Mental Health Provision in Education

1.      Introduction

1.1.Preamble:  Presenting this report, at the request of ECS Scrutiny, is considered timely. Child and young peoples’ emotional and mental health and overall wellbeing is a subject of much debate at this time. This is manifested by a burgeoning policy landscape; strategic fora and a plethora of operational programmes and techniques now at the disposal of professionals. Addressing this very broad and fast-evolving topic will be attempted, by giving due diligence to portraying the range of provision in and around schools. The report will also strive to capture, within the narrative, the report brief as required from the Scrutiny forward plan template.

 

1.2.Issues of Definition and context:

·         Wellbeing – arriving at a precise and universally accepted definition is the subject of much academic debate, which resides outside the scope of this report. As the World Health Organisation maintain, ‘[wellbeing]…is a broad-ranging concept affected in complex ways by the person’s physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment.’1

For the purposes of clarity and simplicity:

“Wellbeing is about feeling good and functioning well, meaning that the person’s condition and experiences are positive”

(for further examination of the concept, see Appendix of CCC ‘Ever Learner Matters’ report)

 

·         Mental Health can be subsumed within the wider wellbeing definition. According to the Welsh Audit Office (WAO 2019) and, in relation to young people aged 16-24, mental health resides alongside other wellbeing considerations such as homelessness, being a young parent, young adult caring responsibilities and skills and employability.

Mental health is about how we think, feel and behave.

Mental health symptoms have, in the main, been divided into groups. They are classed as either:

·         ‘neurotic’ symptoms: which refer to those symptoms which can be regarded as severe forms of ‘normal’ emotional experiences such as depression, anxiety or panic. 'Neuroses’ are now more often called ‘common mental health problems.’

·         'Psychotic’ symptoms, which are less common, are those that interfere with a person’s perception of reality. This may include the person having hallucinations. That is they see, hear, smell or feel things that no one else can.’5

·         Children’s mental health is often defined as different from adult mental health and more multifaceted because of the unique developmental milestones that children experience. Characteristics of the child (e.g., gender, genetics) are important determinants of that child’s well-being. However, child mental health also includes those conditions that directly affect or modify mental health, including aspects of a child’s familycommunity, and broader society.

·         The mental health problems children may experience may be reflected as difficulties in psychological and emotional development, social relationships, and behaviour.

 

·         Well-designed mental health promotion and prevention programs and interventions can enhance the well-being of children and mitigate the escalation of problems.’6. This raises the possibility to plan for, and ensure, good general wellbeing, predicated also upon early support and intervention when neurotic or psychotic symptoms begin to manifest themselves. This entails addressing both general wellbeing and mental health issues in our schools – both of which will be referenced in this report.

 

o   A WAO report notes that:

§  One in four people in the UK will experience a mental health problem in their lifetime – with half of all mental health problems starting by age 14

§  In 2019, the Prince’s Trust Youth Index showed that:

·         Young people’s happiness and confidence across all areas of their life was the lowest since the index began in 2009

·         Around three quarters of respondents from Wales said they feel stressed or anxious ‘often’ or ‘always’

·         Data from 2018 indicated that young people in Wales “were more likely than those in England to worry about: their future, finances, ‘not being good enough’ in general, not knowing what they want in life and the economic climate2

 

o   Suicide An intentional, non-accidental act that results in death’. Contrary to some beliefs, suicide is not a common occurrence among children and young people and is a rare event. The latest Office of National Statistics (ONS) data shows that:

§   There were 20 registered deaths in Wales in 2017 amongst those aged 15-19.

§  ONS data for 10-14-year olds shows that there are generally no such deaths or one such death in any given year

·         That said, one death is one too many

§  Nationally available data for Counselling services in Wales (2017-18) shows that of the 11,365 young people who received counselling in that year, 2.7% received support which was related to suicide

o   Self-harm - ‘any intentional self-poisoning or self-injury that does not result in death, regardless of motive or the degree of suicidal intent is more common with around one in ten adolescents reporting having self-harmed, though most young people who self-harm stop before adulthood3. 6.1% of young people counselled in 2017-18 in Wales received support relating to self-harm. Self-harm is more common in girls than boys.

