Children suffer with mental health difficulties for a range of complex reasons. The Government recommends that schools develop a mental health policy that creates an environment where young people with anxiety feel supported, understood, and able to seek help, making it more likely they will feel safe and able to attend school.
Many children have an underlying Special Educational Need or Disability that contributes to their anxiety; this can include Autistic Spectrum Conditions, ADHD, Sensory Processing Disorder or Dyslexia.
SEND also include Social, Emotional or Mental Health Difficulties, which could affect a child's ability to establish friendships, cope with a variety of strong emotions, and increase a child's vulnerability to bullying.
High levels of anxiety can be classed as a disability and are a barrier to learning requiring the use of assess-plan-do- review cycles. Children and young people will need a consistent, individual support plan which is shared with all staff. If children struggle to engage, they need patience and an experienced professional to help them access the right support.
In addition to the support put in place by the SENDCO, an Educational Psychologist can assess an anxious child and recommend appropriate interventions. This input can be useful as inability to attend school is often a symptom of a significant need or problem that requires more specialist knowledge and understanding.
Where severe problems occur, which are beyond the range of in-school mental health provision, schools should facilitate the child's access to more specialist support. The school nurse, or school directly can support or provide further evidence to expedite a referral. Parents can also ask for referrals to CAMHS, and Paediatricians through their GP. Unfortunately there are often long wait times for referrals , but support from schools goes a long way to ensuring the young people gain access to necessary treatment.
Schools can collaborate with other local services and providers to explore how individual needs can be met most effectively. The Local Offer can be an invaluable source of resources, information, advice and relevant support.
It is important that all professionals ensure that children and their parents participate as fully as possible in decisions leading to a support plan. Health and SEND professionals can advise schools on developing support plans that are flexible, child-led and sympathetic to the features of anxiety disorders, Autism, ADHD and other medical conditions. Plans must be communicated to all staff, and combined with development of relevant staff training and whole-school awareness. Although this may be harder to achieve in a large secondary school than a small local primary, it is fundamental to success.
An EHCP application is crucial if a school does not have the expertise or funding to fully identify a child's needs, or to offer the provision or support a child requires to access an effective education. Parents can also apply to the LA for an ECHP assessment, but a joint approach will be the most beneficial way forward. There have been delays in processing EHCP applications nationally, so support during this process is invaluable.
All medical conditions should be identified. Some illnesses are complex, or less common and may take time to diagnose and treat. Underlying physical illness can add to a child's anxiety. School must follow medical advice, and work with parents and children to support their health and wellbeing, and reduce the risk of further deterioration .
The Department for Education has issued Statutory Guidance and Departmental Advice (best practice) on “Supporting pupils at school with medical conditions“. The governing body of a maintained school, proprietor of an academy and management committee of a pupil referral unit must have regard to the Statutory Guidance in this document. This means that they must follow it unless there is a good reason not to.
Schools should have a Policy for Support for Pupils with Medical Needs.
Schools should also consider if an Individual Healthcare Plan is a proportionate response to a child's medical condition
Absence due to both physical and mental illness should be accurately recorded. The potential legal implications of unauthorised absences rarely help improve attendance, can add to the child's anxiety and substantially increase the difficulties families face. Attendance cannot take priority over health needs and families need your support rather than fines and prosecution.
Not supplying learning opportunities during absence means the pupil gets further behind which adds to anxieties around returning to school.
While on roll a school receives funding for a child so you should consider how to use that funding to support their learning in ways that reflect their needs and abilities. Your responsibility to provide an education doesn't cease if they are unable to attend.
You should notify the local authority if absence due to illness lasts for over 15 days (consecutive or cumulative). The LA have a duty to ensure that a child receives alternative educational provision whilst absent.
Recovery can be a very slow process for many children and young people despite everyone’s best efforts; helping them feel connected, significant and welcomed may encourage that big step back into school. Long term recovery needs a focus on support and encouragement for a child to enjoy other activities and friendships (not only those related to school). This will help rebuild their self-esteem, confidence and happiness, all of which are integral aspects of school refusal recover.
Child Law Advice provide information on the duties of schools and local authorities to provide education for children out of school because of exclusion, illness or other reasons.
Whilst reduced school attendance is a criteria for safeguarding concerns it is important for all professionals involved to gather evidence of the factors which may be impacting on attendance including SEND, health difficulties, and physical and mental health problems, including the impact of high thresholds for referrals, and long waiting times. It is crucial to consider:
There can be many different reasons why a child may start to show signs of school refusal. It can happen gradually, or it can happen overnight. The reason can be obvious, or it can baffle both caregivers and school staff, but when a child is frightened adults must pay attention as their reactions can help or make things a whole lot worse.
The combination of guilt for the child, pressure from schools and heavy-handed threats of fines and prosecution does nothing to ease the strain on these families and is not evidence based practice. Relationships between caregivers and schools can start to break down as their priorities diverge at this point, when instead the focus needs to be on working together in the best interests of the child.
The number one rule of getting a child to go back to school is:
Almost half (45.5%) of parents in the NFIS Attendance Difficulties survey (May 2018) stated that they have forced their child to attend school because they felt under pressure to do so. In addition, 21.2% felt under this pressure but had refused to force attendance.
When asked if the use of force was helpful in resolving their child’s anxiety,
36% of parents said ‘NO’
59.1% said it has made things MUCH WORSE.
Only 0.4% of parents thought force helped & 4.5% thought it might have helped.
Unfortunately, many parents currently report being blamed and pressured to improve attendance, without due regard to the severity of their child's difficulties. Many children are being described as ‘fine in school', when in reality they are not fine, as they often mask or internalise their distress while in school.
