Questions have been raised this week over just how much funding schools and mental health services are to receive in order to deliver on prime minister Theresa May’s mental health promises.
Last week, Ms May repeated pledges first made when she entered Downing Street last year to transform the way we deal with mental health, which she said was a “hidden injustice” in our country.
Speaking at the Charity Commission, the prime minister set out her intention to give schools a clear role in helping to spot and tackle mental health problems in young people.
Research has shown that 75 per cent of all mental health difficulties originate during adolescence, including 50 per cent by the age of 15.
The prime minister’s pledge includes delivering mental health first aid training to one staff member in every secondary school in the UK over the next three years. The training is to be delivered by the community interest company Mental Health First Aid (see below for more details).
Ms May also pledged trials to look at how to strengthen the links between schools and local NHS mental health staff and a new Green Paper which will set out plans to transform mental health services in schools, universities and for families.
There will also be a “major thematic review” of children and adolescent mental health services (CAMHS) across the country, led by the Care Quality Commission with input from Ofsted, “to identify what is working and what is not”. Following this, CQC and Ofsted will consider “how their future joint programme of inspections can ensure CAMHS are properly held to account for performance”.
Ms May said: “For too long mental illness has been something of a hidden injustice in our country, shrouded in a completely unacceptable stigma and dangerously disregarded as a secondary issue to physical health. Yet left unaddressed, it destroys lives, it separates people from each other and deepens the divisions within our society.
“This is a historic opportunity to right a wrong, and give people deserving of compassion and support the attention and treatment they deserve. And for all of us to change the way we view mental illness so that striving to improve mental wellbeing is seen as just as natural, positive and good as striving to improve our physical wellbeing.”
However, while Ms May’s focus has been warmly welcomed across the education and charity sectors, questions are already being asked about funding.
Both the Education and Health Select Committees, teaching and leadership unions and mental health charities have all warned that resources are hugely over-stretched.
Last January, the government invested £1 billion in mental health services. This came on top of £150 million for young people with eating disorders and £1.25 billion for perinatal and children and young people’s mental health unveiled in 2015.
However, the Children’s Society said this week that because the funding had not been ring-fenced, it had too often been spent elsewhere.
The charity’s chief executive Matthew Reed said: “Support in schools and colleges is crucial for children and young people with mental health problems. While specialist training for teachers is welcome, our concern is that teachers are often already overstretched. Access to counselling in every school and college is needed to ensure that young people get the help they need.
“The money earmarked for mental health services for children and young people has all too often been spent elsewhere – this funding must be ring-fenced. What’s more, to fund the support that vulnerable young people urgently need, additional funding, on top of that already pledged in 2015, is required.”
In a joint statement, Neil Carmichael MP, chair of the Education Select Committee, and Dr Sarah Wollaston MP, chair of the Health Select Committee, said: “If long-term improvements are to be achieved then schools and health services must be given the proper resources, support and expertise so they can work more closely and effectively together. They should not simply be burdened with more responsibilities on budgets that dry up after a few years.”
The problems with over-stretched CAMHS are well-known in England’s schools. Research last year by the mental health charity the Anna Freud Centre found that schools are seeing “dramatic increases” in mental health problems but that, because of a lack of capacity in CAMHS, some are now only referring pupils if there is an immediate risk of harm.
Research last year by charity Mind also revealed that local authorities are spending “next to nothing” on mental health prevention, while YoungMinds research found that a majority of clinical commissioning groups and local authorities had reduced or frozen their spending on CAMHS since 2010. The NSPCC, meanwhile, has reported that waiting times between referral to CAMHS and assessment have reached more than 26 weeks in some areas.
Malcolm Trobe, interim general secretary of the Association of School and College Leaders, said: “We look forward to seeing the detailed plans for mental health first aid training and what funding is being allocated to this initiative.
“While some element of mental health training may be helpful in schools, this is a highly complex area and the biggest problem that schools face is accessing the local specialist NHS services that some children desperately need.