Most young people do not self-harm in an attempt to end their lives but sometimes it can be a suicide attempt.

NOTE: Self-harm is a behaviour, often a coping mechanism signalling distress, not a mental illness, though there is an association between self-harm and mental illness such as depression, anxiety and trauma disorders.3

 

2.      Policy Backdrop

2.1.National

·              Mind over Matter Report – published in 2018 by the Welsh Government’s Children, Young People and Education Committee – this influential report called for a step change in the way in which the emotional and mental health needs of children and young people are met. The report contained 27 recommendations and set out a view that schools should play a much greater role in supporting children’s emotional and mental health needs.

Responding to the report, the Ministers for Education and Health and Social Services established a joint Task and Finish Group of education and health experts to advise them on the work needed to embed a whole school approach to emotional and mental wellbeing.4

 

·               New Curriculum for Wales – The new curriculum will be implemented for nursey children to year 7 from September 2022. Planning for the new curriculum is underway. There are:

o   Four core purposes to the curriculum, one being to develop and nurture: Healthy, confident Individuals

o   Six areas of Learning and Experience, one being Health and Wellbeing. Significantly, this area of learning is considered of equal status to other AOLEs such as languages, Science and Mathematics.

(see below as to how this part of the new curriculum is being approached locally in Carmarthenshire). This AOLE is further sub-divided in to 5 ‘What Matters’ statements:

o   Developing physical health and well-being has lifelong benefits

o   How we process and respond to our experiences affects our mental health and emotional well-being.

§  This statement will help learners to understand how mental health and emotional well-being influence the way people think, feel and behave. It will also help learners explore the connections between life experiences and mental and emotional well-being. Through understanding the conditions that promote and impact on mental health and emotional well‑being, learners will be supported to manage the experiences that they encounter. They will also be supported to develop their ability to focus their attention and to be aware of how they are thinking and feeling during their experiences. In addition, they will explore how experiences are perceived.

o   Our decision-making impacts on the quality of our lives and the lives of others.

o   How we engage with different social influences shapes who we are and our health and well-being.

o   Healthy relationships are fundamental to our sense of belonging and well-being.

 

·         Wales Audit Office – Its September 2019 report (previously cited) focuses on 5 dimensions of young people’s wellbeing and was instigated to examine the current Welsh Government focus on wellbeing and healthcare services to young people. In terms of overall desirable improvements to young people’s wellbeing, WAO recommend:

·         A need to listen more to young people and understand what matters

·         Communicating a clear purpose for public services that inspires and empowers people to work together to improve the wellbeing of young people

·         Being brave – encouraging experimentation and taking well-managed risks

In addition, with specific reference to Mental Health, it’s recommended to:

·         Understand what services exist and gaps

·         Understanding costs

·         Joining up policy making

·         Working out who does what

·         Learning from, and improving, delivery on the ground

 

·           The Association of Education Directors Wales (ADEW) are in the process of presenting a report to the Joint Ministerial Task Force, following a comprehensive survey of schools in Wales, with the aim of canvassing views on current practice in relation to emotional wellbeing and mental health. This report augers to identify the range of strategies deployed by schools; examine training currently available; highlight difficulties experienced in gaining support for intervention for pupils, whilst also inviting suggestions to further inform a national approach to supporting pupils’ emotional health and wellbeing. Usefully, several schools in Carmarthenshire took part in the survey (see below).

 

·         Other policy Links: (not exhaustive)

·           The Wellbeing of Future Generations Act (2015) – CCC has embraced the 7 wellbeing goals of the Act, one being of particular significance, namely ‘A healthier Wales’

·           Education in Wales: our national mission (action plan 2017-21) – Four key enabling objectives are offered, the third being of particular relevance, namely ‘strong and inclusive schools committed to excellence, equity and wellbeing’

·           Estyn common inspection framework(2017) – has five inspection areas which include ‘wellbeing and attitudes to learning’ and ‘care, support and guidance.’

