Health Needs – Mental Health

We are seeing an increasing number of children and young people with mental health needs that are impacting on their ability to access to school and on their learning. Even where there is no known existing condition, anxiety can be a significant barrier to their learning and accessing their school environment.

Whilst this page touches on what can be done to support mental health issues in general, our main focus will be within the context of ‘school attendance’ and therefore whose duty it is to offer support and what this might look like.

Is Mental Health covered under SEN – Recap.

As we saw on our previous page Medical Needs – Physical and Mental Health, a child or young person’s mental health could meet the criteria for disability under the Equality Act 2010 or perhaps, if their need requires special educational provision, then it would meet the criteria for SEN (under the SEMH area of need). Either way the school and LA have certain duties to make sure suitable support is in place (even if that is through reasonable adjustments, SEN Support, alternative provision or through the request of an EHC needs assessment).

Even where a child’s mental health does not meet with SEN or disability criteria, there is still an expectation on schools to offer support as set out in the non-statutory guidance ‘Summary of responsibilities where a mental health issue is affecting attendance‘. it is worth noting that this guidance applies to any pupils displaying any social, emotional or mental health issue that is affecting their attendance, not just those who have a diagnosed mental disorder, or a disability or special educational need.

We would suggest taking a little time and seeing whether your child’s or young person’s mental health would meet the criteria for either of these definitions. If both, then go in the direction of seeking SEN Support (but remind schools and LA of their duty to support disabilities).

So where do we start?

Mental health issues can be very complex and be as a result of differing factors. They can often take parents, families and schools by surprise at how quickly the situation has deteriorated. It is therefore vital that as soon as you are aware of any difficulties and issues, raise concerns and help is sought. Sometimes it can be obvious why a child or young person cannot attend school (for example, they are needing treatment) but sometimes it may be that a child or young person does not want to go to school and there is no seemingly, obvious reason.

Most of the advice for the first example is in our Medical Needs – Physical and Mental Health page, and so here we will be mainly look at the second – generally known as EBSA.

Lets take a quick look at this specifically.


Many children and young people may at one time or another say they don’t want to go to school for a specific reason, such as falling out with a friend or not completing homework on time. Emotionally Based School Avoidance (EBSA) is different. This is specifically when a child or young person experiences extreme difficulty in attending school and results in persistent non-attendance where the reason for absence is complex and not always immediately evident to the family or school.

EBSA is often referred to as ‘school refusal’. This term is not helpful as it suggests the issue is located solely with the child or young person. It fails to describe the links between home, school and the child, all of which can contribute to a child with EBSA finding it difficult to attend school.

“School refusal occurs when stress exceeds support, when risks are greater than resilience and when ‘pull’ factors that promote school non-attendance overcome the ‘push’ factors that encourage attendance” – (Thambirajah et al, 2008: p. 33).

Causes of EBSA

There are some key features that may make a child or young person more likely to experience EBSA than others, and these are referred to as ‘risk factors’. These can include:

School -Bullying, transition to secondary school, the structure of the school day, academic pressure, peer and staff relationships.

Child – Temperament, poor self-confidence, physical illness, special educational needs, unidentified or unsupported ASC, traumatic experiences or events.

Family – Separation or divorce, parental physical and or mental health, loss and bereavement, high levels of family stress.

Reasons for non-attendance are generally related to four key areas:

  • Avoiding uncomfortable feelings of anxiety experienced when in school
  • Avoiding stressful situations such as academic demands, social pressures or aspects of the school environment
  • Needing to reduce separation anxiety from a significant adult
  • To participate in activities such as shopping, playing on computer games, spending time with a significant person etc.

Reference: Information from


As well as health professionals there are 3 main groups of people who will have some responsibilities where attendance at school is being affected. Lets take a look.

Parent Carers

As we highlighted in our School Attendance page, parent/carers have a duty, under section 7 of the Education Act 1996, to ensure that their child of compulsory school age (5 to 16) receives an efficient full-time education either by attendance at school or otherwise. They share in the responsibility of ensuring good and regular attendance.

As soon as you think there may be an issue with your child or young person with attendance then arrange to speak with the school.

Guidance says that parents/carers and schools should be encouraged to be open and work together to create a plan for attendance that fits with the needs of the child. Schools need to working with parent/carers and pupils to understand the barriers to their attendance and, where appropriate, make reasonable adjustments to overcome those specific barriers is an effective way of building confidence and reducing anxiety about attending.

