The requester sought specific statistics on adolescent mental health referrals and waiting times for ages 11-18 on the Isle of Man, along with details on school-based interventions. The authority responded by sending a 139-page manual outlining the framework for Mental Health Support Teams in education, rather than providing the specific numerical data requested.
Key Facts
The request was made on 2025-01-02 and the outcome was 'All information sent' on 2025-01-24.
The response consisted of 5 documents totaling 139 pages.
The primary document provided is a manual titled 'Mental Health Support Teams for Children and Young People in Education'.
The manual details the operating principles, core functions, and workforce models for MHSTs.
The response does not appear to contain the specific annual referral statistics or waiting time data requested in the initial query.
Data Disclosed
2025-01-02
2025-01-24
139
5
11-18
Original Request
I would like to request the following information related to adolescent mental health on the Isle of man specifically for ages 11-18:
1- Statistics on adolescent mental health
- The number of adolescents referred to CAMHS in the last 5 years, broken down annually
- How many of these referrals related to anxiety symptoms
- Average waiting times for CAMHS referrals over the same period
- The number of adolescents referred to CAMHS but declined / signposted to another service in the last 5 years, broken down annually, and the reasons for not meeting the criteria
- How many referrals were signposted to Tier 2 services in the last 5 years, broken down annually
- Details on the types of Tier 2 services available and any date on their outcomes and effectiveness, if available
2- Mental health support in schools
- Current availability of mental health support services in schools
- Any existing programmes or initiatives that integrate health professionals into school settings
This information will be used solely for academic purposes as part of my dissertation on improving mental health support for adolescents within the school environment.
Data Tables (77)
Term
Definition
Child in Need
(subject to a Child
in Need plan,
Child Protection
plan, or are a
Looked After
Child)
Child in Need is a broad definition spanning a wide range of children
and adolescents, in need of varying types of support and intervention,
for a variety of reasons. A child is defined as ‘in need’ under section 17
of the Children Act 1989, where:
• They are unlikely to achieve or maintain, or to have the
opportunity of achieving or maintaining, a reasonable standard
of health or development without the provision for them of
services by a local authority
• Their health or development is likely to be significantly impaired,
or further impaired, without the provision for them of such
services; or
• They are disabled
The overall group of Children in Need of help and protection is made
up of children who are designated under a number of different social
care classifications: children on a Child in Need Plan; children on a
Child Protection Plan; and Looked After Children.
Clinical
Commissioning
Group
A health organisation responsible for implementing the commissioning
roles as set out in the Health and Social Care Act 2012.
The funding to plan for, set up and run Mental Health Support Teams
has been provided to specific CCGs by NHS England. CCGs are also
expected to provide strategic governance and oversight of MHSTs, and
work with a range of local partners to guide implementation.
Complexity
Reflects different requirements for services that people with mental
health problems have; people may move through different levels of
complexity as their needs change (from less complex to more
complex). Complexity can be affected by the interaction between
biological, psychological, social and environmental factors.
Less complex problems may reflect situations where a person may
have a diagnosed mental health problem, but they function very well
and require limited help and support in managing their condition.
More complex problems may include a comorbid mental health or
physical health problem, or current social difficulties, and may require
more intensive input or support from a multidisciplinary mental health
team.
Developing or
emerging need or
problem
An initial problem or need with which a child or young person presents,
but which may be at risk of developing into a diagnosable condition and
which would benefit from intervention and support.
Disadvantage
Often used in the context of education initiatives, it relates to a
condition or situation that means that children with certain backgrounds
or experiences tend to achieve worse outcomes than their peers.
The term ‘disadvantaged pupils’ is often used to describe those who
come from low-income families and are eligible for free school meals.
However, it can also include a broader set of pupils beyond just those
who are economically disadvantaged, including those who have
needed a social worker, those with SEND and other factors such as
where children live, their ethnicity and their home environment.
Education, health
and care plan
(EHCP)
A plan detailing the education, health and care support that is to be
provided to a child or young person who has a SEND. It is drawn up by
the local authority after an education, health and care needs
assessment of the child or young person, in consultation with relevant
partner agencies, parents and the child or young person themselves.
Education Mental
Health Practitioner
(EMHP)
The core workforce for the Mental Health Support Teams. They are
new and specifically trained to provide:
• Evidence-based interventions for mild-to-moderate mental health
and emotional wellbeing issues
• Support to the senior mental health lead in each school or college
to introduce or develop their whole setting approach
• Timely advice to staff in schools and colleges, and liaison with
external specialist services, to help children and young people to
get the right support and stay in education
Education setting1
Includes primary, secondary and all-through schools, Further
Education and 6th Form colleges, special schools, alternative
provision, pupil referral units, virtual schools, home education and
hospital schools.
Education setting
MHST coordinator
or school/college
MHST
coordinator*
*please note that
this term may
change
The senior point of contact in a school or college for liaising with Mental
Health Support Teams (MHSTs). This is primarily a logistical and
collaborative role, involving planning for MHST implementation and
managing interactions with statutory roles, and may or may not be
performed by the senior mental health lead.
Please note that this role was previously referred to as ‘senior point of
contact’ and has been changed to avoid confusion with the single point
of contact referred to in the Link Programme training.
Evidence-based
interventions
EMHPs will intervene based on evidence of what works best for
children, young people, and their parents and carers. For example,
brief, low-intensity interventions for those experiencing anxiety, low
mood, friendship difficulties and behavioural difficulties. They will also
carry out group work, such as cognitive behavioural therapy for
children and young people with conditions such as anxiety; or classes
for parents on issues such as conduct disorder or communication
difficulties.
Health inequalities
and equality
Health inequalities are the avoidable differences in people’s health
status including outcomes across a population or between groups and
individuals.
The Department for Health and Social Care, NHS England and Clinical
Commissioning Groups have legal duties to have regard to the need to
reduce health inequalities through delivery of services. These duties
translate to the need to try and ensure that no person’s chance of
enjoying good health and a longer life is determined by the social and
economic conditions in which they are born, grow, work, live and age.
All public sector bodies are covered by the Public Sector Equality Duty;
to give due regard to the need to eliminate discrimination, harassment
and victimisation, to advance equality of opportunity, and to foster good
relations between people who share a relevant protected characteristic
(as cited under the Equality Act 2010) and those who do not share it;
and foster good relations between people.
Mental Health
Support Team
(MHST)
MHSTs are a new service designed to support mental health in schools
and colleges. They are largely comprised of Education Mental Health
Practitioners (EMHPs), supervised by senior clinicians and higher-level
therapists.
MHSTs may also involve a range of other professionals, including for
example Family Resilience Workers, Youth Workers and Peer Support
Educators.
MHST
school/college or
MHST education
setting
A school or college receiving support from an MHST.
MHST site
The area within which the MHST has been set up (referred to as
trailblazers for the 2018-19 phase). Normally this is the patch covered
by the Clinical Commissioning Group(s) funded by NHS England to
plan for, set up and run each MHST. Each MHST will support a number
of education settings within the site.
Mild to moderate
mental health
issue
A range of mental health needs that may be less complex or may be
managed by time-limited interventions. For example, children and
young people who demonstrate anxiety, low mood and behavioural
difficulties which do not meet the diagnostic threshold for specialist
clinical support.
A mild mental health issue is when a person has a small number of
symptoms that have a limited effect on their daily life.
A moderate mental health issue is when a person has more symptoms
that can make their daily life much more difficult than usual.
A severe mental health issue is when a person has many symptoms
that can make their daily life extremely difficult.
A person may experience different levels at different times.
NHS Children and
Young People’s
Mental Health
Services
Specialist services funded by the NHS, provided either by an NHS
Trust / Foundation Trust or an independent sector provider.