 

·               National Data

Figure 1: Counselling Sessions – predominant discussion topics – top 5 issues

 

Figure 2: Counselling Sessions – Suicide Ideation and Self-harm

 

Figure 3: Number of Child and Adolescent Mental Health (CAMHS) Referrals over time

Figure 4: Total Number of people waiting for CAMHS treatment

 

 

2.2.Carmarthenshire County Council

·              Carmarthenshire’s Wellbeing plan – This Public Service plan has the aim of improving the economic, social, environmental and cultural wellbeing of our residents.

 

·              Department for Education and Children

·         Equity and Wellbeing Strategy – This report was written partially in response to The National Mission and the Mind over Matter Report and was tabled for ECS Scrutiny on 13.3.19. In articulating some fundamentals in relation to wellbeing, the vision articulated asserts that, in Carmarthenshire, ‘Pupil wellbeing is integral to our thinking and takes centre-stage’ and that:

·              Ensuring that our young people are content, happy and thriving is an over-riding aim

·              When pupils’ basic needs, are catered for, in combination with positive relationships in school, learners will be more predisposed to learn

·              Positive attitudes to learning make it more likely that learners will be the best they can be and achieve high standards

·              This rationale, and the wider strategy, will be informing our practice in schools for the foreseeable future.

·           Behaviour and Engagement Strategy(Scrutiny Committee 21.12.17) – in aspiring to develop and improve behaviour and engagement support, there are numerous elements which can also, arguably, support pupil wellbeing:

o         Understanding behaviour – instilling a widely held professional understanding of emotion coaching, trauma and attachment awareness

o         Develop restorative practice and widen its deployment

o         Respond to need, react rapidly in a crisis but, conversely, adopt a proactive mindset so that crisis situations become more of a rarity

 

·              Local Curriculum – The new curriculum for Wales allows for the national curriculum architecture to be locally interpreted. On 1.5.19, a conference was staged by ECS Carmarthenshire to consider the contents of the Health and Wellbeing AOLE. This was held on the day following the publishing of the draft national framework – and the timing was no accident but was considered a statement of intent and a way of ascribing importance to the centrality of this area of learning for the local curriculum.

 

·              Healthy Schools – this small, but very active, team have conducted several events of relevance to emotional and mental health e.g. Mental and Emotional Health in Schools Course (17.3.19):

o         Pause Points; 5 ways to wellbeing; Llyfr Ishi; Samaritans; bereavement support; sharing good practice – Speakr, Bydis Buarth, Burns by your side;

o         Stalls/marketplace e.g. ELSA, SEAL, School Nurses, TAF, Occupational Health, Advocacy and Primary Mental Health Care

 

·         Youth Support Service – The YSS provides support to children and young people aged 8-25. There are four pillars of operational delivery:

·           Universal Services – e.g. Youth Clubs and Duke of Edinburgh Award

·           School-based youth Work

·           Youth Justice

·           Post-16 Team

 

·         By its nature, the YSS works with a wide range of young people and very often work with youngsters who have a range of adverse experiences and vulnerabilities - some of whom also exhibit risky behaviours. The scope of this paper does not do justice to the work undertaken, but there will be an opportunity for Scrutiny Members to receive a more detailed report on 23.1.20.  In the meantime, three simple examples of projects undertaken by YSS in relation to wellbeing give a flavour of the range of provision:

 

·              The Safety Trust and Respect programme is run with pupils- this promotes safer relationships and supports young people to learn about what a positive relationship looks like; it helps to prevent young people from entering abusive relationships or developing abusive behavior in the future.

·              Healthy lifestyle courses- through learning how to cook healthy meals.

·              Holiday programmes run by school-based youth workers in conjunction with the Universal Team- e.g.coassteering; waterfall walk; (expanding horizons; trying something new; self-esteem; confidence; new opportunities etc)

·              Project with Syrian girls in a school to learn about and celebrate their culture.

