‘Place2Be: advancing mental health care in schools’ Catherine Roche

Marketing Manager for ACAMH

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Catherine Roche, Chief Executive, Place2Be ‘Place2Be: advancing mental health care in schools’

Recorded on 16 June 2017 at ‘The Jack Tizard Memorial Lecture and Conference; Public mental health for children and young people: addressing mental health needs in schools and communities’.

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Thank you, Francis. And, yes, I get the 4:00 on the Friday afternoon slot. I’d like to talk to you a little bit about the work of Place to Be, but representative of an organisation doing real life, whole school support out there in the front lines in schools, working as a mental health provider, hand in hand with schools, day in, day out. And so, when I was thinking about what I could bring here today, it really, I think, is about the real life and the messiness of what walks in the door and what class teachers, teaching staff, head teachers, what schools are dealing with, day in, day out, and the sort of support that we can provide there.

So for anyone who doesn’t know, we’ve been around for just coming up to 23 years. And we work now with clusters of schools around the country, with just under 300 schools, predominantly primary schools but in more recent years also working with 49 secondary schools and a school population of 116,000 children. And I think it’s so important in terms of understanding the scale of the challenge that is there and the sort of different levels of service, and support, that we can provide, day in, day out, in schools.

We’re also one of the eight founding charity partners of Heads Together, because, in recent times, we really need to get mental health, and the need for mental health support, in the community, high on the agenda. And I’m delighted that we’ve been able to do some of that and seen the shift, and groundswell, of public support for it, in the last year. So we asked as part of Children’s Mental Health Week, which we launched three years ago, we worked with the National Association of Head Teachers to try and get a handle on how many schools have some form of on the ground, professional, mental health support.

Obviously, schools are doing work themselves in terms of what class teachers can do, but we believe strongly in the need, as we heard earlier, for a mental health professional, or practitioner, to be there to back up, and to help, to build out this support. And we found from that survey the good news is that a third of primary schools have some form of professional support in place but that means that right now there are two thirds where there is a real gap.

And that’s where the work, such as the the schools pilot that Jamie talked about and all of the other things that have been happening in the last 12 months is really encouraging in terms of how do we close that gap to really get full coverage right across the country, because that is what we firmly believe is required. No surprises in terms of the barriers that schools highlighted or head teachers highlighted, money, of course. This system needs resources, it needs resources injected into both the preventative end as well as ensuring that the more acute end is is also appropriately resourced.

The other thing that came out of that was the lack of availability of skilled professionals. And for a head teacher, who is an education professional, who doesn’t have a mental health background, to think, where do I find and what does good look like? What is the type of right quality resource that I’m looking for to work and put in place in my school? And that’s where in talking about what do we mean by a whole school approach? For Place to Be, first and foremost, the child is at the centre. And the support that we’re providing is, on the one hand, it’s about positive mental health promotion, which we heard also this morning.

And then, on the other end of the spectrum, it’s about addressing mental ill health, and identifying, and addressing, problems early on. So it’s both ends of the spectrum. Clearly that needs to be linked in and part of a comprehensive can system. So linked in with specialist support where that is necessary. But it’s early intervention, identify, and address, early in the life of a problem. Because that’s where we can stop the problems downstream, and stop the cost, and the spend, that’s required much later downstream when problems become more entrenched.

So whole school, it’s about the child. It’s also about the parent, which we heard lots from one of our speakers today. It’s about work and engagement with school staff, both teaching and non teaching school staff. And that’s right through to the midday supervisors in the playground, it’s that whole piece. And also an important part of that is the clinical supervision, and quality, as part of a quality assurance mechanism for counsellors, and staff, and mental health professionals who are out there working day in, day out, in schools.

So it’s that whole wraparound piece. OK. So I wanted to really bring you into the life, the messiness. We’ve had lots of stats and facts and we can give you some of those too. But what is it, day in, day out, the 116,000 children that our teams are in contact with, day in, day out. I’m going to take you right now to Edinburgh, go to the edges of Edinburgh. And as one of our head teachers, this is from a head teacher about three weeks ago when I visited a school.

