Crying Out For Help

With children’s need for emotional support on the rise, and social services not always available to intervene, the demand for mental health training in schools has never been greater, reports Wendy Jones...

Lisa’s dad left home when she was seven. Her mum was unable to cope and Lisa went to stay with relatives. She returned to her mother a few months later, but her behaviour was changing. She was defiant and aggressive at home and anxious at school. Her school work was slipping.

Lisa is one of hundreds of thousands of children with mental health issues. The facts are stark. One in 10 school-age children is affected. Half of adults with mental health problems showed symptoms before they were 14. Nearly three-quarters of primary heads say they have referred a child to the NHS’s mental health services (and this figure is actually higher among primary than secondary heads).

There are many stories like Lisa’s… an 11-year-old reluctant to go to school after his father committed suicide… a nine-year-old and his two younger sisters whose mother is in prison… a seven-year-old who witnessed domestic violence and starts to self-harm.

The examples come from the case files of the charity Place2Be, which provides counselling in 200 primary schools in Britain. Each story is individual, but common themes emerge: family break-up, the death or departure of a parent, neglect, parental depression.

Marjolein Roerhorst is a Place2Be counsellor at Mellers Primary School in Nottingham, offering one-to-one or group sessions. She says children often don’t have the language to express themselves and need coaxing through story-telling and play.

“Very often when a child has experienced conflict and perhaps seen domestic violence, a lot of their play is around fighting and winning or losing,” she says. “They might be playing with toy dinosaurs and the baby dinosaurs are in danger. But after a while someone comes to rescue the babies, someone’s on their side.”

The children’s real-life problems are usually less tractable than the dinosaurs’ and Marjolein knows she cannot always provide solutions. Sometimes all she can do is help them deal with things. “I might say, ‘I know you’re going through a difficult time since your dad left’ and try to help them not feel scared about voicing their worries. It’s never ‘Tell me about it’.”

Having Place2Be embedded in the school allows staff to raise concerns, however vague. “A teacher will see me in the corridor and say ‘I’m a bit worried about so-and-so – it’s nothing I can put my finger on’.” Marjolein will then observe the child in class before deciding whether an assessment is needed.

Children can also refer themselves, simply turning up for a chat in Marjolein’s office. They may want to talk about issues that on the face of it seem slight but that can loom large in children’s lives – a pet dying or falling out with their best friend.

“Sometimes I have a room full of children who’ve fallen out with each other,” says Marjolein. “Or a child may just knock on my window with that ‘hello, see me please’ look. I had one who came in and said ‘I get angry all the time and I want to do something about it’.”

Lorna Dermody, a year-2 teacher at Mellers, says she can see real progress when children receive counselling. She recalls one boy who was performing about a year below expectation before going to Place2Be.

“He was really disruptive in class. It was constant low-level disruption, fiddling with things, walking out of the classroom. But now he’s keen to learn, his engagement is much better, he’s taking pride in his achievements.”

It emerged that the boy had been separated from his mother at birth. “He hadn’t had early play experiences or been able to form attachments. And then he was suddenly thrown into the school curriculum – maths and English. It was all too much!” says Lorna.

Knowing the signs

Training all staff to be alert to children’s problems is key. King’s Hedges School in Cambridge recently won a national award for its work on children’s wellbeing. It is supported by two specialist local charities and deputy head Barbara Stoneman stresses the importance of everyone -– including lunchtime supervisors and cleaners – knowing what to look out for.

Very occasionally there may be unexplained physical marks or signs of sexual abuse in the child’s behaviour. “I remember watching a PE lesson and noticing bruising on a child’s legs,” she says. “That sort of thing may mean having to call the police or social care.” But more often the signs are of low-level neglect. “It might be nits that are not treated, or a child coming to school with no socks or clothing inappropriate to the weather. The child may be withdrawn, unable to concentrate.”

Barbara feels that children’s resilience is not what it was. “They may lack self-confidence if they come from a home where people put each other down all the time. Or there’ll be outbursts in the classroom because that’s what they experience at home.”

Children are referred from reception upwards. “Parents will sometimes say, ‘He’s only young, he was only a baby when it happened’. But the earlier the counsellor can start working with a child, the better.”

A demand for training

What is clear from all those spoken to is that the need for emotional support has increased – the result of less stable and more transient family circumstances for many children. At the same time, the threshold for statutory social care intervention seems to have risen because of increasing demands and spending pressures.

Mick Atkinson, vice-chair of the Children and Young People’s Mental Health Coalition and head of commissioning at Place2Be, recognises both the squeeze on spending and the increasing prevalence of mental health issues, with signs such as self-harming now seen among younger children.

The ability of schools to deal with this is, he says, incredibly mixed. While some have a good level of insight, many others are struggling. He believes changes to teacher training are one of the underlying reasons for this.

“Child development has been stripped out of a lot of training. My impression is that initial training used to equip teachers with a better understanding of these issues but that has now been sidelined and teachers are coming out with less understanding of children’s behaviour.”

Many staff are on a steep learning curve and the need for intervention is greater than ever, he says. “Our experience is that teachers are crying out for more help and support around child mental health.”

Healthy minds

At Spelthorne Primary School, in Ashford, Surrey, they offer emotional resilience sessions to all key stage 1 children, not just those with problems. This is health education rather than therapy. The school makes use of Zippy’s Friends, a programme offered by the charity Partnership for Children.

Developed around stories of a stick insect and his human friends, this works through issues such as friendship and bullying. Teachers are given lesson plans and trained to deliver the programme, which can also be adapted for children with special needs. Spelthorne’s assistant head Sarah Robinson spends several sessions discussing each story in the programme, encouraging the children to come up with their own solutions.

“I might stop the story and say, ‘Why do you think he said that?’ and ‘Can you remember ever feeling like that?’. If we’re talking about bullying, a child might instantly say ‘My mum or dad’s told me to hit back’. I never tell them that’s wrong. Instead we have a discussion about what that might lead to. And eventually someone will say ‘You could go and tell someone’. ”

She believes the programme has real impact, with children becoming more willing to express their feelings. “They also seem better at including each other and making sure no-one is left out. We’ve had comments from visitors about the way our mainstream children take those from our special language needs centre under their wing.”

About the author

Wendy Jones is a freelance journalist, a former BBC education correspondent and a trustee of National Numeracy nationalnumeracy.org.uk