 

·           Carmarthenshire Data

Figure 5: Counselling Statistics for Carmarthenshire pupils

5A. Gender split

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5B. Top five topics (Males); Top 5 Topics (Females)

 

 

5C. Trends in Counselling Topics

 

 

 

 

 

 

            Figure 6: Staffing Issues

                        6A. Emotional and Mental Health Challenges for Schools in Carmarthenshire

6B. Staff Opinions regarding additional improvements required

3.      Provision in Carmarthenshire Schools

3.1.Pastoral Structures

·         General comments: Traditionally, the wellbeing of pupils is monitored and supported by school pastoral systems. These vary in nature and extent according to factors such as school size, staffing structures, budget etc. Pastoral structures strive to:

·              Monitor the general wellbeing and progress of pupils

·              Signpost pupils to additional support when deemed appropriate

·              Act as a conduit for delivering Personal, Social and Health Education programmes

·           Make links between learner wellbeing and progress

 

·         Nominal Primary structures (exemplar – medium size primary school)

Head Teacher

Senior Leadership Team (Deputy Head; Assistant Head)

Middle Leader (Head of Key Stage 1; Key Stage 2) & ALENCo

Classroom Teacher

Teaching Assistant

 

·         Nominal Secondary Structures (there will be variations)

o   Small Secondary School

Head Teacher

Senior Leadership Team (Deputy Head; Assistant Head i/c Pastoral)

Middle Leader (Head of Key Stage 3; Key Stage 4; Key Stage 5) & ALENCo

Classroom Teacher / Form Teacher

Subject Teacher (& Teaching Assistant)

 

o   Larger secondary School

Head Teacher

Senior Leadership Team (Deputy Head i/c Pastoral) or SLT responsibilities allocated per Key Stage

Assistant  Leader (Assistant Head / Head of  Key Stage 3; Key Stage 4; Key Stage 5); ALENCo

Progress Leaders / Head of Years 7-13 or Assistant Head of Key Stage

Classroom Teacher / Form Teacher

Subject Teacher (& Teaching Assistant)

 

·                    Case Study evidence – Estyn have published good practice case studies for schools in Carmarthenshire in relation to wellbeing provision for learners and for excellent care, support and guidance. Those currently listed on the website include:

o   Ysgol Brynsierfel (2 relevant case studies are on the website)

Ysgol Gymraeg Brynsierfel has an effective procedure for tracking and monitoring pupils’ wellbeing on a daily basis. The school holds intervention sessions to promote positive attitudes, enabling pupils to share their concerns, discuss their feelings and improve their self-control skills. Assemblies at the school discuss morals, and there are sessions to promote healthy and positive relationships, as well as classes for parents. A ‘Playground Buddy’ system is also in place to encourage pupils to include all of their peers in activitiesYoga sessions at Ysgol Gymraeg Brynsierfel promote mindfulness and help pupils to relax, calm down and socialise. These sessions have improved concentration skills, foster resilience and encourage pupils to engage with learning.

 

o   Ysgol yr Hendy

Meetings led to a complete overhaul of the anti-bullying policy, systems and strategies across the school at all levels.  The process involved all stakeholders.  This includes facilitating clear opportunities for pupil voice, for example to create and review the pupil version of the anti-bullying policy every year. An initial anti-bullying task force was set up in the school…All instances of bullying are recorded and monitored.  School leaders and teachers follow up any issues and ‘check-ins’ take place with pupils and parents to ensure that issues are resolved.  Open lines of communication are valued and maintained. A whole school approach is strongly evident through the school with a wide range of systems in place that promote positive behaviour, the development of pupils’ wellbeing and a zero tolerance to bullying.

 

o   Ysgol Coedcae School

Leaders focused on areas that would provide its staff with a greater understanding of social and economic issues affecting its pupils and their families.  Training was given to all school staff in attachment awareness and in emotional coaching.  Whole-school training focused on ensuring that staff understood the importance of empathy, tolerance and patience during any behaviour support programme and staff were trained in restorative approaches to behaviour modification.  All staff were trained in person-centred planning and the school produced a valuable person-centred toolkit for its staff in order to support them in their work with vulnerable pupils.  A new school policy was adopted to ensure that any child who began to show signs of emotional or behavioural difficulty would have timely access to a key worker of his or her choice. 