And she said their school, she said, “It’s kind of…it’s the edge of everything, really, especially in the early morning when you’ve got the dawn police raids.” And it literally is from here to the desk in terms of the fence for the school. 86% of pupils live in the lowest poverty deciles in Scotland. And she describes her children as hungry for everything, hungry for love, for understanding, and hungry for food, and life is tough.

And that’s it, what her staff, and her team, comes into, day in, day out. And it’s even tougher for children when they don’t have a strong attachment to their parent. Some of us are lucky enough that we’ve got family, and parents, and friends, around us, and we have that strong bond and attachment. But if you’re a little one, if you’re five, six, years old, and you’re living in this environment, and you haven’t got that, well, it’s even much tougher.

And that’s what the class teachers are dealing with, with the spectre of academic progress, attainment, and all of that spotlighted on them. So I’m going to fill you in on Peter. He’s a little boy in the school. He started with the school in nursery, unkempt, hungry, smelly, not toilet trained, that’s the reality. A poor attender and he seldom spoke. He is one of three siblings, a different dad to his other two siblings.

And he had had absolutely no contact with his dad since he was five. So when we came into contact with him, he was nine. So, for Peter, that means no birthday cards, no presents, no Christmas cards, no phone calls, while his other two siblings, they have all of that contact, and this…he craves this contact, he needs some form of contact. And mum has mental health problems. He’s almost taken into care several times in and out of foster placements.

So the school is also…it’s one constant place in his life. But his behaviour became more and more bizarre. So from going under tables to pressing himself against the wall when he would walk down the corridors. And, again, clearly not learning, not achieving. So, Place to Be, I won’t go into all the complexities of the work. We worked with him. He was identified by the school. We managed to engage with mum. And part of that is having a professional working hand in hand with the class teacher who can see this and with the head teacher to engage with mum and get that permission to be able to provide one to one counselling support.

I’ll fast forward nine months when he actually had said he loves his time at Place to Be. He has never said…this is a little boy who has never said he loves anything. But that weekly one to one session with a stable counsellor who’s there just for him, helping to make that connection, that really made such a difference in terms of developing a relationship. So he’s developing positive attachments. The school has a window into what’s going on in his life, from what he talks about, in his life, and what’s going on for him. And his mum is now accessing support.

Now, that is one child amongst that school population that we’re working with. It’s not an extreme case as I’ll come on and fill you in some more on the numbers of children that we provide support with. But I think it shows the importance of having somebody who is embedded day in, day out, who can get that picture. And I hope the reality of what it’s like in some of the communities for our children. So we run a drop in service, that’s part of the whole school approach.

And there you can see we gather the stats, the facts. Friendships are a huge challenge. And the children come and they come and check out the counsellor. And, often, it’s around small groups. But that’s really important in terms of peer support. And here, think of the 33,000 last year self referred to our drop in place to talk. And this just gives you…these are all individual children, in primary school, who popped a slip into the postbox to say that they wanted to self refer.

So when we heard this morning about children not being terribly happy in school, or in life, well, I think, some of this shines through. So that’s the self referral and the drop in and at one level and what we can provide. Then in terms of the one to one counselling, which is the type of support that we provided for that little boy in Scotland. So over 4000 children accessed that last year, a mix of boys and girls.

And, definitely, when you are embedded in the school, you are reaching children who have those higher risk factors. So a higher proportion are on free school meals, pupil premium, have special education needs, subject to a child protection plan, they’re looked after. They’re the kids we know who are there but who need support, day in, day out. And, in terms of results, we use Goodman Strengths and Difficulties Questionnaire as a key tool. We also look at some others, and that’s part of the learning journey.

What is the best type of tool and measure to inform our thinking? Half of the children who started in the severe range clinically recovered. And we also know one of the key things in terms of looking at…in the work, in bringing a mental health service into the school, you’re looking at health, but you’re also…because your paymaster is education. So you’ve got to be able to show the impact on learning, on academic progress, or at least make some strides towards that.