Only medical professionals can make a formal diagnosis of a mental health condition. However, children or their carers can inform the school of a suspected mental health difficulty. They do not necessarily need to have a particular condition but you can explain that they have experienced a series of symptoms that you feel is affecting their quality of life. Where possible is it is helpful for the child or young person to voice their experiences themselves.

On the flip side parent/carers should engage with support offered by the school, and will be reminded of the importance of regular attendance and the emotional and mental wellbeing benefits of attending school for children and young people. They should feel reassured that the school has a plan for their child, and parent/carers should feel supported in their responsibility of ensuring the child’s regular attendance at school.

Any reasonable adjustments or support put in place by schools should ensure that the time the child spends in school is prioritised as much as is possible, always considering the needs of the child or young person.

In some instances, parent/carers themselves might be living with mental health problems or experiencing wider vulnerabilities or challenging life circumstances. This may affect their ability to provide support and care, and so it is important to recognise the need for practical, whole-family support and/or early help support where necessary, in order to try to address the causes of poor attendance. For example, where applicable, the family’s support worker might act as a convenor of any additional support offered and is a key party to join any conversations about a child’s attendance.


The DfE guidance “Working together to improve attendance” outlines the expectations of school in regards to attendance and state schools should, for all pupils:

  • Develop and maintain a whole school culture that promotes the benefits of high attendance
  • Have dedicated senior leaders championing attendance.
  • Have a clear school attendance policy which all staff, pupils and parents understand.
  • Accurately complete admission and attendance registers and have effective day to day processes to follow-up absence.
  • Share information and work collaboratively with other schools in the area, local authorities, and other partners when absence is at risk of becoming persistent or severe.

School staff are not expected to diagnose mental health conditions or perform mental health interventions, but they are expected to work to ensure regular attendance for every child, as per the DfE ‘Working together to improve school attendance’ guidance. This means schools have a responsibility to look at the barriers to attendance, make suitable adjustments where needed, and review these regularly. Not just tell a parent that their child or young person must be in school. (our comment)

Teachers within schools are well placed to observe children day-to-day and identify behaviour which suggests that the child may be suffering from a mental health problem or be at risk of developing one. The government is seeking to educate teachers on mental health difficulties in children and young adults; however teachers are not professional psychologists so teachers are not under a duty to identify mental health difficulties.

Broadly speaking, the role of school staff is to ensure that the school is a calm, safe, and supportive environment where all pupils want to be and are keen and ready to learn, which is the foundation of securing good attendance.

Generally, schools will achieve this by promoting children and young people’s mental health and wellbeing through a whole-school approach to pupil mental health, and by developing a trusted relationship with parents/carers and families that involves them in the conversation about the school’s ethos, and emphasises the importance of supporting mental health and regular attendance.

The Department for Education (DfE) encourages schools to identify a senior mental health lead who will have strategic oversight of their setting’s whole school approach to mental health and wellbeing.

In developing a plan to support attendance through reasonable adjustments, school staff will need to take into account the individual circumstances of the child, being mindful of safeguarding responsibilities as set out in the Keeping children safe in education 2022 guidance.

Where support is offered but parent carers and/or pupil has not engaged with it, or where all other options have been exhausted or deemed inappropriate, schools should work with LAs to consider whether to formalise support or to enforce attendance through legal intervention in the normal way under their existing powers.

Again, this should not be a case of ‘you haven’t agreed with what we have offered so now we will just fine you’ but exhausting all other options first.

Summary of responsibilities where a mental health issue is affecting attendance (Feb 2023) Support for pupils where mental health is affecting attendance: effective practice examples

Local Authorities (councils)

According to the DfE’s Summary of responsibilities where a mental health issue is affecting attendance (Feb 2023):

  • Schools should inform the LA where pupils are likely to miss more than 15 days
  • Schools should work with the family to provide educational provision (whilst determining with the LA whether alternative provision should be provided under section 19 of the Education Act 1996, as outlined in statutory guidance)
  • LAs must not follow an inflexible policy of requiring medical evidence before making their decision about alternative education.
  • LAs must look at the evidence for each individual case, even when there is no medical evidence, and make their own decision about alternative education.
  • No pupil should be left without educational provision.

Parents/carers may submit a complaint to the Department for Education where they do not feel the LA has acted in accordance with the School Attendance Parental Responsibility measures guidance.