 

o   Ysgol Bryngwyn School

Distributed leadership at all levels across the federation of Ysgol Bryngwyn and Ysgol Glan-y-Môr School has secured improved pupil outcomes and wellbeing…In addition to the improvements in pupils’ outcomes noted above, the federation has developed an innovative approach to rewards and sanctions which has led to significant improvements in pupils’ wellbeing and positive attitudes to learning.  

 

o   Ysgol Llanmiloe

Pupil participation, and particularly its role in self-evaluation, has improved considerably at the school.  The process of writing and implementing their own policies has had a positive impact on pupils’ wellbeing, with all pupils stating they feel safe and valued in school.  The school implements key policies consistently and successfully as pupils feel they have ownership of them.

 

o   St John Lloyd School

An increase in the proportion of pupils with English as an additional language meant there was an urgent need to provide additional support. The school identified the need to employ a Polish-speaking teaching assistant to improve communication between pupils, their peers, parents and staff. This appointment allowed the school to provide increased and more targeted support to improve the wellbeing of this group of pupils, especially during the initial period after joining the school... This…working has had a significant impact on the progress and wellbeing of pupils for whom English is an additional language.

 

·                    Screening and Baseline Assessment– there are many tools for ‘measuring’, screening and undertaking baseline measurements of pupil wellbeing. Indeed some 20 different methodologies are mentioned in a recent national survey.

    Some measures such as Speakr are ‘check-in measures’ – where pupils in primary schools can record their feelings regularly during the school day. This methodology is in relatively widespread use in Carmarthenshire schools.

Other measures exist to establish ‘snapshots’ at any given point in time, which can subsequently be re-administered as a means of gauging progress over time, or after a period of applying a wellbeing intervention. Though many are referenced in a recent in-county survey (summer 2019), the baseline measure advocated by ECS is the GL assessment tool. This is being rolled out to all schools. This methodology permits a general screening of wellbeing, which can signpost inaugural support and provide insights to apply other, more specific diagnostic tools.

 

·                    Training delivery:

o   Behaviour Transformation - the following areas are identified as core training for all schools in Carmarthenshire: Person Centred Planning, Restorative Practices, ACE Awareness, Emotion Coaching, Trauma Informed Practice and Mindfulness (staff and pupils)

 

The Education and Wellbeing Team is now delivering a set of 5 training sessions. Each session builds upon the one before. This training is also being offered regionally as part of the Regional Transformation Project.

 

Regional Training Programme and Phase 1 training

1.      Understanding ACEs (Adverse Childhood Experiences) and their impact on Child Development.

2.      Understanding Attachment, Developmental Trauma, Neuroscience and Mental Health.

3.      Practical skills for relationships, resilience and repair. Emotion coaching, PACE and play.

4.      Practical skills that help us Protect, Relate, Regulate and Reflect with children.

5.      Self-care and wellbeing, mindfulness and vagal tone.

 

 

The ECS Corporate Parenting team are leading on: ACE Awareness, Emotion Coaching, Trauma Informed Practice and Mindfulness. We are working closely with Trauma Informed Schools UK, the Mindfulness in Schools Project (MISP) and UWTSD to develop and deliver sustainable training that promotes peer support

 

·         Adverse Childhood Experiences and Resilience

·         Early childhood adversity can impact negatively on a child’s cognitive and emotional development, their ability to engage in learning and their ability to sustain relationships. Some of the factors that can build resilience and safeguard against long term effects are having a key adult who respects you and feeling part of a wider community.

·         Person Centred

·         Person Centred strategies identify and act upon what is important to a child or young person and what is important for a child or young person. It is a process for continual listening and learning, focusing on what are important to a child or young person now and in the future.

·         Relationship Based

·         Relationship based principles are supported between children and social workers, foster carers, adopters, teaching staff and peers. This is a purposeful and methodical process of individualised support and engagement that encourages coaching, mentoring, self-reflection and shared learning.

