Speakers: Matthew Blow, Young Minds; Neera Sharma, Barnardo’s; Josie Smith, Barnardo’s.
25th April 2018
Mental Health in Primary Schools
Chair: Baroness Benjamin
Speakers: Matthew Blow, Policy and Government Affairs Manager for Young Minds; Neera Sharma, Senior Policy and Research Adviser at Barnardo’s; and Josie Smith, the PATHS Programme Coordinator for Barnardo’s.
Chair’s Opening Remarks:
Good evening everybody and welcome to this, the 34th meeting of the All-Party Parliamentary Group on a Fit and Healthy Childhood.
Tonight we are looking at an issue of growing concern, mental health in primary schools.
Jeremy Hunt has said, and I would certainly agree, that: ‘Childhood should be the happiest time in life, but for those experiencing poor mental health, it can be anything but,’ (3rd December, 2018).
Unfortunately, awareness about child mental health is still very much ‘under the radar.’ Problems do not suddenly spring up ‘out of nowhere’ in Secondary school and there is a steady rise in the number of children who exhibit symptoms of depression, anxiety and psychosis from as young as five years of age or before!
There are child interventions and therapies in primary school but due to staff shortages and funding difficulties, the number of inadequately trained and supervised persons who are practising some form of therapy with children is a matter of urgent concern.
Overall, young children are simply not receiving the type, availability and quality of services that they deserve and the ‘early interventions’ that they are receiving may be doing more harm than good.
As I’m sure you all know, we are currently working on a new report titled ‘Mental Health in Childhood’ which will explore these issues in detail.
We are pleased to welcome our speakers, thank you all for sparing us a little time this evening.
I have asked them for 5-7 minutes each before we go in to the usual Q&A session.
Matthew Blow, Policy and Government Affairs Manager for Young Minds
Young Minds is the UK’s leading charity in the area of mental health for young people. We are a campaigning charity trying to inform mental health policy mainly using the voices of young people. On the back of the green paper we’ve been doing a lot of focus groups in schools and reporting our findings back to the Dept. for Education. I’d like to outline why we think there should be more mental health provision in schools. I know most of you will know the statistics already but from the last Government survey, 8% of children in primary schools have a diagnosable mental health condition but only 1 in 4 of those are able to access NHS services, which underlines the importance of schools supporting them when they are not able to get the help they need. Obviously, more children have experience of anxiety or depression and a recent survey showed that two thirds of primary school children are always worried about one thing in their life – whether it’s to do with school or home. The pressures on young children are around bullying, body image, bereavement and violence, all of which increase the risk of mental health problems developing later in life.
The last survey was back in 2004 and that was before social media was popular, so the next one, due this year, will be interesting. It will tell us whether the stories we’ve heard about an increase in mental health problems in children has actually happened. We hear from school leaders and 90% of them have noticed an increase in anxiety and depression over the last five years, and this is in line with a 44% increase in CAHMS referrals over the last three years.
We know that primary schools play a really important part in developing children’s social and emotional skills which help them to build resilience to combat anxiety and depression when faced later with adversity. Children need those skills embedded at a very early age. Schools also have a big role to play in identifying potential problems and intervening, especially if the problem is not being picked up or dealt with at home.
There is obviously a link between wellbeing and academic evidence shows that pupils with a greater sense of wellbeing are more likely to achieve and more likely to have positive health outcomes later in life.
Having said all that, the reality is that the education system in unbalanced and there is a significantly greater focus on academic attainment than there is on developing the wellbeing of children.
When schools face funding cuts the part that goes first is provision that goes with pastoral care – support workers, teaching assistants, etc. In terms of infrastructure in policy terms, we don’t think there is enough prioritisation in legislation or the Ofsted framework. There were changes in 2015 and there are some measures around mental health, but a recent report showed that less than 1 in 3 Ofsted reports even mention health and wellbeing.
Other thing is the knock-on effect targets have on teachers, i.e. morale, retention and recruitment problems. In a recent survey 93% of teachers think they will leave the profession in the next five years. By the way, I am happy to share the details of these various polls and surveys if anyone wants them.
In terms of polling, we did some ourselves last year involving more than 3000 children, parents and teachers. There was an overwhelming view that there needs to be a rebalancing of the education system: 82% of teachers said that the focus on exams had become disproportionate; and children said that exam pressure had adverse effects on their mental health.
Parents report that, given the choice, they would rather send their children to a school that has a good focus on wellbeing where the children are generally happier, than a school that has good exam results.