Formerly (and often still colloquially) known as CAMHS: Child and
Adolescent Mental Health Services. The formal name used nationally
was changed in response to feedback from young people.
Senior mental
health lead in a
school or college
Most schools and colleges have a mental health lead. Each school or
college will be able to send a member of staff, who is either on or has
the support of the senior leadership team, on free-of-charge training to
support them in developing a whole-school/college approach to mental
health. This role may or may not be performed by the MHST
coordinator.
Please note that this role was previously referred to as ‘Designated
Senior Lead’ and has been changed to avoid confusion with the
Designated Safeguarding Lead.
Senior mental
health lead
training
The training referred to above which will equip senior mental health
leads to establish or develop their whole-school or whole-college
approach to mental health and provide strategic oversight of it.
Single point of
contact for
CYPMHS/ Link
Programme Lead
The senior member of staff in a school or college who attends the Link
Programme workshops and, beyond the training, is the liaison between
the school/college and children and young people’s mental health
services. It will be for schools and colleges to determine whether the
Link Programme Lead also carries out the roles of the MHST
coordinator and senior mental health lead or not.
Support network
A generic term to encompass any member of a child or young person’s
family, care system or extended professional network who acts as a
source of support to the child or young person over the course of their
presentation to mental health services, or within the community. This
may include a parent, foster carer, sibling, close friend or other
community advocate.
Trailblazer, or
trailblazer site
An MHST site from the first wave in 2018-19. These were the first
places in the country to develop and introduce MHSTs in partnership
with local stakeholders.
Whole-
school/college
approach to
mental health
A holistic approach to mental health in schools and colleges that goes
beyond the teaching in the classroom. This will be reflected in, for
example, the design of the school or college’s policies, values and
ethos, curriculum, pastoral support, how staff are supported with their
own wellbeing, and partnerships with families and the community.
More information is available in Public Health England’s guidance for
headteachers and college principals on promoting emotional health
and wellbeing: https://www.gov.uk/government/publications/promoting-
children-and-young-peoples-emotional-health-and-wellbeing
There should be clear and appropriate local governance involving health and education
The MHST project board/oversight group should include representatives from health and
education backgrounds working collaboratively. As a minimum, governance should include
representation from the leadership of local NHS funded mental health care providers, education
leaders from MHST education settings, commissioners, Local Authorities, children and young
people, families and carers. Governance could also helpfully include representation from
voluntary, community and social enterprise organisations (VCSE), Public Health England,
school and college heads or principals, and/or governors and representatives from the wider
education sector. Governance arrangements should have clear feedback and escalation
processes in place.
MHSTs should be additional to and integrated with existing support
MHSTs are trained to deliver specific mental health support to children and young people and
to support schools and colleges. The team’s contribution should always be considered
additional and complementary to existing support available in education settings and the wider
community. The MHSTs should work with the mental health support that is already provided
by existing professionals, such as school or college-based counsellors, educational
psychologists, school nurses, pastoral care, educational welfare officers, voluntary, community
and social enterprise organisations, local authority provision, primary care and NHS Children
Young People Mental Health (CYPMH) services.
The approach to allocating MHST time and resources to education settings should be
transparent and agreed by the local governance board
The allocation of MHST time and resources should be agreed by the governance board, in
partnership with education settings and should be broadly based on pupil and student
numbers. This could be adjusted for disadvantage or inequality or other factors known to
influence prevalence such as age, gender and other demographic indicators if the governance
board agrees there is a case to do so.
MHST support should be responsive to individual education settings needs, not ‘one
size fits all’
MHSTs should work with the senior mental health lead in each education setting to scope and
design - within the skills, capabilities and capacity of the MHST staff - the support offer, gaining
an understanding of the characteristics relevant to the particular setting and needs of their
children and young people.
Children and young people should be able to access appropriate support all year (not
just during term time).
The MHST service provider will ensure that children, young people and their families and carers
who require interventions during educational holidays receive them, where possible from an
MHST. Where this is not possible, the MHST should make the necessary arrangements to
ensure the continuity of treatments where this is clinically indicated. The location of support
given out of term will be determined by the resources available to the MHST.
MHSTs should co-produce their approach and service offer with users
MHSTs approach should be planned, developed and delivered in true partnership with children
and young people, and their families and carers, to adequately reflect the needs of the
individual, their support network, the education setting needs and the wider community.
MHSTs should be delivered in a way to take account of disadvantage and seek to reduce
health inequalities
MHSTs should work to consider ways in which health needs and inequalities are addressed
and that take account of disadvantage. They may need to develop specific protocols for
working with particular groups to achieve this.
“Mental health is like the weather. Some days the sun will shine, and I will remove my coat
and enjoy the warmth. Other days it will be windy, and I may need to wear a scarf. If the
rain pours, I will put up my umbrella. But whatever the weather I seek to continue with my
day, knowing that it is forever changing.”
A young person’s thoughts on mental health
Delivering evidence-based
interventions for children
and young people with mild-
to-moderate mental health
problems (see Section 3.1)
Supporting the senior
mental health lead in each
education setting to
introduce or develop their
whole school/college
approach (see Section 3.2)
Giving timely advice to
school and college staff, and
liaising with external
specialist services, to help
children and young people
to get the right support and
stay in education (see
Section 3.3)
Delivering evidence-based
interventions for children
and young people with mild-
to-moderate mental health
problems (see Section 3.1)
Supporting the senior
mental health lead in each
education setting to
introduce or develop their
whole school/college
approach (see Section 3.2)
Description
Interventions an MHST might provide
NICE
Guidance
reference
Behavioural problems
Persistent challenging behaviour (such
as disobedience or aggression) and/or
behaviour that seriously violates the
rules of an individual’s home or school.
This is much more than ordinary
childish mischief or adolescent
rebelliousness.
● Work with other professionals who know the child
CG158
CG158
(such as an educational psychologist, teacher or
counsellor), adopting a needs-based approach to
differentiate between classroom behaviour and
what may indicate a diagnosable problem
● Link with behaviour policies and processes of the
education setting on behavioural assessments
and interventions
● Offer classroom-based emotional learning and
problem-solving programmes (typically for
children aged between 3 and 7 years)
● Work with families and carers around behaviour
management
● Individual 1:1 Low intensity work with
parents/carers
Conduct disorders
Describes a range of serious
emotional and behavioural problems
● Parent/carer training programmes (individual or
CG158
group)
● Group social and cognitive problem-solving
programmes
● Multimodal therapy (for ages 11-17)
● Liaise with, and signpost to, NHS CYPMH
services for further assessment or interventions
Depression/low mood
● Group non-directive supportive therapy
● Provide advice around exercise, sleep, nutrition
● Individual Cognitive Behavioural Therapy (CBT)
● Group CBT
● Guided self-help
● Digital / computerised CCBT
● Group non-directive supportive therapy
NG134
A mental health problem characterised
● Provide advice around exercise, sleep, nutrition
by pervasive low mood, a loss of
● Individual Cognitive Behavioural Therapy (CBT)
interest and enjoyment in ordinary
● Group CBT
things, and a range of associated
● Guided self-help
emotional, physical and behavioural
● Digital / computerised CCBT
symptoms. Depressive episodes can
vary in severity, from mild to severe.
Behavioural problems
Persistent challenging behaviour (such
as disobedience or aggression) and/or
behaviour that seriously violates the
rules of an individual’s home or school.
This is much more than ordinary
childish mischief or adolescent
rebelliousness.
Conduct disorders
Describes a range of serious
emotional and behavioural problems
● Liaise with, and signpost to, NHS CYPMH
services for moderate to severe depression
Generalised anxiety disorder
● CBT
● Parent led CBT
● Individual guided self-help
● Psychoeducational groups
QS53
An anxiety disorder characterised by
persistent and excessive worry
(apprehensive expectation) about
many different things, and difficulty
controlling that worry. This is often
accompanied by restlessness,
difficulties with concentration,
irritability, muscular tension and
disturbed sleep.