·         Trauma Informed Practice

·         Trauma-informed practices are effective and can benefit staff and the children they support through promoting safe relationships and environments. Trauma informed practice includes a belief in resilience and in the ability of individuals, organizations, and communities to heal and promote recovery from early trauma.

·         PACE stands for Playfulness, Acceptance, Curiosity and Empathy. PACE is a way of thinking, feeling, communicating and behaving that aims to encourage children who have experienced trauma to feel safe.

·         Attachment Aware

·         A child’s poor early attachment experiences with their main significant adult can hinder a child’s emotional and psychological development. Children with poor early attachment experiences are more likely to demonstrate emotional deregulation and require an active programme of emotion coaching.

·         Emotion coaching helps children to become more aware of their emotions and to manage their own feelings particularly during instances of distress and deregulation. It entails validating children's emotions, setting limits where appropriate and problem-solving with the child to develop more effective behavioural strategies.

·         Relational play and Theraplay promoteshealthy relationship development, develops impulse control and improves attention and empathy. Adults provide a high level of structure and direction for the child, helping them learn to follow the lead of adults, to feel safe in relationships, and to relinquish control in ways that are healthy and anxiety-reducing.

·         Mindfulness trains us to understand and direct our attention with greater awareness and skill. This may improve the capacity of children to concentrate and be less distracted, as well as their working memory and ability to plan.

·         Growth mindset in children can be supported and developed to lead to increased motivation and achievement. Neuroscientific discoveries have shown us that we can increase our neural growth by the actions we take, such as using good strategies, asking questions, practicing, and following good nutrition and sleep habits.

 

 

As part of the PDGLAC training programme the local authority provided:

 

·         We have supported schools to access the 10-day Diploma with Trauma Informed Schools UK and The Centre for Child Mental Health. Work is ongoing with UWTSD to accredit and deliver this course across the Region.

 

3.2. Support Services for Schools

·        Education and Child Psychology Service – schools receive support, advice and guidance including family therapy and school-based counselling. There are 11.2 Full-time equivalent (FTE) education and Child Psychologists in the Carmarthenshire service.

·        ECPs provide consultation to schools and Children’s Services teams, Pre-school assessment, statutory assessment of SEN, multiagency planning, strategic capacity building. 6.7 FTE is dedicated to ECPS- school consultation and preschool activity and a link ECP visit allocation to all schools and special education settings in Carmarthenshire is also provided. The majority of ECPS work supports mental health and wellbeing and activity is prioritised ECP where systems are stuck, problematic and progress and inclusion is a concern.

·                    School Counselling Service– Area 43 are commissioned to provide counselling support, primarily for secondary schools. Provision typically involves a counsellor being available for between 2 and 4 days a week.

·                    Counsellors will provide 5 sessions per day. Young people will be seen either weekly or fortnightly, depending on caseload, waiting list and need. On this basis a counsellor working 3 days per week would typically have between 18 and 24 clients.

·                    Overall waiting list is 62 (across all settings)

·                    There have been 10 year 6 referrals in September 2019

 

·        Child and Adolescent Mental Health Services

o   Hywel Dda S-CAMHS provides both mental health services for children, adolescents and their families. In addition, the service can provide timely responses for urgent situations

o   Local Primary Mental Health Support Service – support provided by S-CAMHS who work alongside non-mental health professionals to meet the needs of young people at risk of developing, or experiencing, moderate mental health problems. Service Level Agreements are in place with several services including:

o        Youth Offending Service

o        Substance Misuse treatment and Prescribing Service

o        Children Bereavement Service

·                    Behaviour Support Community Team – an outreach service that schools can contact for training support or to make individual referrals. This service is currently being remodelled to fit in with the 4-phase behaviour strategy

·                    Pupil Referral Units – supporting young people who demonstrate social, emotional and behavioural difficulties:

o             Bro Tywi – supports primary aged children to manage their behaviour and return to mainstream

o             Carmarthenshire Secondary Teaching and Learning Centre – supports pupils between 11-16 years old

o             Canolfan y Gors – supports 11-16-year old pupils demonstrating significant anxiety and diagnosed emotional and mental health issues

