Let’s take a look at who has responsibility to offer Mental Health support to children and young people and what that support could and should look like.
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)?
- Have there been difficult events recently or in the past that may be resulting in child/young person’s anxiety, feeling unsafe, and/or feeling the need to stay near a care giver (e.g family bereavement, domestic violence in home, health issues of a parent, etc)?
- As well as keeping in close communication with the school, what other actions can I/we take?
This following advice is taken from an article by Dr Lucy Russell, a Clinical Psychologist who has a website www.theyarethefuture.co.uk 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:
Read her post about anxiety, to 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).
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.
Firstly, your child needs to be helped and “skilled up”. They need 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” .
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.
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.
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.
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?
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.
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.
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.
Summary
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.
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?
- Learning Mentor support (via the school).
- 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 ‘Thought-Full’ 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.
- 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 (sussexcamhs.nhs.uk). 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.
Plans
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 (www.nhs.uk). 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.
Consider Pastoral Care
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.
School Nursing Services
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.
Multi Professional Support
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.
– DfE Summary of responsibilities where a mental health issue is affecting attendance (February 2023).
In some ways, the support suggested for EBSA can be the same for all mental health issues:
- 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.
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.
Leadership
- 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.
If a child or young person is not able to attend school, despite all the strategies, interventions and specialist input involved, then as we have seen above, the LA become 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.