The Local Government and Social Care Ombudsman (LGSCO) are seeing increasing numbers of cases where children are unable to attend school because of anxiety. Often, these cases involve children with special educational needs which have yet to be fully understood. There may be little, or even conflicting evidence about the child’s needs. Nevertheless, the Ombudsman is clear in saying councils must assess the available evidence and decide for themselves whether they have a statutory duty to make other arrangements for the child’s education.

Remember: Where a child or young person is not able to attend school because of their health needs (mental) it is the local authority which has the duty to arrange alternative education, not the school Even though this may mean that the LA request the school to arrange and fund it.


Now we have looked at the different responsibilities, lets take a look at what support could and should be offered and by whom.

Parent Carers

Parent/carers know their children best and are often well-placed to support them to recognise and manage their normal emotions. These same parent/carers of children experiencing social, emotional or mental health issues play a vital role in the attendance or non-attendance of that child.

However, even if parent carers do know their child best, it may need some investigating to discover why they are struggling. The following are just a few questions that you can ask yourself, your child or young person or the school to gain some clarity:

  • Is the anxiety/emotionally based school refusal due to an unmet special educational need? (in which case is a request for an EHC needs assessment needed?)
  • Are there any particular triggers, i.e. specific lessons, situations, staff, pupils, learning activities?
  • Are the current difficulties due to a situation in the current specific school or would child/young person experience same feelings even if they moved settings? (maybe they have felt or been threatened or bullied by another pupil or even by a member of staff and no longer feel safe)
  • As well as keeping in close communication with the school, what other actions can you take?

How to take action with a child too anxious to go to school

This following advice is taken from an article by Dr Lucy Russell, a Clinical Psychologist who has a website offering parenting and wellbeing support for parents of school-aged children.

When your child feels too anxious to go to school, the worst possible thing is to force them, without any accompanying understanding. However, avoiding school can be a very slippery slope and should not be encouraged. Consider these measures:

Deepen Understanding

Read my post about anxiety, to ensure you understand the basics.

Once you have a sound understanding of the science of anxiety in young people, ensure key school staff do too. For parents of young children I recommend Brighter Futures It will help to teach staff to feel empowered as it provides a step-by-step guide to working with anxiety in children.


Excellent communication between parents and school

This is the single most important factor, determining whether children will successfully reintegrate into school. This is more difficult when a child is in high school, so parents will need to identify a single member of staff within the school who can provide empathy and consistent practical support. This might be the SENCo/SENDCo, Head of Year, or Head of Pastoral Care.

Work together to develop a clear and consistent plan

Older children – especially secondary school age – need to be part of the process. The plan might include for example:

  • A named member of staff consistently greeting the child in reception each morning and parents “handing over” the child. Pay particular attention to other “transition times” during school days, such as moving from one lesson to another. These can be noisy and overwhelming for some children. Some may need adult support at such times until they can build their coping skills.
  • Your child having a quiet space to go to temporarily, instead of certain “trigger” lessons (for example, PE).
  • Weekly mentoring sessions with a member of staff to discuss issues as they arise, monitor progress and prevent crises.
  • Regular time out of the classroom to calm the nervous system.
  • A safe place to go at break and lunchtimes, with calming activities and staff support.
  • A buddy system to support the child with developing friendship skills.
  • A part-time timetable (for example, coming in late and leaving school early, until the anxiety reduces).
  • Regular communication both ways between home and school (emails or a communications book).

A Scientific Approach

Increase Nurture

As a first step, look at where your child can receive more comfort and an increased feeling of satefy (spelling).

When a child has heightened periods of anxiety the nervous system is strained and requires “downtime” to recover. This must happen both at school and at home.

Your child’s school may have a nurture room which they can access once or more each day. They may go to the nurture room to receive help with symptoms of panic. For example, a staff member – such as the school nurse – could help them slow and deepen their breathing.

Ideally, your child will also have access to the nurture room as a preventative measure. They may go there to engage in a soothing activity, such as mindful colouring. This will give their overworked nervous system a break.

At home, try extra cuddles, chats or special parent and child time.

Approach the problem from two directions

Firstly, your child needs to be helped and “skilled up”. He (They?) needs to learn how to manage overwhelming emotions and thoughts. There are many resources you may find helpful, particularly those based on CBT (cognitive behavioural therapy) – “although CBT may not work with those who have experienced severe past trauma” (ignore that if you think not relevant to this, just something very personal to me).

