Health Needs – Physical & Mental Health

There may be times where due to illness, physical or mental health needs, a child or young person will struggle to attend school full time, part time or even at all.

Where absence escalates and pupils miss 10% or more of school (equivalent to 1 day or more a fortnight across a full school year), schools and local authorities are expected to work together to put additional targeted support in place to remove any barriers to attendance and reengage these pupils. In doing so, schools should sensitively consider some of the reasons for absence and understand the importance of school as a place of safety and support for children who might be facing difficulties, rather than reaching immediately for punitive approaches. Sect 85 Working together to improve school attendance

Some of the statutory guidance and duties on local authorities and schools apply whether these medical issues are around their physical or their mental health. Support can and should be offered regardless of whether a child or young person is physically attending school or not. However, as we are looking at these needs through the lens of ‘school attendance’, most of the information contained here will be in this context.

Where the information is not specifically referred to, it has been taken from the following guidance:

Supporting pupils with medical conditions at school

Ensuring a good education for children who cannot attend school because of health needs

School’s duty to support.

There is a statutory duty placed on the governing bodies of maintained schools, academies and pupil referral units to make arrangements at school to support pupils with medical conditions. Children and Families Act 2014 (section 100) and The DfE statutory guidance Supporting pupils at school with medical conditions

A child’s mental and physical health should be properly supported in these settings so that:

“the pupil can play a full and active role in school life, remain healthy and achieve their academic potential.”

Children & Families Act 2014

Note: the guidance does not apply to maintained nursery schools, 16 – 19 academies and independent schools.

Does this cover disability?

If a child is considered to be disabled, the school has specific duties to make arrangements for that child. For more information about the definition of disability, see our page on “Disability Discrimination in Education“.

Local Authority’s duty to support.

Local authorities (such as West Sussex County Council) must:

“make arrangements for the provision of suitable education at school or otherwise than at school for those children of compulsory school age who, by reason of illness, exclusion from school or otherwise1, may not for any period receive suitable2 education unless such arrangements are made for them”

Education Act 1996, section 19(1) & 19(6)

1‘Otherwise’ is a broad category which covers circumstances other than illness or exclusion in which it is not reasonably possible for a child to take advantage of any existing suitable schooling. 2The term ‘suitable education’ is defined as efficient education suitable to the child’s age, ability and aptitude and to any special educational needs he or she may have.

Local authorities (LAs) must provide suitable full-time education (or as much education as the child’s health condition allows) as soon as it is clear the child will be away from school for 15 days or more (whether consecutive or cumulative) and make every effort to minimise the disruption to a child’s education. This applies for any child who – because of illness or other reasons – would not receive a suitable education without such provision.

This means that where a child cannot attend school because of health problems, and would not otherwise receive a suitable fulltime education, the LA is responsible for arranging provision and must have regard to the guidance set out in the DfE’s – ‘Ensuring a good education for children who cannot attend school because of health needs’ January 2013

The Department for Education also state in their statutory guidance “Alternative Provision – January 2013”. that while there is no statutory requirement as to when suitable full-time education should begin for pupils placed in alternative provision for reasons other than exclusion, local authorities should ensure such pupils are placed as quickly as possible.

The Local Authority in West Sussex expects its schools to use their ‘best endeavours’ to provide work/alternative education arrangements for a child who is presenting with health needs.

In spite of ‘best endeavours’ there may be occasions where a school is not able to provide. Therefore, in line with Section 19 of the Education Act 1996, guidance says: “the Local Authority has a duty to make arrangements for the provision of suitable education at school or otherwise than at school for those children of compulsory school age who, by reason of illness, or otherwise, may not for any period receive suitable education unless such arrangements are made for them”.

In summary – although the LA can ask schools to provide alternative provision for children and young people with physical or mental health needs (including Emotionally Based School Avoidance (EBSA)), it is the local authority’s duty if this is not possible.

A full-time education

The education to be arranged by the council must be full-time unless the council determines that full-time education would not be in the child’s best interests for reasons of the child’s physical or mental health. Education Act 1996, section 3A and 3AA. You can find out more information about full time education in our Reduced Timetables page

The number of hours teaching that constitutes a full-time education varies according to the year a child is in. The assumptions schools work on are set out below:

Reception, Years 1 and 2 (children aged 5 to 7)21 hours per week
Years 3 to 6 (children aged 7 to 11)  23.5 hours per week
Years 7 to 10 (children aged 11 to 15)  24 hours per week
Year 11 (children aged 15 to 16)     25 hours per week
Table showing hours per week of education based on age taken from LGO Focus report – Out of School, Out of Sight

To note: It is generally accepted that If the local authority provides one-to-one tuition, the number of face-to-face hours could be fewer because the provision is more concentrated.