“Many schools already provide their own support on-site, and do a very good job despite limited resources, but they often face serious difficulties in referring young people to CAMHS. There is simply not enough provision – and families face excessively long waiting times. The government’s plans have to be backed up with the funding needed to better support the provision of mental health services both in and outside school.”
Russell Hobby, general secretary at the National Association of Head Teachers, added: “Just as we are becoming more aware of children’s mental health issues the resources are being taken away. School budgets are being cut by £3 billion so it will become increasingly difficult to fund in-school care for children unless these cuts are reversed immediately.
“Moves to make schools more accountable for the mental health of their pupils must first be accompanied by sufficient school funding and training for staff and should focus only on those areas where schools can act, including promotion of good mental health, identification and signposting or referrals to the appropriate services.
“Schools should not be accountable for the lack of mental health services available for children and young people and should not be expected to provide these to close the significant gap in provision.”
The Association of Teachers and Lecturers pointed out that training just one staff member in each school would not be enough.
General secretary Dr Mary Bousted said: “Training one teacher in every secondary school by 2019 is inadequate for the scale of the problem. Half the school staff in our 2016 survey said they had to provide support to pupils with emotional or mental health issues every day.”
On funding, Ms May said the government would “hold the NHS leadership to account for the extra £1 billion we invested in mental health last year” and also said that £67.7 million would be invested in online mental health services. However, specific extra funding for mental health work in schools was not mentioned.
Ms May’s speech also unveiled plans to work with employers to improve mental health support in the workplace and she pledged to support NHS England’s promise to eradicate inappropriate placements to inpatient beds for children and young people by 2021. This practice can result in children being sent far away from their homes to access mental health services.
What is Mental Health First Aid?
Mental Health First Aid (MHFA) training is to be offered to every secondary school as part of prime minister Theresa May’s focus on improving mental health outcomes.
MHFA is an educational course which teaches people how to identify, understand and help a person who may be developing a mental health issue.
Developed in Australia in 2000 and now recognised in 23 countries, MHFA courses teach people “how to recognise the signs and symptoms of common mental health issues, provide help on a first aid basis and effectively guide someone towards the right support”.
MHFA came to England in 2007 and was developed and launched under the Department of Health/National Institute of Mental Health in England. In 2009, Mental Health First Aid became a community interest company (CIC).
Poppy Jaman, CEO of Mental Health First Aid, said: “We are delighted by the prime minister’s commitment that secondary schools across the country will have at least one member of staff trained as a mental health first-aider.
“Mental ill health in young people is a growing health concern, with half of all lifetime cases of mental health issues starting by the age of 14.
This move from the prime minister is a welcome step towards bringing mental health on a par with physical health, and we are particularly pleased to hear that the Department for Health will be putting adequate resource in supporting this commitment.
“The training offered through Mental Health First Aid will provide teachers and frontline professionals working with young people the skills and confidence to spot common signs and triggers of mental health issues, as well as the knowledge and confidence on how to help.
“Currently, only around a quarter of people who need treatment for mental ill health receive it: with access to a Mental Health First Aider we can provide early intervention in guiding a young person to the support they need.”
Visit https://mhfaengland.org/
In her own words: Prime minister Theresa May
“What I am announcing are the first steps in our plan to transform the way we deal with mental health problems at every stage of a person’s life: not in our hospitals, but in our classrooms, at work and in our communities.
“This starts with ensuring that children and teenagers get the help and support they need and deserve – because we know that mental illness too often starts in childhood and that when left untreated, it can blight lives, and become entrenched.
“There is, for example, evidence to suggest an increase in self-harm among young people, with the number of 16 to 24-year-old women reporting self-harm increasing threefold – to one in five – between 2000 and 2014.
“And we know that the use of social media brings additional concerns and challenges. In 2014, just over one in 10 young people said that they had experienced cyber-bullying by phone or over the internet.
“So first, we will introduce a package of measures to transform the way we respond to mental illness in young people starting in our schools. We will pilot new approaches such as offering mental health first aid training for teachers and staff to help them identify and assist children experiencing mental health problems. And we will trial approaches to ensure schools and colleges work closer together with local NHS services to provide dedicated children and young people’s mental health services.”