Welcome to the NSPCC Learning podcast, where we share learning and expertise in child protection from inside and outside of the organisation. We aim to create debate, encourage reflection and share good practice on how we can all work together to keep babies, children and young people safe.
George Linfield (Producer):
Hello, and welcome to the NSPCC Learning Podcast. This episode, recorded in February 2023, focuses on mental health in schools and other education settings.
Mental health is as important to a child's safety and wellbeing as their physical health. Mental health problems can impact on all aspects of a child's life and in some cases can lead to safeguarding and child protection concerns.
It's a topic that professionals working with children need to be aware of. Data from NHS Digital estimates that, in England in 2022, one in six children aged 7 to 16 years had a probable mental health condition.1 And mental or emotional health remains the top concern for children and young people contacting Childline with the topic making up 35% of all counselling sessions where children talked about their own concerns.2
Because most children spend much of their time in school, education professionals are in a good position to look out for children's mental health, to promote their wellbeing, and help prevent any problems from escalating into more serious concerns.
I'm really pleased to be joined today by experts from Place2Be and Childline to discuss the different ways that education professionals can provide this support.
My name is Sharon Cole, and I'm Head of Safeguarding at Place2Be, a children's mental health charity that provides services in schools.
I'm Stef, Stefania Nicotra, and I work at Childline as a Team Manager. Part of my role is safeguarding young people.
Welcome to you both. Thanks for joining me. Sharon, I wonder if you could kick off our discussion today by giving us a quick overview of what the landscape looks like for children's mental health currently. What problems are children facing?
I think young people face so many mental health problems. They might have had particular adverse childhood experiences or ACEs. They may be living in a home where there's not much engagement or where they are the carer for a parent, or they are exposed to a lot of anger or violence in their home. There may also be general anxieties about life.
There are large populations of young people who've gone through COVID and experienced isolation and have found re-socialising really hard. This might be one of the factors in the higher number of young people that we are seeing that are self-harming and experiencing suicidal ideation. And also we've seen a large increase in young people that are struggling with eating difficulties and eating disorders.
Thanks, Sharon. Stef, does that chime with you and what you're seeing in Childline counselling sessions?
Yes, absolutely. I think at Childline we're kind of uniquely privileged to be able to talk to young people about any issues that they might face, and I guess mental health is always at the core of that, and how young people cope with any issues that are going on in their life.
Young people tell us that they are struggling more and more recently, and they might have diagnoses in place by professionals. And so there may be existing supportive networks or strategies that they might use or they might come to Childline and actually they have never told anyone how they're feeling, and how they're feeling can span over a range of emotions from just feeling low right the way through to feeling suicidal and intending to take their own life, for instance, where it becomes more of a safeguarding concern.
We're talking there about young people contacting Childline, but some children might not feel comfortable speaking out about how they're feeling. What are some of the signs that professionals can look out for that a young person might be struggling with their mental health?
Well, I think a change in behaviour is one thing. They could be withdrawn but they could be totally the opposite of withdrawn. I think young people can be very good at masking how they're feeling, so you might not see any signs, but the majority of the time a change of behaviour I think is something that I would be looking out for.
Things like sleeping problems, poor academic behaviour or performance. There are lots of different ways in which you can identify that someone might be struggling, but it's important that we don't attempt to diagnose a mental health issue ourselves or make assumptions about what's happening in a child's life, and really asking open questions and letting them go at their own pace. Because actually a disclosure or a conversation about mental health may not happen all at once. It may happen over a period of time. And letting young people know that they can come back to you is really important.
And we've touched on this a bit already, but when does a mental health concern escalate into a safeguarding concern?
I mean, I think it becomes a safeguarding concern when we've identified a risk of harm to the actual person or that they've identified others that are at risk. Also, it's important that schools and visiting professionals respond appropriately to safeguarding concerns, in a timely way and ensure caregivers are involved in support plans as much as possible.
Lots of young people talk to us about abuse that happens at home, and that can lead to harmful ways of coping that can put a young person's life at immediate risk. We must do whatever we can to keep young people safe, and we always must consider whether we need to take any action to protect young people.
At Childline, we use a mental health continuum model. You know, we recognise that everyone has their own mental health and everybody can have days where they are struggling more or less with how they're feeling. The continuum model essentially helps our counsellors to think about mental health as more of a spectrum.
So we've sort of broken it down into four categories where a person might move within those categories. So it might be that a young person presents to a counsellor as ‘doing well’, they're doing okay, day-to-day life is generally okay. They may have some ups and downs like there has been a recent fall out with a friend or a test in school didn't go quite well, but generally there's lots of resilience and a young person can bounce back from what's happened.
Moving up the scale, we might recognise that young person is ‘struggling’ and there are changes in their moods and behaviour. They might talk to us about struggling with sleep and eating, but again, it's not something that is quite a safeguarding concern as of yet.