Local Authorities should not:

  • Have processes or policies in place which prevent a child from getting the right type of provision and a good education
  • Withhold or reduce the provision, or type of provision, for a child because of how much it costs (meeting the child’s needs and providing a good education must be the determining factors)
  • Have policies based upon the percentage of time a child is able to attend school rather than whether the child is receiving a suitable education during that attendance
  • Have lists of health conditions which dictate whether or not they will arrange education for children or inflexible policies which result in children going without suitable full-time education (or as much education as their health condition allows them to participate in).

Are physical & mental health needs considered as SEN and/or Disability?

Children and young people who have special educational needs (SEN) do not necessarily have a disability. Some disabled children and young people do not have special educational needs. Some children and young people may have physical and mental health needs that do not fit into either. Lets have a closer look.

Section 20 Children and Families Act 2014 defines a child as having Special Educational Needs (SEN) if he or she “has a learning difficulty or disability which calls for special education provision to be made for him or her”

A child is considered to have a learning difficulty if she or he: 

  • has a significantly greater difficulty in learning than the majority of others of the same age; or
  • has a disability which 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. 

From this we can see that there may be children with disabilities who fit the definition of SEN. We go into more detail about the definition of SEN in our SEN Support page.

The Equality Act (2010) defines disability as a physical or mental impairment that: “has a ‘substantial’ and ‘long-term’ negative effect on a person’s ability to do normal daily activities.”  We also go into more detail about this on our Disability and schools page.

Some examples of SEN are:

  • emotional and behavioural difficulties (EBD);
  • Autism;
  • Attention Deficit (Hyperactivity) Disorder (ADHD/ADD);
  • specific learning difficulties such as Dyslexia;
  • Obsessive Compulsive Disorder;
  • communication difficulties;
  • medical needs such as Epilepsy and Cerebral Palsy;
  • mobility difficulties.

Examples of Disabilities could be as follows but certainly not limited to:

  • Paraplegia
  • Quadriplegia
  • Cerebral Palsy
  • Spinal Bifida.
  • Muscular Dystrophy
  • Cardiac Ailments
  • Paralysis
  • Polio
  • Post-Polio Syndrome

Children and young people with these types of conditions don’t necessarily have SEN. But remember, wherever a disabled child or young person requires Special Educational Provision, they fit the criteria as having Special Educational Needs.

Mental Health

Anxiety can be a barrier to learning or indeed accessing the learning environment, and it can be a special educational need (SEN). Why? Because an anxious students ability to access and engage with learning may be impaired significantly when compared to their peers. An anxious child is entitled to a suitable education which may include reasonable adjustments if that is what they need to be properly supported.

The following are examples of mental health symptoms that can be regarded as a mental impairment under the Equality Act:

  • anxiety;
  • low mood;
  • panic attacks;
  • phobias;
  • eating disorders;
  • bipolar affective disorders;
  • obsessive compulsive disorders;
  • personality disorders;
  • post-traumatic stress disorder;
  • some self-harming behaviour;
  • depression;
  • schizophrenia;
  • autistic spectrum disorders;
  • dyslexia and dyspraxia;
  • learning disabilities.

Examples of what would not count as a mental impairment under the Act include:

  • some shyness and timidity;
  • inability to speak in front of an audience as a result of nervousness;
  • inability to concentrate on a task requiring application over several hours.

If any of these are experienced in such a way to be a significant barrier to learning or accessing the educational environment then they meet the criteria for SEN and should be supported accordingly, either by the school / college, alternative provision or by the local authority.

Is a recognisable or diagnosed medical condition required?

Schools do not have to wait for a formal diagnosis by a medical practitioner before providing support to pupils.

With regard to mental health issues, the Summary of responsibilities where a mental health issue is affecting attendance guidance also states:

  • It is important that children and parents/carers do not feel as though their concerns about mental health have gone unheard
  • Schools must record absences as authorised where pupils of compulsory school age cannot attend due to illness (both physical and mental health related).
  • There is no need to routinely ask for medical evidence to support recording an absence as authorised for mental health reasons. (This is because, in general, primary care health professionals such as General Practitioners are unlikely to be able to offer such evidence to support one-off absences related to mental health).
  • 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.
  • If a parent proactively seeks out a note from a GP, it does not imply a need for absence unless this is explicit in their letter.

So it is clear that a formal diagnosis is not needed before support can be given. A school may seek medical evidence but should be done in order to help them understand what support will be needed. Support should not be refused just because there is no medical evidence.

If the condition is unclear, the head teacher will have to make a judgement about what support to provide to the pupil, based on medical evidence available at the time that the school is made aware of an issue. In exercising this judgement, the head teacher must not ignore the views of the child or their parents or ignore medical evidence or opinion. However, the head teacher can challenge the evidence if appropriate.