Highly recommended books include: Think Good, Feel Good by Paul Stallard, and for younger children, The Huge Bag of Worries by Virginia Ironside.

Many children need one-to-one support from a clinical psychologist or similar professional. You can find out more about the role of a clinical psychologist on this page.

Work on graded exposure

Graded exposure is one of the central strategies used in cognitive behavioural therapy for anxiety. It is an evidence-based approach. It involves very slowly (at the child’s pace) exposing the child to their fears, in a planned and calculated way. You can read more about it here.

The most important thing to know is that “flooding” doesn’t work. Flooding is forcing a child to face a huge fear all at once. Imagine a child with a fear of spiders. Flooding is putting a tarantula on the child’s hand. Graded exposure is taking small steps. You start by looking at pictures and videos of spiders, then touching a tiny dead spider, followed by a tiny real spider, and so on.

Avoid avoidance

Avoidance fuels anxiety and keeps it alive.  If children continue to avoid situations they feel worried about, they never give themselves the opportunity to prove that they can cope. When they face fear gradually, they get a sense of accomplishment that will help them not to avoid next time.

Start where your child is right now. Whilst avoiding avoidance is key to recovery, forced exposure can lead to panic attacks.

When a child feels they are not in control of their life, they may begin to have regular panic attacks. This is known as panic disorder. The more you go at the child’s pace, the less likely they are to panic. If they are in control you stand a much higher chance of success.

Reduce demands in your child’s life

Take action immediately to reduce the load. This will give your child’s nervous system the best chance of coping with the anxiety of school.

You may need to ask for your school to be excused from homework or from certain lessons for a while.

Perhaps the playground is the most demanding aspect of the school day, and an alternative can be found.

Reduce extra-curricular activities if your child is exhausted and stressed.

Try to understand whether your child’s senses are becoming overwhelmed.

For example, are some classes causing anxiety because they are too noisy? If so, what can the school do about this?

Review your current strategy

If you have worked on all the suggestions above, and your child is still refusing to go to school or struggling with significant anxiety or panic attacks, then alternative options may need to be considered.

Consider whether a different school might be better suited to your child

When a child is unhappy and anxious, it is tempting to imagine that moving to a different school will be the best way to cure all their problems. All too often, I have witnessed that this may not be the case, and problems soon start to show themselves again. Occasionally, however, there may be a school which can meet your child’s needs better than the existing school because it may:

  • Be smaller, and therefore less overwhelming for your child.
  • Place a stronger emphasis on nurture, and be better placed to help your child feel safe at school.
  • Have access to greater resources, including higher ratios of staff, or staff with more experience in anxiety disorders.

Home-schooling is not an option for most working families but is something many parents of anxious children consider. Needless to say, it is a huge step. Some of the pros and cons of home-schooling are considered in this article.

Don’t wait to seek help

I cannot emphasize enough, how important it is to seek help from a mental health professional (whether through the NHS or privately) if your child’s school anxiety is at risk of spiralling out of control.

Clinical psychologists in particular at experts in understanding and treating anxiety. Psychologists work with the “whole system” around the child. This may include liaison and support for parents and teaching staff and cognitive behavioural therapy with your child.


Childhood anxiety is common, and difficulty attending school because of this anxiety can be particularly debilitating. The good news is that by working as a team, the young person, family and teaching staff can ensure school feels like a safe place again. In some cases, professional support may be needed alongside this. 

Speak to the Senco

Share there is a problem as soon as possible, and work in partnership with the school to address the issue. A plan should be made with the school to help your child. Even if your child is being supported by the pastoral care team, it is important for the SENCO to also be involved with any discussions. This is because anxiety can often be the result of unmet needs, and it is the SENCO who would help staff explore this further.

Have the following strategies been considered/implemented? (again could we link to all these below?)

  • Learning Mentor support
  • Use of EBSA Toolkit
  • Referral to/advice from the WSCC Learning & Behaviour Advisory Team (LBAT)
  • Telephone advice from a WSCC Educational Psychologist
  • Referral to the Community Mental Health Liaison Service
  • Referral to the WSCC ‘Thoughtfull’ service (if your secondary school is signed up)
  • A temporary reduced timetable/lesson attendance with weekly reviews
  • Referral to CAMHS
  • Pastoral support in school – this can include in-school mentoring, Emotional Literacy Support Assistant (ELSA), Teaching Assistants (TA), learning mentors, inclusion support, pastoral leads, nurture groups, lunchtime clubs, after school clubs, breakfast clubs etc. Some schools have access to play therapy and counselling in-house.
  • Referral to the Early Help ‘Designated Schools Team’ can be made by the school. This team can support with successfully treating the root causes of absence and removing barriers to attendance, at home, in school or more broadly requires schools and local partners to work collaboratively with families.

