When we talk about supporting mental health in schools, there is a tendency to zero in on the issues that are the most visible. Schools might consider how to tackle anorexia or self-harm. They might put strategies in place to help pupils to manage symptoms associated with a special educational need or disability.

The incidence - or, at least the rate of diagnosis - of such problems is usually higher in older pupils and so that is where the bulk of the support goes.

But maintaining the mental health of the youngest learners in schools is also important and presents particular challenges because very young children can’t always describe the difficulties they might be facing.

According to Camilla Rosan, head of early years and prevention at mental health charity the Anna Freud National Centre for Children and Families, problems will often manifest themselves in ways that might not be immediately recognisable as a mental health issue.

“The under-fives may not be able to verbalise their feelings and so we see a lot of behavioural manifestations, such as withdrawal, struggling with maintaining or forming relationships, shouting, hair pulling, throwing things and being unable to sit still,” she explains. “With the transition to school, for the child who has so much anxiety or anger in their little body, sitting still on the carpet and listening to a story can feel very challenging.”

The impact of Covid-19 has likely also exacerbated issues. The pandemic brought with it myriad mental health challenges for small children: two years of disrupted schooling, long stretches of lockdown when they were unable to play with friends or see family, anxieties about the virus itself and developmental regressions.

Ofsted findings, published in November, revealed that 53 per cent of early years providers felt that children’s personal, social and emotional development had fallen behind as a result of the first lockdown.

Preschoolers in the picture

But the pandemic is only part of the picture. The 2017 NHS Mental Health of Children and Young People survey included preschoolers for the first time and found that one in 18 had a mental health disorder. So, what support is available for the youngest pupils in our education system?

The government wants every school - including early years providers - to have a designated mental health lead by 2025, and has announced funding to help with training.

Julian Grenier, headteacher of Sheringham Nursery School and Children’s Centre in East London, and director of the East London Research School, says this is a great idea, “but only if that postholder understands the particular needs and patterns of development of children in the early years”.

So, what does effective mental health support for children in early years and key stage 1 look like? While there has undoubtedly been a greater focus on mental wellbeing in schools in recent years - yoga and mindfulness in the classroom, picture books that explore emotions - Rosan argues that it takes more than reading The Colour Monster or doing a kids’ yoga video to make a real impact.

“I would like to see more of that emotional literacy extrapolated. Helping children to understand and regulate their feelings can only be done when they see it in adults and caregivers. Books which talk about feelings are great but there needs to be a translation to when these feelings are happening in the moment,” she says.

“If a child is angry or sad, it can be easy for the adult to try to get rid of that feeling, to distract the child. But that isn’t helpful for emotional literacy. It’s about being with difficult feelings, helping the child notice where they feel it in their body, then helping them to help themselves to work through it and calm down.”

Grenier agrees that we shouldn’t stop the conversation too early when discussing emotions with small children. “We sometimes don’t help children to elaborate enough, so there can be a lot of ‘I feel sad, I feel angry’ but, actually, what helps the children is if you can support them to elaborate on the reasons why. Then you’re helping children to process those emotions and to think about how they might manage them,” he says.

Teachers would do well here to be upfront about the various shades of their own feelings - the good and the bad.

“If the class checks in at circle time to talk about feelings, the teacher might say they feel great. But wouldn’t it be nice if everyone had a spectrum of feelings? Sad days, stressy days, angry days. Of course, children want to see adults as contained but it can work to intentionally show that we all have difficult feelings,” says Rosan.

“If a child is sad, be in that sadness with them,” she suggests. “You can talk about how you have had that feeling before and discuss some of the things you did to help you feel better.”

Of course, finding quality time for this kind of discussion won’t be easy in a busy early years classroom, Rosan concedes, but there is a wider network of support that teachers can draw upon to help them.

“Increasingly, we’re seeing primary schools with mental health leads, or holistic or wellbeing leads, and I think the role of safeguarding officers could be holistic. Teaching assistants can also be a real asset as they are often placed with the children who are experiencing the most complex difficulties in their home lives,” she says.

But, at the same time, there also needs to be better training provision for school staff, suggests Grenier.

“I vividly remember when I was senior early years adviser in Tower Hamlets and working with newly qualified teachers,” he says. “It’s fair to say that some of them were shell-shocked by their experience of their first month in nursery or Reception. There hadn’t really been anything in their training to prepare them for how powerful the children’s emotional responses to coming into school for the first time might be.”

Emotional demands

What would better mental health training and better support for teachers of early years look like, then? Grenier believes there are two areas that many teachers need help with in particular.

“One is to [help them] realise the emotional demands on teachers of working in the early years. Schools need to have a system in place to help staff process that,” he says.

“There’s an interesting area of research and practice called Work Discussion - which Peter Elfer, of the University of Roehampton, and others have led on - which is one approach to giving staff a safe space to think about and talk about the emotional demands of working with young children.”

The second area to focus on, Grenier suggests, is how to put in place clear “care routines and structures to help children deal with those ups and downs”.

“That involves a well-thought-out key-person approach,” he says. “The Education Endowment Foundation’s guidance report on social and emotional learning in schools is clear that if schools have a systematic and well-thought-out curriculum to support social and emotional learning, that’s beneficial not just to children’s emotional development and mental health but to their all-round learning.

“The problem is that a lot of schools aren’t systematic. They either respond to problems as they emerge or have an ad hoc approach to social emotional learning, which means that the impact is poor.”

And, ultimately, of course, prevention is better than cure. Grenier believes that, on the whole, mental health in the early years is about preventing issues in order to avoid “picking up the pieces” later down the line.

“All the best evidence about what will support children’s emotional wellbeing in the primary years suggests that it’s early intervention, when the children are still young, and involving the whole family, that will make a positive difference.”

Investing in well-evidenced parenting programmes to support the families of children displaying early signs of mental health problems would be a good first step, he adds.

Teachers and nursery workers are uniquely placed to offer help to young children in this area, says Rosan, as they will often be one of the few adults, other than parents and guardians, who spend time with those children on a daily basis.

“So much is asked of teachers; they are increasingly becoming like GPs. But they are also perfectly placed to help,” she says.

Yet it’s also important to recognise the limitations of the role, Grenier points out.

“As teachers, the best thing we can do for a child’s emotional wellbeing is to be as good a teacher as we can be,” he says. “It’s a mistake to think that we can become counsellors or mental health experts in class. We can’t.

“But many of the things we do for children - giving care and love, giving them clear routines and expectations, being sympathetic to their upset and distress, helping to develop their language and learning - all give a good foundation for their emotional development and mental health.”

Christina Quaine is a freelance journalist

This article originally appeared in the 13 August 2021 issue under the headline “Tes focus on...Mental health in early years”