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Cindarella’s Poor Relation


So much has been written (not least by me!) about children missing school and missing-out, that we ought really to turn our thoughts to those who are physically present but absent in mind.

Many of us (and our schoolchildren) turn up regularly to school, college or work but are simply too encumbered by the woes of the world outside to focus on what it is we are meant to be doing. What measures are taken to cater for the needs of pupils and students with mental health needs?

About one in ten (9.6%) children (0-16) has a clinically significant mental health disorder. Boys have slightly higher rates overall (11.4% vs 7.8%) but this is possibly down to their rate of conduct disorders which is nearly double that of girls. (Reporting and diagnosis of psychiatric problems in children can be unclear, so these figures are a guide at best.)

What does that figure mean in real life – for teachers and schools – though?

Young Minds (1999) provide the following picture of child mental health in various contexts.

  • In a town the size of Derby, about 5000 children will have a mental health problem.
  • In a primary school with 250 pupils, 14 children will be significantly or seriously depressed, 12 will be affected by phobias and 15 will have a conduct disorder.
  • In a secondary school with 1000 pupils, 150 will be significantly or seriously depressed, 2-10 girls will have eating disorders and 10-20 pupils will have an obsessive compulsive disorder.

Many of these children will have more than one disorder, which blurs boundaries and makes categorical diagnoses difficult. Add in other special needs and the picture is more complex again. As many as 70% of those with learning difficulties also have mental health problems. Almost three-quarters (72%) of those with multiple disorders are boys, reflecting the high degree of overlap between conduct and other disorders.

The effects of these conditions on other aspects of school life is huge. Around half of those with emotional or conduct disorders will be behind at school; a third of the same group will have difficulty making friends and a quarter will be suicidal. Figures from the Mental Health Foundation (1999) show a steady rise in children with mental health problems.

Do their teachers know this? Are they prepared to work with their needs? Sadly, I doubt it.

Break a leg or gash your head and the help and sympathy are abundant, from families, staff and friends. Admit to a diagnosed mental health need and the silence is deafening.

I know things are improving in terms of political rhetoric but, in practice, Child and Adolescent Mental Health is still Cindarella’s poor relation.

About ten years ago, I interviewed professionals, children and families about how schools coped with mentally ill children. One social worker told me this story. He said that he had been to see one of his clients in the local hospital following an episode of deliberate self harm. She was a high achiever and had not been unpopular in her class. When he arrived, he saw that there was no-one else with her and he learned that no staff from the school had been in touch or sent in schoolwork for her to keep up.

Just down the ward, there was another girl from the same year of the same school, who had broken her leg. This child was visited regularly by school friends and received her work to keep up to date. There were lots of possible explanations, but my interviewee claimed that the reason for the difference was that the one girl had a physical and accidental injury whereas his client was in hospital due to the self-inflicted damage from a mental illness.

I wonder how much things have changed? What are teachers taught about CAMH? Are they prepared to work with those young people who have emotional and psychological as well as learning needs?

What do you think?

  1. Ian permalink

    I think you have a very one-sided view and the same is not true of the entire teaching profession.

    • One sided? Moi? I think not. As a former teacher, SENCo and special school head, I have specialised, in my academic and university work, in researching the special needs of children with mental health difficulties. Teachers are increasingly informed about special educational needs in schools but, last time I worked in a classroom (2007), CAMH was not on their radar. I wish it was… and I know I get it wrong every now and then. But that is why I left an open question at the end of today’s piece. Now, the question is, as one of my regular readers, where are you coming from in this…?

  2. Ian permalink

    A parent and a teacher – a current teacher who is aware of how much outreach support is bought into both the school I work in and the school my children attend – this involves services such as CAHMs but also many other services that are there for our children in today’s world such as counsellors and outreach services who come into school and also work with parents and children in their homes following referral from school. The schools and the teachers invest a lot of time and effort in this both in my own school and in that of my children, and whilst I am aware that this is not the case in every school, I feel strongly that you should not tar the whole teaching profession with the same brush.

    As you say you are a former teacher – perhaps one who worked in a school or schools where there was a less than supportive attitude to both physical and mental problems. That was not necessarily the case everywhere, and neither is it necessarily the case in 2010.

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