·                     Alternative Curriculum

o        Cynnydd – European funded, the scheme provides support to young people who require an alternative provision to mainstream, and part of the positive outcomes measure emotional wellbeing scores using self-efficacy models

o        Cam Nesa’ – similar service for post 16 learners and those in danger of becoming NEET

o        Alternative Learning Company – caters for 33 KS4 learners in Carmarthenshire who find working in mainstream schools difficult

·                    Families First / Team around the Family – offer a range of services that include parenting support, youth work, domestic abuse, family engagement, and young carers

·                    Health and Wellbeing LAC – actively supporting the wellbeing of care experienced children and care leavers

·                    Carmarthenshire Carers Service – core funded by BBC Children in Need, supporting over 180 young carers to address issues they may have because of their caring responsibilities

 

3.3.Wider Support Services (not an exhaustive list – there are many third sector support services which assist young people experiencing distress).

·                      Paper to Social Care & Health Scrutiny Committee (17.4.19 – authored by Avril Bracey, Head of Mental Health and Learning Disabilities), provides greater detail pertaining to section 3.2 above and also refers to the additional services listed below – included in summary here:

·         Tonic Surf Programme – 6-week Surf Therapy programme

·         Community Crisis Assessment and Treatment Team - S-CAMHS extension for out of hours and weekend provision

·         Talk to Me2 – suicide and self-harm prevention

·         Regional Implementation – development of a regional suicide and self-harm prevention strategy

·         Young People with Autism – working to create additional capacity and expertise in working with young people with autism, particularly those who have Asperger’s Syndrome and High Functioning Autism

·         Choices – Substance Misuse Services – brings together services involved in substance misuse

 

3.4  Groups and Fora (known to exist, which ECS officers attend)

o    Wellbeing and Young People Group, multiagency, chaired by Avril Bracey

o   Behaviour and Wellbeing Strategic Implementation Group, Chaired by Jo Antoniazzi

o   Curriculum and Wellbeing Strategic Group, chaired by Dr. Llinos Jones, Head, Ysgol Bro Myrddin

o   Supporting Vulnerable Learners’ Group, chaired by Jo Antoniazzi

o   Vulnerability Assessment Panel (VAP), chaired by Barry Roberts

o   Wellbeing, Health and Emotional Support Team (WHEST) – Chaired by Cllr. Emlyn Schiavone

 

4.      Issues Arising

·         Anecdotal Evidence from schools suggests that:

o   Pupils present with increasing complexity

o   A growing volume of learners are deemed vulnerable

o   Vulnerability and need are profiling younger and is becoming more noticeable in early years provision

·         Challenges to wellbeing cited by young people in recent participation team workshops in 6 secondary schools indicates that the following are the main pressures:

o   Exams, school expectations: 68 responses

o   Mental Health: 31

o   Peer pressure: 17

o   Discrimination 10

o   Stress: 8

·         Wellbeing recipes cited by young people in the same survey:

o   Support of family and friends: 36

o   Less school pressure: 24

o   Physical Activities: 18

o   More sleep: 14

o   More trust: 15

o   More mental health support: 14

·         Trends from Counselling (see Figure 5 above):

o   Getting family relationships and support right

o   Tacking anxiety, stress and self-worth

·         Carmarthenshire response to ADEW paper:

o   Reduce waiting time to specialist services

o   Lack of capacity/budget for additional staffing

o   Counselling services available earlier for primary school children

·         Ongoing debate re delivery of Health and &Wellbeing AOLE; – apportioning time etc

·         Definitive statements required around addressing the current accountability paradigm

 

5.      Plans Already In Place

o   The Carmarthenshire Missing Middle Conference – 7.11.19: to support those young people experiencing poor mental health or low-level mental illness, but who don’t meet the thresholds for specialist services and who often receive little or no support.

