range of professionals, where work was coordinated, referrals made and difficulties followed up.

Mental health and schools
Schools promote mental health through both the curriculum and the provision of supportive learning environments which emphasise the acquisition of communication, social and problem-solving skills. The school environment also provides opportunities to develop a range of relationships with peers.

Educating about mental health has the capacity to achieve a number of outcomes including: – Promote cognitive and social skills that contribute to positive mental health (protective factors). – Increase students’ awareness and understanding of mental health and its relevance to them.

– Decrease the stigma associated with mental health and mental illness.

Health services, social services and schools all use different terms to describe pupils and their conditions. ‘Mental health’ and ‘mental health difficulties’ are more commonly used terms within health and social care. However, schools and local authorities are increasingly using the term ‘emotional health and wellbeing’ in relation to both the care they take of pupils and the curriculum they provide. The lack of shared definitions and understanding of mental health problems makes it difficult for schools to identify and discuss these with pupils.

One barrier to improving provision for pupils’ emotional wellbeing was the low level of awareness amongst staff of its importance. According to the Ofsted report, hardly any schools were aware of the comprehensive guidance issued by the DfES in 2001. Even fewer schools had provided any staff training to raise awareness of the issues and the strategies described in the guidance. Training for staff on mental health difficulties was unsatisfactory in just over a third of the schools visited and good in only just under a quarter. Most training tended to focus on managing pupils’ behaviour rather than on promoting a positive approach to relationships and resolving conflicts.

The Ofsted survey found that, in the schools visited, only between 4% and 6% of pupils had been identified as having some form of mental health difficulty, in comparison with the DfES guidance survey which indicated that about 10% of pupils experience clinically defined mental health difficulties. This under-identification of mental health issues in pupils might go some way to explaining why schools struggle to manage the behaviour and attendance of some pupils if they are not correctly identifying their difficulties and providing for them.

The pupils who were least mentally well were those who were withdrawn or depressed and who were underachieving as a result. Schools commonly identified pupils whose attendance was unsatisfactory and who did not participate fully in school life. Typically, these pupils had few or no friends and were isolated in the playground. However, they presented few challenges to teachers and, too often, their problems were not followed up. Few schools saw non-attendance, lateness or falling behind in course work and homework as indicative of deeper problems.

Letting pupils take a lead
On one level, there is the reality that for some youngsters their school is the main provider of mental health services. Arrangements for pupils to refer themselves for support and help are popular with them, as well as effective.

This is particularly true when a pupil is struggling emotionally but where the school has not noticed changes in the pupil’s behaviour. Mentoring and support from peers is also very effective at providing a listening ear and opportunities for positive friendships.

Self referral or drop in schemes enable pupils to identify themselves and seek the help they want and need. Pupils who have such opportunities report that this is supportive and gives them confidence.

A programme of education about values also helps pupils to talk freely and openly about their feelings. Clubs and after school activities enable schools to support vulnerable pupils in a way that reduces the stigma of referrals.

Two thirds of the secondary schools visited had good peer counselling, support and mediation systems. Peer mentors, who had themselves experienced difficulties in the past, commented on how much they valued helping younger pupils who were also experiencing problems. The most successful schemes provided thorough training for the pupils offering the support, as well as careful monitoring from the teachers responsible for it.

Relationships with parents A key to effective identification and provision lies in schools’ relationships with parents. The main characteristics of good practice between schools and parents are: – home visits by teachers and other support staff – training for parents in developing healthy minds – parental support groups – regular meetings and telephone contact – coordination with other agencies so that parents had to attend only one meeting Difficulties in working with parents stemmed from: – late diagnosis of a pupil’s problems – uncoordinated support from a range of agencies – poor information provided for parents about whom to contact – inadequate account taken of parents’ childcare arrangements, so that they sometimes had difficulties in attending meetings – negative feedback to parents about their children

– parents’ perceptions that the school had ‘given up’ on their child

Supporting pupils
There are three basic levels of support for children and young people – universal, targeted and specialist services. Schools are in a unique position as the primary universal service to children, and consequently have an important role in mental health promotion.

A partnership approach with the local authorities and other key agencies is essential when providing targeted and specialist services, but it is essential to recognise that children receiving these higher levels of support also need access to the universal types of support too.

School based and school linked programmes have been developed for the purposes of early intervention, crisis intervention and prevention, treatment, and promotion of positive social and emotional development.

The Ofsted report strongly suggests that there has been insufficient communication between local authorities and schools to ensure that guidance around mental health and promoting wellbeing has been understood and implemented by school staff. This needs to be addressed, possibly by developing a specific strategy about this communication approach, and needs to ensure that clear strategies for implementing guidance are put forward.

Viewing mental health in schools as essential to addressing barriers to learning, and not as an agenda separate from a school’s instructional missions, is an integral component to schools being able to demonstrate how they are contributing to the Every Child Matters outcomes.

Fiona Denman is a policy analyst at TEN (The Education Network), specialising in children’s services and social care. A registered social worker, she has worked extensively with children, young people and their families in a range of settings.

Ofsted recommendations to schools

– use the DfES national guidance on mental health difficulties to develop clear procedures, that are known and used by all staff, for identifying and supporting pupils – ensure that issues concerning mental health are tackled successfully, either through the National Healthy School Standard (NHSS) programme or the PSHE curriculum – establish arrangements for preventing bullying and promoting positive relationships and monitor their effectiveness

– work together to ensure that the DfES guidance is disseminated to all staff

The criteria for national Healthy School status

Core theme 4: Emotional health and wellbeing Promoting positive emotional health and wellbeing to help pupils understand and express their feelings, and build their confidence and emotional resilience and therefore their capacity to learn. A Healthy School: – identifies vulnerable individuals and groups and establishes appropriate strategies to support them and their families; – provides clear leadership to create and manage a positive environment which enhances emotional health and wellbeing in school – including the management of the behaviour and rewards policies; – has clear, planned curriculum opportunities for pupils to understand and explore feelings using appropriate learning and teaching styles; – has a confidential pastoral support system in place for pupils and staff to access advice – especially at times of bereavement and other major life changes – and this system actively works to combat stigma and discrimination; – has explicit values underpinning positive emotional health which are reflected in practice and work to combat stigma and discrimination; – has a clear policy on bullying, which is owned, understood and implemented by the whole school community; – provides appropriate professional training for those in a pastoral role; – provides opportunities for pupils to participate in school activities and responsibilities to build their confidence and self esteem;

– has a clear confidentiality policy.