There is a window of opportunity to improve children’s mental health. Primary schools have a vital part to play.
Current policy developments
During 2018 there has been much speculation about primary schools’ responsibilities and activities in respect of their pupils’ emotional well-being and mental health. This has been caused by a Government statement to commit an additional £1.4 billion for children and young people’s mental health over five years, coupled with the publication of a Green Paper to enable this funding to be used appropriately. The ‘Fit and Healthy Childhood All Party Parliament Group (APPG)’ published the ’Mental Health in Childhood on June 26th containing 73 recommendations, many aimed at improving the Green Paper.
We’ve just been through a similar situation with GDPR where poor advice is still being given. Too many organisations left their planning too late which led to too many uninformed decisions. Four key issues have been identified that you may wish to think about.
1 Appointment of mental health leads in primary schools
The proposal is that every school should appoint a Designated Senior Lead for Mental Health’ to oversee the school’s approach to mental health and wellbeing and to provide rapid advice, consultation and signposting. This is a good proposal, although the job specification still needs to be developed in detail and competencies defined so that adequate learning objectives may be derived for training.
Consider who is the best person to take over this role and any impact on your staffing plan. Recruiting someone from outside has the disadvantage of lack of knowledge of the pupils and being more of ‘an unknown quantity’.
2 Service delivery channels
The recommended appointment of a Senior Lead for Mental Health is followed by a more contentious one. The Government ‘will fund new Mental Health Support Teams, supervised by NHS children and young people’s mental health staff, to provide specific extra capacity for early intervention and ongoing help. Their work will be managed jointly by schools, colleges and the NHS. These teams will be linked to groups of primary and secondary schools, providing interventions to support those with mild to moderate needs and supporting the promotion of good mental health and wellbeing’
This seems a step backwards. Many schools are already carrying out these services satisfactorily where teachers and assistants have been trained to register standards. This has been proved to be very effective and cost efficient – so why change? just apply the new funding to this service.
Those who do not yet provide this service might consider if their pupils will be better off receiving therapy in their known school environment and don’t have to travel to another centre, probably have less waiting time and whether there’s less administrative burden and school control as compared to using an external team.
This area is a striking weakness of the Green Paper. No reference was made at all to regulation aimed at safeguarding children with psychological or mental health problems. Play Therapists and School Counsellors have had registers accredited by the Professional Standards Authority since 2013. The APPG report covers this serious omission by recommending that: ‘All counselling, including play therapy, must be delivered by suitably trained practitioners who are on a Professional Standards Authority Accredited Register such as: http://www.playtherapyregister.org.uk‘
Every school needs to consider risk management. If the work is carried out by a registered therapist the risk of complaints by parents and others to the school is minimised because the professional organisation who manages the register are responsible for resolving the complaints. This protects the reputation of the school.
4 Evidence based practice
The Green paper makes a simple statement ‘Committing to recruiting 1,700 more therapists and supervisors, and training 3,400 existing staff to deliver evidence based treatments’. Again, the intention is good but the devil is in the very important detail. It is essential to specify exactly what evidence based practice (EBP) means for therapeutic work with children. The current medical model with a high reliance upon random control trials (RCT) is inappropriate mainly because of the ‘crisis of reproducibility’ associated with this research method.
Practice based evidence collected over a number of years is a better way forward. This shows effectiveness and efficiency under real life conditions with all their complexity. One model of play therapy, ‘Integrative Holistic’, has achieved this with over 59,000 outcome observations by parents and teachers. It shows that overall 77% to 84% of the children show positive outcomes. The variation is due to presenting condition, age, gender and number of sessions.
Schools should consider carefully which model of therapy is chosen, what practice based evidence exists and how they are going to compare their results, including cost effectiveness, to the national pattern.
The window of opportunity may not stay open long and may be obscured by the Government’s preoccupations with Brexit. But all schools can help themselves by thinking through the issues raised above for them.
Hope that this has been helpful.
Monika Jephcott – Chief Executive Play Therapy UK
More details, help and information from: Jeff Thomas Registrar Play Therapy UK firstname.lastname@example.org