A new report highlighting pupils’ difficulties in accessing specialist mental health support suggests teachers’ misunderstanding of mental health could be driving an increase in exclusions.

The report by the Education Policy Institute (EPI) think tank, published today, suggests that teachers’ inability to recognise the symptoms of conduct disorder (CD) could be behind the rising number of school exclusions.

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The Royal College of Psychiatrists defines CD as a condition characterised by “repetitive and persistent patterns of disruptive and aggressive behaviour which affect development and the child’s ability to lead a normal life”.

Children with the disorder manifest their distress outwardly, with aggression, bullying, rule-breaking and deception among the behaviours that are symptomatic of the condition.

Mental health warning

But the EPI report notes that “because of how CD symptoms manifest, children and young people with the disorder may be seen by parents, teachers and even GPs as wilfully disobedient - and their need for mental health treatment may not be recognised”.

The report states that CD remains “one of the least widely recognised or studied mental health disorders”.

“Arguably, this is reflected in the disproportionately high number of official and unofficial school exclusions amongst low-income young people and those in social care for reasons to do with ‘persistent disruptive behaviour’,” the report says.

Mary Bousted, NEU teaching union joint general secretary, said that in the absence of a “coherent national programme of CPD” it was “no good blaming teachers for what they haven’t been told”.

She said NEU-run professional development classes on how to assist pupils with SEND were consistently fully booked because there was such a lack of CPD provision for teachers.

“The whole basis of being in school classrooms is a teacher with 30 pupils and one child’s conduct disorder could be 29 other children’s disruptive behaviour,” Dr Bousted added.

 “But it’s not surprising to me that some children will be behaving badly because they are distressed or worried, not for the fun of it but because they have a personality disorder or a mental health illness. Those children are not being seen and schools are being left to get on with it really.

“If there were proper support for these children in terms of Camhs, speech and language therapy, SEND training, there would be fewer exclusions and less off-rolling.”

CD is strongly linked with difficult experiences in early childhood, including maternal smoking during pregnancy and maternal depression. Some experts have suggested adverse experiences in infancy or neglect could have a negative impact on brain development, leading to poorly regulated responses to stress.

This can lead to children overreacting to triggers and finding it difficult to calm down - alternatively, the report states that they may become disassociated, appearing to be “switched off” and behaving in ways that may seem “puzzling or threatening to others”.

CD is one of the most common mental health issues experienced by children and young people, according to the report, with around 7 per cent of boys and 3 per cent of girls aged between 5 and 10 across England suffering from the disorder, according to a 2017 survey.

Yet findings from a Millennium Cohort Survey covering a nationally representative cohort of children born around the year 2000 suggest the real prevalence of CD may be much higher.

The report also suggests that there may be a long wait before targeted mental health support is available in schools.

“Meanwhile the outlook is not positive in terms of extending provision to the children in need of it,” the report says.

“The government’s existing plans for rolling out improvements to mental health provision - including a (voluntary) dedicated mental health lead in all schools, local mental health teams supporting schools and colleges, and a four-week waiting time standard - will not reach the majority of children for several years.”

The research also found that more than a quarter - 26 per cent - of children and young people referred to child and adolescent mental health services (Camhs) were rejected for treatment in 2019.