Debate on the role of schools in caring for mental health and wellbeing of pupils and their development as community and family members

Since 2004, research suggests that there has been a sharp rise in mental ill-health among children and young people in England:

• Data from the 2004 children and young people’s mental health prevalence study found that one in ten children and young people aged 5 to 16 experienced a mental health difficulty.
• Data from NHS Digital in 2017 suggested there was a marginal increase to one in nine among 7- to 16-year-olds.
• However, by 2022 we observed a significant rise within the same age group reporting a common mental health problem.

Some groups of children and young people are disproportionately impacted by mental health problems largely driven by a complex interplay of social and environmental determinants of poor mental health. This includes the following:

• Looked-after children and care leavers experience a higher rate of mental disorders than the general population – 45 per cent, rising to 72 per cent for those in residential care compared to 10 per cent in the general population.
• People who identify as LGBT+ have higher rates of common mental health problems and lower wellbeing than heterosexual people. A 2018 report by Stonewall found that just 52 per cent experienced depression in the last year.
• Black boys and young men report lower levels of diagnosable mental health difficulties at the age of 11 years than white or mixed heritage boys. But, while sample sizes are generally small, national data suggests that from early adulthood Black men are 11 times as likely as white young men to present with major psychiatric conditions; three times more likely to present with suicidal risk; and 1.5 times more likely to present with post-traumatic stress disorder (PTSD).
• Children from a white ethnic background are more likely to have a probable mental disorder than those from Black and Minority Ethnic background.
• Refugees and asylum seekers are more likely to experience poor mental health than the general population.
• Children and young people with learning disabilities are more than four times more likely to develop a mental health problem than average. This means that 14 per cent or one in seven of all children and young people with mental health difficulties in the UK will also have a learning disability.
• Autistic children and young people are more likely than the general population to experience a range of mental health problems including hyperactivity disorders, anxiety and depressive disorders.

The following are some of the key risk factors that contribute to poor mental health:

• Poverty: Children from low-income families are four times more likely to experience mental health problems by the age of 11 than children from higher-income families. Housing insecurity and homelessness are also risk factors.
• Parental mental health: According to the Children’s Commissioner for England, around a third (32 per cent) of children aged 0 to 15 live in a household where an adult has moderate or severe symptoms of mental ill-health. While most parents with mental health problems are responsive and sensitive parents, this remains a consistent risk factor for diagnosable mental health problems in children.
• Children who have experienced adversity and trauma: Children who experience maltreatment, violence, abuse, bullying, loss or bereavement are much more likely to experience mental health problems in later life. An estimated one in three adult mental health conditions is thought to be associated with adverse experiences in childhood.
• Caring responsibilities: Around one in three young carers are estimated to experience a mental health problem. There are an estimated 800,000 young carers in the UK.
• Bullying: Data by NHS Digital suggests that young people with a mental health condition are nearly twice as likely to be bullied, and more than twice as likely to be cyberbullied.

Emerging evidence also suggests that there are other key risk factors for young people’s mental health which are contemporary concerns for many practitioners and researchers. These include factors such as:

• Racism and discrimination. Everyday experiences of racism can undermine self-belief and self-confidence.
• Poor housing can lead to psychological distress, respiratory problems and impact on development.
• The climate crisis. A survey of over 10,000 young people across the world highlighted that 45 per cent of respondents felt their feelings about climate change negatively affected their daily life and functioning.
• The impact of the cost-of-living on young people can impact mental health.  
• Social media pressures are growing for young people, particularly with regard to accessing harmful content and cyberbullying. 

Councils have a range of responsibilities in relation to children and young people’s mental health. They also have a key leadership and delivery role in promoting good mental health and wellbeing in communities. For example, through system-wide local leadership on health and wellbeing boards, integrated care partnerships and place-based care and support systems. Councils also have statutory duties and powers for children and young people, those in care and under the Mental Health Act. 

Having a strong partnership with schools is also essential. Councils can provide a strategic oversight role in co-ordinating different partners (mental health specialists but also youth groups and the voluntary sector) to support schools, children and young people, as well as using their expertise to facilitate conversations locally and bringing schools nurses, educational psychologists and others together.

However, the reduction of budgets for early intervention and prevention services, the stress on public health budgets, despite some small increases in the past year, and pressures on other services such as green space, housing and communities has impacted the ability of councils to create happy, healthy environments that support children and young people’s mental health.

