Teams set up provide early help for pupils’ mental health issues face a “moral dilemma” on whether to support youngsters with more severe needs, experts warned MPs. Mental health support teams (MHST) were an early intervention project launched under the previous government, aimed at helping pupils with mild to moderate mental health issues. But Jo Ellins, professor at the University of Birmingham who is evaluating MHSTs, told a joint health and social care and education committee inquiry there’s “something of a moral dilemma” about whether teams help the “missing middle”. These are youngsters whose needs are too severe for MHST support but don’t meet the higher thresholds for children and adolescent mental health services (CAMHS). A report last year found about 4 per cent of MHST staff said they always accepted referrals for outside of their “mild to moderate” scope, while 28 per cent said “often” and 45 per cent said “sometimes”. ‘We don’t want to be mini CAMHS’ Ellins, a health services researcher, said this was done on an “ad-hoc basis” and there were questions about “how are they making that decision within that group” of youngsters. While the teams have flexibility to help these children, one team member told them “we don’t want to become a mini CAMHS” with risks of cutbacks to preventative work. Ellins said the dilemma was “do we hold to that original mild to moderate remit which is what our frontline workforce is trained for and where we feel we can maybe have the greatest impact” or do “we stretch to cover, because we know that group that’s often referred to as the missing middle, often doesn’t access support elsewhere, there simply aren’t services for them. “It creates a real moral dilemma as to how to respond to that.” She called for detailed research to understand the “missing middle’s” needs, to decide what support they need. The British Association for Counselling and Psychotherapy’s estimate of 730,000 pupils a year facing this gap may be “conservative”, she added. Schools in ‘insidious position’ Morgan Flack, policy officer at the NAHT school leaders’ union, said a lack of support for these children leaves schools in “an in insidious position where they are then trying to work out how do we effectively support these pupils when we are not mental health professionals and aren’t actually able to support them in that particular way”. The government revealed last week it met its target of 60 per cent of pupils in schools and colleges being covered by a mental health support team by April this year. It said it was on track to hit its target of all schools having access by December 2029. But the data showed how the expected number of newly commissioned health teams this year has dropped to 73, from above 100 in previous years. Claire Evans, deputy chief executive at Anna Freud mental health charity, said there was a problem between “what’s happening in policy and what’s happening on the ground”. She said many areas are not taking on trainee education mental health practitioners (EMHPs) who staff the teams because they are worried about “having the funding to keep them in place”. ‘Huge turmoil’ “We know there’s been huge turmoil, huge change in integrated care boards, we know within services that recruitment is frozen and cuts are being made across the board whether that’s third sector, local authority, NHS services. “So you’ve got the commissioned numbers, and then the money that’s not necessarily ring fenced on the ground. So even though trainees are salary supported for the first year, there’s not necessarily any money to keep them post-qualification. “The rollout should be accelerating but on the ground it’s a very different story.” Jess Mundy, research fellow at the London School of Hygiene and Tropical Medicine, said 63 per cent of MHST respondents found it had been difficult to fill the vacant EMHP roles. There is also retention issues, MPs heard, as there is little career progress for EMHPs and some viewed the training as “very different to the reality of doing the job”. de Souza’s worries Last week Rachel de Souza, children’s commissioner, told the committees she was “slightly worried that the new SEND legislation puts mental health outside of it. “That is a worry to me, so we are saying mental health will not be part of how we do SEND. “Not because that’s the wrong thing to do, but because we have such limited capacity in schools and other places that I’m worried that’s going to impact on children getting the help they need and it’ll become a bit ‘Cinderella’.” Under the current SEND code of practice, social, emotional and mental health is one of the “broad areas of need”. But under the government’s reforms, mental health will not factor into five new proposed “areas of development”. In its SEND consultation, the Department for Education said the proposed change would bring mental health “in line” with the other areas of development “which do not lend themselves to specific clinical intervention”. The DfE’s reforms state many children in mainstream schools will at some point need mental health support. As a result, the reforms set out what all schools should do to support youngsters, whether or not they also have identified SEND. Clinical medical interventions are “likely” to play a significant role in some of the new propose specialist provision packages. But schools will continue to have an “ongoing, important role to play” in early support and prevention of poor mental health. Unique identifier on ‘too hard pile’ The government plans to introduce a single unique identifier number, to help link children’s data across services. The DfE is currently piloting this. But de Souza questioned “why it’s going so slow” and urged government to “get a move on” with joined up data. “It often goes into the too hard pile, it’s cross government, so that’s difficult. I haven’t seen enough ambition for it in children’s social care, I am worried it’s more race to the bottom.” She said there is “a risk aversion, sometimes, in Westminster and particularly in my own department, that’s like ‘oh, what about the data sharing problems’ or going straight to the most difficult case”. de Souza got “fed up waiting” and is working in Greater Manchester to pilot a model that could be adopted nationwide. Senior mental health leads Under the 2018 green paper commitments, the Conservatives also ran a four-year grant window for schools and colleges to apply for senior mental health lead training cash. It closed in December 2024 with 76 per cent of eligible settings having claimed the grant. Flack told MPs that members “really valued” the training and the CPD landscape can be “a bit challenging”, with many providers offering different quality training. “So our members have made it clear to us that they would appreciate it if the government has identified a particular training need, that then should be fully funded.”