If all of the above has been tried without signs of improvement, schools can consider:

Referral to Local Authority’s ‘Fair Access Team’ can be made by the school for consideration of Blended Learning or attendance at an Alternative Provision College (APC) as alternative/interim provision


Transitions from one school year to the next, and of course starting a new school, can be major flashpoints.  (A flashpoint is a critical situation or area having the potential of erupting in sudden violence – or in this case meltdowns, refusals, difficulties and so on)

If your child has a tendency to be anxious, it will be crucial to alert the school in advance and ensure they have a transition plan in place. Staff will monitor your child’s process.

Difficulties can sneak in very quickly. One day, a child might complain of a tummy ache or feeling sick, and within a few days, this could escalate. It may also manifest itself as a long-term problem that ebbs and flows. For example, a child may be more anxious about school at certain times of the school year but relatively settled at other times.

As well as keeping in close communication with the school, what other actions can you take?

  • Book an appointment with the WSCC Educational Psychology Telephone Consultation Service for parents/carers – Link here:
  • Speak to your GP or any other medical professionals involved – can your child’s needs (mental health/emotional wellbeing, depression, anxiety, school phobia, any other diagnoses impacting on ability to attend school) be put in writing and shared with the school/Local Authority Teams?
  • Speak to the WSCC Pupil Entitlement Advice Line – 0330 222 8200. Explain the background and reasons for your child’s difficulties with school attendance prior to any school referral being made.
  • Self-refer to the WSCC Single Point of Access (SPoA)West Sussex Single Point of Access (SPoA) :: Sussex Partnership NHS Foundation Trust ( The West Sussex Single Point of Access (SPoA) is a dedicated service which provides a simplified single route to access specialist emotional wellbeing and mental health support. The SPoA helps direct you to the right service, eliminating the need to refer to multiple services.


In developing a plan to implement reasonable adjustments to support attendance, school staff should aim to involve parents/carers to support a child who is anxious about attending from an early stage, making it clear that part of the aim of the plan is to maximise face-to-face attendance as much as possible.

The plan should have regular review points built into it, and have been agreed in advance of implementation. Support is available at Children’s mental health – Every Mind Matters – NHS ( This is important for children of all ages, but in particular if the child is transitioning from one school to another, or to another class, which may make them more anxious about school. – DfE Summary of responsibilities where a mental health issue is affecting attendance (February 2023)

As part of any plan to support the child to attend well, schools should facilitate relevant pastoral support. This should be done with the clear aim of improving attendance as much as possible while supporting the underlying mental health issue. This will involve having sensitive conversations with pupils and with parents/carers as swiftly as possible after having been made aware of the issue, and making reasonable adjustments in order to overcome specific barriers to attendance.

For example, a trusted adult periodically checking how the pupil is feeling or enabling the pupil to access a quiet space at break times can be effective ways of helping a child to feel less anxious about attending school. Or, if a pupil is anxious about returning to school because they are worried about being behind academically, they might be supported by providing access to additional educational support and tutoring.
Any plan to help the child to attend will also likely involve making referrals to in-school or external professional support, and schools should be supportive where parents/carers feel the child needs to visit a health professional in relation to a mental health concern.

Schools should consider additional pastoral care inputs for pupils, including any support that can be offered by the pupil’s most trusted adults in school, and where appropriate making referrals to other services. This might include community groups, counselling services, psychological practitioners or, where available, Mental Health Support Teams. Any professional workers supporting a pupil with a mental health or emotional issue should maintain the same ambition for the attendance of the child as the school, maximising in-person learning where possible.

Where available, school nursing services can also play an important role in helping to alleviate barriers to attendance, by providing health advice or information to pupils, including an assessment of individual needs and strengths. The school nurse can work with young people, parents/carers and the school to offer support based on these assessments, including helping families to navigate health and care services. School nurses can work with families, schools and others for early identification of vulnerability that may impact on education or attendance, so early support or referral to other services can be offered.