Mixed anxiety and depressive
● Individual non-directive supportive therapy
● Provide advice around exercise, sleep, nutrition
● Individual or group CBT
● Individual guided self-help
● Psychoeducational groups
CG28
QS53
disorder
Characterised by symptoms of
depression and anxiety that are not
intense enough to meet criteria for any
of the conditions described above but
are nevertheless troublesome. The
diagnosis should not be used when an
individual meets the criteria for a
depressive disorder and one or more
of the anxiety disorders above – such
people should be described as being
comorbid for depression and the
relevant anxiety disorder(s).
Self-harm
● Liaise with NHS CYPMH services
● Psychological intervention specifically structured
for people who self-harm – can include CBT,
psychodynamic therapy or problem-solving
elements
CG133
Intentional engagement in behaviours
that inflict injury or damage to one’s
body, such as cutting, burning and
overdosing
Social anxiety disorder (social
● Individual or group CBT; involve parents or carers
to ensure effective delivery of the intervention
CG159
phobia)
Characterised by intense fear of social
or performance situations, resulting in
considerable distress which in turn
impacts on a person’s ability to
function effectively in aspects of their
daily life. Central to the disorder is the
fear that the person will do or say
something that will lead to being
judged negatively by others and being
embarrassed or humiliated. Feared
situations are avoided or endured with
intense distress.
● Liaise with, and signpost to, NHS CYPMH
services for moderate to severe depression
● CBT
● Parent led CBT
● Individual guided self-help
● Psychoeducational groups
● Individual non-directive supportive therapy
● Provide advice around exercise, sleep, nutrition
● Individual or group CBT; involve parents or carers
to ensure effective delivery of the intervention
Young people, parents and carers need to be involved in evaluating and measuring the
performance of the MHSTs. Feedback needs to be used in the right way to ensure people
get the right care.
Young person and carer group
Mental health is everybody’s responsibility. Mental health professionals, teachers and
other staff are all accountable for acting in a caring, kind and compassionate way towards
students with mental health needs.
Young person and carer group
Education setting
coverage
● Each team supports a cluster of approximately 20 education settings
(this may vary depending on geographical area, mental health
prevalence data and size or composition of education settings)
● Population of approximately 7,500 to 8,000 children and young people
● Professionals working across a number of education settings
● Time spent in each setting may vary depending on population size,
needs of the education setting and existing support
Staffing
(approximate
numbers)
● 8 WTEs total (this will vary by locality), of which:
- 4 WTE EMHPs (Band 4 during training and band 5 once qualified)
- 3 WTE senior clinicians (Band 7 and Band 8a manager/supervisor)
- 0.5 WTE team manager
- 0.5 WTE administrative support
Other
considerations (in
addition to core
functions outlined
in section 3)
● How staff manage caseloads over larger geographical areas
● Location of main team hub (for team meetings or supervision) – could
be an education setting, NHS CYPMH service location, or VCSE or
community location
● Travel time between education settings if the MHST is based in a more
rural area
● Centralised contact number (to manage general requests, complaints,
feedback)
● Ensure a diverse staff from a range of backgrounds, who are sensitive
to issues around culture, gender, sexuality, language and religion
● There must be an appropriate physical environment/space provided within
school settings for interventions to be undertaken.
Hours of
To be determined locally
To be determined locally
operation
Cover during
holidays, annual
leave, sick leave
Cover during
● Teams will be expected to ensure children and young people and
holidays, annual
students can access appropriate support all year
leave, sick leave
● Will need to have appropriate cover for annual leave and sick leave
● Consider working agreements for term breaks; whether this would
include home visits, linking with VCSEs, running groups or workshops,
encouraging self-management or online support, or working as usual
● Will need safeguarding processes in place for operating out of term
time and a suitable location (either on or off site)
Education setting
coverage
Staffing
(approximate
numbers)
Other
considerations (in
addition to core
functions outlined
in section 3)
Summary of Key Points
● Local governance structures should be established, linking with existing structures,
to provide operational and strategic governance and service quality assurance.
● There is an expectation that there is a project board/oversight group in place where
there isn’t an existing governance structure.
● The project board/oversight group should include representatives from health and
education, working in collaboration.
● The project board/oversight group should consist of representatives from NHS
CYPMH services, the VCSE sector, the Local Authority(ies), Public Health England,
school and college representatives, commissioners, representatives from already
existing support services within education settings, local councillors and children and
young people, parents and carers.
● There are a number of operational governance processes that should be
implemented and communicated to MHSTs from the beginning of the programme to
ensure the day to day running of MHSTs
Summary of Key Points
● The planning, developing, delivering and evaluating of services should be done in
true partnership with service users, providers and others who may be affected by
the service.
● Children and young people, families, parents and carers should be involved
throughout the development, implementation and evaluation of MHSTs
● MHSTs should promote equality and reduce inequalities by ensuring access to
support for children and young people, families, parents and carers with known
vulnerabilities, at higher risk of developing mental health problems or who may
experience barriers to accessing support
● Information sharing between professionals, children and young people, and their
families, parents or carers should be encouraged in order to provide the best
support, while respecting the principles of confidentiality and the need for
appropriate consent.
● MHSTs should offer flexibility around where they see the child or young person or
their family, parent or carer. Locations away from the education setting should be
available.
● MHSTs should have access to a safe, calm, neutral environment with no stigma
attached, within the education setting in an appropriate alternative.
● As part of the mental health support provide, MHSTs will be expected to provide
support to children and young people, and their families, parents and carers
throughout the year, including educational holidays. If education settings are not
able to provide accommodation to support their work, consideration should be
given to the use of additional accommodation for example community centres,
local libraries and GP surgeries.
Building relationships and developing trust across services, professionals, parents, carers,
and children and young people will take time.
Expert Reference Group
Co-production is an ongoing partnership between people who design, deliver an
d
commission services, people who use the services and people who need them.
Digital resources include:
● Guided self-help online tools or apps to support the child or young person, or their family
or carer
● Mood tracker apps for use in between sessions
● Using a mixture of digital and face-to-face interventions
● Mental Health Services Passport
Summary of Key Points
● Consideration should be given to supporting children and young people who are at
risk of developing mental health problems, or who may experience health
inequalities or disadvantage. MHSTs should support children and young people
throughout, without question.
● The assessment and formulation of need for an individual child or young person
should be carried out by a professional with appropriate skills, competence and
experience.
● Every effort should be made to build on information already gathered to avoid
duplication and so the child or young person does not have to repeat their story.
● The impact of MHSTs should be regularly evaluated to determine how well they
are meeting the needs of different groups of children and young people. MHSTs
may need to develop specific protocols for working with particular groups, including
children and young people who are home educated, to further advance mental
health equality.