When we start to really worry about young people, we talk about young people being ‘unwell’. So, there may be diagnosed mental health conditions or problems like an eating disorder or an anxiety disorder or whatever it might be, and it might not be diagnosed but the young person is... We identify them as being unwell because they are not able to cope with those experiences that they're going through. And actually they might be completely isolated, unable to talk to the people around them and feel really reluctant to seek support. There may be trust issues.
And again, moving sort of past that stage in the continuum, we talk about young people being ‘in crisis’ – so a mental health crisis – so a young person who's actually unable to engage with normal support services that are in place for them and they may be struggling with more severe mental health problems like hearing voices. They've perhaps taken numerous attempts to take their own life. When they contact Childline, they may be highly disregulated, and that might look like lots of different things, like unable to engage completely; being very quiet, or being very angry and ruminating over an issue over and over again; being very distrustful of services and people around them.
And when they're in crisis, at that point they've normally taken some form– they've taken some steps to harm themselves in some way. That means that safeguarding is required, and that's the priority over and above exploring what has led to that point.
Thanks, Stef. It is really important to remember that a person's mental health is always changing and the continuum model is a useful way of gauging how a young person is feeling and whether they might need more support, so thank you for introducing that tool.
I'd like to move on now to talk about the role that schools can play in supporting young people with their mental health and potentially preventing any difficulties from escalating into those safeguarding concerns that we've been discussing. Sharon, please, can you start us off? Why is it so important for schools to look after students' mental health and wellbeing?
Well, as you mentioned earlier, young people spend the majority of their time in schools. And so it's going to be one of those places that they're more likely to disclose about how they're feeling; and actually dealing with in person's mental health in the early stages could prevent it escalating into adulthood. I think it's really important that schools provide that environment for young people that it's okay to talk about mental health.
What does that environment look like? How can we go about creating that environment?
I think it's really important to have an openness, to really listen to what people are saying and take that time, however busy you are, to listen. I think it's really important that we don't miss things that are going on because we're so busy and we're rushing around and we've got things to do. Even if you can't speak to the person at that moment, then say, "look, I really want to hear what you have to say. Can you meet me at this time and we can talk?" And I think just making sure that there is time in a school day for wellbeing to be discussed.
Having workshops where you're actually talking to young people about what is mental health, getting them to say what they think mental health is and having that narrative ongoing in school. Also that wherever possible schools can provide counselling services in-house where young people can talk about their worries and concerns.
What I also think is important is that we also educate parents around mental health because it's okay with us talking to young people about mental health but if they're going home to parents who are not very good at having those conversations or not very aware, then it could be helpful if some education is done around that.
I think it's really important to provide that healthy environment and I think we have to really tune into individual needs as well. We want to be able to promote resilience and autonomy to some extent, and allow young people to talk about problems when they are ready. But balancing that against, you know, does this young person need to be safe right now? Do they need safeguarding right now?
We mentioned family and, you know, families, friends, schools can help to provide some routine and structure as that can go a long way with managing mental health. And of course, being wary that that routine or structure is healthy and, you know, again doesn't contradict the work that we're trying to do. If the young person has an eating disorder and they're likely to ruminate or have a perfectionist mind frame, too much routine is not very good. So it's a really tuning into individual needs.
And parents and families work really closely with schools often, and they can do a really fantastic job when it comes to promoting mental health. They need support too. And we need to, as professionals, remove some stigma around what they should know, what they're already expected to know, and just focus on what tools we can provide for them.
Absolutely. Thank you, Stef. I wanted to jump back to something you said, Sharon, about mental health workshops for young people. What do these workshops look like?
They've been run differently in different schools but we've tended to look at… have lots of, sort of, cards with different titles like… we've got different types of mental health, I suppose, and for young people to identify which ones are mental health and which ones are not mental health. We're trying to say that everyone has a level of mental health every day. And, you know, sometimes it's good and sometimes it's not so good and it's okay. And it's about just identifying those different things for young people and relieving that stigma, that mental health is something that you don't want to be identified with making sure that they feel comfortable having those conversations, and it's okay. And we do see the difference that that makes in the conversations that people have with each other and staff after those workshops.
There's different ways that people are doing this across the UK in the schools. But I think mainly it's just happy that conversation about what is mental health and just getting rid of the stigma and getting more clarity for young people.
We talked about providing an environment where young people feel like they can talk about what's going on for them. But actually that might not always be as easy. You know, it’s always easier said than done. Young people can find it hard to talk for a number of different reasons. It might be that they're scared to be labelled as attention seeking or crazy, or that no one will believe them. Or it might be that actually they don't have the capacity to put into words what it is that they're going through.
And I think when working in a school or working anywhere with young people, finding different ways to allow young people to open up, so whether it be through an activity like a sport or drawing helps young people to open up. So there's not so much pressure when you're making eye contact with an adult. Older teenagers or older young people will often want to deal with situations on their own and not want to feel helpless or out of control.
So sometimes taking a step back and asking them, “What would you like to happen and what do you want to do with this?” before you give your advice and input and jump straight in. I think we are sometimes quite quick to react to a situation and I think we need to just slow down and respond in a way that allows a young person to tell you what's going on for them in their own time.