 

o   Carmarthenshire Healthy Schools Conferences:

o   21/22.10.19: Mental Health First Aid training for secondary schools (Accredited)

o   24.10.19: 1-day Mental Health Awareness

o   2/3.12.19: Further Mental Health First Aid training

o   4.12.19:  1-day Mental Health Awareness

 

5.1. Additional Funding of £90,121 has been recently announced for Carmarthenshire to support the following workstreams:

·                     Counselling – we intend to:

o        Increase counselling hours to reduce waiting lists in secondary schools;

o       initiate a pilot to deploy peripatetic counselling to address demand for services to pupils younger than year 6 in primary schools

·                    Training – we intend to:

o        Fund the multi-agency, collaborative event to identify support for ‘The Missing Middle’

o        Respond to ‘The Missing Middle’ for school leaders and practitioners to deliver anxiety training to school professionals and deliver as interventions, support and guidance in schools.

o        To fund the Carmarthenshire School Staff Wellbeing conference, nominally arranged for 17.1.20

o        Develop a further cohort for ELSA (Emotional Literacy Support Assistants) training in specialist settings prior to rollout to mainstream schools

·                    School Based Interventions – we intend to:

o        Improve Understanding and managing anxiety and appropriate services and interventions by deployment of TAPPAS model in the Carmarthenshire Llanelli schools pilot project

o        Deploy further Phase 1 interventions - individual schools will have support to identify pupils and deliver intervention packages to fully promote and embed interventions through early identification using the emotional literacy assessment toolkit

 

6.      Further possible Recommendations

6.1.Further consideration of case study evidence and ensure wider dissemination of best practice

6.2.Young People and practitioner stakeholder focus groups – undertake more detailed work in this area

6.3.Governance and strategic overview for Groups and Fora – attempt to draw together the work of various working groups - to curb duplication, over-delivery, ensure greater clarity and ensure efficient and effective delivery and support

6.4.Crisis response – continue to review our processes and procedures

6.5.Suicide and Self-harm guidance training – work to rollout training around the latest Welsh Government guidance

6.6.Further develop trauma informed approaches, with a greater emphasis for higher end need

6.7.Harmonise training and staff development opportunities to ensure consistency of approach

 

6.8.Peer Counselling – Continue to explore this avenue as a way of empowering young people and address some capacity challenges

6.9.A more rigorous typology is required around screening tools, with clear intervention pathways

6.10.                    Further work on interpersonal relationships in schools, and for pupils in their wider family and personal lives, adopting a restorative approach

6.11.                    Develop teacher agency and empowerment in respect of the current change agenda and dovetail this approach with further wellbeing support for professionals

6.12.                    Lobby Welsh Government regarding the challenges presented to schools – not only in relation to the emotional and wellbeing agenda, but also contextualised within the wider change agenda and accountability climate

6.13.                    Consider and address growth pressures arising from staff capacity challenges and ongoing training requirements

6.14.                    Gauge and measure added value of services provided

6.15.                    Work proactively to consider shortly anticipated national policy developments:

o   Public Health Wales Suicide Desktop research

o   Mind over Matter Implementation Framework for Schools (12.19?)

o   Interim Evaluation report of CAMHS schools in-reach pilots (12.19)

 

7.      Conclusions

There’s a lot going on and a lot happening. This paper is an attempt to encapsulate the main trends, issues and provision offered currently. Recommendations offered are presented for consideration, with a view to ensure that the wellbeing of our learners and staff continues to be our over-riding concern. If health and wellbeing can occupy centre-stage in our schools and services, we can more profitably and positively strive for excellence, so that our staff and learners can be the best they can be.

 

References

1.       Dodge, R., Daly,A., Huyton, J., Sanders,L. (2012): The challenge of defining wellbeing, International Journal of Wellbeing

2.       Welsh Audit Office (2019): The wellbeing of Young People – summary report

3.       Welsh Government (2019): Responding to issues of self-harm and thoughts of suicide in young people, circular249/2019

4.       WG letter, 16.9.19

5.       NHS Direct Wales, https://www.nhsdirect.wales.nhs.uk/encyclopaedia/m/article/mentalhealth, accessed 20.9.19

6.       https://www.britannica.com/topic/child-mental-health, accessed 30.9.19