Children who are at higher risk of developing mental health problems or
experiencing barriers to accessing support include those:
● with special educational needs, communication
● from a lower socioeconomic background
● who do not have a fixed address
● who may be geographically isolated, or live in
areas where there are fewer resources to
support their mental health and wellbeing
● who are not enrolled in schools or colleges,
who are home educated, have left or are
excluded from formal education, and those not
in training or employment – these people may
be difficult to identify
● who are from Black, Asian and Minority Ethnic
(BAME) communities
● who are asylum seekers or refugees
● who may be a part of travelling communities
● who are in contact with the youth justice system
● from a lower socioeconomic background
difficulties, learning disabilities and behavioural
● who do not have a fixed address
difficulties
● who may be geographically isolated, or live in
● with comorbid neurodevelopmental problems,
areas where there are fewer resources to
or physical health problems
support their mental health and wellbeing
● with drug and alcohol problems or issues such
● who are not enrolled in schools or colleges,
as problem gambling
who are home educated, have left or are
● for whom English is not their first language
excluded from formal education, and those not
● who identify as lesbian, gay or bisexual
in training or employment – these people may
be difficult to identify
● who identify as transgender or non-binary
● who are from Black, Asian and Minority Ethnic
● who may have experienced, or been witness
(BAME) communities
to, abuse, violence, child sexual exploitation or
● who are asylum seekers or refugees
female genital mutilation
● who may be a part of travelling communities
● who may be affiliated with a gang
● who are in contact with the youth justice system
● who are children of military personnel and
those dependent on military personnel
● with caring responsibilities
● who are about to transition to adult services –
these young people are at greater risk of falling
through gaps between services
● who may be in care, are about to leave care,
are on the edge of care, or are on a Child
Protection Plan or a Child in Need Plan
● previously looked-after children e.g. adopted
children
● who are about to transition to adult services –
these young people are at greater risk of falling
through gaps between services
BAME
Black, Asian and Minority Ethnic
CCG
Clinical Commissioning Group
CCQI
College Centre for Quality Improvement
CORC
Child Outcomes Research Consortium
CORE
Centre for Outcomes Research and Effectiveness
CQC
Care Quality Commission
CYPMH
Children and young people’s mental health
DCMS
Department of Digital, Culture, Media and Sport
DHSC
Department of Health and Social Care
EHCP
Education, health and care plan
EIP
Early intervention in psychosis
EMHP
Education mental health practitioner
ESCaSS
Effective, Safe, Compassionate and Sustainable Staffing
IAPT
Improving Access to Psychological Therapies
IT
Information technology
LTP
Local transformation planning
MHSDS
Mental Health Services Data Set
MHST
Mental Health Support Team
NICE
National Institute for Health and Care Excellence
NCCMH
National Collaborating Centre for Mental Health
PSHE
Personal, Social and Health Education
SCIE
Social Care Institute for Excellence
SEAL
Social and Emotional Aspects of Learning
SENDCO
Special educational needs coordinator
SEND
Special educational needs and disabilities
STP
Sustainability and transformation partnership
UCL
University College London
VCSE
Voluntary, community and social enterprise
WTE
Whole time equivalent
January
47
50
34
58
57
68
February
54
45
45
64
73
77
March
72
53
27
70
63
150
April
54
29
36
45
55
127
May
61
33
77
63
62
138
June
38
41
67
51
75
67
July
51
53
47
69
74
114
August
44
41
28
34
32
74
September
36
45
40
69
90
October
61
63
51
56
71
November
53
79
66
82
86
December
39
85
44
67
60
Advice / Information
2
Assessment
123
At Risk / Concern - Child
2
Crisis Intervention Assessment
4
Information Received
2
MARM Meeting Request
3
Mental Health
3,951
Mental Health Act
1
Other
32
Request for Information
1
Therapeutic Approach
8
Total
Referrals
Appointments & Outcomes
Years
0
1
2
3
4
5
No
App
601
2019
404
60
3
3
1
130
Attended
250
32
3
2
1
Cancelled
87
16
DNA
40
3
No Outcome
24
1
130
Telephone
3
9
600
2020
366
109
4
10
111
Cancelled
57
21
DNA
16
17
No Outcome
35
6
4
111
Telephone
10
7
549
2021
313
65
18
2
151
Attended
194
35
7
1
Cancelled
50
12
2
DNA
31
12
1
No Outcome
32
6
8
1
151
Telephone
6
701
2022
260
96
4
341
Attended
137
51
1
Cancelled
24
12
1
DNA
35
8
No Outcome
63
25
2
341
Telephone
1
768
2023
266
10
492
Attended
114
4
Cancelled
20
3
DNA
16
No Outcome
115
3
492
Telephone
1
Grand Total
1609
340
29
12
3
1
1225
Term
Definition
Child in Need
(subject to a Child
in Need plan,
Child Protection
plan, or are a
Looked After
Child)
Child in Need is a broad definition spanning a wide range of children
and adolescents, in need of varying types of support and intervention,
for a variety of reasons. A child is defined as ‘in need’ under section 17
of the Children Act 1989, where:
• They are unlikely to achieve or maintain, or to have the
opportunity of achieving or maintaining, a reasonable standard
of health or development without the provision for them of
services by a local authority
• Their health or development is likely to be significantly impaired,
or further impaired, without the provision for them of such
services; or
• They are disabled
The overall group of Children in Need of help and protection is made
up of children who are designated under a number of different social
care classifications: children on a Child in Need Plan; children on a
Child Protection Plan; and Looked After Children.
Clinical
Commissioning
Group
A health organisation responsible for implementing the commissioning
roles as set out in the Health and Social Care Act 2012.
The funding to plan for, set up and run Mental Health Support Teams
has been provided to specific CCGs by NHS England. CCGs are also
expected to provide strategic governance and oversight of MHSTs, and
work with a range of local partners to guide implementation.
Complexity
Reflects different requirements for services that people with mental
health problems have; people may move through different levels of
complexity as their needs change (from less complex to more
complex). Complexity can be affected by the interaction between
biological, psychological, social and environmental factors.
Less complex problems may reflect situations where a person may
have a diagnosed mental health problem, but they function very well
and require limited help and support in managing their condition.
More complex problems may include a comorbid mental health or
physical health problem, or current social difficulties, and may require
more intensive input or support from a multidisciplinary mental health
team.
Developing or
emerging need or
problem
An initial problem or need with which a child or young person presents,
but which may be at risk of developing into a diagnosable condition and
which would benefit from intervention and support.
Disadvantage
Often used in the context of education initiatives, it relates to a
condition or situation that means that children with certain backgrounds
or experiences tend to achieve worse outcomes than their peers.
The term ‘disadvantaged pupils’ is often used to describe those who
come from low-income families and are eligible for free school meals.
However, it can also include a broader set of pupils beyond just those
who are economically disadvantaged, including those who have
needed a social worker, those with SEND and other factors such as
where children live, their ethnicity and their home environment.
Education, health
and care plan
(EHCP)
A plan detailing the education, health and care support that is to be
provided to a child or young person who has a SEND. It is drawn up by
the local authority after an education, health and care needs
assessment of the child or young person, in consultation with relevant
partner agencies, parents and the child or young person themselves.
Education Mental
Health Practitioner
(EMHP)
The core workforce for the Mental Health Support Teams. They are
new and specifically trained to provide:
• Evidence-based interventions for mild-to-moderate mental health
and emotional wellbeing issues
• Support to the senior mental health lead in each school or college
to introduce or develop their whole setting approach
• Timely advice to staff in schools and colleges, and liaison with
external specialist services, to help children and young people to
get the right support and stay in education
Education setting1
Includes primary, secondary and all-through schools, Further
Education and 6th Form colleges, special schools, alternative
provision, pupil referral units, virtual schools, home education and
hospital schools.
Education setting
MHST coordinator
or school/college
MHST
coordinator*
*please note that
this term may
change
The senior point of contact in a school or college for liaising with Mental
Health Support Teams (MHSTs). This is primarily a logistical and
collaborative role, involving planning for MHST implementation and
managing interactions with statutory roles, and may or may not be
performed by the senior mental health lead.
Please note that this role was previously referred to as ‘senior point of
contact’ and has been changed to avoid confusion with the single point
of contact referred to in the Link Programme training.
Evidence-based
interventions
EMHPs will intervene based on evidence of what works best for
children, young people, and their parents and carers. For example,
brief, low-intensity interventions for those experiencing anxiety, low
mood, friendship difficulties and behavioural difficulties. They will also
carry out group work, such as cognitive behavioural therapy for
children and young people with conditions such as anxiety; or classes
for parents on issues such as conduct disorder or communication
difficulties.