The Government, as you know, published a green paper last December and that was really good that they are recognising the role that schools can play. Main proposals were:
- Each school to have a designated senior lead for mental health
- Mental health support teams to be trialled in a quarter of the country over the next five years – they will work with schools but also link into CAMHS
- One teacher in every primary school will be taught mental health first aid
- Relationships education will be embedded in the curriculum
- Starts September 2019
This is obviously a good step in the right direction, but a lot of these provisions are particularly focussing on students with emerging or identified mental health problems, and putting the expertise into the hands of one person in the school. We think that it is really important that there is a universal whole-school approach e.g. in addition to having modules in initial teacher training, to try to build a situation where all school staff have knowledge of child development and mental health. It’s important that schools are supported in prioritising mental health in their school improvement plans. We also think that in the implementing of the green paper the focus on mental health support teams and the designated senior leads should be in the context of a universal approach to wellbeing and resilience, and not just specifically focussing on students with identified problems
Neera Sharma, Senior Policy and Research Adviser at Barnardo’s
Barnardo’s, the UK’s largest children’s charity, last year supported 272,000 children and their families through 1000 services nationwide. Mental health and wellbeing is a strategic priority for us for the next 10 years. The children we help are some of the most vulnerable e.g. in care or leaving care, being abused, going missing, etc. As well as specialist services we also run early intervention and prevention services and our work in schools is something that my colleague Josie will talk about shortly.
Through our children’s centres and family support services, we focus on preventing problems and supporting families before problems escalate. We’re doing quite a lot of work on “adverse childhood experiences” as the evidence tells us that when a child is exposed to four or more episodes it impacts on their lives and on their outcomes as adults. It’s not inevitable, because lots of people who have been exposed to adverse childhood experiences do well, especially if they get the right support at the right time.
The Welsh and Scottish Governments are doing a lot on this, including setting up hubs and commissioning research, but we need to bring this thinking right across the UK. We’re working with Professor Gordon Harold who has created the toolkit we use. We’re rolling it out to schools and the police so that professionals are trained to recognise adverse childhood experiences and have the tools to support young people who experience them.
Moving on to our work in schools and the PATHS programme, PATHS stands for Promoting Alternative Thinking Strategies and the programme was developed in the United States and brought over here, initially to Northern Ireland where Barnardo’s helped to adapt it. It is research-based and evidence-based, so we have data that shows that it actually works and has an impact, and we continue to gather that data. It is now being rolled out across the UK in primary schools. In Northern Ireland they are starting to roll it out into nurseries as well. As well as PATHS in Northern Ireland they have something called “friendship groups” and an initiative called “time for me” which gives extra support for children who need it. Extension of these initiatives across the UK might well be the next step.
The fact that one in ten children has a diagnosable mental health problem means that in a class of 30, on average 3 children will have a mental health disorder. Half of all adult mental health problems start before the age of 14 and 75% of lifetime conditions are present at the age of 24. There are also gender differences, with boys more likely to have problems than girls.
We believe in a universal whole school approach, and PATHS as part of such an approach can help to prevent mental health problems arising.
Josie Smith, the PATHS Programme Coordinator for Barnardo’s.
I am the PATHS co-ordinator for London and prior to that I was a primary school teacher in Tower Hamlets for five years, so I feel very strongly about improving mental health provision in primary schools.
The PATHS programme is based on fundamental social and emotional competencies. The first competency is self-awareness and the way the programme addresses this is to teach children to identify feelings and recognise those feelings in themselves.
PATHS comes as a curriculum programme and runs from Reception right through to Year 6. It is a preventative programme rather than a reactive one: it’s not there to troubleshoot behaviour management problems as they arise but rather to help prevent those problems arising as much in the first place by teaching the children to have better emotional understanding and emotional resilience. Children are taught what feelings look like on a face or in a body, what feelings feel like inside, and what those feelings might make them do.
When children are able to recognise those feelings they are more able to control them. It’s very important in this programme that children are taught that all feelings are ok, but not all behaviours are ok. For example, it is ok to feel angry but it’s not ok to hit someone because you’re feeling angry.
Sometimes teachers react to that, but children need to be able to separate feelings and behaviour. Feelings are not good or bad: they’re comfortable (yellow faces cards) or uncomfortable (blue faces cards).
After self-awareness the next competency is self-management, which is taught in two separate ways. In key stage one – younger children – we use a turtle prop and teach children to “Do the turtle”, which means first of all, stop. Secondly they take a deep breath and thirdly they say the problem out loud (to another child or to a teacher).
