The mental health of children in the UK is becoming a major issue for the NHS. And nowhere is this more obvious than in the classroom. From the pressures of social media, to the stress caused by academic performance, schools across the UK are seeing a surge in cases of mental health conditions. With a general election on 8 June, various groups are pushing for greater recognition of these challenges from political parties.
Last month, a letter to the Daily Telegraph signed by 2500 teachers, and 1000 mental health professionals, among others urged political parties to make commitments to improve children’s mental health in their manifestos, stating: ‘Children and young people face a huge range of pressures from exams to cyberbulling, from body image to finding a job when they finish education. An estimated three children in every class have a mental health condition, one in four experience emotional distress, and rates of self-harm are skyrocketing.’
Additionally, a report1 published in May jointly authored by the Health and Education Select Committees notes that half of all cases of mental illness in adult life start before the age of 15 and that one in 10 children aged between 5-16 have had a diagnosed mental disorder. It is also estimated that during their school years the number of children who will experience mental health problems is between 10% and 20%. According to the report1, this forms the ‘largest single source of health need’ among school age children in the United Kingdom.
According to evidence cited in the report, these difficulties can have a detrimental effect on a child’s day-to-day functioning. if left untreated, they can lead to severe long-term consequences, which can have an impact on educational attainment and personal and social development. Mental health problems include anxiety, depression, conduct disorders, eating disorders, self-harm, psychotic disorders and severe behavioural issues. Young Minds reports that over the last ten years the numbers of young people suffering injuries so severe through deliberate self-harm that they require hospitalisation has increased by 68%.
It is also estimated that by 2020, over 100,000 children and young people will be hospitalised each year due to self-harm. It has also been highlighted that around 80,000 children and young people suffer from severe depression. According to the report, while these figures alone provide cause for concern they relate only to the children and young people who have received a diagnosis of having a mental illness and recognise that many children go undetected, unseen and untreated.
‘With half of all mental illness starting before the age of 15, and three quarters by aged 18, the Government and educators must ensure sufficient time is allowed for activities in schools and colleges that develop the life-long skills children and young people need to support their wellbeing,’ said Chair of the House of Commons Health Committee, Dr Sarah Wollaston MP.
‘Many schools are doing excellent work to promote good mental health. But funding constraints, coupled with the lack of prominence given to wellbeing in legislation and the Ofsted inspection framework, mean that when schools face tough decisions about which services to cut, they are under pressure to prioritise other areas,’ added Ms Brennan. ‘At a time when rates of self-harm are skyrocketing, and when teachers are seeing a sharp rise in anxiety and stress among their students, this cannot be right.
The report cites social media as a key factor in the spread of mental health conditions in schools. It recommends educating children on how to assess and manage the risks of social media and providing them with the skills and ability to make wiser and more informed choices about their use of social media.
‘Generally speaking, young people have more pressures on them than previous generations. Students didn’t have pressures from social media, which has a massive impact on young people because it is glued to the palm of their hand,’ said Richard Cotton. ‘They see it everyday, that all plays a part. If you took away smartphones for a long period of time, you might see improvements to mental health. That is the only logical factor in why mental health conditions have increased in the last five to ten years.’
The report also cites the stress of examinations and academic rigour, staing that ‘the apparent trade-off between a focus on achievement and on well-being was criticised as a false dichotomy.’ A survey by Young Minds found that 82% of teachers agree that the focus on exams has become disproportionate to the overall wellbeing of students, while 70% think that the government should rebalance the education system to focus more on student wellbeing.
The Role of the School nurse
Bearing the burden of this situation is the school nursing workforce. Already under pressure from financial constraints and staff shortages, school nurses are increasingly picking up the slack, despite pressures. NHS workforce statistics from September 2016 show that the number of school nurses has fallen by 13% since 2010 – with just 2606 left in NHS employment.
An increasing number of education providers are having to cut back on mental health services, such as in-school counsellors, despite a growing prevalence of mental ill health among children and young people. ‘Predominantly [for school nurses] their work is around mental health concerns,’ said Richard Cotton, a school nurse in Staffordshire.
‘Any school nurse would say that mental health takes up a big part of their work,’ said Annie Jenkins, a former school nurse and the Chair for the National Forum of School Health Educators. ‘It combines with safeguarding, if you read any documents you will see mental health goes hand in hand with that. It’s very large part of their work.’
Ms Jenkins believes that the school nurse is ideally placed to support a child with a suspected mental health condition. ‘School nurses have a unique role, as they are the interface between health and education. They have a good contact opportunities with children and young,’ said Ms Jenkins. It presents a unique opportunity in being able to see children on their own. Those young people might be seeing a school nurse about anything, it doesn’t define why you are attending a service, compared to a more specialist service such as sexual health.’
According to both Ms Jenkins and Mr Cotton, school nurses will generally be equipped with some training, with many areas offering additional skill building to meet demand. ‘There are opportunities [for school nurses] to do level one courses on mental health and tier one,’ said Mr Cotton. ‘for example, Local CAMHS units run sessions [to enhance mental health knowledge].’
The report also identified a successful pilot aimed at increasing the level of integration between schools and CAMHS services. In 2015–16, the Department of Education worked with NHS England to provide joint training to schools and CAMHS staff and test how having single points of contact in both schools and CAMHS can improve referrals to specialist services. The government’s evaluation of the pilot found that the scheme improved schools’ knowledge and awareness of mental health issues, and their understanding of referral routes, and boosted confidence in supporting children and young people.
‘At a national level, the pilot programme very much demonstrates the potential added value of providing schools and NHS CAMHS with opportunities to engage in joint planning and training activities, improving the clarity of local pathways to specialist mental health support, and establishing named points of contact in schools and NHS CAMHS,’ commented the authors of the evaluation. ‘At the same time, the evaluation has underlined the lack of available resources to deliver this offer universally across all schools at this stage within many areas.’
With a pledge from the Government to conduct a root and branch reform of mental health, children in schools is a crucial priority, but one that may not receive the coverage it deserves. ‘It is crucial that the new government makes the mental health of our children an absolute priority. But at the moment the education system is so heavily skewed that it’s hard for schools to focus on the wellbeing of students rather than their academic achievements,’ said Sarah Brennan, chief executive of charity Young Minds.
It is clear that school nurses have a powerful role to play in supporting mental health conditions, but this is contingent on proper investment in the service.
‘All children deserve access to the right care, in the right place, at the right time,’ said Janet Davies, chief executive of the RCN, speaking in 2016. ‘Only by investing in school nursing and wider mental health services, can this crisis be tackled and children be given the best chance possible of leading happy and healthy lives.’
1. Health Select Committee and Education Select Committee. Children and young people’s mental health — the role of education. 2017