Health inequalities
and equality
Health inequalities are the avoidable differences in people’s health
status including outcomes across a population or between groups and
individuals.
The Department for Health and Social Care, NHS England and Clinical
Commissioning Groups have legal duties to have regard to the need to
reduce health inequalities through delivery of services. These duties
translate to the need to try and ensure that no person’s chance of
enjoying good health and a longer life is determined by the social and
economic conditions in which they are born, grow, work, live and age.
All public sector bodies are covered by the Public Sector Equality Duty;
to give due regard to the need to eliminate discrimination, harassment
and victimisation, to advance equality of opportunity, and to foster good
relations between people who share a relevant protected characteristic
(as cited under the Equality Act 2010) and those who do not share it;
and foster good relations between people.
Mental Health
Support Team
(MHST)
MHSTs are a new service designed to support mental health in schools
and colleges. They are largely comprised of Education Mental Health
Practitioners (EMHPs), supervised by senior clinicians and higher-level
therapists.
MHSTs may also involve a range of other professionals, including for
example Family Resilience Workers, Youth Workers and Peer Support
Educators.
MHST
school/college or
MHST education
setting
A school or college receiving support from an MHST.
MHST site
The area within which the MHST has been set up (referred to as
trailblazers for the 2018-19 phase). Normally this is the patch covered
by the Clinical Commissioning Group(s) funded by NHS England to
plan for, set up and run each MHST. Each MHST will support a number
of education settings within the site.
Mild to moderate
mental health
issue
A range of mental health needs that may be less complex or may be
managed by time-limited interventions. For example, children and
young people who demonstrate anxiety, low mood and behavioural
difficulties which do not meet the diagnostic threshold for specialist
clinical support.
A mild mental health issue is when a person has a small number of
symptoms that have a limited effect on their daily life.
A moderate mental health issue is when a person has more symptoms
that can make their daily life much more difficult than usual.
A severe mental health issue is when a person has many symptoms
that can make their daily life extremely difficult.
A person may experience different levels at different times.
NHS Children and
Young People’s
Mental Health
Services
Specialist services funded by the NHS, provided either by an NHS
Trust / Foundation Trust or an independent sector provider.
Formerly (and often still colloquially) known as CAMHS: Child and
Adolescent Mental Health Services. The formal name used nationally
was changed in response to feedback from young people.
Senior mental
health lead in a
school or college
Most schools and colleges have a mental health lead. Each school or
college will be able to send a member of staff, who is either on or has
the support of the senior leadership team, on free-of-charge training to
support them in developing a whole-school/college approach to mental
health. This role may or may not be performed by the MHST
coordinator.
Please note that this role was previously referred to as ‘Designated
Senior Lead’ and has been changed to avoid confusion with the
Designated Safeguarding Lead.
Senior mental
health lead
training
The training referred to above which will equip senior mental health
leads to establish or develop their whole-school or whole-college
approach to mental health and provide strategic oversight of it.
Single point of
contact for
CYPMHS/ Link
Programme Lead
The senior member of staff in a school or college who attends the Link
Programme workshops and, beyond the training, is the liaison between
the school/college and children and young people’s mental health
services. It will be for schools and colleges to determine whether the
Link Programme Lead also carries out the roles of the MHST
coordinator and senior mental health lead or not.
Support network
A generic term to encompass any member of a child or young person’s
family, care system or extended professional network who acts as a
source of support to the child or young person over the course of their
presentation to mental health services, or within the community. This
may include a parent, foster carer, sibling, close friend or other
community advocate.
Trailblazer, or
trailblazer site
An MHST site from the first wave in 2018-19. These were the first
places in the country to develop and introduce MHSTs in partnership
with local stakeholders.
Whole-
school/college
approach to
mental health
A holistic approach to mental health in schools and colleges that goes
beyond the teaching in the classroom. This will be reflected in, for
example, the design of the school or college’s policies, values and
ethos, curriculum, pastoral support, how staff are supported with their
own wellbeing, and partnerships with families and the community.
More information is available in Public Health England’s guidance for
headteachers and college principals on promoting emotional health
and wellbeing: https://www.gov.uk/government/publications/promoting-
children-and-young-peoples-emotional-health-and-wellbeing
There should be clear and appropriate local governance involving health and education
The MHST project board/oversight group should include representatives from health and
education backgrounds working collaboratively. As a minimum, governance should include
representation from the leadership of local NHS funded mental health care providers, education
leaders from MHST education settings, commissioners, Local Authorities, children and young
people, families and carers. Governance could also helpfully include representation from
voluntary, community and social enterprise organisations (VCSE), Public Health England,
school and college heads or principals, and/or governors and representatives from the wider
education sector. Governance arrangements should have clear feedback and escalation
processes in place.
MHSTs should be additional to and integrated with existing support
MHSTs are trained to deliver specific mental health support to children and young people and
to support schools and colleges. The team’s contribution should always be considered
additional and complementary to existing support available in education settings and the wider
community. The MHSTs should work with the mental health support that is already provided
by existing professionals, such as school or college-based counsellors, educational
psychologists, school nurses, pastoral care, educational welfare officers, voluntary, community
and social enterprise organisations, local authority provision, primary care and NHS Children
Young People Mental Health (CYPMH) services.
The approach to allocating MHST time and resources to education settings should be
transparent and agreed by the local governance board
The allocation of MHST time and resources should be agreed by the governance board, in
partnership with education settings and should be broadly based on pupil and student
numbers. This could be adjusted for disadvantage or inequality or other factors known to
influence prevalence such as age, gender and other demographic indicators if the governance
board agrees there is a case to do so.
MHST support should be responsive to individual education settings needs, not ‘one
size fits all’
MHSTs should work with the senior mental health lead in each education setting to scope and
design - within the skills, capabilities and capacity of the MHST staff - the support offer, gaining
an understanding of the characteristics relevant to the particular setting and needs of their
children and young people.
Children and young people should be able to access appropriate support all year (not
just during term time).
The MHST service provider will ensure that children, young people and their families and carers
who require interventions during educational holidays receive them, where possible from an
MHST. Where this is not possible, the MHST should make the necessary arrangements to
ensure the continuity of treatments where this is clinically indicated. The location of support
given out of term will be determined by the resources available to the MHST.
MHSTs should co-produce their approach and service offer with users
MHSTs approach should be planned, developed and delivered in true partnership with children
and young people, and their families and carers, to adequately reflect the needs of the
individual, their support network, the education setting needs and the wider community.
MHSTs should be delivered in a way to take account of disadvantage and seek to reduce
health inequalities
MHSTs should work to consider ways in which health needs and inequalities are addressed
and that take account of disadvantage. They may need to develop specific protocols for
working with particular groups to achieve this.
“Mental health is like the weather. Some days the sun will shine, and I will remove my coat
and enjoy the warmth. Other days it will be windy, and I may need to wear a scarf. If the
rain pours, I will put up my umbrella. But whatever the weather I seek to continue with my
day, knowing that it is forever changing.”
A young person’s thoughts on mental health
Delivering evidence-based
interventions for children
and young people with mild-
to-moderate mental health
problems (see Section 3.1)
Supporting the senior
mental health lead in each
education setting to
introduce or develop their
whole school/college
approach (see Section 3.2)
Giving timely advice to
school and college staff, and
liaising with external
specialist services, to help
children and young people
to get the right support and
stay in education (see
Section 3.3)
Delivering evidence-based
interventions for children
and young people with mild-
to-moderate mental health
problems (see Section 3.1)
Supporting the senior
mental health lead in each
education setting to
introduce or develop their
whole school/college
approach (see Section 3.2)
Description
Interventions an MHST might provide
NICE
Guidance
reference
Behavioural problems
Persistent challenging behaviour (such
as disobedience or aggression) and/or
behaviour that seriously violates the
rules of an individual’s home or school.
