It is well-documented that there is a rising mental health crisis among young people.

The extent of this issue was underlined by a 2021 survey by NHS Providers, in which 100 per cent of mental health trust leaders said that the demand their trusts were experiencing for children and young people (CYP) services had increased in the previous six months - with 80 per cent saying the increase had been “significant”.

Furthermore, almost two-thirds (65 per cent) of trust leaders said they were not able to meet demand for inpatient children and adult mental health services (Camhs), with one trust CEO saying that they had seen a 72 per cent increase over the usual level of Camhs referrals.

It’s shocking data and no doubt many teachers will have seen this issue first-hand - and been involved in the referrals to Camhs.

Keeping education going

However, while any such referral to Camhs is chiefly about providing the necessary medical support that a child requires, a large effort is also made to maintain as much education for these children while they are unable to attend their own school.

Indeed, even when a child is registered to a Camhs hospital, they also remain on-roll with their home school or college in a dual registration arrangement, with the aim that they will return once they are discharged.

Furthermore, to help maintain as consistent an education as possible when a young person arrives, one of our first duties is to establish their education up to that point and to make it clear how we will support them going forward.

This involves speaking to their school or college and their parents or carers to find out their current study programme, their academic levels and attainment, any special educational needs, strategies that work well for engaging them, their previous attendance record and any safeguarding issues that we need to be aware of.

We also speak to the young person as quickly as possible when they arrive.

Building relationships

The sooner we see the child, the easier it is to build a positive relationship. Once we know about their likes and dislikes and how they like to be supported, we can start to establish trust and really make a breakthrough as early as possible.

Specialist subject teachers will then use diagnostic assessments to identify specific areas for development - this ensures we aren’t making assumptions about what they know.

It is often the case that our students have not attended school consistently for a period of time owing to the impact of their mental health conditions. They will have gaps in subject knowledge that need to be addressed before moving on to the next stage of learning.

All of this comes together in a detailed individual education plan (IEP), which is very bespoke to each learner.

This level of personalisation helps prevent them from falling behind with their education during admission, as this would create more stress for them. Ultimately, we want to prepare them to go back into their community and be successful.

Close collaboration 

To help with this, progress on their IEP is regularly fed back to the wider multi-disciplinary team (MDT) of doctors, nurses, psychologists, occupational therapists, support workers and school staff who work together to make decisions that are in the best interests of each young person.

This allows them to see what progress is being made or any issues that may have come to light and adjust the IEP accordingly. This can sometimes mean adopting an entirely different approach for those who are acutely unwell if the first IEP put in place wasn’t appropriate.

The actual act of teaching is of course different to mainstream settings - lessons start at 10am, for example - and part of our curriculum is aimed at improving mental health functioning in education (MHFE).

This can mean that some of the educational activities we use have the aim of also developing communication (with adults/peers), concentration, motivation and hope for the future.

This might include educational board games with someone who is anxious around peers,  introduced in a graded fashion - starting with the requirement only to sit opposite a peer, and extending to higher-order, collaborative challenges.

Reusable checklists, problem-solving cards and resilience strategies are provided to help students stick with independent tasks such as reading.

Focusing teaching to help their health 

Organisation and planning tools, very short-term targets, links to a bigger picture/careers and recovery through activity strategies are used alongside accreditations linked to interests - such as Koestler Trust entries, AQA unit pathways, arts awards and Stem activities.

We try to focus on mental health within our PSHE program, too. For example, with nutrition, we will talk about foods that boost mental health. With first aid, we tend to focus on handling minor injuries because of the prevalence of self-harm among the young people in our care.

The flexible nature of our curriculum helps accommodate changeable mental health presentations and means young people who are judged to be high risk can still participate.

Sometimes, students are taught on a one-to-one basis on the wards because of their individual health needs, or where their level of risk prevents access to the school environment.

It is the job of our school staff to make sure that we pitch the work at the right level - not too easy or not too hard - and make support available should the students need it. We want to give them the support they need to be challenged and to be successful.

Close contact with schools

Throughout all this, we keep in regular contact with schools and colleges, invite them to review meetings and send half-termly progress reports.

These engagements are often productive, although the level of understanding from community school teachers and pastoral staff around how hospital schools work, and an appreciation of the high expectations we have for our students to make progress (despite their health difficulties), remains unclear.

Furthermore, we have a major focus on attendance as an important outcome measure for tier 4 hospital schools as we need to prepare students for attending their community school after they have been discharged.

We have the highest expectations for this, although we must make informed judgements on wellness, and co-working with the multi-disciplinary team (MDT) is essential.

Policy issues that need addressing

Currently, though, this is not helped by the lack of national benchmarks for attendance in tier 4 hospital schools as current national averages for special schools don’t account for the changeable nature of mental health conditions.

Furthermore, because our young people are often being cared for in a secure environment, our schools must contribute to the provision of “least-restrictive practice” in their care. This is the provision of care that does not restrict individual liberty but rather maximises a young person’s independence and recovery.

We must make sure our schools are inclusive to even the most unwell student, in terms of access to teachers and equipment (in a safe manner, of course), opportunities to experience visits or outside speakers, or anything else that peers in the community may have access to.

It can be challenging to achieve this balance, but daily risk assessments made each morning allow professionals to make decisions based on individuals rather than groups. 

This all has an impact on being inspected, too. Being regulated by Ofsted in these settings is a different experience because the uniqueness often means an inspector won’t have experienced a school of this type before.

As such, it is vital to factor in opportunities for the inspection team to see the whole provision and speak to the young people to get a sense of context and what we are trying to achieve.

The deep-dive methods used as part of the new framework can also be demanding to implement because of scale and the impact of questioning on the young person, which has to be carried out sensitively.

Unintentionally, this can go too far. In order to find out students’ views on the value a school adds, you have to discuss starting points and challenges, but this can be tough for some students to recount.

A possible solution would be for Ofsted to employ a specialist in this sector to advise inspectors and improve awareness among them.

Why education is so important 

Ultimately, education provides young people with a sense of normality and routine. When you are in a hospital, participation in community-associated activities can provide comfort through familiarity.

It can be so rewarding when you see a young person slowly start to engage and have fun when initially they were reluctant. It’s an important part of their journey, going through their work and seeing what they’ve achieved, in what has been quite a difficult time for them.

Teaching is a rewarding job and it’s a real privilege to work in this setting.

Ed Hall is head of education at Cygnet Health Care, overseeing hospital school provision for young people accessing their tier 4 Camhs