Especially where pupils have complex and long-term health conditions that are impacting attendance, school nurses can offer support to young people to manage their health condition and medication within school. Whilst schools generally do not have school nurses on site, they should all have access to the school nurse team who can be consulted with.

Professionals should join up and provide cross-agency support through a team around the school or family where they feel other services may help to alleviate a pupil’s concerns about barriers to attending school, and ensure that the pupil knows which school staff they can talk to if required.

Under general public law principles, LAs have an obligation to take into account the DfE’s ‘Working together to improve school attendance’ guidance in exercising their functions and, as such, should give due consideration to that guidance when making decisions about their attendance service and on school attendance matters.

Support specifically for EBSA

In some ways, support can be the same for all mental health issues. However these have been identified as being of particular benefit for those with EBSA:

  • Early identification of the issues and a quick response to re-engaging with the pupil
  • Develop a Sunday evening plan with the family and a special Monday morning school plan
  • Positive relationships with educational staff Positive peer relationships
  • Develop a signal with the child so they can communicate when they are overwhelmed e.g. show a card or use BSL
  • Having a designated area in which to retreat if feeling under threat
  • Having an empathic adult to talk issues through with
  • Planned transition from primary to secondary school
  • A trusted adult who can negotiate the timetable and support a more flexible approach
  • Lack of bullying
  • Opportunities to engage in extra-curricular activities
  • A well organised and responsive SEN department
  • Schools whose staff are ALL aware of the issues and how to deal with them
  • A welcoming, nurturing context which promotes a sense of belonging

Dr Tina Rae, Consultant Educational and Child Psychologist

Tools for Schools is a website of resources and information, designed to support the inclusion of all West Sussex children and young people in early years, schools, post 16 and other education settings. Their section on EBSA has guidance and toolkits that may be of particular help in understanding the expectations on schools in West Sussex where EBSA might be suspected.

Sector – led Effective Practice Examples

Below is a non-exhaustive list of sector – led effective practice examples in supporting pupils with mental health issues taken from the DfE guidance Feb 2023 of the kinds of support and reasonable adjustments that schools have in place in order to support social, emotional or mental health issues affecting attendance, and to help to reduce pupils’ anxiousness about attending school.

This guidance also has some case study examples.

Reasonable Adjustments

  • Pupils can pre-order lunch and it is collected by the staff and distributed to them to eat in solace.
  • Pupils are supported by staff members to integrate into the canteen to build their confidence with eating in the assigned area. This gives them the confidence to meet friends and make friendships that ease their anxiety.
  • Seating at breaks and lunches can be provided to support with anxiety.
  • Pupils can be withdrawn from lessons on a short-term basis and do work on
    emotional regulation, to build their resilience and alleviate anxiety about attending school.
  • Pupils can be provided with “Early Leave” cards, that will allow them to avoid main transition times in corridors between classes.
  • Where required, a short period of phased timetabling to allow a transition back into school and to attend full-time, where the child is in school but does not attend all lessons, working with the pupil to support with any anxiety they are experiencing during time not spent in class.
  • Some pupils will sit exams in smaller examination venues e.g. smaller rooms of 10 or 12 pupils.
  • Ear defenders are provided to students who are particularly sensitive to noise.
    They wear these in and out of lessons as needed.
  • Children with sensory difficulties are considered as part of the school uniform
    policy, such as allowing them to wear shorts instead of trousers, which helps to alleviate anxiety about attending.

Building confidence

  • Pupils can attend draw and talk, baking and gardening therapy sessions, as well as group social skills lessons.
  • Some pupils are offered a “meet and greet” at the school gate to support transition back into school after period of absence.
  • Pupils are made aware that they can speak with anyone they have confidence in, and staff know that, where they need help, they should contact a member of the trained mental health team.
  • Pupils can be paired up with buddies/mentors from Y11/13 who have received
    specific training to support, e.g. meet 6th form progress mentor during registration.
  • Pupils are encouraged to take part in after-school clubs, to help to build
    confidence about attending.
  • Pupils can access a pastoral/safeguarding drop-in chat team.
  • Pupils are offered 1-1 coach support to “catch-up” on core content for
    English/Maths. Often a barrier to returning as pupils overwhelmed with content they have missed.
  • Pupils are offered 1-1 or group sessions with a pastoral coach using sport, which can be an escape from the pressures of school life and help the pupil with any feelings of anxiousness they are experiencing.


