A flagship school mental health support scheme is struggling to retain staff due to “emotional intensity”, high workload and frustration with the approach and scope of the work, according to a new evaluation.
The rising demand for mental health support in schools and growing gaps in specialist services since the pandemic have left staff recruited to support students with “mild to moderate” needs feeling as if they were “in over their head”, according to senior teachers.
The evaluation comes as former schools minister Robin Walker, now chair of the Commons Education Select Committee, warned last week that mental health spending is not meeting the needs of young people and the “burden” of supporting them should not primarily fall on schools.
Mental health support teams (MHST) were launched to support children in primary, secondary and further education by then mental health minister Gillian Keegan, now education secretary, in a joint Department of Health and Department for Education response to the 2017 children and young people’s mental health Green Paper.
There are currently 287 teams covering just over a quarter of pupils. The government said it had planned to increase this number to 399 teams covering just over a third of pupils (35 per cent) by April but has not confirmed if it has met this target by the time of publication. Its final target is to have 500 in place by the end of this year.
The evaluation, commissioned by the National Institute for Health and Care Research, examined the progress of 58 teams covering over 1,000 schools and colleges across 25 Trailblazer sites, interviewing teachers, pupils, parents, mental health workers and regional and national leaders.
It praises the work done in establishing teams against the backdrop of the pandemic, and is positive about progress in areas such as improved staff knowledge and confidence in dealing with mental health issues, and improved access to support for some pupils.
However, it warned that the increasing scarcity of specialist support means that some young people with mental health problems, that were more serious than the “mild to moderate” conditions the teams aim to tackle, were not serious enough to be accepted by other services, putting pressure on teams without the right knowledge and training to meet their needs.
Although teams can refer to specialists, the evaluation says “significant gaps and restricted capacity meant that many young people with more complex needs could not be supported by specialist services”.
Professor Nicholas Mays from the London School of Hygiene and Tropical Medicine, a co-author of the report, said: “Our findings suggest that the gap between the support that MHSTs are providing and the criteria for accessing specialist help may be widening as a result of the Covid-19 pandemic.
“Schools and colleges in particular were concerned about the lack of available support for children and young people whose mental health needs fell between these services,” he added.
The evaluation also found MHSTs spent over half their time providing direct support (an average of 52 per cent) and only spent less than a quarter on both whole-school support (24 per cent) and giving advice and liaising with external services (23 per cent).
As a result, the authors warn that “critical decisions will need to be taken about what, if any, role MHSTs should have in providing support to children and young people beyond the ‘mild to moderate’ remit that the programme was designed to address” as the programme is rolled out.
“There is also the question of how the programme can continue to retain a dual focus on mental health promotion (such as through the development of whole-school approaches) and early intervention, and what additional support or resources might help educational partners and settings maximise the opportunities offered by the programme,” the report adds.
Emotional intensity and high workloads
Retention of staff, especially the new role of education mental health practitioner (EMHP), was widely flagged as a challenge across the pilot sites, the report reveals.
Staff are not staying in the role partly because they struggle with the high workloads and “emotional intensity” of the work, according to the report.
Some recruits also see the role as a stepping stone to better jobs elsewhere, while others said a lack of opportunities for progression forced them to look to move on, the report found.
Meanwhile, others developed frustration at the parameters of the role or limitations of the cognitive behavioural therapy approach to managing pupils’ mental health needs, the report warns.
Margaret Mulholland, special educational needs and disabilities (SEND) and inclusion specialist at the Association of School and College Leaders, said the scheme should take on board the report’s findings around improving recruitment and retention, and greater investment in establishing longer-term relationships with schools, but stressed that teams should be rolled out across the country “as a matter of urgency”.
She added that the finding that young people are not being accepted for specialist support is concerning: “There needs to be clear clinical thresholds that determine at what point [pupils] must be provided with treatment by other agencies.
“External services such as Camhs also need to be given more resources to increase capacity and reduce the lengthy waits for support that families are regularly faced with.”
Sarah Hannafin, senior policy adviser at the NAHT school leaders’ union, said the report highlights “a worrying gap in provision for children whose needs are beyond their remit but who do not meet the high thresholds for referral to specialist mental health services”.
“The government must invest further and be more ambitious in their plans to support the mental health and wellbeing of children and young people. Funding access to talking and other creative therapies in all schools and developing early support hubs in every community should be a priority,” she added.
Warren Carratt, chief executive officer of Nexus Multi Academy Trust in Rotherham, said that as the long-term impact of the pandemic on social and emotional development in children becomes clearer, “there is a clear need for greater and sustained funding throughout the school system that goes beyond the ‘catch up’ funding provided so far”.
Additionally, he calls for the impact of the DfE’s Delivering Better Value and Safety Valve funding initiatives that target SEND in deprived areas to be reassessed “to ensure specialist provision isn’t underfunded at a local level and that the sector is better positioned to step up to this challenge when this support is most needed”.
Responding to the evaluation, mental health minister Maria Caulfield said the research shows there is “room for improvement”, which she would take on board as the programme expanded, but that it was “excellent to see” that teams are “having a positive impact in schools, giving staff more confidence, improving access to advice and support, and strengthening relationships between schools and mental health services”.
Ms Caulfield said: “This research shows there is room for improvement, which I hope will be taken onboard as the number of MHST will increase to almost 400 by April 2023. These will cover three million children and young people - part of an extra £2.3 billion a year investment into mental health services.”
A DHSC spokesperson said the evaluation findings would be used to inform future rollout. The spokesperson added that the MHST programme has been designed to enable teams to deliver targeted support in line with the needs of education settings, with a particular focus on addressing health inequalities.
“We are committed to ensuring that every aspect of the mental health support teams programme ensures equality of access and outcomes, and we continuously review learning and progress in this area,” the spokesperson added.
