The Case for In-School Counselling
As the election draws closer, and all the manifesto promises are being laid bare for scrutiny I have been eargerly waitng to hear what each party has to offer for chidren's mental health provision.
I also thought it would be a good time to discuss it with the two candidates hoping to get my vote on the 12th December. I contacted both the Labour and Conservative candidates and have already met the Conservative hopeful and am meeting his Labour opposition in the next few days.
I have asked that the current provision for CAMHS be supported by using in-school counsellors to give quick access to children suffering form mental health issues. My concerns were listened to and a letter was sent to the Dept for Education on my behalf. I had a reply very quickly which acknowledged that schools play an important role in suporting mental health, but didn't offer any funding for this and said that the view of the Department for Education is that any money for counselling should not be mandatory and each school should have the freedom to decide what support they offer to students. I think our children who have suffered trauma, ACES or mental health problems deserve better, much much better.
I thought you might like to read my response.
Thank you for your quick response. I feel I must take issue with some of the points you raised. Firstly, the in the run up to the upcoming general election there have been many pledges by all parties of hundreds of millions of pounds in manifesto promises, yet you say that “all government departments should refrain from making new announcements that could be seen to be advantageous to any candidates or political parties” The day after I received your letter there was an announcement that an extra £10m will be spent on Ofsted inspections for schools. Please can you explain how this is not a “new announcements that could be seen to be advantageous to any candidates or political parties”
I am however pleased that you share my opinion that all schools have an important part to play in supporting mental health and wellbeing in their pupils. This view mirrors the conclusion of many reports and studies into childhood mental health. A report by Young Minds in 2017 recognised that “the teacher is usually the first port of call for parents worried about their child’s mental health. It was your own department, The Department for Education who reported in 2015 that just 32% of teachers felt that they had received the appropriate mental health awareness training.
You are correct when you state that schools and colleges are “increasingly providing support to children and young people with mental health problems” but this is through necessity not choice.
The British Association of Councillors and Psychotherapists have voiced grave concerns over teachers providing mental health support fearing it will “damage the pupil/teacher relationship” and cause confidentiality issues. A study by Rhule in 2006 raised further concerns that school staff untrained in mental health can have an iatrogenic affect and cause more harm than good.
I also agree with you when you say that schools should expect that pupils and families should be able to access support from professional working in children’s mental health. However, the simple fact is they are unable to access that level of support. A recent report from Young Minds revealed that in a survey of 1,008 GPs across the UK, 76% said they did not usually feel confident a young person they referred to CAMHS would receive treatment for their illness. Only 10% were confident that treatment would follow. A different report by STEM4 in 2018 stated that 99% of doctors “fear that these young people may come to harm while waiting for specialist mental health treatment”
Mental illness in children has risen from 10% to 12.8%, that equates to around 3-4 children in every class with a diagnosable mental health condition, estimates of underlying mental health conditions which do not reach the threshold for diagnosis suggest that 45% of our school children have mental or emotional health issues. Continuing to rely on referrals to CAMHS which has been unable to cope with the demands placed on it year on year is not morally right and it’s not economically right.
In 2018- 2019 the number of referrals to CAMHS increased by 18% from 345,386 to 405,798 and in the period from August 2018 – to July 2019 175,094 CAMHS appointments were cancelled. The House of Commons debate on Mental Health and Wellbeing in schools last year (2018) accepted that “most children with a mental health condition do not get the treatment they need, and under current plans this will be the case for years to come” of the 338,000 children referred to CAMHS in 2017 only 31% received treatment within a year, 37% were placed on a waiting list and the remaining 31% were not offered treatment at all. The stark and undeniable reality is that the current system of treating children’s mental health is deeply, deeply flawed, and as a result we are knowingly failing our children.
The professionals who work in CAMHS are also being let down 45% thought that cost-cutting had led to a decline in service provision according to the British Medical Association. The former Children’s Commissioner Sir Al Ainsley-Green has described the current CAMHS situation as “experiencing a tsunami of need; there is a grossly inadequate provision for the service, with disastrous outcomes. The current Children’s Commissioner has also raised concerns “improving children’s mental health service has been unacceptably slow” Even your own colleague Jeremy Hunt as recently as 2017 described children’s mental health as “The weakest area of NHS provision”
There simply has to be a new approach. In-school counselling offers many advantages over the current failing system:
1. A school-based counsellor is on hand when the first signs of mental health problems arise, so treatment can begin quicker preventing a deterioration of the condition and enabling a faster recovery.
2. A school-based counsellor is known to the pupils and is not a stranger they have to speak to about their most private fears.
3. A school-based counsellor will mean a minimum disruption to education as the child and parent do not have to travel to a clinic or hospital.
4. The school staff will benefit from having access to a mental health professional which will result in them being upskilled in mental health.
5. There is less stigma associated with an in-school counsellor, as recognised by the British association of Counsellors and Psychotherapists.
6. A school-based counsellor can treat a pupil who has a condition that would not reach the threshold for CAMHS.
7. A school- based counsellor will reduce the burden on CAMHS and allow them to work with the most severe cases.
8. The number of sessions will not be capped.
9. A school-based counsellor could be aware of family problems which exacerbate mental health conditions.
10. Studies (Cooper,2013) have shown that the use of in-school counselling can shows a tenfold increase of children accessing treatment with up to 80% of children needing treatment, getting treatment.
11. A school-based counsellor can support a child who is on a waiting list for CAMHS.
12. A school-based counsellor has easy access to the child’s teachers and support staff to both gain their perspective and opinions and offer advice on how to support the child.
Economically there is strong evidence that using in-school counselling is more cost-effective than the current system. A report by Pro-Bono Economics into the economic viability of Place2Be (a school counselling charity) showed that the £4.2m spent in delivering counselling session saved £29.2m in later public spending. Showing that for every £1 that is spent on in-school counselling there is a saving of £6.20. The Children’s Commissioner’s report in to in-school counselling concludes that it is “vastly cheaper to provide” with a cost of just £229 per pupil as opposed to £2,338 for non-school counselling.
Your final point is that the Department for Education does not want to make the provision mandatory; however without the protection of a mandatory (or even statutory) status any money for in-school counselling could be diverted to plug other gaps. This has already been investigated and shown to be the case within CAMHs and highlighted by the British Medical Association, Kings fund and Anne Longfield the Children’s Commissioner. Failure to ring-fence any money set aside for school- counselling may well see schools, who feel under pressure to produce academic success, divert the money meant for on-site mental health professionals into other areas.
There is a desperate need to change the way our children and young people with mental health conditions are treated. In-school counselling has shown to be not only highly effective but cost-effective too. The Government’s current target is to increase CAMHS capacity so that by 2020 35% of children who need mental health support will receive it. There seems not to be a provision for the remaining 65%. If every school in the UK had an in-school counsellor funded jointly from Education, NHS and Public Health there will be a reduction in the severity of burden of mental ill-health to the whole economy. The Governments own finding in its ‘No health without Mental Health’ report states “The wider economic costs of mental illness in England have been estimated at £105.2 billion each year. This includes direct costs of services, lost productivity at work and reduced quality of life.
It is for these reasons I believe that continuing to fail our children and young people with mental health illness is morally and fiscally irresponsible and the a new government has a duty to look again at the feasibility of in-school counselling.