In key stage 2 we don’t use the turtle prop but we have traffic light signals – red light (stop and calm down), amber (think about a solution) and then green (solve the problem).
The next competency is social awareness where children learn to recognise the feelings in someone else, and that leads to the development of empathy. Once they have empathy, they can develop relationship skills and, finally, responsible decision-making
We use a “wheel of competencies” which has three circles representing the class teacher (ideally 2 sessions a week); the whole school (teachers and teaching assistants); and parents’ involvement.
It’s not about targeting certain children – it’s aimed at all children.
Neera: We have research data from 2008 to the present day involving 225 schools and over 50,000 pupils across 5 regions – Northern Ireland, Swindon, Scotland and Wandsworth in London. 154 teachers and 12 schools last page of the handout shows the survey results.
Questions and Comments
Amanda Gummer: What is the role of play in both these initiatives?
Matthew Blow: We deliver training to the leaders and teachers in order that they can clarify appropriate interventions. The key point at primary school level is emotional literacy.
Josie Smith: In terms of play, I understand its importance. Teachers get lesson guides and during circle time I see the children playing quite openly with puppets. It’s not explicitly in PATHS but the programme should enable children to play more happily.
Amanda Gummer: Children develop these skills through play.
Josie Smith: PATHS is a small part of the school week: there will be other opportunities for children to play.
Baroness Benjamin: All children have all the emotions naturally but they have to be taught to recognise and develop them.
Charlotte Davies, Fit2Learn: Sue Palmer, a literacy expert and campaigner, is calling on the Scottish Government to recognise that formal education before the age of 7 is child abuse. What are your feelings on this issue?
Matthew Blow: This might not be directly answering the question, but the notion of education is very prescriptive and we think there does need to be more focus around emotional skills and we have called for a rebalancing of the education system. In terms of age, we don’t have a strong view.
Josie Smith: It’s difficult because I have personally taught 5 and 6 year olds and I would hate to think that I was doing anything bad to them. I agree that there needs to be a rebalancing. Delivering a programme like PATHS is what teachers want to do, but they often can’t fit it in because of SATs. When time is being squeezed, the first things to go are the non-academic areas. It’s not that the teachers or the children don’t want them – they love these kinds of lessons.
Neera Sharma: PATHS works best when it is a whole school approach, but schools say they have no resources so it is usually delivered piecemeal. If there was more flexibility and more space in the curriculum things would be different. It’s a matter of time, but also resources as there is a limit to what they can buy in.
Eunice Lumsdem, University of Northampton: How are we going to support the adults to take responsibility for children? How can we change the language that we use, and stop labelling children? We need to move to a “positive strengths” approach, away from the negative.
Neera Sharma: We need to challenge Ofsted and develop a non-stigmatising approach. If you label children they don’t want to come forward for support. Early intervention from universal services that don’t stigmatise is the way to go.
Baroness Benjamin: It’s becoming trendy to refer to mental health problems as if they are the accepted norm. It’s true we need to be careful about language. Who should be saying this?
Neera Sharma: There is a big difference between “wellbeing”, which can be easily helped, and “mental health disorders”, which need more specialist help. There are a lot of children on CAHMS waiting lists who could have been helped earlier. The solution is to identify the appropriate intervention at the right time.
Matthew Blow: There is a risk around stigma. There has been some positive work but more needs to be done. We need to get the message across to children as early as possible to that they feel able to talk about it.
Eunice Lumsdem, University of Northampton: There are multi-faceted roots to the current situation. The education system is about performance and we bandy around the term “resilience” as we try to prepare young people for the life we are giving them. No one is actually speaking for children: we haven’t had a Minister for Children since 2010.
Josie Smith: I have an example of a school head who did away with the “traffic lights” behaviour management system and replaced it with the language of PATHS, with great success.
Neil Coleman, OPAL: Baroness Benjamin asked the question earlier “when did these changes begin?” I would like to suggest that in the early 1980s there was a change. Nowadays there is 90% less outside play than there was in the 80s, and a well-documented rise in mental health problems over the same period. If children could just play out more we would go a long way to reversing this trend, although it would take time for the effects to be felt.
Neera Sharma: There are a lot of different reasons why children are not out as much as they used to be: the rise of “stranger danger” hasn’t helped. The murder rate hasn’t actually gone up but the media coverage has. There is also more traffic; there’s technology keeping children inside with their tablets and games; and in some deprived communities children are scared to come out because of drugs, gangs and knife crime.
Matthew Blow: Children we speak to often report that they are under pressure at school because of tests and exams, and also from bullying.
