The mental health crisis calls for urgent policy solutions

Andrew Howard describes the desperate state of SEMH support – but argues the solutions are already here for determined policy makers to fix it

Andrew Howard describes the desperate state of SEMH support – but argues the solutions are already here for determined policy makers to fix it

8 Oct 2023, 5:00

Imagine being told you are lazy, stupid, loud, clumsy, or any other number of other negative attributes 20,000 times by your twelfth birthday. For the average young person with ADHD, this is how many times more they are likely to have heard such comments than their non-ADHD peers by that tender age.

And young people with ADHD are just one of the groups included in the relatively new SEND subset we refer to as SEMH (social, emotional and/or mental health), which replaced the term EBD (emotional and behavioural difficulties) in the 2014 SEND code of practice.

This was the first step in recognising the complexities of emotional and behavioural dysregulation. Dropping the word ‘behaviour’ from the label was a deliberate attempt to emphasise their needs and to move away from labelling some settings as ‘naughty childrens’ schools’ or even ‘sink schools’.

Unfortunately, we have not come far enough on this journey. Many of those with a ‘diagnosis’ of SEMH needs go through the education system following a well-worn path of challenging behaviour, not fitting in, uncertainty and failure. We still do not fully recognise the impact on young people of trauma, emotional neglect, abuse, or indeed of deprivation and poverty.

Children are being failed every day

The problem is still writ large in our schools. As a mainstream headteacher, I lost count of the number of times I heard ‘it’s outside the school gate, so it’s not my problem’. But ask any family who has adopted a neglected nine-month-old who arches their back when you hug them because they don’t know what else to do; they will tell you how deep emotional damage goes, and they will be clear that yes, it is our problem too.

Moreover, it is a grave, growing and urgent one. SEMH needs are now the second largest category of SEND behind speech and language needs. In 2021/22, over 250,000 young people were identified with an SEMH need. Unfortunately, it is often the challenging behaviours that end up with a young person getting the help and diagnosis they need.

It is also a problem riddled with inequity. Only 12 per cent of 4-year-olds with SEND are identified as SEMH, rising to 21 per cent of 14-year-olds with SEND, proving that the link between behaviour and SEMH persists. Nationally, approximately 80 per cent of all young people with an SEMH diagnosis are male. The challenging behaviour from male students will get them moved through the system, whereas female students with SEMH needs tend to exhibit in less challenging ways, being held within the mainstream sector. There are also huge disparities in SEMH diagnosis within BAME communities.

Meanwhile, we have not only an attendance crisis but some 116,000 young people who are ‘electively’ home educated, and the term ‘emotionally-based school avoidance’ (EBSA) is growing in currency.

In short, every day young people with SEMH needs are being failed by mainstream settings in the name of comprehensive, inclusive education. Settings that specialise in supporting them are not ‘behaviour schools’, where naughty boys are sent to be contained until they become old enough to be passed onto the criminal justice sector. They are experts in their specialism, around which local collaboration should be constructed.

What better looks like

As executive head for a trust overseeing SEMH provision for over 200 young people aged 4 to 19 across eastern Manchester, I know we are some of the few adults in their lives who totally believe in a large number of our pupils.

And that belief is founded in fact. In nationally recognised baseline assessments, the vast majority of our students fall within the ‘normal’ range for their age; they are more than capable of achieving academic qualifications and progressing to university and beyond. It is their experiences in the past, including gaps in their education, that hold them back.

Our curriculum is aspirational, and it is truly broad, unlike many in the mainstream sector. We support life skills and employability, putting vocational destinations front and centre.

Our environments are genuinely inclusive, with soft furnishings and small tables to work around. For students can’t access even these spaces, we have ‘satellite’ centres at the local cricket club and sports centre and we are converting a local office building into a nurture base. For those who can’t meet us there either, we offer fully online learning with live lessons designed to be sensitive and supportive of neurodivergent needs and delivered by specialist teachers.

Our staff is highly skilled, including social workers and other adults who have worked in supporting adult mental health initiatives locally and nationally.

And our offer is for 48 weeks, with staff providing activities, food and a safe place to be throughout most of the ‘holidays’ too. Because no one else will meet the needs of young people who are effectively homeless or who don’t know where their next meal is coming if we don’t. I recently posted a plea on LinkedIn for a wardrobe and a sofa bed for a couple of our families in desperate need. I received loads of reposts and ‘likes’ but no offers of practical support.

‘Things frequently go wrong’

This is a mark of how impoverished our economy is, and it isn’t just individuals and families who lack finances. Stretched local authorities are doing their best, but dwindling finances and growing demands mean things frequently go wrong.

Our trust’s schools are now full and bursting at the seams, all well beyond the capacity they were designed for. Sadly, it isn’t always with the young people we are best-placed to support. Mis-diagnosis is rife, especially in SEMH.

A young person exhibiting challenging behaviours in their mainstream setting will frequently get a blanket diagnosis of SEMH. Little or no time is taken to understand the reasons behind the behaviour. Behaviour equals SEMH, the thinking goes, and so young people are placed in the wrong setting, given the wrong support and traumatised all over again.

Even when a setting recognises this (as we do) and says no, LAs often have no choice to place anyway because there’s nowhere else for the young person to go.

And those are young people who are lucky enough to get any support at all. Many of them and their families are left far too long to get a diagnosis and/or the documentation they need to unlock any help.

It’s clear that we need much better early intervention and assessment. And the good news is that we could have it if LAs worked with us to set it up. We have the knowledge, and working collaboratively we can build the resource to deliver much better support.

Children and adolescent mental health services (CAMHS) are stretched beyond breaking point, leaving too many young people unidentified and unsupported. A well planned and thought-out assessment and intervention centre in partnership between the LA, education specialists and third-sector health professionals could transform this.

At the other end, young people aged 18 or 19 are cast adrift. Education ends, health services reset and social services pull away. If they’re lucky, young people in the care system are given a one-bed flat and a couple thousand pounds to kit it out, but very little support. Here too, a collaborative approach with education, employability and health professionals working together could be transformative. And here again, our settings can provide the evidence of their ability and potential, as well as advise on how best to support their continuing social and emotional needs. Too many of our students are simply written off despite the amazing progress they make with us.

We simply can’t afford to allow this status quo to continue. We’ve come some way from the ‘naughty children’s school’ mindset, but neither our economy nor our society can continue to fail so many. Whatever other education policies are on offer as conference season comes to a close and the race to the next election begins, the mental health crisis and its solutions must be at the top of political parties’ priorities.

One thing is certain: The SEND and AP improvement plan doesn’t even come close to what is required.

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