Many councils have high quality services for children and young people’s mental health, but these are under pressure with rising demand and workforce pressures, including:

• Cheshire West and Chester: the Youth Federation’s Holistic Mental Health Support service
• Durham County Council: the Rollercoaster project supporting parents and carers of children and young people with emotional and mental health problems.
• Portsmouth: a needs-led city for children and young people.
• Salford: place-based centres with easy access for young people and their families.
• Solihull Metropolitan Borough Council: an integrated approach for children’s mental health, supporting families and carers as well as young people.

School can be both a protective factor and a cause for poor mental health, particularly when considering stressful periods such as exams. The LGA has long called for the roll out of counsellors in all state secondary schools across England to provide support to young people. This should be alongside support seen through the expansion of mental health support teams (MHSTs) in schools. 

It is essential that a range of professionals can support children and young people’s mental health needs. 

Despite a real terms increase in the 2024/25 Public Health Allocations, this settlement continues to leave local public health teams with limited resources to maintain essential services. This is on the back of LGA analysis that found that between July 2015 and 2024, the Public Health Grant received by councils had been reduced in real terms by £858 million (in 2022/23 prices). This has resulted in reduction in councils’ ability to spend on public health commissioned services.

Many schools have been raising concerns about their financial stability with councils. Schools are facing increased costs of fuel, energy and food for school meals, alongside the need to fund agreed staff pay rises, and support a growing number of pupils experiencing disadvantage. We are concerned that the 1.9 per cent increase in per pupil funding for 2024-25 does not address the funding challenges that schools are currently facing. 

The Institute of Fiscal Studies’ annual education spending report, published on the 11^th December, estimates that the core schools budget of £58.6 billion for 2024–25, while reversing past reductions, will only return per-pupil school spending to 2010 levels, based on standard measures of economy-wide inflation.

Some children and young people will also require a clinical intervention. Often, the system considers what the medical response is to children and young people rather than the social factors that may be contributing to their mental health needs. This means the system sometimes does not have the right response to children and young people with mental health needs and looks to clinical treatments rather than holistic support.

The current system is constructed to incentivise behaviours that prioritise specialist and complex treatments at the expense of earlier intervention and prevention. There remains inadequate data collected on the outcomes of children and young people with health and commissioned services measured against access to specialist treatments. Strong and robust partnerships can help improve local systems to deliver support for children and young people.

Local health services have gone through significant change over the past decade with a move from smaller footprints through Clinical Commissioning Groups to now larger bodies, Integrated Care Systems, working through integrated care boards and integrated care partnerships. Although this means local arrangements can be complex with the potential of a post-code lottery of services, the move to a new model equally provides an opportunity for children’s mental health to move up the priority agenda. The LGA maintains that local decision making is key as local decision makers know their communities, services, and the needs of children and young people best.

Research commissioned by the LGA has shown that although there have been some positive ambitions in government policies over the past ten years, there is a lack of national direction, and the ambitions haven’t been sufficient to keep pace with the mental health needs of children and young people. Positive steps included:

• The vision set out in Future in Mind and the subsequent expansion of services
• The Transforming Children and Young People’s Provision green paper and its focus on support in schools; 
• The NHS Long Term Plan with greater commitment for funding for children and young people’s mental health services. Whilst this has increased the number of children able to access services, unfortunately the NHS is behind target meaning many children remain without support. Indeed, even if targets were met it would still not cover the demand of support required; and
• The £5 million fund for Early Support Hubs in providing open access to mental health interventions for children is welcomed. However, this is a proposal well tested and would need to go further to tackle the continual pressures on children’s mental health. There is also the risk a postcode lottery of support, given different levels of investment across the country. 

It is crucial that the Government maintains a strong focus on children and young people’s physical and mental health. We remain concerned that without an explicit strategy on children’s health, mental health needs will be overlooked. Many conditions in the major conditions strategy are primarily, though not exclusively, experienced by adults so there is a substantial risk that children’s physical and mental health may be overlooked.

The LGA would like a series of changes made to improve children and young people’s mental health and wellbeing and the system that supports them. 

