Rethinking mental health first aid in schools


The need to improve support for children’s mental health is rising to the top of the political agenda. As a highly emotive issue with celebrity status it makes sense to politicians for them to launch headlines that promise the earth.
But we need more than promises on the front line, where caring is something we’re doing minute by minute, an essentially practical issue. We need a well-evidenced approach that staff in schools can take up to provide timely support, preventing healthy distress from morphing into mental illness in partnership with the reactive work our medical colleagues provide. Most importantly we need an approach that doesn’t demand extra work and effort on the part of busy people but fits naturally into the school routine to rebalance demands and stresses.

Mrs. May’s unfunded promise of a mental health expert in every school exposes a key issue. Mental health is most commonly read in terms of mental illness, medicalising children’s responses to challenges that in all other areas of schooling we treat as being responsive to appropriate teaching. This persistent medicalisation of healthy distress runs against the stream of new scientific thinking which challenges the categorisation of distress as disorder and is developing non-medical definitions and responses.

New thinking, new practice

Underpinning this new thinking are concepts of brain plasticity, epigenetics and memetics, evidence of the positive role of emotion in healthy growth and a broader biopsychosocial perspective on growth and development.

Evidence of this shift in mindset is widespread and typified by the appointment of the first ever social scientist, Professor Sarah Harper, as president of the Royal Institute and the first non-clinician as president of the British Psychological Society, Professor Peter Kinderman.
The assumption that only mental health experts can offer support overlooks the fact that in the UK there are 1.3 million school staff, many of whom are routinely doing good preventative work but who lack guidance and recognition. The mental health charity for teenagers, stem4, in their March 2017 survey of 500 children found that 79% of 12 and 13 year olds experienced distress after starting secondary school and felt their teachers did not have the skills to help them. Only one in twenty said they would turn to a teacher for help if they felt depressed, anxious, stressed or emotionally unable to cope. But here again, the founder of stem4, a clinical psychologist, fails to address this skills issue and said the answer is to have trained health professionals in schools who could deal with the problems directly or make referrals to outside services. But CAMHS is only receiving funding from clinical commissioning groups of between £2 and £25 per child this year. That’s half an hour’s talking therapy at best from a school counsellor who might be disappearing from school as a result of cuts to funding.
The Government has commissioned pilot trials of three programmes designed to increase knowledge about mental health, focused on adolescents. Given that better knowledge leads to improved understanding that’s a good thing, but it’s only part of the answer. Included in the trial is psychiatrist Professor Stan Kutcher’s “Guide” a curriculum package for 12 to 14 year old children. However the linked role of “Go-to Educator” included in Kutcher’s research in Canada, a member of staff who provides an unconditional listening ear, has been left out. Teaching children about mental health and mental illness, important though it is, does not address the practical problem of how to improve pastoral support for children at risk of mental illness and Government thinking overlooks children in primary school.

Coping and caring

Historically schools and teachers have been poorly prepared to take on this preventative pastoral role. The officially sanctioned behaviour management strategy of segregation, isolation and exclusion of children in effect ‘diagnoses’ children who fail to comply as failures with fixed deficits. On the advice of a high profile behaviour expert, the current Government insists that this rigid strategy is justified in putting the non-compliant child under increasing pressure until as a ‘last resort’ they are ejected from school, by implication to be picked up by ‘behaviour specialists’ elsewhere. It’s an approach based on the idea that children’s emotions can be sidelined, that their intelligence is a fixed quantity, that if a child doesn’t change their behaviour in response to conditioning they must be faulty and the correct response is to change their provision.The same old routine of punishing failure doesn’t meet children’s needs at crucial times, although it may improve the school’s performance figures if needy children are removed.

It’s worth recalling here that major triggers for exclusion are low level disruption and high-level needs. Children in care and those with additional educational needs and disabilities are disproportionately excluded. Children are excluded from special schools and other placements specially set up to include so-called challenging children too.

At the very least permanent exclusions, coming as they do further down the road from temporary exclusions which are also rising, should be showing a marked decline not a substantial rise in numbers, if exclusion teaches children to behave as is claimed.

Healthy distress and the kindest response

My phrase ‘healthy distress’ needs some explanation. Transient anxiety and distress are natural features of the human condition, something we learn to cope with given the kindness and support of the people around us. Indeed it could well be taken as a sign of illness if we didn’t show distress as the appropriate response to losses and reversals in life.

Those of us who work in schools are very familiar with heathy distress. It comes and goes, children disengage, get upset, cry, shout, and every event teaches them something about themselves as people coping with the changeable world. As school staff we take it in our stride. We offer what we can and the clouds usually pass. We engage our kindness and understanding, we listen and offer a supporting hand or a tissue to wipe away the tears.

We aren’t taught how to do this kind of work in initial training, we simply do our best to import it from our store of life experience. But when distress is more serious, still healthy and not yet at a level of mental disorder we have nothing to go on, except the same old policies of regulation and control.

Structured kindness

We need what I call ‘structured kindness’ that incorporates both teacher-centred boundary setting and regulation and the empathetic child-centred approach when they’re called for. Not either/or but both/and.

Pie in the sky? No. I’ve been working this way for sixteen years, it’s a scientific educational approach, it promotes learning behaviour, inclusion, mental health and achievement.

I’m a Solutions Focused coach.