  • Staff account for the needs of all children, including offering a safe place,
    someone to talk with and liaising with parents at home.
  • Staff who have the requisite training wear ‘Mental Health Matters’ lanyards, which lets pupils know that we are trained and available to support directly if required.
  • Staff take a bespoke approach to each child with an emphasis on breaking down barriers to attendance, so that children are ready to learn, feel safe and grow in confidence.
  • The school has in place a well-trained, dedicated Mental Health team.
  • Mental Health awareness days and sessions are arranged for pupils.

Local Authority

If despite all the strategies, interventions and specialist input has not worked and a child or young person is not able to attend school then as we have seen above, the LA are then responsible for their education.

This will likely be in the form of alternative provision. Please see our main Health Needs – Physical & Mental Health page for further information on how LA’s should consider this and what alternative provision may be considered.

Frequently Asked Questions

Frequently Asked Questions around Mental Health Needs

My concerns about my child having SEN are constantly dismissed – what should I do?

Mental health issues, especially anxiety, can sometimes be as a result of unmet needs. Where a child or young person experiences anxiety or EBSA we would expect schools to have investigated any special educational needs as part of their Best Endeavours duty.

Whilst cognitive and learning needs would likely have already been identified, it may be that one of the other 3 areas have not (Communication & Interaction, SEMH, Sensory & Physical). Even in the area of cognitive and learning needs, they may have kept on top of the work with huge effort. Indeed, masking may well have taken place in previous years to such an extent that the child has gone under the radar in terms of considering any SEN but has now reached a point where they cannot continue.

Until the correct assessments have been carried out, a school cannot state categorically that a child does not have SEN. In fact, where a child is waiting for a diagnosis, the school should support with appropriate strategies and interventions as though this has been confirmed.

Whilst it will be important to continue with pastoral care, where SEN is suspected or being investigated, the child will benefit from a joined up approach and any support decisions should be discussed with involvement from both the pastoral team AND the SEN team / Senco.

If you feel that your concerns about SEN are not being taken seriously then you may want to consider writing a letter to the SENCO stating:

  • Why you believe your child has or may have SEN (i.e. has a learning difficulty or disability which calls for special education provision to be made for him or her). You will need to explain:
    • why you feel he or she has a significantly greater difficulty in learning than the majority of others of the same age; or
    • what disability they have that prevents or hinders them from making use of facilities of a kind generally provided for others of the same age in mainstream schools or mainstream post 16 institutions. 
  • Request that they do some assessments based on your concerns (and ask them to explain in writing what they have done and the results of these). You can point them in the direction of the Graduated Approach pages in tools for schools which indicate what assessments can be done for each area of need.

For more information about SEN and SEN Support please see our SEND Pages

I’ve been told we need a letter from a consultant otherwise it will be unauthorised absence and we will face a fine. Is this correct?

Not entirely. The DfE’s Working Together to Improve School Attendance guidance, section 219 & 220 state “school staff should advise parents/carers to notify them on the first day the child is unable to attend due to illness. School staff must record absences as authorised where it is not possible for a pupil to attend due to illness (both physical and mental health related).

In the majority of cases a parent’s notification that their child is ill can be accepted without question or concern. Schools should not routinely request that parents provide medical evidence to support illness. Only where the school has a genuine and reasonable doubt about the authenticity of the illness should medical evidence be requested to support the absence.

In instances of long-term or repeated absences for the same reason, however, seeking medical evidence may be appropriate to assist in assessing whether the child requires additional support to help them to attend more regularly, and whether the illness is likely to prevent the child from attending for extended periods.

In other words, schools should only be insisting on medical evidence if they doubt your word as a parent or do not feel that you are fulfilling your parental responsibilities under section 7 of the Education Act 1996. It will therefore be important that you show the school as much other evidence as you can in the absence of any medical evidence. This could (and should) include the voice of your child or young person.

If you are still threatened with a fine, you do have the option to appeal and/or complain to the school for not marking the register in accordance with guidance, especially where you have done all that you can to fulfil your responsibilities.

School have said that they cannot support because my child is not in school enough.

LAs are responsible for arranging suitable, full-time education for children of compulsory school age who, because of illness, would not receive suitable education without such provision. This applies whether or not the child is on the roll of a school and whatever the type of school they attend. (Additional Health Needs Guidance).

Therefore even if school is not able to make suitable provision, the LA should. Where the LA have told the school to make provision and the school have not, it will be the LA that you will need to contact. You can do this by contacting the WSCC Pupil Entitlement Advice Line – 0330 222 8200.

