When schoolchildren are suffering from bereavement or family problems, who can they turn to in school? And if they approach their teacher or school nurse, how helpful is the response? A project being launched this month will aim to help children suffering from problems that could affect their mental health. Schools are in the front line, say organisers of the programme, which aims to advise school nurses and teachers.
The Quest (Quality Improvement Evaluation for School Nurses and Teachers) project, led by the Institute of Psychiatry at King's College London and the mental-health charity Rethink, and funded by a £416,000 grant from the Health Foundation, has already completed a pilot project in one primary care trust and secondary school, and is now launching the main trial of training and resources, mainly for school nurses but also for teachers, pupils, parents and carers.
The facts are frightening, says Rethink: between 10% and 20% of children and young people have a mental-health problem, and some have severe mental illnesses. "Many emotional disorders and mental-health problems start in adolescence," says Dr Mark Haddad, clinical research fellow at the Institute of Psychiatry and project coordinator. "They can lead to higher rates of social exclusion and lower educational achievement, as well as issues with substance abuse and smoking," he says. Mental-health issues in children are also a factor for suicide risk. Yet there is a low take-up of mental-health services among this age group, Haddad points out, even though around half of the people in their mid-20s with mental-health problems had already met the criteria for the disorders by their mid-teens.
The need is huge, confirms Christine Blower, acting general secretary at the National Union of Teachers. "As the Unicef survey last year showed, children in the UK are among the unhappiest in the world. Unhappy children are more likely to be stressed, which can lead to emotional and mental-health problems.
"Teachers need ongoing continuing professional development to help identify difficulties. In particular, though, they need easy and speedy access to support systems. And they need to be able to work easily with other children's services to help remedy the problems."
From this month, Quest is being rolled out across 13 London primary care trusts, with a view to setting up training for school nurses, and developing materials for families and teachers which the Institute of Psychiatry team believes will help to tackle mental-health issues nationwide.
Will teachers and school nurses be able to cope? "Mental-health problems can be quite complex, so need to be dealt with by professionals who have had specialist training," says Dr Mary Bousted, general secretary of the Association of Teachers and Lecturers. "We would want local authority specialist social and health services to be involved with any pupils who have mental-health problems, rather than the onus being put on school nurses."
An ATL survey found that 73% of teachers who responded believed that children were under more pressure than a decade ago. Yet just 18% of teachers believed that local services to support children were sufficiently joined up.
Highlighting the problems
School nurses, meanwhile, have been working with Quest to develop mental-health resources that can be used nationally. "We are seeing more young people with emotional problems, so we are keen to highlight the issues," says Veronique Black, school nurse at Sutton and Merton PCT in Surrey, who worked on the pilot project with fellow school nurse Belinda Shear. "We would like to see school nurses who are competent and confident about working with mental-health problems, and know when to refer," says Shear.
Many schoolchildren, Quest believes, find it easier to approach school nurses than other school staff with problems such as bereavement and self-harm. Peer support is also vital. The project will help school nurses to develop support networks, and raise awareness among teachers.
Yet overcoming young people's reluctance to seek help is crucial. "It is likely that stigma plays a significant part because young people may feel uncertain, embarrassed or ashamed of their problems," says Haddad. "To overcome that requires particular skills."
Spotting mental-health problems early enough to help young people reach effective treatment could improve the mental health of a whole generation, says the team. "Practitioners on the front line are key," says Haddad. "We are confident that by working with school nurses, we can make a huge difference."