What good looks like in psychological services for schools and colleges: primary prevention, early intervention and mental health provision

A person experiences greater psychological and physical development and change during childhood than at any other time in their lives. Experiences during childhood also have an important and lasting impact on both the individual, their family and others close to them.

Children and young people will experience episodes of psychological distress during childhood and adolescence, from cutting their fingers, to losing a pet, or falling out with their best friend. For most this will be short-lived and through the social support of family and friends may increase their resilience and ability to cope with upsetting events later in life.

For some however, the nature of the experience, for example abuse, significant bereavement, the extent of the distress or the lack of positive social and family support can have an extremely negative impact on their mental health which may be life-long unless the right help is provided at the right time and in the right way. Current statistics show that:

●● Approximately one in ten children and young people have a diagnosable significant psychological difficulties.
●● Around one in four children and young people show signs of a mental health condition, including anxiety and depression.
●● This means that up to three children in every classroom may have psychological difficulties which could be helped.
●● Only 25–40 per cent of these young people receive input from a mental health professional early enough, if at all.

Whilst it is not compulsory for children and young people to attend school in order to receive their education, the majority will attend. Outside of the home, school is often the most important consistent influence in children’s development. There are therefore significant opportunities for high quality psychological services to promote resilience and wellbeing; as well as creating a psychologically healthy school environment for both children and staff. The option of delivering help in the school to children and young people who are experiencing psychological difficulties is increasingly being explored.

Children’s mental health has never had a higher profile than it does now. ‘Future in Mind’ (Department of Health, 2015) developed by the Children and Young People’s Mental Health and Wellbeing Taskforce, made recommendations for the future development of children’s mental health services in the NHS that were later incorporated into the 5 Year Forward View for Mental Health. The Government’s response outlined a £1.4 billion investment in child mental health over the 2017–20 period, including:

●● Making mental health first-aid training available to all secondary schools, with the aim of having trained at least one teacher in every secondary school by 2019.
●● Evaluating different approaches which schools can use for mental health promotion and prevention.
●● Launching a pilot programme on peer support for young people in schools and online.
●● Possible Care Quality Commission and Ofsted joint inspections on children’s mental health and wellbeing.
●● £20 million to the Time to Change anti-stigma programme, improving the attitudes of young people towards mental health and reaching 1.75 million young
people and 1.5 million parents each year by 2020.
●● Reporting on the prevalence of mental health conditions in children and young people by 2018

With a Green Paper on children and young people’s mental health being published later this year, which will have a focus on mental health and schools, reviewing what the role of psychological services in schools might be, and how psychologists can be involved in the debate over the design of what services could look like is crucial to inform the shaping of future Government policy in this area.

In this volume, we will briefly review the issues and the evidence and discuss the practical ways in which psychological wellbeing can be addressed in school settings, as well as the implications for commissioning and delivery of provision. This will further develop a key part of any ambition to create integrated Psychological Health and Wellbeing services (PHWBS) of which CAMHS would be a part. For more discussion of this concept, see ‘What good could look like in integrated psychological services for children, young people and their families: Preliminary guidance and examples of practice’.

Most of the text in this publication refers to schools for convenience but should be taken as applicable to colleges as well.

In the first chapter the various roles that schools could undertake are discussed, including primary prevention, early intervention and mental health provisions and the role of applied psychologists and psychological services.

Chapter 2 reviews the demographics and mental health conditions in children and young people and considers the importance of addressing risk factors and building resilience.

Chapter 3 considers the key elements in the provision of a good psychological service in school settings.

The final chapter considers the practical ways that psychological services can be organised in schools and the ways they can contribute at universal, selective and
integrated levels of provision.