This is much more than ordinary
childish mischief or adolescent
rebelliousness.
● Work with other professionals who know the child
CG158
CG158
(such as an educational psychologist, teacher or
counsellor), adopting a needs-based approach to
differentiate between classroom behaviour and
what may indicate a diagnosable problem
● Link with behaviour policies and processes of the
education setting on behavioural assessments
and interventions
● Offer classroom-based emotional learning and
problem-solving programmes (typically for
children aged between 3 and 7 years)
● Work with families and carers around behaviour
management
● Individual 1:1 Low intensity work with
parents/carers
Conduct disorders
Describes a range of serious
emotional and behavioural problems
● Parent/carer training programmes (individual or
CG158
group)
● Group social and cognitive problem-solving
programmes
● Multimodal therapy (for ages 11-17)
● Liaise with, and signpost to, NHS CYPMH
services for further assessment or interventions
Depression/low mood
● Group non-directive supportive therapy
● Provide advice around exercise, sleep, nutrition
● Individual Cognitive Behavioural Therapy (CBT)
● Group CBT
● Guided self-help
● Digital / computerised CCBT
● Group non-directive supportive therapy
NG134
A mental health problem characterised
● Provide advice around exercise, sleep, nutrition
by pervasive low mood, a loss of
● Individual Cognitive Behavioural Therapy (CBT)
interest and enjoyment in ordinary
● Group CBT
things, and a range of associated
● Guided self-help
emotional, physical and behavioural
● Digital / computerised CCBT
symptoms. Depressive episodes can
vary in severity, from mild to severe.
Behavioural problems
Persistent challenging behaviour (such
as disobedience or aggression) and/or
behaviour that seriously violates the
rules of an individual’s home or school.
This is much more than ordinary
childish mischief or adolescent
rebelliousness.
Conduct disorders
Describes a range of serious
emotional and behavioural problems
● Liaise with, and signpost to, NHS CYPMH
services for moderate to severe depression
Generalised anxiety disorder
● CBT
● Parent led CBT
● Individual guided self-help
● Psychoeducational groups
QS53
An anxiety disorder characterised by
persistent and excessive worry
(apprehensive expectation) about
many different things, and difficulty
controlling that worry. This is often
accompanied by restlessness,
difficulties with concentration,
irritability, muscular tension and
disturbed sleep.
Mixed anxiety and depressive
● Individual non-directive supportive therapy
● Provide advice around exercise, sleep, nutrition
● Individual or group CBT
● Individual guided self-help
● Psychoeducational groups
CG28
QS53
disorder
Characterised by symptoms of
depression and anxiety that are not
intense enough to meet criteria for any
of the conditions described above but
are nevertheless troublesome. The
diagnosis should not be used when an
individual meets the criteria for a
depressive disorder and one or more
of the anxiety disorders above – such
people should be described as being
comorbid for depression and the
relevant anxiety disorder(s).
Self-harm
● Liaise with NHS CYPMH services
● Psychological intervention specifically structured
for people who self-harm – can include CBT,
psychodynamic therapy or problem-solving
elements
CG133
Intentional engagement in behaviours
that inflict injury or damage to one’s
body, such as cutting, burning and
overdosing
Social anxiety disorder (social
● Individual or group CBT; involve parents or carers
to ensure effective delivery of the intervention
CG159
phobia)
Characterised by intense fear of social
or performance situations, resulting in
considerable distress which in turn
impacts on a person’s ability to
function effectively in aspects of their
daily life. Central to the disorder is the
fear that the person will do or say
something that will lead to being
judged negatively by others and being
embarrassed or humiliated. Feared
situations are avoided or endured with
intense distress.
● Liaise with, and signpost to, NHS CYPMH
services for moderate to severe depression
● CBT
● Parent led CBT
● Individual guided self-help
● Psychoeducational groups
● Individual non-directive supportive therapy
● Provide advice around exercise, sleep, nutrition
● Individual or group CBT; involve parents or carers
to ensure effective delivery of the intervention
Young people, parents and carers need to be involved in evaluating and measuring the
performance of the MHSTs. Feedback needs to be used in the right way to ensure people
get the right care.
Young person and carer group
Mental health is everybody’s responsibility. Mental health professionals, teachers and
other staff are all accountable for acting in a caring, kind and compassionate way towards
students with mental health needs.
Young person and carer group
Education setting
coverage
● Each team supports a cluster of approximately 20 education settings
(this may vary depending on geographical area, mental health
prevalence data and size or composition of education settings)
● Population of approximately 7,500 to 8,000 children and young people
● Professionals working across a number of education settings
● Time spent in each setting may vary depending on population size,
needs of the education setting and existing support
Staffing
(approximate
numbers)
● 8 WTEs total (this will vary by locality), of which:
- 4 WTE EMHPs (Band 4 during training and band 5 once qualified)
- 3 WTE senior clinicians (Band 7 and Band 8a manager/supervisor)
- 0.5 WTE team manager
- 0.5 WTE administrative support
Other
considerations (in
addition to core
functions outlined
in section 3)
● How staff manage caseloads over larger geographical areas
● Location of main team hub (for team meetings or supervision) – could
be an education setting, NHS CYPMH service location, or VCSE or
community location
● Travel time between education settings if the MHST is based in a more
rural area
● Centralised contact number (to manage general requests, complaints,
feedback)
● Ensure a diverse staff from a range of backgrounds, who are sensitive
to issues around culture, gender, sexuality, language and religion
● There must be an appropriate physical environment/space provided within
school settings for interventions to be undertaken.
Hours of
To be determined locally
To be determined locally
operation
Cover during
holidays, annual
leave, sick leave
Cover during
● Teams will be expected to ensure children and young people and
holidays, annual
students can access appropriate support all year
leave, sick leave
● Will need to have appropriate cover for annual leave and sick leave
● Consider working agreements for term breaks; whether this would
include home visits, linking with VCSEs, running groups or workshops,
encouraging self-management or online support, or working as usual
● Will need safeguarding processes in place for operating out of term
time and a suitable location (either on or off site)
Education setting
coverage
Staffing
(approximate
numbers)
Other
considerations (in
addition to core
functions outlined
in section 3)
Summary of Key Points
● Local governance structures should be established, linking with existing structures,
to provide operational and strategic governance and service quality assurance.
● There is an expectation that there is a project board/oversight group in place where
there isn’t an existing governance structure.
● The project board/oversight group should include representatives from health and
education, working in collaboration.
● The project board/oversight group should consist of representatives from NHS
CYPMH services, the VCSE sector, the Local Authority(ies), Public Health England,
school and college representatives, commissioners, representatives from already
existing support services within education settings, local councillors and children and
young people, parents and carers.
● There are a number of operational governance processes that should be
implemented and communicated to MHSTs from the beginning of the programme to
ensure the day to day running of MHSTs
Summary of Key Points
● The planning, developing, delivering and evaluating of services should be done in
true partnership with service users, providers and others who may be affected by
the service.
● Children and young people, families, parents and carers should be involved
throughout the development, implementation and evaluation of MHSTs
● MHSTs should promote equality and reduce inequalities by ensuring access to
support for children and young people, families, parents and carers with known
vulnerabilities, at higher risk of developing mental health problems or who may
experience barriers to accessing support
● Information sharing between professionals, children and young people, and their
families, parents or carers should be encouraged in order to provide the best
support, while respecting the principles of confidentiality and the need for
appropriate consent.
● MHSTs should offer flexibility around where they see the child or young person or
their family, parent or carer. Locations away from the education setting should be
available.
● MHSTs should have access to a safe, calm, neutral environment with no stigma
attached, within the education setting in an appropriate alternative.