Alternative Provision

The definition of ‘alternative provision’ is as follows: “education arranged by the local authority for pupils who, because of exclusion, illness or other reasons, would not otherwise receive suitable education, education arranged by schools for pupils on a fixed period exclusion; and pupils being directed by schools to off-site provision to improve their behaviour”.

At the point where a school has sought outside advice from local authority support teams,  and community support services, have used guidance from the ‘EBSA Toolkit’ by implementing strategies to re-engage the pupil and this has not brought about a positive change, a referral to the WSCC Fair Access Team should be made. This is the first step in having alternative provision considered by the local authority.

The LA’s Duties to provide alternative provision

A recent Ombudsman case highlighted the importance of a council liaising with its local health trust in relation to identifying children and young people’s needs. The report stated:

“as soon as a parent, or a school, raises questions and informs the council that there may be medical reasons for a pupil’s non-attendance, it is good practice for the council, normally with the parents’ consent, to seek information from the local health trust”.

The report findings went on to say:

“Councils can take action against parents, and should do so, where there is no reason not to send their child to school.  But, in cases where there are legitimate reasons, it is important that the council, once aware that a child is out of school, considers its responsibility to ensure a child receives education.

The council can ask schools to make alternative provision, while a child is unable to attend. But failing that, the law is clear that, where a school does not make appropriate arrangements for a child who is missing education through illness, the council must intervene and make such arrangements itself”.

The Ombudsman accepts that not all school refusers will be entitled to ‘alternative provision’ as set out in the Education Act 1996, Section 19. Each case will depend on the facts.

What Alternative provision is offered in West Sussex

The WSCC Fair Access Team manages the requests for alternative provision from schools for pupils who are deemed to be medically unfit* to attend school.

*please see guidance in the ‘Law & Guidance’ section regarding medical evidence required.

Alternative Provision College

The West Sussex Alternative Provision Colleges provide education to those pupils who have been permanently excluded from school and those who cannot attend their own schools for medical reasons that mean they are too physically or emotionally unwell to attend. These settings provide appropriate primary and secondary learning provision for a range of vulnerable and challenging students, to the equivalent of 292 full time places for children and young people across West Sussex.

Blended Learning

The Blended Learning team provides a ‘blend’ of learning opportunities to young people unable to
access mainstream school due to health needs. Blended Learning mentors are allocated pupils and support the structure and learning for the week, which can be a mix of face to face and online education.

Alternative Provision ‘offer’ in West Sussex See link here for details of these and other alternative provision options in West Sussex –

Fines and Prosecution for low / non attendance

A parent cannot be penalised if a statutory exception applies. These exceptions are: where the school has given permission; where the pupil is prevented from attending by sickness or other unavoidable problems; where their family is marking a day reserved exclusively for religious observance; or where the local authority has failed to fulfil any duty it has to help them get to school.

It is for schools or the local authorities to decide if they wish to use a penalty notice as a sanction.

Penalty notices are governed by the Education (Penalty Notices) (England) Regulations 2007 as amended. The regulations require every local authority, in consultation with their schools and the police, to draw up a code of conduct for issuing penalty notices.

It is for local authorities to decide whether to prosecute a parent having taken account of all the circumstances of the case and the information submitted by the school. Local authority officers are best placed to assess the family’s circumstances and decide upon the most appropriate course of action.

We would encourage parents to work with their child’s school and their local authority, to discuss the reasons behind their child’s absence and agree an action plan so that the right support can be put in place to help their child to return to regular and consistent education, whether at school or otherwise.

In West Sussex it is the Pupil Entitlement team who investigate such situations and therefore we advise you to contact them should you have received notification of a fine or prosecution. You will have chance to explain they situation including what you have tried to do.

The DfE published some helpful guidance in Feb 2023: Summary of responsibilities where a mental health issue is affecting attendance (  It is particularly worth noting Page 14.

What if my Child or Young person has an EHC plan?

Even where a child or young person’s health needs are already stated in the EHC plan, if there has been a significant change then an Interim or emergency Review should be requested. Significant changes may be (but not restricted to):

  • Struggling to attend school full time
  • Sudden or increased fixed term exclusions
  • Sudden or Increased anxiety / meltdowns / mood swings
  • lethargy / extreme tiredness
  • Increase in existing symptoms
  • Decrease in self esteem

This will give you and any professionals involved with your child’s needs opportunity to discuss the current provision. It may be that not all the needs or provisions are being met, or it may be that amendments to the plan are needed. It will be especially important that any health and social care professionals are invited to participate.

Once the meeting has occurred, all the paperwork and amendment requests are sent to the LA. If you do not agree with any of their decisions then you will have the right to mediation or appeal. However, due to the timeframe of these, if a solution can be found without this, then that is going to be beneficial longer term. See our Annual Review page for more information.

For more information about the specific areas, click on the following below:

Physical Health