Recommendations for change

Partnership approaches

• The whole system needs to work together to support children and young people’s mental health, reducing fragmentation. There are positive steps forward with the Integrated Care Systems, however, further focus on children and young people needs to be part of these discussions, as well as joined up funding to ensure that support and treatment is in the right place. 
• Local partners should come together to tackle the social determinants of children and young people’s mental health, including poverty and inequality, and consider the role of other local departments including housing, transport, sport and leisure services.
• Examples of good practice are shown in the LGA’s Building Resilience report.

Early intervention and prevention

• The Government needs to ensure local authorities have the resources needed to commission innovative and effective services. 
• The Government should increase the provision of early intervention support in the community through a national roll out of early support hubs in every local area.
• The Government should gather clear data on early intervention services (availability, access, spend) in order to have a clear picture of the landscape and to monitor progress made in developing and implementing services of this kind.
• The Government should increase investment in youth services to ensure they are able to continue and expand to be available for all young people. The key strategic and coordinating role of local authorities should be recognised for them to be able to implement their statutory duty through the recently amended statutory guidance.
• To help address the inequalities that emerge in the early years, local authorities should work with their partners to develop a dedicated mental health offer for families around early years which draws on support offered through parenting programmes, health visiting, perinatal mental health services, and family hubs.
• The Government should ensure full roll out of Family Hubs.
• The Government should seek to increase the number of health visitors, school nurses and other vital public health teams to support early intervention.
• Mental health support teams in schools need to have sustainable investment and be expanded to all state secondary schools. Counsellors should also be in all state secondary schools. 

NHS Children and Young People’s Mental Health Services

• Alongside supporting the whole children and young people’s workforce, specific focus needs to be taken to build the workforce. Significant progress has been made in expanding the children and young people’s mental health workforce, however growth in the workforce continues to be the biggest risk to the expansion of services, as do increasing vacancies. Young people still continue to experience challenging transitions between children’s mental health services and adult’s mental health services. This particularly impacts care leavers, who may be left with decreased access to mental health support at the very time they may be leaving care placements, going through significant life changes and/or living independently. 
• There are well documented challenges facing inpatient mental health provision for children and young people. A review of how to improve these services needs to be considered with a view of the whole journey. Proposals made in the Government’s stable homes, built on love consultation to improve the social care system go some way to supporting children and young people in the community, however without significant investment this will not go far enough. All partners need to work together to support children and young people with the most acute needs.

Support for vulnerable children and those with special educational needs and disabilities

• The Government should use the SEND improvement plan to recognise the interconnection between special educational needs, emotional needs and mental health. However, current proposals do not go far enough in tackling the rising demand of mental health need, nor sufficiently focus on the needs of SEND children. 
• Increasing numbers of children are being subject to Deprivation of Liberty Orders (DOLs). Councils and health partners are seeing more children presenting emotional wellbeing and mental health needs, but without a diagnosable mental health condition. There are increasing pressures on identifying the right support of provision, including placements for children in care. It requires a holistic working between different partners to ensure that children get the right support.
• Children in the justice system need to receive better mental health support, with health partners working alongside others to co-commission appropriate services for children who have emotional and behavioural needs which affect their mental health both in custody and in the community.

Data collection

• For children and young people, understanding a clear picture of access to mental health services is challenging with no definitive national dataset which covers referrals, access to support and outcomes for mental health at different levels of need. The data which is regularly collected nationally typically only relates to CAMHS or very specialist admissions, with no visibility afforded to the significant activity in supporting children and young people with lower levels of need.

Local education systems are seeing increasing numbers of children in the mainstream school system with additional needs that can cause barriers to school attendance. These can relate to deprivation and poverty, poor mental health, trauma, SEND and communication and interaction needs.

We have long highlighted that there is a need for a cross-government child centred-strategy, backed by concerted action, to improve outcomes for children and young people across all services. This would help to tackle rising disadvantage and the wider socio-economic factors that are contributing to children and young people’s persistent absence from school. This must include reforming the SEND system so that it delivers the support all children need to thrive; improving access to mental health support and youth services; and ensuring schools are resourced, supported and incentivised to create inclusive learning environments that enable every young person to reach their potential. 

The LGA supports the introduction of a register of children who are out of school (elective home education (EHE)) to improve data and visibility of these children, combined with powers for councils to meet face-to-face with children. This measure is vital to allow councils to verify that children are receiving a suitable education in a safe environment. 

Archie Ratcliffe, Public Affairs and Campaigns Advisor 

Mobile: 07867 189177 | Phone: 020 3838 4868 

Email: [email protected]