We recognise that there are limited resources in schools, but many helpful actions including understanding, are cost free! The longer anxious children are unsupported the harder it will be for them to return to school. Continuing to describe anxious children as being ‘fine in school' means they are less likely to be able to access the help they need to recover, and ultimately to attend regularly and achieve their potential.
Families often struggle because they find that school staff, CAMHS staff and Social Services staff do not know how each other work and do not communicate effectively. This means families get trapped in a cycle of being given advice or information by one service that is then disputed by another and this is very difficult to navigate or resolve.
Working together will be much more beneficial for all involved
Being open about mental health, and encouraging conversation, can be a powerful way to improve wellbeing at your school.
In this short film two teachers share their experiences and approaches to promoting good mental health amongst both teachers and students.
This blog aims to provide SENCOs and other professionals with evidence based approaches to meeting the needs of vulnerable children and allow them to share successes in practice that have improved the well-being and academic outcomes for children and young people with special educational needs and disabilities. It is a community resource and is still in development.
YoungMinds Professionals is a toolbox of consultancy and training services for leaders and front line workers across the children’s mental health system.
A collection of articles that discuss the problem of children 'masking' their difficulties at school. This collection has a focus upon the links with Autism however masking can also be a coping strategy for children who are not autistic but do try to hide their distress to avoid ridicule or punishment.
CAMHS is used as a term for all services that work with children and young people who have difficulties with their emotional or behavioural wellbeing.
Local areas have a number of different support services available.
A beginner's guide to the NHS's Child and Adolescent Mental Health Services (CAMHS) for young people and parents.
Independent Parental Special Education Advice (known as IPSEA) is a registered charity operating in England. IPSEA offers free and independent legally based information, advice and support to help get the right education for children and young people with all kinds of special educational needs and disabilities (SEND).
Services for Professionals:
Nurtureuk is working tirelessly to promote access to education for all. With increasing numbers of children and young people affected by social, emotional and behavioural difficulties inhibiting their progress and limiting their life chances, nurtureuk has developed a range of interventions and support to give disadvantaged children and young people the opportunity to be the best they can be.
The ELSA (Emotional Literacy Support Assistant) project was originally developed within Southampton then Hampshire by Sheila Burton, Educational Psychologist. It was designed to build the capacity of schools to support the emotional needs of their pupils from within their own resources. It recognises that children learn better and are happier in school if their emotional needs are also addressed.
The Include Programme aims to develop a national focus for young carers, their families and those who work to support them; to promote common standards and to work towards the realisation of equitable services.
Samaritans has been carrying out suicide prevention work with young people in schools and colleges for nearly 60 years.
Our work promotes positive emotional health, building resilience and seeking help when it is needed.
We have a number of resources to support the work of education professionals.
Place2Be is a children's mental health
charity providing school-based support
and in-depth training programmes to
improve the emotional wellbeing of pupils,
families, teachers and school staff.
Raising awareness of mental health amongst young people is very important to the Charlie Waller Memorial Trust. Our programme for schools and young people provides evidence-based presentations and training sessions that motivate, build confidence, inform and offer practical ideas and tools that can easily be put into practice.
The solution-focused practice toolkit provides inspiration for worksheets and activities to use, adapt or devise for the children and young people you work with.
Developed by practitioners from our Face to Face service, the toolkit is based on their experiences using a solution-focused approach. It's available as one download or 11 printable sections covering different aspects of solution-focused practice.
The SEND Gateway is an online portal offering education professionals free, easy access to high quality information, resources and training for meeting the needs of children with special educational needs and disabilities (SEND)
Dyslexia Action is a leading provider of specialist teacher training/practitioner training and specialist teacher/practitioner assessor training. We offer a range of pathways to achieve specialist teacher/practitioner assessor status. Our dyslexia courses are designed to strengthen the expertise and confidence of teachers, SENCos, practitioners, teaching assistants, learning support staff, language therapists, tutors and lecturers who support students with literacy difficulties, dyslexia and other specific learning difficulties.
Schools in Mind is a free network for school staff and allied professionals which shares practical, academic and clinical expertise regarding the wellbeing and mental health issues that affect schools. The network provides a trusted source of up-to-date and accessible information and resources that school leaders, teachers and support staff can use to support the mental health and wellbeing of the children and young people in their care.
Catch22 is a social business, a not for profit business with a social mission. For over 200 years we have designed and delivered services that build resilience and aspiration in people and communities.
As a social business we have the heart of a charity, and the mindset of a business.
Coram Voice enables and equips children and young people to hold to account the services that are responsible for their care. We uphold the rights of children and young people to actively participate in shaping their own lives.
We do this because we believe in a society which recognises and willingly accepts its responsibilities to children and young people, where the inequalities and discrimination they currently face have been eradicated, where they are fully engaged in all decisions made about their lives and where their views, needs and feelings are at the core of those decisions.
This section lists all our conferences and training courses. It also provides a wealth of information and support for anyone encountering autism in their working life. We carry information for professionals in education, health, research and social care and even in recruitment, theatres, sports or the sphere of criminal justice.
The NUT is fully committed to inclusive education and to exploring and sharing the factors that support and enable teachers to develop inclusion and meet the needs of disabled children and children and young people with SEN.
The NUT recognises that many class teachers and SENCOs are likely to experience additional workload relating to the SEN reforms and the SEND Code of Practice. The guidance in this section is aimed at both supporting and informing members
When asked to deliver keynote presentations or workshops at events, I always try to keep them super practical as I've found that that's what folk are after. In September, Medica CPD commissioned me to present at their annual children's mental health conference in Glasgow and Medica's CEO set me an awesome challenge... she said I had an hour and that she wanted no introduction, no fluff, just pure practical ideas that everyone could try out.