Neil Coleman, OPAL: These are symptoms. If children play out, they are happier.
Neera Sharma: Agreed, but it’s complicated. Cuts have led to a decrease in common spaces and an absence of park keepers. Children don’t feel as safe as they did.
Jeff Thomas, Play Therapy: I have a concern about records following a child throughout their lifetime. Are the changes to data protection laws making any progress on this?
Neera Sharma: The green paper is good in its aspiration but poor in other respects, and there is no mention of registration for people who work with children.
Jeff Thomas, Play Therapy: What happens next? Is this meeting a one-off or will our campaigning continue?
Baroness Benjamin: We meet regularly (this is our 34th meeting) to campaign for anything that will help our goal of ensuring that children have a fit and healthy childhood. We are continually campaigning for a Children’s Minister. At each meeting we listen to the speakers and act upon what we hear. Over the time the group has been active, we have produced ten reports which have been very well received by politicians and policy makers. In our latest report we’re dealing with mental health and wellbeing. If you want me to put a question down in the House of Lords, please let me know because I will be glad to do so.
Dr Jane Murray, University of Northampton: It is true that there is a danger in labelling, but I’d like to point out that we do not have enough Educational Psychologists.
Neera Sharma: I attended a recent meeting of the APPG for Psychology where I heard that at one time every local authority employed their own educational psychologist(s), but now schools have to buy in the services and there are a lot of schools without access. That APPG is campaigning to turn this around so that local authorities once again employ their own.
Agnes Javor: In an ideal world all of this would be in the curriculum. What would help to get your programmes into all schools?
Josie Smith: Finance and time are the biggest problems. In Wandsworth, the NHS funds the PATHS programme but otherwise schools have to buy it in. If there was Ofsted recognition of mental health in schools that would influence things. It’s difficult to get hard numbers though – there is a bigger focus on academic attainment because that’s much easier to measure.
Baroness Benjamin: What is the duration of the PATHS programme? What do schools have to buy and how much does it cost?
Josie Smith: It’s across the whole of the primary school from Reception to year 6, and the classroom time is two lessons per week. Schools have to buy the resources, which are manuals, posters, props, etc. There are three levels of cost: 1) just resources; 2) resources and training; 3) resources, training and coaching support. The PATHS manager can provide precise costs.
Martin Amor, Cosmic Kids: There are two different aspects: medical grade mental health problems, and mental health challenges. We work with children on mindfulness which can help with the latter.
Josie Smith: PATHS is not really about mental health as such. Regarding the former, schools have a big role to play in identifying mental health problems.
Sonia Fihosy, Mytime Active: What has been the reaction from parents?
Josie Smith: We would like to do more with families so that the messages from the programme can be reinforced at home. We do send handouts home with children and make resources available to share with parents at parents’ evenings, but there are often difficulties, for example when English is not the first language at home. We could work on more cohesion between school and home.
Kathryn Sexton, Juka Dance: How rigid is the PATHS programme? Arts teachers are struggling to hold their place in the curriculum so could PATHS be delivered through performance work? At primary school level there is funding available through the pupil premium which is meant to cover health and wellbeing as well as movement.
Josie Smith: This particular PATHS programme is fairly rigid and designed to be delivered in a specific way, but it could be looked at again with a view to adaptation.
Chris Allbut, Greenhouse Sports: We deliver social and emotional programmes through sports, with good results. How can we convince head teachers that sports and arts lessons deliver these extra benefits?
Josie Smith: I agree: sports and arts lessons are excellent opportunities to develop emotional intelligence and they can also be used to reinforce the skills learned in PATHS.
Neera Sharma: We’ve been saying for some time that the curriculum is too narrow with too much focus on exams. We are awaiting a response to this.
Jaime Amor, Cosmic Kids: I have found from working with teachers that they don’t like being given lesson plans and manuals. Can the programme be changed so that teachers don’t feel overwhelmed?
Josie Smith: The lesson plans are very simple and not stressful. They can be delivered in an engaging way and can be adapted to personalise them. The duration of the lessons can be decided by the teachers.
Paula Timms, Barnado’s: Returning to the earlier point about language, staff are reluctant to talk about “mental health” and young people want us to open this up. They have told us that they want to be taught about mental health as well as physical health – and the young people themselves use the term “mental health”.
Matthew Blow: Young people use the term “mental health” very neutrally.
Neera Sharma: It’s true – they use the term “mental health” but they talk about a range of issues. They don’t shy away from the term because that’s how it is referred to in society.
The meeting closed at 7.30 pm.