● As part of the mental health support provide, MHSTs will be expected to provide
support to children and young people, and their families, parents and carers
throughout the year, including educational holidays. If education settings are not
able to provide accommodation to support their work, consideration should be
given to the use of additional accommodation for example community centres,
local libraries and GP surgeries.
Building relationships and developing trust across services, professionals, parents, carers,
and children and young people will take time.
Expert Reference Group
Co-production is an ongoing partnership between people who design, deliver an
d
commission services, people who use the services and people who need them.
Digital resources include:
● Guided self-help online tools or apps to support the child or young person, or their family
or carer
● Mood tracker apps for use in between sessions
● Using a mixture of digital and face-to-face interventions
● Mental Health Services Passport
Summary of Key Points
● Consideration should be given to supporting children and young people who are at
risk of developing mental health problems, or who may experience health
inequalities or disadvantage. MHSTs should support children and young people
throughout, without question.
● The assessment and formulation of need for an individual child or young person
should be carried out by a professional with appropriate skills, competence and
experience.
● Every effort should be made to build on information already gathered to avoid
duplication and so the child or young person does not have to repeat their story.
● The impact of MHSTs should be regularly evaluated to determine how well they
are meeting the needs of different groups of children and young people. MHSTs
may need to develop specific protocols for working with particular groups, including
children and young people who are home educated, to further advance mental
health equality.
Children who are at higher risk of developing mental health problems or
experiencing barriers to accessing support include those:
● with special educational needs, communication
● from a lower socioeconomic background
● who do not have a fixed address
● who may be geographically isolated, or live in
areas where there are fewer resources to
support their mental health and wellbeing
● who are not enrolled in schools or colleges,
who are home educated, have left or are
excluded from formal education, and those not
in training or employment – these people may
be difficult to identify
● who are from Black, Asian and Minority Ethnic
(BAME) communities
● who are asylum seekers or refugees
● who may be a part of travelling communities
● who are in contact with the youth justice system
● from a lower socioeconomic background
difficulties, learning disabilities and behavioural
● who do not have a fixed address
difficulties
● who may be geographically isolated, or live in
● with comorbid neurodevelopmental problems,
areas where there are fewer resources to
or physical health problems
support their mental health and wellbeing
● with drug and alcohol problems or issues such
● who are not enrolled in schools or colleges,
as problem gambling
who are home educated, have left or are
● for whom English is not their first language
excluded from formal education, and those not
● who identify as lesbian, gay or bisexual
in training or employment – these people may
be difficult to identify
● who identify as transgender or non-binary
● who are from Black, Asian and Minority Ethnic
● who may have experienced, or been witness
(BAME) communities
to, abuse, violence, child sexual exploitation or
● who are asylum seekers or refugees
female genital mutilation
● who may be a part of travelling communities
● who may be affiliated with a gang
● who are in contact with the youth justice system
● who are children of military personnel and
those dependent on military personnel
● with caring responsibilities
● who are about to transition to adult services –
these young people are at greater risk of falling
through gaps between services
● who may be in care, are about to leave care,
are on the edge of care, or are on a Child
Protection Plan or a Child in Need Plan
● previously looked-after children e.g. adopted
children
● who are about to transition to adult services –
these young people are at greater risk of falling
through gaps between services
BAME
Black, Asian and Minority Ethnic
CCG
Clinical Commissioning Group
CCQI
College Centre for Quality Improvement
CORC
Child Outcomes Research Consortium
CORE
Centre for Outcomes Research and Effectiveness
CQC
Care Quality Commission
CYPMH
Children and young people’s mental health
DCMS
Department of Digital, Culture, Media and Sport
DHSC
Department of Health and Social Care
EHCP
Education, health and care plan
EIP
Early intervention in psychosis
EMHP
Education mental health practitioner
ESCaSS
Effective, Safe, Compassionate and Sustainable Staffing
IAPT
Improving Access to Psychological Therapies
IT
Information technology
LTP
Local transformation planning
MHSDS
Mental Health Services Data Set
MHST
Mental Health Support Team
NICE
National Institute for Health and Care Excellence
NCCMH
National Collaborating Centre for Mental Health
PSHE
Personal, Social and Health Education
SCIE
Social Care Institute for Excellence
SEAL
Social and Emotional Aspects of Learning
SENDCO
Special educational needs coordinator
SEND
Special educational needs and disabilities
STP
Sustainability and transformation partnership
UCL
University College London
VCSE
Voluntary, community and social enterprise
WTE
Whole time equivalent
Full Response Text
Mental Health Support
Teams for
Children and Young
People in Education
A Manual
2
Mental Health Support Teams for Children and Young People
in Education
A Manual
3
Contents
Foreword
6
Dear Mental Health Support Team – a letter from a young person
7
Glossary
9
Mental Health Support Team (MHST) Operating Principles
13
Purpose of this document
15
1.
Introduction and background
16
1.1
What is a Mental Health Support Team (MHST)?
16
1.2
Background and context
17
1.3
Core functions of Mental Health Support Teams (MHSTs)
17
2.
Working with education to improve mental health
19
2.1
Understanding the school and college landscape
19
2.2 The role of schools and colleges
21
2.3 What is a whole school/college approach?
22
Figure 3. DfE: school/college roles in mental health and wellbeing
24
Leadership and Management
24
Identifying need and monitoring impact
25
Staff development
26
Enabling Student Voice – children and young people involvement in design and approach
27
Working with parents and carers
27
2.4 The Role of Local Authorities and Regional School Commissioners
28
Regional schools commissioners:
29
The role of Ofsted
30
3
Delivering the core functions
31
3.1
Deliver evidence-based interventions for children and young people with mild-to-
moderate mental health problems
31
Identifying and understanding the needs of children, young people, and their families and
carers
33
Further assessment by Mental Health Support Teams (MHSTs)
34
Formulation
35
Components of a good assessment
36
Care plans
36
3.2
Supporting the senior mental health lead in each education setting to introduce,
develop and support in the delivery of their whole school/college approach
37
3.3
Giving timely advice to school and college staff, and liaising with external specialist
services, to help children and young people to get the right support and stay in education
38
4
Monitoring Outcomes and Impact
40
4.1
Data collection
40
4.2
Routine collection of outcomes of evidence based interventions
41
5
Workforce
43
4
5.1
Workforce model
43
Education Mental Health Practitioners (EMHPs)
43
Senior Mental Health Clinicians
Error! Bookmark not defined.
Delivery
43Error! Bookmark not defined.
Plans
44
MHST staff wellbeing
45
5.2
Mental health roles in education settings
45
School/ college MHST coordinator
45
Senior mental health lead
45
5.3
Training
47
Mental Health Support Teams (MHSTs)
47
Training for education professionals
47
Training for pupils, students, parents and carers
47
5.4
Competences
48
5.5
Supervision
48
6
Governance, Accountability and Senior Leadership of the Mental Health Support Teams
(MHSTs)
50
6.1 Governance and Oversight
50
Case Study Examples Governance Structures:
51
Please note this is place marker for additional content providing case study
51
examples of good governance structures.
51
6.2 Operational Governance
51
7
Developing and implementing the Mental Health Support Teams (MHSTs)
52
7.1
Co-production
52
7.1.1
How to ensure genuine co-production
53
7.2
Understanding the needs of the local population and education setting
53
7.3
Accessing Mental Health Support Teams (MHSTs)
54
Location of Mental Health Support Teamss
55
7.4
Information sharing, confidentiality and consent
55
7.5
Safeguarding
56
7.6
Utilising digital resources
56
7.7
Support for transitions
57
8
Addressing disadvantage, inequalities and need
58
8.1
Advancing mental health equality, and narrowing health inequalities and disadvantage
58
8.2
Strategies to proactively advance mental health equality
59
9
Learning from the Trailblazers
60
10
Abbreviations
61
11
How was this document developed?
