The issue of managing mental health in a secondary school is worthy of a series of books from a variety of perspectives; it is impossible to cover all aspects in one article.
So I want to highlight some key and recurring themes, not from the point of view of a psychologist or psychiatrist, but from my experiences as a former teacher, a SENCO and now as an inclusion expert.
Dealing with students with mental health issues is now a routine part of a teacher’s job, even though most teachers are not qualified psychologists or psychiatrists. But are teachers sufficiently trained to deal with these issues? Is it covered on the PGCE or equivalent course?
Mental health is hard enough to manage in a safe, one-to-one environment let alone in a large secondary school. Child and Adolescent Mental Health Services (CAMHS) is being called into question for its value and whether, with its stretched resources, it can really meet the need of our children and young people.
At the same time, our awareness of the prevalence and impact of mental health issues is broader than ever. This may be a valuable opportunity to consider how we can best support our students in the school environment.
In this article I will draw on my team’s pastoral and SEN reviews to outline some helpful approaches to managing mental health in the secondary school environment.
Unique hurdles of the secondary school
A classroom teacher may see more than 200 different students in a week and, unlike primary schools, there exists a significant challenge to ensure that all staff are equally aware of how they should approach certain students.
It is not just knowing what to do for a student with mental health issues, but enabling all staff to be aware – especially of what not to do, such as calling them to the front of the class to do something in front of their peers.
Equally, a student may see up to 20 different staff in any given week and interact with dozens more throughout the life of the school and this poses challenges for students who present with a need for predictable environments and anchoring relationships.
Larger secondaries may experience a high number of challenging student problems concurrently. It can be very difficult to keep track of each case without senior staff getting hijacked into spending every spare moment on the phone to someone about a case or dealing with the ramifications of yet another incident in the school.
In light of this, I understand why schools need someone “outside” to take care of the situation as soon as possible. Sadly, where external support is not used to good effect, a rapid decline can lead a student out of the door to an alternate provision or school.
Strategies for supporting mental health
A key condition for good mental health to flourish is a predictable and stable environment. Creating this stability requires:
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Easily understood boundaries around relationships with staff.
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A day that is controlled, where unexpected events are planned for as best as possible.
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A carefully thought-out set of support structures, which will include relationships with peers, whether informal or through buddy systems or similar.
It is easy to set the bar unfairly high and so it is important to put these suggestions into the context of “within reason”.
More important than achieving absolute perfection is the genuine attempt and thoughtfulness that you should be able to demonstrate.
Presenting behaviour
We must view mental health issues in terms of presenting behaviour, not diagnoses. There is a valuable legal view of mental health which is designed to safeguard society and it boils down to a simple rule of thumb: is the person a danger to themselves or someone else?
However, this doesn’t deal with the issues that fall into the vast, undefinable spectrum which can include vagaries such as “can display significant neediness once or twice a week depending on a multitude of factors” and some other classic moments of challenge for some students.
An example could be behaviour exhibited at the very start or very end of the school week, when the student is recovering from or anticipating time with their parent or guardian.
It is common to still hear phrases like “Johnny has completely lost the plot” or “he was running up the walls”, which is a way of expressing frustration rather than accurately identifying the presenting issues.
A better response would be “Johnny presents with hyperactivity”.
I encourage schools to use a framework of assessment that can help articulate presenting behaviours and issues in order to baseline, identify strategies and improve communication between schools and mental health professionals responsible for treating and diagnosing the young person to have a clear picture of what is going on.
Identify the right support
Most often, one key member of staff can be the safe, go-to person that can also help maintain a regular communication with home and any support agencies.
However, this kind of support must promote independence and instil coping mechanisms to avoid creating dependence or reinforcing the need to be supported.
Most teachers will be able to remember cases where the approach of bolting a teaching or support assistant to the student was used, and the detrimental effect on that child when the crutch of total support was gone.
There is another common issue that can emerge from “too much support”, a type of histrionic behaviour where the student seeks support from everybody they can.
This needs to be reflected upon with a health professional who can advise when support is indeed enough and not actually beginning to stoke a negative cycle.
Expert advice about your strategy
Systems need to be highly tailored to the setting at your school; what works well in one school may fail in another.
Ask local mental health teams or, when necessary, buy-in support and advice for how to best adapt to an individual’s needs. Keep a record of the advice, implement it and measure the impact of the suggested strategies.
If the strategies did not work, you have a solid case to take to the SEN panel or CAMHS, which should spark a more established and urgent response.
Schools I work with often try to pre-empt these scenarios by looking at mental health in the context of provision, financial mapping, presenting and managing your information, and communicating with key people.
It is really difficult to do this on a case-by-case basis and it is much better to consider a more robust, whole-school approach.
Train, train and train again
Many teachers simply have not had the right kind of training to handle the types of mental health problems that they frequently encounter and this can create great stress.
When teachers have to deal with a vulnerable student – to the extent of fearing for their life or being concerned that they may harm someone else – it can evoke a range of deep emotional responses which may not always be so conscious to those without training or the opportunity to reflect on how a situation may affect them.
These natural, deep emotional responses can seriously affect teachers and contribute to their own latent issues and stress.
Audit your staff capability against the kind of cases you have dealt with in the last three years and ask yourself whether there could be a better skill level and know-how and how that may have had an impact on those cases.
Pastoral staff are often not trained and since they are your front-line, I would strongly recommend they get some basic counselling training at least from a visiting counsellor who could do this in-house.
Two heads are better than one
Host working parties with a mental health theme. Invite guests such as health visitors, CAMHS workers and substance abuse professionals. For the price of your refreshments you have made expert links who can advise you in the future over a quick phone call or email.
These links may also have an impact on the mental health of teaching staff. The creation of networks and working parties to share strategies may be a lifeline for those with difficult cohorts.
A common outstanding pastoral activity is a weekly team meeting about the top concerning students which comprises a variety of staff including teaching assistants, counsellors and outside agencies. Colleagues feedback to case leaders about their views in order to give perspective. As well as providing an opportunity for colleagues to share or off-load, this also provides for the highest quality case-based CPD.
See the wood from the trees
My experience with tribunals appealing permanent exclusion – whether around SEN, mental health or behaviour issues – is that most schools make a simple, avoidable mistake. Amid the mounting paperwork that can stretch to hundreds of pages, there is only one summary page needed with three columns: what was the issue, what did you do about it, and what was the impact.
Firmly adhering to this simple formula and not getting lost in the details of bureaucracy will add clarification to the process. I have never yet shown the case summary template I provide to schools to a single professional who hasn’t adopted it.
One-off incidents can easily blow out of proportion; this is greatly reduced with improved and increased communication with home and outside agencies. A robust emotional health and wellbeing infrastructure enables you to predict and respond as opposed to react.
In summary
Managing mental health in the secondary school environment can absorb time, money and emotional energy. Doing it well requires thinking, training and a commitment to prioritising skills and systems. Be clear in how you describe what you perceive. Focus on how a student “presents” rather than your diagnosis. Utilise the strength of a collaborative approach through a team meeting.
Finally, and most importantly, get a mental health-trained professional to make the judgement calls and put them in writing. In furthering your management of mental health in your school, you will generate in your staff a sense of understanding, compassion and supportive feedback.
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Daniel Sobel is founder of inclusionexpert.com and his team support schools with Pupil Premium, SEN and pastoral reviews.