Comment Blog 31 January, 2019

Mental health support teams in schools: The way towards whole-system transformation?

Recent years have seen a turning point in the mental health policy agenda, with the government committing to achieving ‘parity of esteem’ between mental and physical health, addressing the chronic underfunding faced by the sector and developing cross-government strategies to implement a fresh vision for service transformation.

Improving mental health services for children and young people is at the core of these ambitions, with the Department for Education (DfE) and the Department of Health and Social Care (DHSC) jointly publishing a Green Paper in 2017, pledging to transform the quality and access to these services. The Green Paper positions the education system at the forefront of new proposals which include, amongst others, £215 million to pilot a programme to deliver mental health prevention and support within schools and colleges.  As of this year, 25 ‘trailblazer’ regions will start testing this new approach, which will include Mental Health Support Teams (MHSTs) working closely with schools to design interventions for pupils experiencing mild and moderate mental health conditions.

Building mental health prevention expertise into the school system could pave the way towards more responsive and personalised care models, improved ways of working and, ultimately, better outcomes for pupils. However, a whole-systems transformation will not happen overnight. The NHS has already warned in its Long Term Plan that it would take up to “a decade” for these teams to reach all the schools around the country, with the DHSC confirming that pilots would initially cover only 5.8 per cent of children and young people in England. Whilst Secretary of State for Health and Social Care, Matt Hancock has claimed that “this is not a pilot that has an end date'', without a clear pathway to a national roll-out and appropriate investment and resources, MHSTs will remain in the realm of ideas rather than becoming meaningful solutions.

It is important that the government ensures that the phased introduction of MHSTs does not contribute to a post-code lottery and add further complexity to what the Care Quality Commission (CQC) has dubbed as a ‘fragmented’ system. It is estimated that 70 per cent of secondary schools and 52 per cent of primary schools in England already provide some form of mental health counselling, however the availability of the services provided is patchy and there is considerable variation in quality. MHSTs could offer an opportunity to test and evidence what good quality interventions look like, whilst also reducing pressure on already overstretched NHS Child and Adolescent Mental Health Services (CAMHS). For this to happen MHSTs will need to complement the work already happening in these areas, rather than be slotted into existing structures.

There are also questions about what this means for schools outside the pilot programme. The government should evaluate making further provision available, for instance through DfE’s counselling at schools programme as well as continuing to embed mental health education in schools. Finally, a well-resourced and capable workforce will be crucial, especially as school nurse numbers have reduced by 19 per cent since 2010 and the number of NHS psychiatrics treating children and young people in England reached a second all-time lowest last July.

It will take time for MHSTs to deliver the step-change needed in children and young people’s mental health services. However, if trialed, implemented and scaled-up correctly (and at pace) MHSTs could begin to bridge some of the accessibility and quality gaps currently facing the system.