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The real crisis in mental health is a lack of training on how to help

Painful questions need to be asked in light of research revealing more pupils are experiencing mental health problems and increased awareness of how the adolescent brain works

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Is there a mental health crisis among our children? Study after study has pointed to an increasing incidence and has been met with handwringing or outright dismissal.

Thanks to an enormous research project by NHS Digital, the headline results of which were released last week, we now know that we do not have an epidemic (bit.ly/RiseProblems). But we do have evidence that more children are experiencing mental health issues than in 1999 or 2004. On average, three pupils in a class of 24 will be struggling.

Plus, we have a huge dataset that should help to inform schools – and, arguably more importantly, government – about where resources should be targeted and what questions we should be asking.

Of course, the biggest question is whether schools are the right places to triage – and provide much of the support for – mental health problems. Schools were “the most common service” contacted within the previous year about mental health, yet training in this incredibly complex area is minimal.

Plans to have a trained mental health professional in every school indicate the government now thinks this is something that they should be responsible for. But the skillset to do that job is not in place, so how are schools expected to cope in the meantime? Are children going to be left to suffer while the policy stuff gets sorted? And considering the diversity of problems, is a single expert going to be enough?

Plus, of course, little will change without improved access to child and adolescent mental health services.

Another big question is whether we need to look closely at the ages when mental health diagnoses peak. According to Tamsin Ford, a researcher on the NHS Digital project, boys “were more likely to be diagnosed with ADHD, ASC and behavioural disorders, which were more common among preschool and primary-age children”. Girls, however, “were more likely to be identified with emotional and eating disorders, which increased significantly in adolescence” (see pages 22-27). What factors could be influencing this? How can we unpick them?

Then what about behaviour? Ford says that exclusions were more frequently reported if the child had a mental health condition and were most common among those with hyperactivity or conduct disorder. Do we know enough about how mental health problems impact on behaviour? And when these children are excluded, are they getting the appropriate support? If not, is exclusion really the right approach?

Early intervention is the obvious – and economically sensible – answer, but it is very difficult to achieve. In mental health, the evidence suggests it may be impossible to spot a problem before it becomes manifest. But happily, neuroscientist Sarah-Jayne Blakemore’s lab is trying to understand the predictive factors.

What we do already know, though, is that functions that engage “the prefrontal cortex – like planning and decision-making, and thinking about the consequences of actions – all these behaviours and the brain regions they rely on are undergoing a very protracted, slow and substantial change in adolescence”, Blakemore says.

But as soon as a child looks more like an adult, we expect them to do all their own planning, to make decisions – and to make the right decisions. We tend to overestimate teenagers, she explains in this week’s Tes Podagogy podcast (search for “Tes news” on your podcasting platform).

Blakemore adds: “Of course, teenagers’ brains are much more developed than young children’s brains, but they are still not fully adult yet. We need to remember that.”

Indeed we do. In the light of this research and the NHS Digital survey, there are many painful questions we need to ask about the way we run our schools, both locally and at policy level. Are the things we’re doing serving the needs of children? If not, then why aren’t we doing something to change them?

@AnnMroz