So we know that a child…this is about unlocking barriers to learning. So children…we know we can also help make a real impact there. And it’s not just for the individual child that you’re supporting. It’s also what that means in terms of the classroom and that lower level of disruption in the classroom. And, again, we know that we can have a real impact there. And then extending out because it’s also about home life, and longer term, in terms of some of those protective factors, the importance of being able to make friendships, not walking down the corridor by yourself and isolated. And actually being able to engage in leisure activities and having wider aspirations that can take you back out into the world.

Again, having a professional. So, we really believe there’s a real difference between being able to access one to one counselling support, which is good, but, actually, having a professional who is able to engage with parents and be there. Our team talks about the wet therapist, or the therapist on a wet Tuesday morning, hanging out by the school gate so that you can engage with parents and break down that stigma. And that is so important. And I think hopefully you see from 33000 children accessing a self referral, there is no stigma involved when you are there day in, day out, within the school.

And I think here we are, part of Cork. And we had some of the…Miranda talked about a little bit about Cork earlier on. We’re a member of Cork, we benchmark our data against and with the CAMHS services to to look, to challenge, to try and learn. And one of the things it highlights is the impact that we have, and the ability to engage with parents. And in terms of our ability to gather data and response rates from parents and to make a real, real, difference.

I think, again, you’ll see a quote from there from one of the parents. And it’s just that difference that, you know, you think about a child, but, at the same time, what is actually going on in mum’s mind, and how can she effectively parent? A really crucial part of providing mental health provision in a school, we are part of the school safeguarding system. It’s so fundamental. And I think what this…this was… yes, what this highlighted to me was…and the importance of the whole school approach, the safeguarding issues, they come out not just in the one to one, even we were surprised ourselves at the volume, and proportion, of safeguarding issues that come through the drop in the self referral.

So it’s not just friendships where you think on the one hand, oh, yeah, it’s just, you know, this and that. But, actually, really serious safeguarding issues. Because the child, they build up trust and then they will share what’s truly going on. And that…those of you who work in schools, I’m sure that sounds familiar for you. We also…we heard earlier from from Tamzin around work for training for school staff. We’ve developed a programme for new and recently qualified teachers.

We need to have mental health training, and understanding, understanding around child development in teacher training. We did a programme, had a comparison group, a number of…over a couple of years, and a follow up. And, again, just the things I’d like to highlight from that is how this helped teachers who are stressed and under pressure as a profession. It helped them to understand children’s mental health, also, how they work with parents, but, importantly, one where there’s a deep job satisfaction.

So where that had gone negative for the comparison group, but, actually, had…and that plays out to the turnover in the teaching profession, especially for newly qualified teachers. So future direction and learning, because there’s so much we still need to learn. So continuous improvement and refinement of our service based on what we’re learning, what we’re learning from the data. And I have Miranda’s FOPs data in my mind, but what we’re learning as we’re going along and in terms of the wider research that’s happening now.

So some questions we challenge ourselves. The duration, how long should we be working with a child for, and is it sustained, and how can we demonstrate it’s sustained over time? We’re also going back to that link between health and school, at the moment, doing some analysis with the national pupil data set to look and see if we can make that connection. Also trying to understand more about the characteristics of schools who commission our service and what can that do in terms of us making the case for schools nationally?

And technology. We, ourselves, would say we’re a bit dinosaurish on the technology front. We’ve been very people focused, not surprisingly, but integration of technology into the service and our organisation. And I love this quote, which is from one of our head teachers, which is about how you have to be integrated and absolutely at the heart of the school community. So, finally, just to wrap up, I think the connection linking health, and education, and the wider systems, is absolutely crucial, continuing to share learning and evidence.

We heard…somebody touched earlier on the workforce. And there is quite a road to travel, to build a workforce who can work effectively with children, and in the messy, noisy, hubbub and very structured and timetabled world of the school environment. So there we go. That’s Place to Be and our work. So a whole school approach is what we truly believe in.


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