We don't want to just frighten a young person, we want them to do it at their pace, definitely. And so I think that is definitely right, what Stef was saying. I think also if they don't like talking, you know, if they find it difficult to talk about what's going on with them, they may find it easier to do via Childline or via maybe Shout crisis text line or other agencies – Young Minds. They might find that talking or texting easier. So there's different modes and methods that they can talk about their worries. I think that's really important because that can lead on to them feeling more able to actually speak about what's going on with them.
Thank you both. We've spoken a lot now about preventative measures around mental health. Sharon, what processes should schools have in place to support children when mental health is becoming more of a safeguarding concern?
I think initially there is making sure firstly that your school is very aware of mental health. So as talked about earlier, about the culture, but also that the senior leadership team have attended mental health training, that staff have had mental health awareness training. Also, it's really good to do a mental health assessment of your school to make sure that you are covering everything you should be covering that would help young people.
It's really important that everyone is following safeguarding policies and that if there is a concern around a young person and their wellbeing and safeguarding that we're honest with them that we will be passing that information on in order to help them with this. Basically being really clear and transparent with young people that we have a concern, and we're concerned about them, and that we do need to share information and that school do actually, you know, do the actions to keep that young person safe. Whether that's a need to refer to social care or whether it's a referral to CAMHS. And then there's the support mechanisms that need to be in place whilst waiting for things to happen if you make a referral to another agency.
What would those support mechanisms look like?
Well, for instance, in schools that we work in, if we– if there's been a referral to CAMHS, we would continue to see that young person, meanwhile, as a stopgap, whilst they're waiting. As you will be aware, there's quite large waiting lists for young people to get the support that they need. And I think there's also, maybe individualising the day for a young person. If there's certain things that, you know, certain parts of the day that trigger them. Looking at all the systemic things around them really, and what can we put in place to make it easier for them and what can we put in place to ensure their safety.
There could be a safety plan. A safety plan could be put in place if you're talking about a young person that's got suicidal ideation or self-harm, which would involve all different things about strategies for them to use, things for their family to do to help keep them safe and things for the school to do to help keep them safe.
So, taking a really individualised, child-centred approach in these instances?
Yes, that's what I would say.
We're coming to the end of our discussion now. But before we finish, I wanted to talk about ways that school staff can continue to build their own knowledge and confidence in responding to mental health difficulties.
At NSPCC Learning we've recently launched a new mental health safeguarding and education elearning course that uses video scenarios and interactive quizzes to help professionals learn more about the topic. What other information, tools, resources can education professionals use to improve their knowledge and understanding around providing mental health support?
We supply lots of resources around mental health to schools at all times, but especially during Children's Mental Health Week, there's lots of activities and different things that are put on our site to help schools do particular lessons, or our staff working in schools to provide workshops. So that is going on all the time.
We also provide mental health training for senior leadership teams and mental health champions training. These are going on all year round.
Our real push is on trying to get the whole school community very mental health aware. And making it a much easier environment for young people to open up and talk about what is going on for them, whether that be something really high risk or whether that is, you know, just life in general. And I think it's really important that they have that opportunity to do that.
The NSPCC has a wealth of information online. We have the NSPCC elearning courses. There are very specific courses, things like managing safeguarding in schools, in classrooms or in sport or safeguarding young people with additional needs, etcetera. There's lots of information out there that is easily accessible that professionals can use, and young people have a website as well that they can access themselves.
Often young people tell us that they access information online to help themselves. And sometimes they don't want external input. They just want some more information on what abuse looks like; what it means to have a mental health problem, helping them identify maybe changes in their mood, changes in how they're coping, changes in how they relate and talk to people, how they socialise or not socialise; anything and everything that could help them make sense of the world and how it's changing around them and whether they need some extra help with that is available also online, as well as of talking directly to a Childline counsellor. Yeah, there's lots of information there.
And those resources for young people that Stef's been talking about that are all available on the Childline website. We will also include links to all the tools and resources mentioned in our discussion today, including the NSPCC Learning Mental Health and Safeguarding in Education elearning course in the podcast shownotes.
But that's all we've got time for, for today's discussion. We've covered a lot of ground. We've outlined why it's so important for schools to look after students’ mental health. We've looked at how to foster a positive and supportive mental health culture in school that removes stigma and helps young people to speak out when they need support. And we've also talked about how to recognise when a mental health concern is escalating into a safeguarding concern, and what needs to happen in those instances.
Thank you to my guests, Sharon Cole from Place2Be and Stefania Nicotra from Childline for sharing their insight and expertise. If you want to learn more about children's mental health, you can find dedicated information pages on the NSPCC Learning website.
Thanks for listening to this NSPCC Learning podcast. At the time of recording, this episode’s content was up to date but the world of safeguarding and child protection is ever changing – so, if you're looking for the most current safeguarding and child protection training, information or resources, please visit our website for professionals at nspcc.org.uk/learning.