Exclusion and Mental Health. Professor Harry Daniels Fellow of Green Templeton College Department of Education University of Oxford

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1 Exclusion and Mental Health Professor Harry Daniels Fellow of Green Templeton College Department of Education University of Oxford

2 BBC News Today Mental health services in England are "a car crash" and the health secretary is not taking the problems seriously, according to the outgoing president of the Royal College of Psychiatrists. Prof Sue Bailey told BBC News mental health services were "in crisis". She said Health Secretary Jeremy Hunt had a basic understanding of mental health, but had not made it a priority.

3 Mental health services cuts 'affecting children By Jeremy Cooke BBC News 20 th June 2014 Young Minds submitted a Freedom of Information request about funding of child and adolescent mental health services for and the previous four financial years. It had responses from 99 out of the 151 councils it contacted. More than half had made cuts over the last five years, while nine councils had kept funding at the same level. The biggest reduction was at Birmingham City Council, from just above 2.3m in to 125,000 in , a drop of 94%

4 Young Minds Survey results Over half of children and young people believe they will be a failure if they don t get good grades Over half of year olds have viewed online pornography with four out of ten of these saying it has affected their relationships with others of their age Half of children and young people have been bullied Four out of ten year olds skip meals to stay thin One third of children and young people don t know where to turn to get help when they feel depressed or anxious. N = 2000

5 Mental health inequalities: Measuring what counts Just as there is no health without mental health, there is no equality without mental health equality. There is sufficient demonstrable proof that the interaction between good or poor mental health and a range of health and social outcomes is profound. Sainsbury Centre for Mental Health (2010)

6 Unicef Innocenti Report (2007), The true measure of a nation s standing is how well it attends to its children their health and safety, their material security, their education and socialization, and their sense of being loved, valued, and included in the families and societies into which they are born.

7 Dimensions of child well-being used by UNICEF Material well-being Health and safety Educational well-being Family and peer relationships Behaviours and risks Subjective well-being

8 UNICEF INNOCENTI 7 and 9 Card 7: The United Kingdom and the United States find themselves in the bottom third of the rankings for five of the six dimensions reviewed. Report card 9 shows slight improvement in UK but very similar trends

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10 Exclusion: numbers total number of children excluded from school decreased between (to approximately 5% of the total school population), the proportion of excluded children with special educational needs (SEN) increased (from 61% in 2001/02 to 73% in 2011/12) (Department for Education, 2013).

11 Parents and the exclusion process The decision made by a school to exclude a child does not necessarily mean the support will be available; parents are often left unsure of where the responsibility and ownership of the exclusion lie. Parker, and Ford (2013) Editorial Perspective: School exclusion is a mental health issue Journal of Child Psychology and Psychiatry 54:12 pp

12 Is support for SEN adequate Pupils with a statement of special educational needs (SEN) are around eight times more likely to receive a permanent exclusion than those pupils with no SEN Pupils with SEN without statements are around eleven times more likely to receive a permanent exclusion than pupils with no SEN DfE 2013 Approx 75 % of those excluded with SEN are designated SEBD Is lack of adequate support particularly the case for low SES and some minority groups?? Shirley, E., & Cornell, D. (2011). The contribution of student perceptions of school climate to understanding the disproportionate punishment of African American students in a middle school. School Psychology International, 33(2),

13 risk factors for adolescent mental health problems Youth who are from poorer backgrounds, Black and ethnic minority groups, Experiencing familial discord (Green et al., 2005 Parents have mental health problems (British Medical Association, (2006), In the care of the state (Meltzer et al., 2003) British Medical Association (2006) Child and Adolescent Mental Health: A Guide for Professionals. London: BMA. Green, H., et al. (2005) Mental Health of Children and Young People in Great Britain, Newport: Officefor National Statistics. Meltzer, et al (2003) The Mental Health of Young People Looked After by Local Authorities in England. Newport: Office for National Statistics.

14 Key Data on Adolescence 2013 Mental health

15 Key Data on Adolescence 2013 Mental health

16 mental health problems in children intensify over time being excluded from school worsens educational (and other) prospects for the child mental health problems in children persist into and/or recur in adulthood Anxiety disorders affect 10% of children by the age of 16 They significantly impair everyday functioning, persist into adulthood and increase the risk of other psychiatric disorders in adolescence and young adulthood Educational failure has been identified as one of the five pathways to poverty in a report carried out by the Centre for Social Justice (Centre for Social Justice, 2007) Low education and literacy levels are associated with poverty and social exclusion which, in turn, are associated with mental health issues (Weare, 2007).

17 School exclusion more likely for children who have a psychiatric disorder or impairing psychopathology?? Two recent systematic reviews of the literature, Exclusion among children and young people with clinically impairing psychopathology The prevalence of clinically impairing psychopathology among children who had been excluded from school no one has explored this relationship as a primary research question Parker, and Ford (2013) Editorial Perspective: School exclusion is a mental health issue Journal of Child Psychology and Psychiatry 54:12 pp

18 Services only a minority (one-sixth to one third) of children with an impairing psychological problem are in contact with mental health services whether provided from inside the school or from external services Ford, T., Hamilton, H., Meltzer, H., & Goodman, R. (2007). Child mental health is everybody s business: The prevalence of contacts with public sectors services by the types of disorder among British school children in a three-year period. Child and Adolescent Mental Health, 12,

19 being excluded reduces the likelihood that children will access mental health support or specialist educational services Vincent, K., Harris, B., Thomson, P., & Toalster, R. (2007). Managed moves: Schools collaborating for collective gain. Emotional and Behavioural Difficulties, 12(4),

20 Paucity of literature Particular burden on teachers, education professionals, and schools Given the difficulty accessing further mental health services - Education with mental health professionals)- a role in identifying the mental health needs of children within their school, (mental health needs assessment, particularly in cases of ongoing behavioural/disciplinary difficulties) Early identification -> effective support in the classroom to help teachers and others A holistic approach to supporting children with their parents Support for young people vulnerable to depression may also reduce exclusion. School absence could be a useful indicator for further assessment of that child s mental health Tamsin Ford, Jo Thompson-Coon and Ken Stein Rebecca Whear, Ruth Marlow, Kate Boddy, Obioha C. Ukoumunne, Claire Parker, Psychiatric disorder or impairing psychology in children who have been excluded from school: A systematic review School Psychology International published online 23 December 2013

21 Children s Commissioner, 2012 Where a child with SEN is at risk of being permanently excluded from school, the school should be required to make a proposal for exclusion which should trigger a review of the child s statement.

22 Anxiety prevention in schools: a cluster randomised controlled trial of a universally delivered cognitive behaviour therapy programme (FRIENDS) Stallard et al A universal (whole class) anxiety prevention programmes delivered in schools to 10/11 year old children do reduce anxiety symptoms. low symptom children benefited from the programme fits well with school timetables and organisational structures results suggest that the same programme can result in different effects depending upon who delivers it.

23 Methodological problems difficulties surrounding definitions and terminology purpose, meaning and use of the exclusion from school varies country to country but also school to school. ethos, policies and their role in exclusion is not always feasible, but must be considered and acknowledged

24 Ford et al 2013 little attempt to manage those children differently with much psychopathological impairment continuing to go unidentified and unsupported. The evidence in this review suggests a potential association between being excluded, suspended, or expelled from school and having psychiatric disorders (such as depression or ADHD) or clinically impairing psychopathology.

25 Where to intervene? Improvements in child wellbeing in rich societies will depend more on reductions in inequality than on further economic growth.