This article was originally posted in Headteacher Update 10/9/15.
Tackling the silent majority of unaddressed CAMHS cases has become a challenge for many schools. Daniel Sobel discusses two particular problems.
Much has been written in recent months about Child and Adolescent Mental Health Services (CAMHS), and the issues which plague its ways of working.
A recent survey of parents by charity Young Minds on behalf of NHS England revealed that two-thirds believed they did not get enough support and that one-quarter had to wait more than a year for treatment for their child, as well as numerous other problems.
In an ideal world, CAMHS would support schools that have serious concerns about a student’s mental health. Instead, the system is inefficient and many urgent referrals get stuck on endless waiting lists.
Staff in many of the schools where I have consulted tell me of their frustrations that not a single student they refer to CAMHS ever gains immediate support, even if the student is self-harming.
What is causing this to happen? CAMHS is certainly over-stretched and perhaps it is also too disconnected from schools. The current “service provider” set-up keeps schools isolated, and surrounds them with satellite organisations such as social services. Schools are only supposed to refer to such satellites if the situation is significant. I suggest that there are two main problems caused by this structure.
Problem: teacher awareness and training
Schools refer every student about which they are unsure to CAMHS, regardless of the scale of the problem. Staff may not have accumulated much evidence about the student, and may not have taken simple steps to deal with the issues.
The system at present doesn’t enable a school, or its teachers or senior leaders, to have access to a health expert, and so the school might not know which “symptoms” to seek out or which questions to ask. Is a student being disruptive because they have had a bad day, or is there a deeper problem to be concerned about?
Instead of CAMHS being drawn in if and when it is needed, the school has to wade through an unending flow of paperwork and processes.
Of course, this is not due to any lack of concern for, or willingness to help, the student. Nearly all teachers that I meet express real, emotional anxiety for their most troubled students, and sometimes feel powerless to know how best to help them.
It is not often discussed, but sometimes this can take a toll on pastoral and SEN staff, and the lack of training, support and supervision they might need is often absent, even if they are working as hard as they can to support some of our most vulnerable children.
Solution: up-skilling our teachers
Teachers can become savvier about SEN and how these needs can be identified. Having a basic system of assessment might allow teachers to fill out a simple form about a student’s behaviour, their responses to teaching and any difficulties they may have speaking or interacting. This could then lead to some simple strategies that a teacher can take, and this can allow the tracking of the student’s progress if the form is filled out regularly.
Through improved training, which focuses on how to identify and manage students in the early stages of any problems, issues can be addressed before they spiral into more complex problems, and referrals will become more accurate and specific and, indeed, fewer.
Problem: lack of integration of CAMHS in schools
With CAMHS as an external body, there exists a lack of communication and co-ordination between the school and the health sector. Many CAMHS workers don’t even get to meet the child’s school-based link. Instead liaison is irregular; it can be a rare occurrence that both the SENCO and the CAMHS worker happen to be free at the same time for a phone conversation. Meetings between the school and CAMHS are then wasted, just catching up on basic information, rather than finding the solution to a child’s situation. The opportunities to integrate CAMHS expertise into the classroom are rare, despite this being the setting where a student can best be nurtured by the school.
Solution: three clear steps
I believe that the answer to this problem is bold, simple and three-fold:
- We need to reposition CAMHS as fully integrated within the school, rather than orbiting it as a satellite.
- A mental health representative should meet regularly with school senior leaders, so that he or she remains up-to-date with the mental state of the pupils.
- Not only should CAMHS be focused on building up in-school provisions but shift their focus from being merely reactive to mental health but being proactive in both education of teachers, students and their parents.
Increasing the capacity of schools to deal with emotional health will help the majority of cases, and this can be done in many different ways. In one borough where I have worked, one that served the needs of 150,000 students, family therapy was provided for two days every week.
Given that studies have consistently demonstrated that the relationship between school and family is crucial to a child’s learning, this kind of solution could allow mental health problems to be identified and solved before they become too serious.
If school staff become more adept at dealing with mental health within the school’s walls, the unending stream of requests to CAMHS could be stemmed.
Concurrently, if CAMHS does more to communicate with schools outside of referrals, it can improve how it deals with referrals. And through a more integrated way of working, we would ensure that the mental health problems of young people are not ignored.