I have been told we cannot have help because school don’t see any mental health issues whist my child is there. Is this right?

When considering SEN or disability, The SEND Code of Practice 2015 (6.45) says: schools should take seriously any concerns raised by a parent. Where your child or young person has been off for more that 15 days then the school and LA each have duties in considering what support is needed and actions to be taken.

Where possible keep a diary of the occasions where your child or young person’s mental health has affected them and show this as evidence.

School have said that they have been told by the LA not to send work home as this encourages young people to stay away. We are approaching exams and they are falling further behind – what should we do?

Children unable to attend school because of health needs should be able to access suitable and flexible education appropriate to their needs. The nature of the provision must be responsive to the demands of what may be a changing health status.

The use of electronic media – such as ‘virtual classrooms’, learning platforms and so on – can provide access to a broader curriculum, but this should generally be used to complement face-to-face education, rather than as sole provision (though in some cases, the child’s health needs may make it advisable to use only virtual education for a time). Additional Health Needs Guidance (Section 7&8).

Speak to the school in regard to these duties and discuss what provision can be provided. If school continue to quote the LA, ask for the name of the person / department and get in touch with them directly (again quoting the guidance).

School said that they need a professional diagnosis in order to support properly. They want to help but don’t know how.

This can be a very difficult situation, for families and for the school involved. Often school may be prone to do nothing at all in fear of making things worse. The delay in being able to get a diagnosis will often mean that no-one knows what to do and so nothing happens. Effective communication and understanding is going to be extremely important. But remember if a child or young person is likely to be absent from school for 15 days or more, then it is the school’s duty to inform the LA and the LA’s duty to consider alternative provision.

My child has not attended school for 3 months and we still don’t seem to be anywhere nearer to getting help.

As stated in the one above, it is the duty of the school to have informed the LA of absences over 15 days and the duty of the LA in these circumstances to consider what is needed (e.g. alternative provision), even if this is done through the school. If nothing has been done, check that the school informed the LA and then get in touch with the LA (Pupil Entitlement Advice Line – 0330 222 8200)

I requested an EHC Needs assessment because my child will not go back to school. It has been refused because the LA say he doesn’t need one if he won’t attend school.

There are only 2 criteria that the LA must consider when deciding to agree to an EHC needs assessment. 1) that the child or young person has or may have SEN and 2) that they may need provision to be made through an EHC plan. Whether a child is or is not in school at this stage, is not a necessary consideration at this point.

My child needs to see a professional but there is such a long waiting list. What can we do?

This is difficult one especially as parent who want the best for their child. Keep communication going with friends, family, school and support groups. The more support you have around you as a family the better the outcome. In the meantime you can consider self -referring to the West Sussex Single Point of Access (SPoA) :: Sussex Partnership NHS Foundation Trust ( This is a dedicated service which provides a simplified single route to access specialist emotional wellbeing and mental health support. The SPoA helps direct you to the right service, eliminating the need to refer to multiple services.

Further Information

Resources for parent carers

Reaching Families is a well established parent support group in Worthing, their details are here, if you’d like to see what they can offer:

Hope Charity Project – The HOPE Charity Project has been set up to help families in Sussex and surrounding areas, who are worried or struggling to support their children suffering with their emotional health. We offer a very real, compassionate approach to providing advice, support, and comfort to the children, parents and siblings who are all affected by this growing nationwide problem.

The SID Youth – wellbeing mentors and workshops covering the Worthing, Adur and surrounding areas

The Listening Ear Service by CONTACT – Emotional support, advice or ideas to help you cope. Appointments are free, confidential and over the phone with a family support adviser. The Listening Ear Service has daytime, evening and weekend appointments available, bookable online.

Anna Freud – free text support but also a section for Parent/ Carers that may be helpful.  Should we also include the link to spoon feed? Parents and Carers | Advice and Guidance | Anna Freud Centre

Well At School website – Helping Children and Young People with Medical or Mental Health Conditions get the Best out of School

Not Fine In School  is a parent/carer-led organisation set up in response to the growing number of children and young people who struggle with school attendance. –

They Are The Future website , training and resources – 

Minded is a free educational resource on children and young people’s mental health for adults, but can also be really useful for teenagers. It covers a wide range of topics including school refusal.   

Relate gives specific advice for different types of worries and problems aimed at young people including school refusal.