1. Promoting mental health- The role of the school governor
Dr Simon Munk,
CYP Mental health and resilience Strategic lead, LBN
Associate, Evidence Based Practice Unit, Anna Freud Centre

2. Prevalence of Mental health disorder
Half of all lifetime cases of mental health start in childhood or adolescence.
National prevalence: 1/10 young people have a clinical mental health disorder
In 2015 a survey of 869 Newham schoolchildren found 5% showed signs of having a significant emotional disorder – including depression, anxiety, self harm and eating disorders.
6% showed signs of having a clinically significant behaviour disorder including ADHD and conduct disorder.
Nationally the proportion of 15/16 year olds reporting that they frequently feel anxious or depressed has doubled in the last 30 years, from 1 in 30 to 2 in 30 for boys and 1 in 10 to 2 in 10 for girls.
55% of children who have been bullied later developed depression as adults
Up to 160 young people under the age of 20 die by suicide in England each year, of whom are under 18. Only 14% of suicides aged under 20 have been in contact with specialist mental health services
Young People in gangs:  86% will have conduct problems: 59% will have anxiety disorders: 34% will have attempted suicide: 25% will have psychosis; 30% of female gang members identify as self-harming or at risk of suicide

3. Common mental health disorders in children and young people
Depression
Self-harm Generalised anxiety disorder (GAD) can cause young people to become extremely worried. Very young children or children starting or moving school may have separation anxiety.
Post-traumatic stress disorder (PTSD) can follow physical or sexual abuse, witnessing something extremely frightening of traumatising, being the victim of violence or severe bullying or surviving a disaster.
Children who are consistently overactive ('hyperactive'), behave impulsively and have difficulty paying attention may have attention deficit hyperactivity disorder (ADHD).
Eating disorders usually start in the teenage years and are more common in girls than boys. The number of young people who develop an eating disorder is small, but eating disorders such as anorexia nervosa and bulimia nervosa can have serious consequences for their physical health and development.
Conduct disorder, is diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated

4. Impact of improving mental health on educational outcomes
Pupils with better health and wellbeing are likely to achieve better academically. (PHE 2014)
Effective social and emotional competencies are associated with greater health and wellbeing, and better achievement.
Children with generalised anxiety disorder and those with depression- a quarter had had more than 15 days absence in the previous term.

5. What can a school do to improve mental health outcomes
1) Reduce risk factors for developing mental health disorder 2) Promote resilience in vulnerable students through whole school approaches and targeted resilience interventions. 3) Support young people to access effective specialist support when required

6. Reducing risk factors for developing mental health disorder
World Health Organisation categorises risk factors into 3 key groups:
Social circumstances: like loneliness, bereavement and neglect
Environmental factors: like injustice, discrimination and exposure to trauma
Individual factors: like cognitive/emotional immaturity and medical illness
What can you do to reduce these risk factors in pupils?

7. Promoting resilience in all but particularly vulnerable pupils
Resilience- “Positive adaptation to adversity despite serious threats to adaptation or development’
Often best understood as a set of competencies- rather than one thing. These include:
Positive school connnectedness
Positive connectedness with individuals and activities in community
Positive peer connectedness
Positive home and family connectedness
Autonomy
Positive self esteem
Empathy
Problem solving skills
Aspiration

8. How to promote resilience in the school
Whole school approaches
Universal vs targeted approaches
Targeted interventions, including in schools, the community and online

9. Whole school approaches
Promotion of mental health is embedded in all the school's policies and procedures.
Pupil voice
School ethos
Staff wellbeing
Connectedness with home life and community
Behaviour policies
Bullying
PSHE and promotion of resilience across curriculum
Identification of vulnerability and when to refer for specialist support
Partnership working with specialist services
Use of enrichment activities
CPD for school staff

10. Targeted interventions for students with emerging difficulties
Bought in or provided by school?
Effectiveness?
Examples- mentoring, creative and sports activities, social action projects
Counselling
Support for parents

