Troubled children given House room

21st February 1997 at 00:00
Pupils' mental health problems are becoming harder to contain, reports Nicholas Pyke. Whether you call it bad behaviour or "psychosocial disorder", schools believe there is more of it around, and they can point to plenty of classroom evidence. Children, they say, are more disruptive and less well socialised than in the past.

A rising proportion of pupils, moreover, are so disturbed that they cannot be contained; increasing numbers are thrown out of school - "permanently excluded" - as a consequence. Until the late 1980s it was rare for children under 10 to be expelled, yet recent figures from the University of Portsmouth suggest that in the past year alone some 1,500 primary children have been judged too disruptive to be in class.

The common-sense view that today's children are indeed more troubled received powerful support in 1995 when Professor Sir Michael Rutter and Professor David Smith published the most authoritative study so far. They found that psychosocial disorders - suicide, eating disorders, crime - had risen across nearly the whole of Western society.

It is against this gloomy backcloth that the House of Commons Select Committee on health has turned its attention to children's mental health services. Its report is due out soon.

Not everything is as uniformly black as the newspaper reports might suggest. Much of it is grey: the evidence is difficult to collect and harder still to analyse. Rutter and Smith were, for example, frustratingly unable to pick out any actual causes behind the disorder they identified. The development of isolated teen culture, rising expectations of life, and a breakdown in community were all cited as probable factors; TV violence was not. Our increasing awareness of mental health, leading to a willingness to look for problems, is a further complication.

There are some positive notes to be struck. In fact, on this issue the Government agencies have a comparatively liberal record. Recent publications have been praised by professionals in the field. These include the "six-pack" series of education circulars for dealing with troubled children; and Together we Stand, the Department of Health's "multi-agency" blueprint for child mental health, promising co-operation between health, social services and education.

But whatever the select committee finally puts in its report, the majority of its witnesses were certain of two things: that, whether increasing or not, mental health problems are a matter of urgency; and that the sort of response made by the statutory authorities, schools included, makes a massive difference to the life chances of the individuals involved.

In fact one of the most striking things was the extent to which schools were thought to be central in identifying and helping troubled young people. Yet there were few education professionals called as witnesses, and the committee investigation has attracted little interest from the educational press.

And central or not, schools are struggling. Even though the paperwork attempts to break down departmental barriers, in practice, co-operation is the very thing that is missing. Driven by ever-tighter financial margins, services such as education are attempting to shuffle off the responsibility and the cost - until, all too frequently, the adolescents end up in the arms of the Home Office.

Dr Richard Williams, a health service adviser, found no examples at all of successful collaboration. On the contrary, he told the MPs, there was "incontrovertible evidence that most of these cross-agency services are under enormous pressure".

According to Dr Stephen Scott from the Institute of Psychiatry: "There are a lot of central directives saying you must have lots of inter-agency co-operation. Next week we will hear of educational social workers being cut and withdrawn.

"We have had to reduce our referral pattern by only accepting them through GPs because of the overload. We get into quite a lot of fights.

"There is a lot of cold-shouldering going on at the moment, lack of agreement about where the boundaries are." Even the Government departments were attacked for their insular attitude.

The current mechanisms for dealing with the most vulnerable children in society are, on this evidence, woefully inadequate. The British Psychological Society, for example, told the MPs that only a small proportion of children with significant problems - between one in five and one in three is getting specialist professional help. The greater burden is carried by teachers and GPs.

There is a national shortage of clinical psychologists. According to Dr Williams there are some areas of the country where children are waiting from six months to one year before a first referral.

Schools, meanwhile, now seem to be less capable than they once were of coping. Increasingly they are measured on easily quantifiable criteria paying little or no regard to the quality of relationships the schools maintain - relationships which in this context are crucial.

Dr Peter Hindley from St George's Hospital in south London told the committee that schools no longer had time to concentrate on the vulnerable: "In many ways the directions from the Department for Education and Employment make it very difficult for teachers to take on these sorts of responsibilities. I know of many teachers in secondary schools who would be very keen to undertake preventive work, but the pressures of the national curriculum are such that they are unable to do it."

And while the education system is very much more aware of vulnerable children, in practice it has found itself unwilling to fund the sort of therapeutic schooling that had once been available. A network of local authority schools dedicated to looking after some of the most troubled students is now near collapse. The private sector system of therapeutic schools is also under severe financial pressure - as the closure of the internationally renowned Peper Harow school in Surrey in 1993 indicates.

This is partly a reflection of the current distrust of isolated institutions: the stories of abuse in children's homes are partly responsible. But it is also a reflection of the enormous cost - therapeutic education for a single child could easily cost the local education authority Pounds 100,000 or more.

The 10-strong Charterhouse Group of private-sector therapeutic schools has lost five members in the past five years. All of them had specialised in adolescents referred through education, health or, in particular, social services which in most parts of the country have faced massive cuts.

It is an unfortunate fact that progressive attitudes are expensive. And public spending has not been in step. "It's approaching a scandal how inadequate the resources are," said Peter Wilson, the director of the children's mental health charity, Young Minds. "While we're becoming more aware of children's mental health, we're not matching that greater awareness with additional resources. "

While the Government is committed to spending millions on secure accommodation for young offenders, children's mental health, he said, is run on a shoestring.

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