62
Expert Reference Group members
62
5
Young people and carer reference group
62
NCCMH technical team and national advisers
63
Special advisers
63
Wider stakeholder group
63
12
References
63
6
Foreword
I have been delighted to chair the Expert Reference Group charged with producing this manual.
I would like to thank everyone who has given their time and enthusiasm to the project, with
particular reference to the experts by experience whose pragmatic and honest approach always
makes such a difference. Special thanks also to the technical team at the National Collaborating
Centre for Mental Health (NCCMH) whose tireless attempts to capture the rich and diverse
conversations are truly impressive.
The manual is a small, but important, part of a much bigger programme. It tries to look at the heart
of some of the challenges that multi-agency programmes face and build principles and
frameworks for success.
The worlds of health and education are really very different – the very separate training to date of
professionals in these fields has led to differing approaches to intervention, differing cultures and
often separation by a common language. So, conversations about things like the framing of
interventions for children, and the defining of mild and moderate mental health issues are
challenging but important.
It is also easy for professionals to go into their own comfort zones; for health professionals, this
is often the concentration on individual clinical interventions; for education, it is often a default to
a whole-school/college approach or problem solving for individual children and young people.
And yet for success, to really make a difference to outcomes for children and young people, all of
the elements need to come together, and this has been the task of the manual: to understand
how to speak to both teachers and clinical staff in ways that make sense to them and enable them
to see this area of work as a priority and a key part of how we support children and young people.
We have been really well supported in this by some excellent practitioners and I would want to
pay particular tribute to the work going on in Liverpool and Barnsley. The fact they have taken on
these challenges and can now demonstrate the real difference this makes to children and young
people gave us the real impetus to continue.
This manual is being produced at the very early stages of the work of the trailblazers which are
not yet fully operational, and in future versions we will want to incorporate the learning from this
key practice as it develops.
The really important thing about the manual is its underlying belief that children’s mental health
and wellbeing matters. Working in partnership with education at an early stage can make a real
difference to young people’s outcomes and we can move mental health, for many children and
young people, from clinics into education settings and communities, destigmatise it and promote
positive mental health.
Dame Christine Lenehan
Chair of the Expert Reference Group
Director, Council for Disabled Children
7
Dear Mental Health Support Team – a letter from a young
person
I am currently both scared and confused; my mind is consumed with overwhelming feelings and
emotions, making even the smallest tasks so incredibly difficult. Asking for help is something I
have wanted to do, but until now have felt unable. I've always known that opening up about my
difficulties was the first step towards feeling better, but I don't think even I knew how much courage
it would take. Now I have reached out, there are a few things that you could do to make this
journey a little easier for me.
It took me many weeks to gain the courage to ask for help, and now I would like to be seen as
soon as possible. In many ways, just being able to talk to someone else will help by making me
feel less alone and isolated. Although, I am worried about my friends finding out about me seeing
you, so I would like my appointments to be somewhere I feel comfortable. Having a safe space
where we always meet will make attending so much easier.
My thoughts are like a tangled ball of wool, and my emotions are confusing even to me. I don't
find talking about how I am feeling easy, as I see it as a sign of weakness. So, feeling comfortable
enough to truly open up may take me time, but please do not give up on me. I have had a difficult
past, so trusting people is hard. Please be patient and compassionate and help build our positive
relationship. I know it must be frustrating for you when I can't be honest, but you need to respect
that it isn't my fault, it is just the place I am in currently.
Although I want my current difficulties to be respected, I would hate to be viewed just as my illness,
as I am so much more than that! I enjoy writing, playing football and eating ice cream, and these
are the things that make me who I am, not my mental state. Connecting with me on a human level
will help me get to know and trust you. Just talking about the things I love will allow me to feel
more relaxed and comfortable.
I would also appreciate it if you could be transparent with me from the start. Being open about
things like when you would have to tell my parents what I have said will help me in deciding when
I am ready to share things. When I do finally choose to reveal something, please be careful with
how you respond. I don't want my experiences to be belittled, as they are very significant to me.
I know you may not understand my thoughts, and that this can make responding hard. If you are
unsure of what to do or say, please just ask me what I want and need!
Sometimes I feel really motivated to get better, and other days it all feels too much. This may
mean that I don’t attend appointments or may not speak much. Please don't write me off if I am
unable to engage, it is just because I am scared. In fact, if I suddenly isolate myself, it is probably
a sign I need your help more than ever.
I am hopeful that we can work together so I can start to feel a little more like me again. I know
that seeing you individually will help me with that. But it is very easy to feel like you are the only
person struggling with your mental health and wellbeing. I would really like the option to receive
other types of help like support groups. This would be especially important if I do have to wait to
see you. But please let this be my decision, as what is right for someone else you see might not
be right for me.
I know your job is demanding, and this must all seem like a lot to consider. When young people
like myself are seeing you, we are at our most vulnerable. I didn’t ever choose to feel this way
and I want nothing more than for my life to go back to how it was. You are now in a position to
8
help me and so many young people by not only transforming, but also saving lives! I know your
role isn't easy, but the work you are doing is very much needed and appreciated.
Best wishes,
A young person
9
Glossary
This glossary provides definitions for key terms used throughout the document. In addition, it
seeks to identify and provide definitions for key terminology used by both health and education
which can be referred to differently but mean similar things. Additional terms may be added as
the manual continues to be developed.
Term
Definition
Child in Need
(subject to a Child
in Need plan,
Child Protection
plan, or are a
Looked After
Child)
Child in Need is a broad definition spanning a wide range of children
and adolescents, in need of varying types of support and intervention,
for a variety of reasons. A child is defined as ‘in need’ under section 17
of the Children Act 1989, where:
•
They are unlikely to achieve or maintain, or to have the
opportunity of achieving or maintaining, a reasonable standard
of health or development without the provision for them of
services by a local authority
•
Their health or development is likely to be significantly impaired,
or further impaired, without the provision for them of such
services; or
•
They are disabled
The overall group of Children in Need of help and protection is made
up of children who are designated under a number of different social
care classifications: children on a Child in Need Plan; children on a
Child Protection Plan; and Looked After Children.
Clinical
Commissioning
Group
A health organisation responsible for implementing the commissioning
roles as set out in the Health and Social Care Act 2012.
The funding to plan for, set up and run Mental Health Support Teams
has been provided to specific CCGs by NHS England. CCGs are also
expected to provide strategic governance and oversight of MHSTs, and
work with a range of local partners to guide implementation.
Complexity
Reflects different requirements for services that people with mental
health problems have; people may move through different levels of
complexity as their needs change (from less complex to more
complex). Complexity can be affected by the interaction between
biological, psychological, social and environmental factors.
Less complex problems may reflect situations where a person may
have a diagnosed mental health problem, but they function very well
and require limited help and support in managing their condition.
More complex problems may include a comorbid mental health or
physical health problem, or current social difficulties, and may require
more intensive input or support from a multidisciplinary mental health
team.
Developing or
emerging need or
problem
An initial problem or need with which a child or young person presents,
but which may be at risk of developing into a diagnosable condition and
which would benefit from intervention and support.
10
Disadvantage
Often used in the context of education initiatives, it relates to a
condition or situation that means that children with certain backgrounds
or experiences tend to achieve worse outcomes than their peers.
The term ‘disadvantaged pupils’ is often used to describe those who
come from low-income families and are eligible for free school meals.
However, it can also include a broader set of pupils beyond just those
who are economically disadvantaged, including those who have
needed a social worker, those with SEND and other factors such as
where children live, their ethnicity and their home environment.
Education, health
and care plan
(EHCP)
A plan detailing the education, health and care support that is to be
provided to a child or young person who has a SEND. It is drawn up by
the local authority after an education, health and care needs
assessment of the child or young person, in consultation with relevant
partner agencies, parents and the child or young person themselves.
Education Mental
Health Practi
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