11. HeadStart Targeted Resilience Building Activities
HeadStart Champions Opportunity for young people to be trained as HeadStart Champions and support the development of their school’s resilience strategy Open to Year 5-11 pupils from HeadStart schools
Supported Volunteering As a group, young people identify a social action project and are supported to co-develop and complete this over an academic term. Regular 1:1s allow reflection on learning Open to Year 8-9 pupils from HeadStart schools
More than Mentors Locally developed evidence based peer mentoring model. Peer mentors are trained, supervised and accredited to 1:1 mentor younger pupils weekly over a term Open to Year 7-8 or Year 10 pupils from HeadStart schools
HeadStart Targeted Resilience Building Activities
Creative and Sports Activities Menu of group sporting and creative activity courses in the community including drama, slam poetry, film making and creative writing. Activities focus on building confidence and developing skills. Open to Year 5-11 from any Newham school
Peer Parenting Courses Peer led parenting courses offering workshops and 8 week parenting courses focusing on positive parenting, boundary setting, behaviour management and parental peer support Open to parents of any young person who could benefit from HeadStart
Academic Resilience Training Expert training delivered to staff groups to build your organisation’s confidence in identifying vulnerable young people, building their resilience and making recommendations to HeadStart. Open to agencies interested in recommending young people and parents to HeadStart
Bounce Back Newham Evidence based resilience behaviour change workbook (online and offline versions). Offline, young people are supported over 5 to 8 sessions. Online version is open to all and designed for self-use Open to Year 6 pupils from HeadStart schools

12. Scrutinising effectiveness
Evaluation of whole school approaches
Priority for school?
Pre and post monitoring for any school interventions involving validated metrics
Analysis of who accesses support
Analysis of waiting times

13. Approaches to identification of need
Based on observed symptoms and behaviour
Based on risk factor data
Based on screening tools

14. How schools can support young people with more severe mental disorder
Schools can play a key role in identifying young people who need specialist help and supporting them to engage with these services
They also play a key role in supporting young people currently under specialist care to stay in education where possible and supporting their recovery.
Joint partnership working with specialist mental health services

15. Improving access to specialist mental health support
National evidence that young people and their families do not always engage with specialist mental health services for a number of reasons. Lack of engagement results in non attendance at clinic appointments. Reasons for this include:
Have to wait too long to be seen
Uncomfortable seeing a mental health specialist (stigmatising- especially in some communities)
Clinic seen as “uncomfortable setting”

16. Improving access to specialist CAMHS in Newham
CAMHS Telephone consultation nudges families to attend clinic appointments and ensures more effective triaging of referrals.
CAMHS link workers based in schools
Increasing focus on seeing young people in schools and the community rather than in the clinic is aiming to improve access.
Enhancing the skills of teachers, social workers and youth workers to provide early support as well as training student and parent peers aims to further improve access.
New funding is ensuring that CAMHS has increased capacity to support more young people. Includes a new East London community specialist eating disorder service.

17. Proactive support for vulnerable young people
Many young people with emerging or more significant mental health disorders are well known to other services such as social services or youth offending team
Newham has model whereby CAMHS practitioners form part of these teams- they support the team members in their work with the young people and families through training and case support.
They also provide direct 1-1 clinical interventions out in the community.
This helps to engage these vulnerable young people who often would not otherwise engage with CAMHS.

18. Who benefits from specialist CAMHS support
Increasingly sophisticated evidence for what specialist mental health interventions work with whom in which circumstances
Vital to involve pupils and families in decisions about their care
Average require 6-7 CAMHS sessions. (e.g. for depression and anxiety)
However significant minority (approx 5%) require significantly more specialist support (average 30 sessions)- e.g. for eating disorders and psychosis.
Note significant minority of young people will not be “recovered” at the end of even the best evidence-based treatments.